Abstract
Doxorubicin (DOX)-induced cardiotoxicity in chemotherapy is a major treatment drawback. Clinical trials on the cardioprotective effects of exercise in cancer patients have not yet been published. Thus, we conducted a systematic review and meta-analysis of preclinical studies for to assess the efficacy of exercise training on DOX-induced cardiomyopathy. We included studies with animal models of DOX-induced cardiomyopathy and exercise training from PubMed, Web of Sciences and Scopus databases. The outcome was the mean difference (MD) in fractional shortening (FS, %) assessed by echocardiography between sedentary and trained DOX-treated animals. Trained DOX-treated animals improved 7.40% (95% CI 5.75–9.05, p < 0.001) in FS vs. sedentary animals. Subgroup analyses revealed a superior effect of exercise training execution prior to DOX exposure (MD = 8.20, 95% CI 6.27–10.13, p = 0.010). The assessment of cardiac function up to 10 days after DOX exposure and completion of exercise protocol was also associated with superior effect size in FS (MD = 7.89, 95% CI 6.11–9.67, p = 0.020) vs. an echocardiography after over 4 weeks. Modality and duration of exercise, gender and cumulative DOX dose did were not individually associated with changes on FS. Exercise training is a cardioprotective approach in rodent models of DOX-induced cardiomyopathy. Exercise prior to DOX exposure exerts greater effect sizes on FS preservation.
Highlights
Doxorubicin (DOX)-induced cardiotoxicity in chemotherapy is a major treatment drawback
We investigated the influence of the study quality on the main outcome (Table 2 and Figure S6, supplementary material), and we identified that the cardioprotective effects of exercise occurred independently on the study quality score (MD = 7.40%, 95% confidence interval (CI) 5.75–9.05, p = 0.900)
Analyses of the effects of exercise features suggested a greater cardioprotective effect of exercise training prior to DOX exposure; (3) subgroup analyses of the timing of final cardiac function assessment suggested that a more pronounced effect size of exercise training on FS is likely to occur in those studies which echocardiography is performed up to 10 days after all experimental protocols completion (i.e., DOX exposure and exercise training protocol)
Summary
Doxorubicin (DOX)-induced cardiotoxicity in chemotherapy is a major treatment drawback. In order to maintain the proper DOX doses to meet oncological outcomes pharmacological cardioprotective strategies, such as Dexrazoxane and neurohormonal therapy (β-blockers, angiotensin receptor blockers, angiotensin-converting enzyme inhibitors) have been broadly explored It has been recently reported in two meta-analyses that both strategies have a role in reducing the risk of heart failure and cardiac events in patients exposed to anthracyclines-based r egimens[8,9]. Exposure to exercise training before cancer diagnosis is associated with a 20–37% risk reduction of adverse cardiovascular events in patients with primary breast cancer[11] While these evidences demonstrate that regular physical activity in cancer patients improve both oncological and cardiovascular o utcomes[11,12,13,14], the existing body of evidence still lacks of randomized clinical trials and high level data with respect to modalities, duration, intensity and ideal timing of exercise realization in relation to the schedule of cancer treatment. We conducted this systematic review with meta-analysis to summarize the available information of the influence of exercise practice in prevention and/or attenuation of DOX-induced cardiotoxicity in rodents
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
