Protective effects of acute exercise prior to doxorubicin on cardiac function of breast cancer patients: A proof-of-concept RCT
Stöhr, Eric J.
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Background: Preclinical studies have reported that a single treadmill session performed 24 h prior to doxorubicin provides cardio-protection. We aimed to characterize the acute change in cardiac function following an initial doxorubicin treatment in humans and determine whether an exercise session performed 24 h prior to treatment changes this response. Methods: Breast cancer patients were randomized to either 30 minutes of vigorous-intensity exercise 24 h prior to the first doxorubicin treatment (n=13), or no vigorous exercise for 72 h prior to treatment (control, n=11). Echocardiographically-derived left ventricular volumes, longitudinal strain, twist, E/A ratio, and circulating NT-proBNP, a marker of later cardiotoxicity, were measured before and 24-48 h after the treatment. Results: Following treatment in the control group, NT-proBNP, end-diastolic and stroke volumes, cardiac output, E/A ratio, strain, diastolic strain rate, twist, and untwist velocity significantly increased (all p≤0.01). Whereas systemic vascular resistance (p<0.01) decreased, and ejection fraction (p=0.02) and systolic strain rate (p<0.01) increased in the exercise group only. Relative to control, the exercise group had a significantly lower NT-proBNP (p<0.01) and a 46% risk reduction of exceeding the cut-point used to exclude acute heart failure. Conclusion: The first doxorubicin treatment is associated with acutely increased NT-proBNP, echocardiographic parameters of myocardial relaxation, left ventricular volume overload, and changes in longitudinal strain and twist opposite in direction to documented longer-term changes. An exercise session performed 24 h prior to treatment attenuated NT-proBNP release and increased systolic function. Future investigations should verify these findings in a larger cohort and across multiple courses of doxorubicin.
International Journal of Cardiology;
Kirkham, A. A., Shave, R. E., Bland, K. A., Bovard, J. M., Eves, N. D., Gelmon, K. A., McKenzie, D.C., Virani, S.A., Stöhr, E.J., Warburton, D.E.R. and Campbell, K. L. (2017) 'Protective effects of acute exercise prior to doxorubicin on cardiac function of breast cancer patients: A proof-of-concept RCT' International Journal of Cardiology. http://dx.doi.org/10.1016/j.ijcard.2017.07.037
Dynodwr Gwrthrych Digidol (DOI)http://dx.doi.org/10.1016/j.ijcard.2017.07.037
This article was published in International Journal of Cardiology on 14 July 2017 (online), available at http://dx.doi.org/10.1016/j.ijcard.2017.07.037
Cardiff Metropolitan University (Grant ID: Cardiff Metropolian (Internal))
- Sport Research Groups 
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The effect of an aerobic exercise bout 24 h prior to each doxorubicin treatment for breast cancer on markers of cardiotoxicity and treatment symptoms: a RCT Kirkham, A.A.; Eves, N.D.; Shave, Rob; Bland, K.A.; Bovard, J.; Gelmon, K.A.; Virani, S.A.; McKenzie, D.C.; Stöhr, Eric J.; Waburton, D.E.; Campbell, K.L. (Springer, 2017-11-06)Purpose = In rodents, a single exercise bout performed 24 h prior to a single doxorubicin treatment provides cardio-protection. This study investigated whether performing this intervention prior to every doxorubicin ...
Serrano-Ostariz, E.; Terreros-Blanco, J.L.; Legaz-Arrese, A.; George, Keith; Shave, Rob; Bocos-Terraz, P.; Izquierdo-Alvarez, S.; Bancalero, J.L.; Echavarri, J.M.; Quilez, J.; Carranza-Garcia, L.E.; Aragones, M.T. (2009)Numerous studies have observed cardiac biomarker release with prolonged exercise. Despite this, we are unsure as to the constituent aspects of any given exercise bout that may be important in promoting cardiac biomarker ...
Left ventricular wall segment motion after ultra-endurance exercise in humans assessed by myocardial speckle tracking George, Keith; Shave, Rob; Oxborough, David; Cable, Tim; Dawson, Ellen; Artis, Nigel; Gaze, David; Hew-Butler, Tamara; Sharwood, Karen; Noakes, Tim (2009)Aims Assessment of the left ventricular responses to prolonged exercise has been limited by technology available to assess cardiac tissue movement. Recently developed strain and strain rate imaging provide the unique ...