Physical exercise in the prevention of chemotherapy-induced cardiotoxicity: a systematic review with meta- analysis

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Abstract Objective: To review literature data demonstrating preservation of cardiac function in patients participating in exercise when initiating cardiotoxic anticancer therapy. Methods: LILACS, MEDLINE/PubMed, SCOPUS and Web of Science, without filters for year of publication or languages. Study selection: Randomized and non-randomized clinical trials were selected that included outcomes assessment of left ventricular ejection fraction (LVEF) and global longitudinal strain index (GLS) comparing physical training concomitant with antineoplastic therapy to usual treatment. Results: Four studies were included, totaling 137 individuals (51.5±8.5 years). Three studies combined training (resistance and aerobic) and exclusive aerobic training. All studies were performed on breast cancer patients. The data did not show protection from physical exercise on LVEF (MD: 1.37 [-0.84, 3.59]; p=0.23, I2:55%) and GLS (MD: 0.21 [-0.84, 1.26]; p=0.69, I2:49%). However, the reduction in VO2peak was greater in the control group (14%) compared to the intervention group (5%). Limitations: Clinical trials evaluating the cardioprotective effects of exercise on cardiac function are rare and heterogeneous. Conclusion: Physical exercise performed at the start of cardiotoxic antineoplastic treatment does not alter echocardiographic markers of cardiac function. However, no dysfunctional changes were observed in this population in the time period investigated. The preventive role of exercise on functionality during this phase of treatment strengthens the evidence for peripheral benefits that have been widely recognized in the literature.

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