Abstract：
OBJECTIVE: Anthracycline-based chemotherapy has well-known cardiotoxic effects, butmay also cause skeletal muscle myopathy and negatively affect cardiorespiratory fitness and quality of life. The effectiveness of exercise training in improving cardiorespiratory fitness and quality of life during chemotherapy is highly variable. We set out to determine how the effect of exercise training on cardiorespiratory fitness (primary outcome) and quality of life (secondary outcome) in cancer patients is affected by the type of therapy they receive (cardiotoxic therapy with or without anthracyclines; non-cardiotoxic therapy) and the timing of the exercise training (during or after therapy).
METHODS: Consecutive patients with cancer who participated in an exercise-based cardio-oncology rehabilitation programme at a university hospital in Switzerland between January 2014 and February 2022 were eligible. Patients were grouped based on chemotherapy (anthracycline vs non-anthracycline) and timing of exercise training (during vs after chemotherapy). Peak oxygen uptake (VO2) was assessed with cardiopulmonary exercise testing (n = 200), and quality of life with the Functional Assessment of Cancer Therapies questionnaire (n = 77). Robust linear models were performed for change in peak VO2 including type and timing of cardiotoxic therapies, age, training impulse and baseline peak VO2; change in quality of life was analysed with cumulative linked models.
RESULTS: In all patients with valid VO2 (n = 164), median change in peak VO2 from before to after exercise training was 2.3 ml/kg/min (range: -10.1-15.9). The highest median change in peak VO2 was 4.1 ml/kg/min (interquartile range [IQR]: 0.7-7.7) in patients who completed exercise training during non-anthracycline cardiotoxic or non-cardiotoxic therapies, followed by 2.8 ml/kg/min (IQR: 1.2-5.3) and 2.3 ml/kg/min (IQR: 0.1-4.6) in patients who completed exercise training after anthracycline and after non-anthracycline cardiotoxic or non-cardiotoxic therapies, respectively. In patients who completed exercise training during anthracycline therapy, peak VO2 decreased by a median of -2.1 ml/kg/min (IQR: -4.7-2.0). In the robust linear model, there was a significant interaction between type and timing of cancer treatment for anthracycline therapy, with greater increases in peak VO2 when exercise training was performed after anthracycline therapy. For quality of life, higher baseline scores were negatively associated with changes in quality of life.
CONCLUSIONS: In our cohort, the increase in cardiorespiratory fitness was diminished when exercise training was performed concurrently with anthracyclines. For patients with cardiotoxic treatments other than anthracyclines, cardiorespiratory fitness and quality of life was not associated with timing of exercise training.
METHODS: Consecutive patients with cancer who participated in an exercise-based cardio-oncology rehabilitation programme at a university hospital in Switzerland between January 2014 and February 2022 were eligible. Patients were grouped based on chemotherapy (anthracycline vs non-anthracycline) and timing of exercise training (during vs after chemotherapy). Peak oxygen uptake (VO2) was assessed with cardiopulmonary exercise testing (n = 200), and quality of life with the Functional Assessment of Cancer Therapies questionnaire (n = 77). Robust linear models were performed for change in peak VO2 including type and timing of cardiotoxic therapies, age, training impulse and baseline peak VO2; change in quality of life was analysed with cumulative linked models.
RESULTS: In all patients with valid VO2 (n = 164), median change in peak VO2 from before to after exercise training was 2.3 ml/kg/min (range: -10.1-15.9). The highest median change in peak VO2 was 4.1 ml/kg/min (interquartile range [IQR]: 0.7-7.7) in patients who completed exercise training during non-anthracycline cardiotoxic or non-cardiotoxic therapies, followed by 2.8 ml/kg/min (IQR: 1.2-5.3) and 2.3 ml/kg/min (IQR: 0.1-4.6) in patients who completed exercise training after anthracycline and after non-anthracycline cardiotoxic or non-cardiotoxic therapies, respectively. In patients who completed exercise training during anthracycline therapy, peak VO2 decreased by a median of -2.1 ml/kg/min (IQR: -4.7-2.0). In the robust linear model, there was a significant interaction between type and timing of cancer treatment for anthracycline therapy, with greater increases in peak VO2 when exercise training was performed after anthracycline therapy. For quality of life, higher baseline scores were negatively associated with changes in quality of life.
CONCLUSIONS: In our cohort, the increase in cardiorespiratory fitness was diminished when exercise training was performed concurrently with anthracyclines. For patients with cardiotoxic treatments other than anthracyclines, cardiorespiratory fitness and quality of life was not associated with timing of exercise training.
摘要：
目的：蒽环类化疗具有众所周知的心脏毒性作用，但也可能导致骨骼肌肌病，并对心肺健康和生活质量产生负面影响。运动训练在化疗期间改善心肺健康和生活质量的有效性是高度可变的。我们着手确定运动训练对癌症患者心肺功能（主要结果）和生活质量（次要结果）的影响如何受到他们接受的治疗类型（含或不含蒽环类药物的心脏毒性治疗；非心脏毒性治疗）和运动训练时间（治疗期间或之后）的影响。
方法：2014年1月至2022年2月在瑞士一所大学医院连续参加基于运动的心脏肿瘤康复计划的癌症患者符合资格。根据化疗（蒽环类与非蒽环类）和运动训练的时间（化疗期间与化疗后）对患者进行分组。用心肺运动试验评估峰值摄氧量（VO2）（n=200），和生活质量的癌症治疗功能评估问卷（n=77）。对峰值VO2的变化进行了稳健的线性模型，包括心脏毒性治疗的类型和时机。年龄,训练冲动和基线峰值VO2;使用累积关联模型分析了生活质量的变化。
结果：在所有有效VO2的患者中（n=164），运动训练前后VO2峰值的中位数变化为2.3ml/kg/min（范围：-10.1-15.9）。在非蒽环类药物心脏毒性或非心脏毒性治疗期间完成运动训练的患者中，峰值VO2的最高中位数变化为4.1ml/kg/min（四分位距[IQR]：0.7-7.7）。其次是2.8ml/kg/min（IQR：1.2-5.3）和2.3ml/kg/min（IQR：0.1-4.6）在蒽环类和非蒽环类心脏毒性或非心脏毒性治疗后完成运动训练的患者，分别。在蒽环类药物治疗期间完成运动训练的患者中，峰值VO2降低中位数为-2.1ml/kg/min(IQR:-4.7-2.0)。在鲁棒线性模型中，蒽环类药物治疗癌症的类型和时间之间存在显著的相互作用，蒽环类药物治疗后进行运动训练时，峰值VO2增加更大。为了生活质量，较高的基线评分与生活质量的变化呈负相关.
结论：在我们的队列中，当运动训练与蒽环类药物同时进行时,心肺适应性的增加减弱.对于使用蒽环类药物以外的心脏毒性治疗的患者，心肺功能和生活质量与运动训练的时机无关.
方法：2014年1月至2022年2月在瑞士一所大学医院连续参加基于运动的心脏肿瘤康复计划的癌症患者符合资格。根据化疗（蒽环类与非蒽环类）和运动训练的时间（化疗期间与化疗后）对患者进行分组。用心肺运动试验评估峰值摄氧量（VO2）（n=200），和生活质量的癌症治疗功能评估问卷（n=77）。对峰值VO2的变化进行了稳健的线性模型，包括心脏毒性治疗的类型和时机。年龄,训练冲动和基线峰值VO2;使用累积关联模型分析了生活质量的变化。
结果：在所有有效VO2的患者中（n=164），运动训练前后VO2峰值的中位数变化为2.3ml/kg/min（范围：-10.1-15.9）。在非蒽环类药物心脏毒性或非心脏毒性治疗期间完成运动训练的患者中，峰值VO2的最高中位数变化为4.1ml/kg/min（四分位距[IQR]：0.7-7.7）。其次是2.8ml/kg/min（IQR：1.2-5.3）和2.3ml/kg/min（IQR：0.1-4.6）在蒽环类和非蒽环类心脏毒性或非心脏毒性治疗后完成运动训练的患者，分别。在蒽环类药物治疗期间完成运动训练的患者中，峰值VO2降低中位数为-2.1ml/kg/min(IQR:-4.7-2.0)。在鲁棒线性模型中，蒽环类药物治疗癌症的类型和时间之间存在显著的相互作用，蒽环类药物治疗后进行运动训练时，峰值VO2增加更大。为了生活质量，较高的基线评分与生活质量的变化呈负相关.
结论：在我们的队列中，当运动训练与蒽环类药物同时进行时,心肺适应性的增加减弱.对于使用蒽环类药物以外的心脏毒性治疗的患者，心肺功能和生活质量与运动训练的时机无关.
