Elsevier

JACC: CardioOncology

Volume 4, Issue 4, November 2022, Pages 491-503
JACC: CardioOncology

Original Research
Optimal Timing of a Physical Exercise Intervention to Improve Cardiorespiratory Fitness: During or After Chemotherapy

https://doi.org/10.1016/j.jaccao.2022.07.006Get rights and content
Under a Creative Commons license
open access

Abstract

Background

Despite the widely acknowledged benefit of exercise for patients with cancer, little evidence on the optimal timing of exercise on adverse effects of cancer treatment is available.

Objectives

The aim of this study was to determine whether an exercise intervention initiated during chemotherapy is superior to an intervention initiated after chemotherapy for improving long-term cardiorespiratory fitness (peak oxygen uptake [VO2peak]).

Methods

In this prospective, randomized clinical trial, patients scheduled to receive curative chemotherapy were randomized to a 24-week exercise intervention, initiated either during chemotherapy (group A) or afterward (group B). The primary endpoint was VO2peak 1 year postintervention. Secondary endpoints were VO2peak postintervention, muscle strength, health-related quality of life (HRQoL), fatigue, physical activity, and self-efficacy. Between-group differences were calculated using intention-to-treat linear mixed-models analyses.

Results

A total of 266 patients with breast (n = 139), testicular (n = 95), and colon cancer (n = 30) as well as lymphoma (n = 2) were included. VO2peak immediately postintervention and 1 year postintervention did not differ between the 2 groups. Immediately postchemotherapy, patients in group A exhibited significantly lower decreases in VO2peak (3.1 mL/kg/min; 95% CI: 2.2-4.0 mL/kg/min), HRQoL, and muscle strength and reported less fatigue and more physical activity than those in group B.

Conclusions

Exercise can be safely performed during chemotherapy and prevents fatigue and decreases in VO2peak, muscle strength, and HRQoL, in addition to hastening the return of function after chemotherapy. Also, if exercise cannot be performed during chemotherapy, a program afterward can enable patients to regain the same level of function, measured 1 year after completion of the intervention. (Optimal Timing of Physical Activity in Cancer Treatment [ACT]; NCT01642680)

Key Words

cardiorespiratory fitness
chemotherapy
fatigue
muscle strength
physical exercise
quality of life

Abbreviations and Acronyms

HIIT
high-intensity interval training
HRQoL
health-related quality of life
MET-h
the amount of kcal burnt per kilogram body weight per hour
PASE
Physical Activity Scale for the Elderly
SAE
serious adverse event(s)
UMCG
University Medical Center Groningen
VO2peak
peak oxygen uptake

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The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center.

Drs van der Schoot and Ormel contributed equally to this work.