January 15, 2018

A.A. Kirkham a, R.E. Shave b, K.A. Bland a, J.M. Bovard a, N.D. Eves c, K.A. Gelmon a,d, D.C. McKenzie a, S.A. Virani a, E.J. Stöhr b, D.E.R. Warburton a, K.L. Campbell a

a University of British Columbia, 2329 West Mall, Vancouver, BC V6T1Z4, Canada
b Cardiff Metropolitan University, Cyncoed Campus, Cyncoed Rd, Cardiff CF236XD, UK
c University of British Columbia Okanagan, 1147 Research Road, Kelowna, BC V1V1V7, Canada
d British Columbia Cancer Agency, 600 W 10th Ave, Vancouver, BC V5Z4E6, Canada

In this study, we aimed to translate the finding demonstrated by research studies in rodents that performing a single treadmill session 24 hours prior to receipt of a class of chemotherapy agents called anthracyclines can protect the heart from the chemotherapy’s damaging effects. Twenty-four women with early stage breast cancer were randomly assigned to perform a supervised 30-minute, vigorous-intensity treadmill walking session 24 hours prior to their first chemotherapy treatment or were requested not to exercise vigorously. We took blood samples and a heart ultrasound before the first treatment and 24-48 hours after completion of the first treatment. The patients who performed the exercise sessions had significantly reduced levels of marker released from the heart muscle in response to stress, called NT-proBNP. Elevated levels of this marker after the first treatment are known to predict development of cardiac injury at a later point after treatment. The exercise group also had a small increase in the heart’s ability to contract (systolic function). These preliminary findings suggest that acute aerobic exercise may be an easy way to reduce the detrimental effects of chemotherapy on the heart. However, in order for this finding to be clinically relevant, further investigation is need to determine whether performing the exercise session prior to every chemotherapy treatment extends the benefits across the course of treatment.

Summary of Key Points:

  • Preclinical studies have reported that a single treadmill session performed 24 hours prior to treatment with doxorubicin protected the hearts of rodents from the damaging effects of chemotherapy.
  • We demonstrated that this intervention significantly attenuated circulating NT-proBNP, a predictor of cardiac events, resulting in a 46% absolute risk reduction of exceeding the cut-point used for exclusion of acute heart failure in women with breast cancer.
  • This feasible and accessible intervention may be a method of reducing potential cardiotoxicity of doxorubicin chemotherapy treatment, especially if this effect occurs with subsequent treatments.

This summary was submitted by Amy Kirkham and reviewed by the CSEP Knowledge Translation Committee. The original paper Protective effects of acute exercise prior to doxorubicin on cardiac function of breast cancer patients: A proof-of-concept RCT is published in the International Journal of Cardiology, 10.1016/j.ijcard.2017.07.037.