Washington: According to a study published in JACC: CardioOncology, physical activity intervention during chemotherapy is safe, increases long-term cardiorespiratory fitness, and alleviates some of the side effects of cancer treatment. If exercise is not possible during chemotherapy, the individual may engage in a post-treatment exercise program to regain the same level of function.
Cardiorespiratory fitness, measured by maximal oxygen uptake (VO2peak), is considered one of the most important independent predictors of cardiovascular health. During cancer treatment, VO2peak decreases by up to 25%. Cancer treatment often results in adverse effects that impair the patient’s health-related quality of life (HRQoL), including decreased cardiorespiratory fitness, increased fatigue and cardiovascular morbidity. Physical activity has been shown to mitigate these risks. Exercise therapy is associated with better cardiorespiratory fitness, improved VO2peak, and lower cardiovascular morbidity, cancer mortality, and overall mortality.
“The benefit of exercise for cancer patients is widely recognized. However, there is insufficient evidence on the optimal timing of exercise intervention to improve long-term cardiorespiratory fitness in patients with cancer,” said Annemiek ME Walenkamp, MD, PhD, lead study author and a medical oncologist in the Department of Medical Oncology, University Medical Center Groningen in Groningen, Netherlands.
In the ACT trial, researchers examined the effectiveness of physical intervention during chemotherapy versus after treatment for improving long-term cardiorespiratory fitness. Adult patients recently diagnosed with breast cancer, colon cancer, testicular cancer, or B-cell non-Hodgkin’s lymphoma who were to receive curative chemotherapy were eligible for the study. Between February 2013 and November 2018, trial participants were randomized to a 24-week exercise intervention initiated during or after chemotherapy. Types of exercise included moderate to vigorous effort on a stationary bike, resistance training using weight machines and free weights, and badminton. The primary endpoint was the difference in VO2peak one year after the intervention. Secondary endpoints were VO2peak after completion of chemotherapy and intervention, muscle strength, HRQoL, fatigue, physical activity, and self-efficacy at all time points.
The researchers found that immediately after chemotherapy, the group that started exercise therapy during treatment reported less fatigue and more physical activity and had less declines in VO2peak, HRQoL and muscle strength. Three months after chemotherapy, the group that started exercising after treatment showed values similar to those of the group that exercised during. Both groups were back to baseline cardiorespiratory fitness one year after completing the exercise intervention, regardless of timing.
“These results suggest that the most optimal time for exercise is during chemotherapy. However, initiating an exercise program after chemotherapy is a viable alternative when exercise during chemotherapy is not possible,” Walenkamp said. “We hope our findings will motivate healthcare providers to guide patients to engage in exercise interventions during cancer treatment.”
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