Tailored exercise as a protective tool in cardio-oncology rehabilitation: a narrative review.



Cardiovascular disease is the leading cause of long-term morbidity and death among cancer survivors, after second malignancies. Preventing cancer treatment-induced cardiotoxicity (CTC) constitutes a crucial endpoint in oncology, from oncology treatment implementation. The American Association of Clinical Oncology has recently highlighted the role of physical exercise as an essential component of co-adjuvant cancer treatment and cancer survivor care programs. Exercise training may protect from cardiotoxicity on a molecular and physiological basis. Two major types of training in this field are: cardiovascular and resistance/strength training. Little is known about the effects of these modalities of exercise on CTC. This narrative review aimed to gather evidence and extract conclusions about the effectiveness of exercise training on CTC. To do so, we reviewed scientific literature under a sophisticated approach in line with the PRISMA project guidelines. Studies on physical training exercise effects and cardiac-related measures throughout the cancer stages (cancer treatment and survivorship) were selected.
Data collection comprised extracting information of study features, exercise training characteristics and related effects. As a result, 1087 studies were retrieved from database search and 33 studies were selected, comprising 2778 participants. Most of the studies (n = 29) examined the effects of cardiovascular training on CTC. No studies analysed the effects of resistance-based training. We observed a lack of systematic effect of exercise across studies due to the high heterogeneity (e.g., many studies did not follow the guidelines for training interventions in cancer settings). However, studies combining both cardiovascular and resistance components showed promising results. To sum up, higher adherence to clinical guides should be encouraged to implement physical exercise interventions in medical settings and to ensure intervention effectiveness. Moreover, personalized protocols and routines should be implemented in Cardio-Oncology Rehabilitation Units. Finally, it is mandatory to avoid physical inactivity in patients with cancer.