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Effects of exercise training on cardiac toxicity markers in women with breast cancer undergoing chemotherapy with anthracycline: a randomized controlled trial
Session:
Comunicações Orais - Sessão 25 - Prevenção Cardiovascular e Reabilitação
Speaker:
Pedro Antunes
Congress:
CPC 2023
Topic:
J. Preventive Cardiology
Theme:
29. Rehabilitation and Sports Cardiology
Subtheme:
29.2 Cardiovascular Rehabilitation
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Pedro Antunes; Ana Joaquim; Francisco Sampaio; Eduardo Vilela; Madalena Teixeira; Jorge Oliveira; António Ascensão; Andreia Capela; Anabela Amarelo; Cristiana Marques; Sofia Viamonte; Alberto Alves; Dulce Esteves
Abstract
<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>INTRODUCTION:</strong> Breast cancer (BC) survivors treated with anthracycline-containing chemotherapy have increased risk of cardiac dysfunction. It is well established that exercise training is effective to mitigate some chemotherapy-related side effects. Recently, exercise training has also been suggested as a potentially approach to prevent anthracycline-related cardiac dysfunction, but clinical-based evidence is scarce.</span></span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>AIM:</strong> We here analyzed the effects of a supervised exercise training program (SETP) on cardiac toxicity markers in women with early-stage BC receiving anthracycline-containing chemotherapy.</span></span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>METHODS:</strong> Ninety-three women with early-stage BC were randomized to a SETP plus usual care (exercise group, n=47) or usual care alone (UC group, n=46). The SETP consisted of 3 sessions per week (planned exercise sessions ranged from 60 to 72), combining aerobic and resistance training, conducted concurrently across the chemotherapy length. The primary endpoint was the change in left ventricular ejection fraction (LVEF) from baseline to the end of anthracycline-containing chemotherapy. Secondary endpoints included global longitudinal strain (GLS) and other echocardiographic parameters, exercise capacity [estimated peak oxygen consumption (pVO2)], circulating biomarkers (NT-proBNP and troponin I), and safety of the SETP. These study endpoints were assessed at the end of anthracycline-containing chemotherapy, and 3 months after this point.</span></span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>RESULTS:</strong> All patients were prescribed 4 cycles of doxorubicin plus cyclophosphamide (AC). </span></span>Mean adherence to SETP frequency was 63.2 ± 26.9%. <span style="font-family:Calibri,sans-serif"><span style="color:#000000">There were no between-group differences in LVEF change at the end of AC [mean difference: 0.7%, 95% confidence interval (CI): -0.8, 2.3; <em>p</em>=0.349] or 3 months after AC [1.1% (95% CI: -0.5, 2.6; <em>p</em>=0.196] (table 1). Compared to the UC group, estimated pVO2 significantly increased in the exercise group at the end of AC (1.6 mLO2·kg−1·min−1; 95% CI: 0.06, 3.1; <em>p</em>=0.041) and 3 months after AC (3.1 mLO2·kg−1·min−1; 95% CI: 1.4, 4.7; <em>p</em><0.001) (table 1). No between-group differences were found in other secondary endpoints. No serious adverse events occurred during exercise sessions.</span></span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>CONCLUSIONS:</strong> Although no significant exercise-related effects were seen on cardiac toxicity markers (LVEF and GLS), exercise training demonstrated to be safe and significantly improved exercise capacity in BC patients undergoing anthracycline-containing chemotherapy.</span></span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>TRIAL REGISTRATION:</strong> ISRCTN32617901.</span></span></span></p>
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