High intensity exercise during breast cancer chemotherapy - effects on long-term myocardial damage and physical capacity - data from the OptiTrain RCT

Josefin Ansund,Kate A Bolam,Sara Mijwel,Renske Altena,Yvonne Wengström,Eric Rullman,Helene Rundqvist

doi:10.1186/s40959-021-00091-1

Josefin Ansund, Kate A Bolam + Show 5 more

Open Access

https://doi.org/10.1186/s40959-021-00091-1

Copy DOI

Abstract

BackgroundAdjuvant systemic breast cancer treatment improves disease specific outcomes, but also presents with cardiac toxicity. In this post-hoc exploratory analysis of the OptiTrain trial, the effects of exercise on cardiotoxicity were monitored by assessing fitness and biomarkers over the intervention and into survivorship.Methods; Women starting chemotherapy were randomized to 16-weeks of resistance and high-intensity interval training (RT-HIIT), moderate-intensity aerobic and high-intensity interval training (AT–HIIT), or usual care (UC). Outcome measures included plasma troponin-T (cTnT), Nt-pro-BNP and peak oxygen uptake (VO2peak), assessed at baseline, post-intervention, and at 1- and 2-years.ResultsFor this per-protocol analysis, 88 women met criteria for inclusion. Plasma cTnT increased in all groups post-intervention. At the 1-year follow-up, Nt-pro-BNP was lower in the exercise groups compared to UC. At 2-years there was a drop in VO2peak for patients with high cTnT and Nt-pro-BNP. Fewer patients in the RT-HIIT group fulfilled biomarker risk criteria compared to UC (OR 0.200; 95% CI = 0.055–0.734).ConclusionsIn this cohort, high-intensity exercise was associated with lower levels of NT-proBNP 1-year post-baseline, but not with cTnT directly after treatment completion. This may, together with the preserved VO2peak in patients with low levels of biomarkers, indicate a long-term cardioprotective effect of exercise.Trial registrationClinicaltrials.govNCT02522260, Registered 13th of august 2015 – Retrospectively RegisteredGraphical abstract

Highlights

Cardiovascular disease is the second leading cause of morbidity and mortality among breast cancer survivors after recurrence [1]
The odds ratio for a patient in the usual care group to fall in this category compared to a patient allocated to resistance and high-intensity interval training (RT-high intensity interval training (HIIT)) was 0.200
The 2-year follow up from baseline VO2peak ratio for the patients fulfilling the risk criteria was 0.97 (±0.17) meaning an onaverage decline by 3%, while the patients not fulfilling the risk criteria had a 2-year to baseline ratio of 1.09 (± 0.18), representing an increase in VO2peak of 9%. These findings suggest that these biomarker criteria are of relevance to cardiorespiratory fitness, and thereby cardiovascular function, in this patient population

Summary

Introduction

Cardiovascular disease is the second leading cause of morbidity and mortality among breast cancer survivors after recurrence [1]. The main culprit for cardiac toxicity in the wake of chemotherapy are anthracyclines [3, 5, 6]. Anthracyclines are often used in combination with other potentially cardiotoxic agents, such as trastuzumab, and/or thoracic radiation therapy (RT). These combinations improve breast cancer specific outcomes but may further compromise cardiac function [10, 11]. Adjuvant systemic breast cancer treatment improves disease specific outcomes, and presents with cardiac toxicity. In this post-hoc exploratory analysis of the OptiTrain trial, the effects of exercise on cardiotoxicity were monitored by assessing fitness and biomarkers over the intervention and into survivorship. Outcome measures included plasma troponin-T (cTnT), Nt-pro-BNP and peak oxygen uptake (VO2peak), assessed at baseline, post-intervention, and at 1- and 2-years

Results

Discussion

Conclusion