The cardioprotective effect of aerobic exercise in children with cancer
Aerobic exercise, an activity that increases heart rate and the utilization of oxygen, has been demonstrated to play a vital role in prevention of numerous conditions, including cardiovascular disease and diabetes, in children with cancer.
The 5-year survival rate among childhood cancer survivors has significantly increased. This is largely due to the advances in antineoplastic therapy. Late effects, however, related to cancer therapies, continue to develop. Cardiovascular disease is one of the most significant late effects. The two major contributors to increased risk of cardiovascular disease are chemotherapy and radiation therapy-induced damage to heart tissue. The most threatening manifestation of cardiovascular disease is congestive heart failure, which may present as many as 40 years after anthracycline treatment in childhood.
According to an analysis, based on nine articles, published in the Supportive Care in Cancer [1], the effect of an aerobic exercise intervention on cardiopulmonary fitness was statistically significant, in favor of exercise. Another important finding was the effect of an aerobic exercise intervention on relative Volume of Oxygen expiration (VO2) was statistically significant, in favor of exercise. It is possible that the cardiotoxic effect and damage could have been avoided had the exercise intervention been implemented earlier. This review provides the first comprehensive collection of existing studies that examined the effect of an aerobic exercise intervention on cardiopulmonary fitness in childhood cancer survivors, who received cardiotoxic therapies.
Patients were children, who were managed most often for acute lymphoblastic leukemia.
In conclusion, the findings from this review, although not directly demonstrating a cardioprotective effect, are a preliminary step towards establishing the putative cardioprotective effect of aerobic exercise against the direct cardiotoxic impact of cancer treatments. Moreover, this article highlights the need for more high-quality, larger-sample randomized controlled trials in the future to further elucidate the effectiveness of aerobic exercise in this context.
[1] Bourbon A et al. Aerobic exercise and cardiopulmonary fitness in childhood cancer survivors treated with a cardiotoxic agent: a meta-analysis. Supportive Care in Cancer 2018;26:2113-2123.
