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Exercise rehabilitation in patients with cancer

Nature Reviews Clinical Oncology volume 9, pages 288–296 (2012)Cite this article

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Abstract

Emerging evidence indicates that patients with cancer have considerable impairments in cardiorespiratory fitness, which is likely to be a result of the direct toxic effects of anticancer therapy as well as the indirect consequences secondary to therapy (for example, deconditioning). This reduced cardiorespiratory fitness is associated with heightened symptoms, functional dependence, and possibly with an increased risk of cardiovascular morbidity and mortality. Current understanding of the complex interaction between the effects of the tumour and cancer-associated therapies on the organ components that govern cardiorespiratory fitness, and the effects of exercise training on these parameters is limited; further research will be critical for further progress of exercise-based rehabilitation in the oncology setting. We assess the current evidence regarding the level, mechanisms, and clinical importance of diminished cardiorespiratory fitness in patients with cancer. The efficacy and adaptations to exercise training to prevent and/or mitigate dysfunction in conjunction with exercise prescription considerations for clinical use are also discussed.

Key Points

  • Cardiorespiratory fitness is governed by the integrative capacity of the pulmonary and cardiovascular systems and skeletal muscle to transport and use oxygen to resynthesise ATP

  • Patients with cancer have marked reductions in cardiorespiratory fitness due to impairments in one or more organs in the transport or use of oxygen as a result of anticancer therapy and effects secondary to therapy

  • Emerging evidence indicates that cardiorespiratory fitness might be a robust predictor of prognosis following a cancer diagnosis

  • Cardiorespiratory fitness level assessment might be an important tool to assess treatment tolerability in patients prior to therapy initiation

  • Randomised trials indicate that exercise training is a safe and efficacious adjunct therapy to recover and/or prevent cancer therapy induced impairments in cardiorespiratory fitness

  • Exercise should be prescribed on a patient-by-patient basis with consideration for cancer type, therapy, personal limitations and other medical characteristics

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Acknowledgements

L. W. Jones is supported in part by research grants from the National Cancer Institute (CA143254, CA142566, CA138634, CA133895 and CA125458) and funds from George and Susan Beischer.

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Authors and Affiliations

  1. Division of Hematology/Oncology, Vermont Cancer Center, University of Vermont, Given E-214 - UVM363, 89 Beaumont Avenue, Burlington, 05405, VT, USA

    Susan G. Lakoski

  2. School of Health and Exercise Sciences, University of British Columbia Okanagan, 3333 University Way, Kelowna, V1V 1V7, BC, Canada

    Neil D. Eves

  3. Department of Medicine, Duke University Medical Center, Durham, 27710, NC, USA

    Pamela S. Douglas

  4. Department of Radiation Oncology, Duke University Medical Center, Durham, 27710, NC, USA

    Lee W. Jones

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  1. Susan G. Lakoski
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Contributions

S. G. Lakoski and L. W. Jones researched data for the article. N. D. Eves, P. S. Douglas and L. W. Jones made a substantial contribution to the discussion of the content, S. G. Lakoski, N. D. Eves and L. W. Jones wrote the article and all authors edited and revised the manuscript prior to submission.

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Correspondence to Lee W. Jones.

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Lakoski, S., Eves, N., Douglas, P. et al. Exercise rehabilitation in patients with cancer. Nat Rev Clin Oncol 9, 288–296 (2012). https://doi.org/10.1038/nrclinonc.2012.27

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