A Longitudinal Study of the Association of Clinical Indices of Cardiovascular Autonomic Function with Breast Cancer Treatment and Exercise Training
Background Cardiovascular autonomic dysfunction is an early marker for cardiovascular disease. Anthracycline chemotherapy and left‐sided radiation for breast cancer are associated with negative autonomic function changes. This study's objectives were to characterize changes in, and the associat...
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| Veröffentlicht in: | The oncologist (Dayton, Ohio) Ohio), 2019-02, Vol.24 (2), p.273-284 |
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| creator | Kirkham, Amy A. Lloyd, Matthew G. Claydon, Victoria E. Gelmon, Karen A. McKenzie, Donald C. Campbell, Kristin L. |
| description | Background
Cardiovascular autonomic dysfunction is an early marker for cardiovascular disease. Anthracycline chemotherapy and left‐sided radiation for breast cancer are associated with negative autonomic function changes. This study's objectives were to characterize changes in, and the association of exercise training with, clinical indices of cardiovascular autonomic function across the trajectory of breast cancer therapy.
Subjects, Materials, and Methods
Seventy‐three patients receiving adjuvant chemotherapy participated to varying degrees in supervised aerobic and resistance exercise during chemotherapy ± radiation and for 20 weeks after. Resting heart rate (HRrest) and blood pressure were measured weekly during chemotherapy. HRrest, exercise heart rate recovery (HRrecovery), and aerobic fitness were measured at enrollment, end of chemotherapy ± radiation, and 10 and 20 weeks after treatment.
Results
During chemotherapy, HRrest increased in a parabolic manner within a single treatment and with increasing treatment dose, whereas systolic and diastolic blood pressure decreased linearly across treatments. Tachycardia and hypotension were present in 32%–51% of participants. Factors associated with weekly changes during chemotherapy included receiving anthracyclines or trastuzumab, days since last treatment, hematocrit, and exercise attendance. Receipt of anthracyclines, trastuzumab, and left‐sided radiation individually predicted impairments of HRrest and HRrecovery during chemotherapy ± radiation; however, aerobic fitness change and at least twice‐weekly exercise attendance predicted improvement. By 10 weeks after treatment, HRrest and blood pressure were not different from prechemotherapy.
Conclusion
In this study, chemotherapy resulted in increased HRrest and tachycardia, as well as decreased blood pressure and hypotension. Anthracyclines, trastuzumab, and left‐sided radiation were associated with HRrest elevations and impairments of HRrecovery, but exercise training at least twice a week appeared to mitigate these changes.
Implications for Practice
This study characterized changes in clinically accessible measures with well‐established prognostic value for cardiovascular disease, and investigated associations with cardiotoxic treatments and the positive influence of exercise. The chemotherapy‐related incremental increase in resting heart rate, with tachycardia occurring in one third of patients, and decrease in blood pressure, with hypotension occurring |
| doi_str_mv | 10.1634/theoncologist.2018-0049 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6369953</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2113267490</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4726-dd703f2ac223ffae6143fb620ccf351100770e98180f74c8e5a0dcfbff70be523</originalsourceid><addsrcrecordid>eNqNUcFu1DAUjBCIlsIvgI9cUp7tJE4uSMuqhUor9kCRuFneF3vXyLGL7bTsd_DDeNtS6I2Tx-OZec-aqnpD4ZR2vHmXdzp4DC5sbcqnDGhfAzTDk-qYts1QNwN8e1ow9LwWtB2OqhcpfQcokLPn1REH1oq-74-rXwuyCn5r8zxarxz5UsCeBEPKBLJIKaBV2QZ_oJbOeotFdOFHizrdciqONlyrhLNTkSzmHHyYLJLz2eOt8cbmHfkQtUq5qD3qSC7LLU_aZ6L8SM5-6og26UKrMsBvX1bPjHJJv7o_T6qv52eXy0_1av3xYrlY1dgI1tXjKIAbppAxbozSHW242XQMEA1vKQUQAvTQ0x6MaLDXrYIRzcYYARvdMn5Svb_LvZo3kx6xLBSVk1fRTiruZVBWPn7xdie34Vp2vBuGlpeAt_cBMfyYdcpysgm1c8rrMCfJKOWsE6WNIhV3UowhpajNwxgK8lCpfFSpPFQqD5UW5-t_t3zw_enw7zdurNP7_82V68_LNWUCOv4beDy6ZQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2113267490</pqid></control><display><type>article</type><title>A Longitudinal Study of the Association of Clinical Indices of Cardiovascular Autonomic Function with Breast Cancer Treatment and Exercise Training</title><source>MEDLINE</source><source>Oxford Journals Open Access Collection</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Wiley Online Library All Journals</source><source>PubMed Central</source><creator>Kirkham, Amy A. ; Lloyd, Matthew G. ; Claydon, Victoria E. ; Gelmon, Karen A. ; McKenzie, Donald C. ; Campbell, Kristin L.</creator><creatorcontrib>Kirkham, Amy A. ; Lloyd, Matthew G. ; Claydon, Victoria E. ; Gelmon, Karen A. ; McKenzie, Donald C. ; Campbell, Kristin L.</creatorcontrib><description>Background
Cardiovascular autonomic dysfunction is an early marker for cardiovascular disease. Anthracycline chemotherapy and left‐sided radiation for breast cancer are associated with negative autonomic function changes. This study's objectives were to characterize changes in, and the association of exercise training with, clinical indices of cardiovascular autonomic function across the trajectory of breast cancer therapy.
Subjects, Materials, and Methods
Seventy‐three patients receiving adjuvant chemotherapy participated to varying degrees in supervised aerobic and resistance exercise during chemotherapy ± radiation and for 20 weeks after. Resting heart rate (HRrest) and blood pressure were measured weekly during chemotherapy. HRrest, exercise heart rate recovery (HRrecovery), and aerobic fitness were measured at enrollment, end of chemotherapy ± radiation, and 10 and 20 weeks after treatment.
Results
During chemotherapy, HRrest increased in a parabolic manner within a single treatment and with increasing treatment dose, whereas systolic and diastolic blood pressure decreased linearly across treatments. Tachycardia and hypotension were present in 32%–51% of participants. Factors associated with weekly changes during chemotherapy included receiving anthracyclines or trastuzumab, days since last treatment, hematocrit, and exercise attendance. Receipt of anthracyclines, trastuzumab, and left‐sided radiation individually predicted impairments of HRrest and HRrecovery during chemotherapy ± radiation; however, aerobic fitness change and at least twice‐weekly exercise attendance predicted improvement. By 10 weeks after treatment, HRrest and blood pressure were not different from prechemotherapy.
Conclusion
In this study, chemotherapy resulted in increased HRrest and tachycardia, as well as decreased blood pressure and hypotension. Anthracyclines, trastuzumab, and left‐sided radiation were associated with HRrest elevations and impairments of HRrecovery, but exercise training at least twice a week appeared to mitigate these changes.
Implications for Practice
This study characterized changes in clinically accessible measures with well‐established prognostic value for cardiovascular disease, and investigated associations with cardiotoxic treatments and the positive influence of exercise. The chemotherapy‐related incremental increase in resting heart rate, with tachycardia occurring in one third of patients, and decrease in blood pressure, with hypotension occurring in one half of the patients, is relevant to oncology practitioners for clinical examination or patient report of related symptoms (i.e., dizziness). The weekly dose of two 60‐minute sessions of moderate‐intensity aerobic and resistance exercise that was identified as protective of cardiovascular autonomic impairments can easily be prescribed to patients by oncologists.
摘要
背景。心血管自主神经功能障碍是心血管疾病的早期指标。针对乳腺癌的蒽环类药物化疗和左侧放疗与自主神经功能的负面变化有关。本研究的目的是描述在乳腺癌治疗过程中心血管自主神经功能临床指标的变化，及这些指标与运动训练之间的关联。
受试者、材料和方法。接受辅助化疗的 73 名患者在化疗 ± 放疗期间及 20 周之后参加了不同程度的指导性有氧及抗阻运动。化疗期间每周测量静息心率 (HRrest) 和血压。我们会在报名时、化疗 ± 放疗结束时，以及治疗后 10 周和 20 周测量 HRrest、运动心率恢复 (HRrecovery) 和有氧适能。
结果。在化疗期间，HRrest 在单次治疗中以抛物线形式随着治疗剂量的增加而增加，而收缩压和舒张压会在治疗过程中呈线性下降。有 32%‐51% 的参与者出现心动过速和低血压。与化疗期间每周变化相关的因素包括接受蒽环类药物或曲妥单抗、上次治疗后的天数、血细胞比容和参加运动的人数。接受蒽环类药物、曲妥单抗和左侧放疗分别预示出化疗 ± 放疗期间 HRrest 和 HRrecovery的障碍；但是，有氧健身的变化和每周至少两次的运动预计会有所改善。到治疗后 10 周，HRrest 和血压与化疗前相比没有分别。
结论。在本研究中，化疗导致 HRrest 增加、心动过速、血压下降和低血压。蒽环类药物、曲妥单抗和左侧放疗与 HRrest 升高和 HRrecovery 障碍有关，但每周进行两次运动似乎可以减缓这些变化。
对实践的启示:本研究根据心血管疾病的确定预后值来表现临床上可利用措施的变化，同时研究了与心脏毒性治疗和运动的积极影响之间的关联。与化疗相关的静息心率逐步增加，导致 1/3 的患者出现心动过速，血压降低，导致 1/2 患者出现低血压，这些均与肿瘤医生进行临床检查或患者报告相关症状(即头晕)相关。肿瘤医生可轻易给患者开具处方，每周进行两次 60 分钟的中等强度有氧及抗阻运动，这些运动被认为可以避免心血管自主神经损伤。
Treatment for breast cancer, including chemotherapy and radiation can have cardiovascular side effects. This study's objectives were to characterize changes in, and the association of exercise training with, clinical indices of cardiovascular autonomic function across the trajectory of breast cancer therapy.</description><identifier>ISSN: 1083-7159</identifier><identifier>EISSN: 1549-490X</identifier><identifier>DOI: 10.1634/theoncologist.2018-0049</identifier><identifier>PMID: 30257888</identifier><language>eng</language><publisher>Hoboken, USA: John Wiley & Sons, Inc</publisher><subject>Adult ; Aged ; Autonomic Nervous System Diseases - etiology ; Blood pressure ; Breast neoplasms ; Breast Neoplasms - complications ; Breast Neoplasms - pathology ; Breast Neoplasms - therapy ; Cardiovascular Diseases - etiology ; Exercise ; Exercise - physiology ; Female ; Heart rate ; Humans ; Longitudinal Studies ; Middle Aged ; Symptom Management and Supportive Care</subject><ispartof>The oncologist (Dayton, Ohio), 2019-02, Vol.24 (2), p.273-284</ispartof><rights>AlphaMed Press 2018</rights><rights>AlphaMed Press 2018.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4726-dd703f2ac223ffae6143fb620ccf351100770e98180f74c8e5a0dcfbff70be523</citedby><cites>FETCH-LOGICAL-c4726-dd703f2ac223ffae6143fb620ccf351100770e98180f74c8e5a0dcfbff70be523</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6369953/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6369953/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,1417,27924,27925,45574,45575,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30257888$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kirkham, Amy A.</creatorcontrib><creatorcontrib>Lloyd, Matthew G.</creatorcontrib><creatorcontrib>Claydon, Victoria E.</creatorcontrib><creatorcontrib>Gelmon, Karen A.</creatorcontrib><creatorcontrib>McKenzie, Donald C.</creatorcontrib><creatorcontrib>Campbell, Kristin L.</creatorcontrib><title>A Longitudinal Study of the Association of Clinical Indices of Cardiovascular Autonomic Function with Breast Cancer Treatment and Exercise Training</title><title>The oncologist (Dayton, Ohio)</title><addtitle>Oncologist</addtitle><description>Background
Cardiovascular autonomic dysfunction is an early marker for cardiovascular disease. Anthracycline chemotherapy and left‐sided radiation for breast cancer are associated with negative autonomic function changes. This study's objectives were to characterize changes in, and the association of exercise training with, clinical indices of cardiovascular autonomic function across the trajectory of breast cancer therapy.
Subjects, Materials, and Methods
Seventy‐three patients receiving adjuvant chemotherapy participated to varying degrees in supervised aerobic and resistance exercise during chemotherapy ± radiation and for 20 weeks after. Resting heart rate (HRrest) and blood pressure were measured weekly during chemotherapy. HRrest, exercise heart rate recovery (HRrecovery), and aerobic fitness were measured at enrollment, end of chemotherapy ± radiation, and 10 and 20 weeks after treatment.
Results
During chemotherapy, HRrest increased in a parabolic manner within a single treatment and with increasing treatment dose, whereas systolic and diastolic blood pressure decreased linearly across treatments. Tachycardia and hypotension were present in 32%–51% of participants. Factors associated with weekly changes during chemotherapy included receiving anthracyclines or trastuzumab, days since last treatment, hematocrit, and exercise attendance. Receipt of anthracyclines, trastuzumab, and left‐sided radiation individually predicted impairments of HRrest and HRrecovery during chemotherapy ± radiation; however, aerobic fitness change and at least twice‐weekly exercise attendance predicted improvement. By 10 weeks after treatment, HRrest and blood pressure were not different from prechemotherapy.
Conclusion
In this study, chemotherapy resulted in increased HRrest and tachycardia, as well as decreased blood pressure and hypotension. Anthracyclines, trastuzumab, and left‐sided radiation were associated with HRrest elevations and impairments of HRrecovery, but exercise training at least twice a week appeared to mitigate these changes.
Implications for Practice
This study characterized changes in clinically accessible measures with well‐established prognostic value for cardiovascular disease, and investigated associations with cardiotoxic treatments and the positive influence of exercise. The chemotherapy‐related incremental increase in resting heart rate, with tachycardia occurring in one third of patients, and decrease in blood pressure, with hypotension occurring in one half of the patients, is relevant to oncology practitioners for clinical examination or patient report of related symptoms (i.e., dizziness). The weekly dose of two 60‐minute sessions of moderate‐intensity aerobic and resistance exercise that was identified as protective of cardiovascular autonomic impairments can easily be prescribed to patients by oncologists.
摘要
背景。心血管自主神经功能障碍是心血管疾病的早期指标。针对乳腺癌的蒽环类药物化疗和左侧放疗与自主神经功能的负面变化有关。本研究的目的是描述在乳腺癌治疗过程中心血管自主神经功能临床指标的变化，及这些指标与运动训练之间的关联。
受试者、材料和方法。接受辅助化疗的 73 名患者在化疗 ± 放疗期间及 20 周之后参加了不同程度的指导性有氧及抗阻运动。化疗期间每周测量静息心率 (HRrest) 和血压。我们会在报名时、化疗 ± 放疗结束时，以及治疗后 10 周和 20 周测量 HRrest、运动心率恢复 (HRrecovery) 和有氧适能。
结果。在化疗期间，HRrest 在单次治疗中以抛物线形式随着治疗剂量的增加而增加，而收缩压和舒张压会在治疗过程中呈线性下降。有 32%‐51% 的参与者出现心动过速和低血压。与化疗期间每周变化相关的因素包括接受蒽环类药物或曲妥单抗、上次治疗后的天数、血细胞比容和参加运动的人数。接受蒽环类药物、曲妥单抗和左侧放疗分别预示出化疗 ± 放疗期间 HRrest 和 HRrecovery的障碍；但是，有氧健身的变化和每周至少两次的运动预计会有所改善。到治疗后 10 周，HRrest 和血压与化疗前相比没有分别。
结论。在本研究中，化疗导致 HRrest 增加、心动过速、血压下降和低血压。蒽环类药物、曲妥单抗和左侧放疗与 HRrest 升高和 HRrecovery 障碍有关，但每周进行两次运动似乎可以减缓这些变化。
对实践的启示:本研究根据心血管疾病的确定预后值来表现临床上可利用措施的变化，同时研究了与心脏毒性治疗和运动的积极影响之间的关联。与化疗相关的静息心率逐步增加，导致 1/3 的患者出现心动过速，血压降低，导致 1/2 患者出现低血压，这些均与肿瘤医生进行临床检查或患者报告相关症状(即头晕)相关。肿瘤医生可轻易给患者开具处方，每周进行两次 60 分钟的中等强度有氧及抗阻运动，这些运动被认为可以避免心血管自主神经损伤。
Treatment for breast cancer, including chemotherapy and radiation can have cardiovascular side effects. This study's objectives were to characterize changes in, and the association of exercise training with, clinical indices of cardiovascular autonomic function across the trajectory of breast cancer therapy.</description><subject>Adult</subject><subject>Aged</subject><subject>Autonomic Nervous System Diseases - etiology</subject><subject>Blood pressure</subject><subject>Breast neoplasms</subject><subject>Breast Neoplasms - complications</subject><subject>Breast Neoplasms - pathology</subject><subject>Breast Neoplasms - therapy</subject><subject>Cardiovascular Diseases - etiology</subject><subject>Exercise</subject><subject>Exercise - physiology</subject><subject>Female</subject><subject>Heart rate</subject><subject>Humans</subject><subject>Longitudinal Studies</subject><subject>Middle Aged</subject><subject>Symptom Management and Supportive Care</subject><issn>1083-7159</issn><issn>1549-490X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNUcFu1DAUjBCIlsIvgI9cUp7tJE4uSMuqhUor9kCRuFneF3vXyLGL7bTsd_DDeNtS6I2Tx-OZec-aqnpD4ZR2vHmXdzp4DC5sbcqnDGhfAzTDk-qYts1QNwN8e1ow9LwWtB2OqhcpfQcokLPn1REH1oq-74-rXwuyCn5r8zxarxz5UsCeBEPKBLJIKaBV2QZ_oJbOeotFdOFHizrdciqONlyrhLNTkSzmHHyYLJLz2eOt8cbmHfkQtUq5qD3qSC7LLU_aZ6L8SM5-6og26UKrMsBvX1bPjHJJv7o_T6qv52eXy0_1av3xYrlY1dgI1tXjKIAbppAxbozSHW242XQMEA1vKQUQAvTQ0x6MaLDXrYIRzcYYARvdMn5Svb_LvZo3kx6xLBSVk1fRTiruZVBWPn7xdie34Vp2vBuGlpeAt_cBMfyYdcpysgm1c8rrMCfJKOWsE6WNIhV3UowhpajNwxgK8lCpfFSpPFQqD5UW5-t_t3zw_enw7zdurNP7_82V68_LNWUCOv4beDy6ZQ</recordid><startdate>201902</startdate><enddate>201902</enddate><creator>Kirkham, Amy A.</creator><creator>Lloyd, Matthew G.</creator><creator>Claydon, Victoria E.</creator><creator>Gelmon, Karen A.</creator><creator>McKenzie, Donald C.</creator><creator>Campbell, Kristin L.</creator><general>John Wiley & Sons, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>201902</creationdate><title>A Longitudinal Study of the Association of Clinical Indices of Cardiovascular Autonomic Function with Breast Cancer Treatment and Exercise Training</title><author>Kirkham, Amy A. ; Lloyd, Matthew G. ; Claydon, Victoria E. ; Gelmon, Karen A. ; McKenzie, Donald C. ; Campbell, Kristin L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4726-dd703f2ac223ffae6143fb620ccf351100770e98180f74c8e5a0dcfbff70be523</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Autonomic Nervous System Diseases - etiology</topic><topic>Blood pressure</topic><topic>Breast neoplasms</topic><topic>Breast Neoplasms - complications</topic><topic>Breast Neoplasms - pathology</topic><topic>Breast Neoplasms - therapy</topic><topic>Cardiovascular Diseases - etiology</topic><topic>Exercise</topic><topic>Exercise - physiology</topic><topic>Female</topic><topic>Heart rate</topic><topic>Humans</topic><topic>Longitudinal Studies</topic><topic>Middle Aged</topic><topic>Symptom Management and Supportive Care</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kirkham, Amy A.</creatorcontrib><creatorcontrib>Lloyd, Matthew G.</creatorcontrib><creatorcontrib>Claydon, Victoria E.</creatorcontrib><creatorcontrib>Gelmon, Karen A.</creatorcontrib><creatorcontrib>McKenzie, Donald C.</creatorcontrib><creatorcontrib>Campbell, Kristin L.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The oncologist (Dayton, Ohio)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kirkham, Amy A.</au><au>Lloyd, Matthew G.</au><au>Claydon, Victoria E.</au><au>Gelmon, Karen A.</au><au>McKenzie, Donald C.</au><au>Campbell, Kristin L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Longitudinal Study of the Association of Clinical Indices of Cardiovascular Autonomic Function with Breast Cancer Treatment and Exercise Training</atitle><jtitle>The oncologist (Dayton, Ohio)</jtitle><addtitle>Oncologist</addtitle><date>2019-02</date><risdate>2019</risdate><volume>24</volume><issue>2</issue><spage>273</spage><epage>284</epage><pages>273-284</pages><issn>1083-7159</issn><eissn>1549-490X</eissn><abstract>Background
Cardiovascular autonomic dysfunction is an early marker for cardiovascular disease. Anthracycline chemotherapy and left‐sided radiation for breast cancer are associated with negative autonomic function changes. This study's objectives were to characterize changes in, and the association of exercise training with, clinical indices of cardiovascular autonomic function across the trajectory of breast cancer therapy.
Subjects, Materials, and Methods
Seventy‐three patients receiving adjuvant chemotherapy participated to varying degrees in supervised aerobic and resistance exercise during chemotherapy ± radiation and for 20 weeks after. Resting heart rate (HRrest) and blood pressure were measured weekly during chemotherapy. HRrest, exercise heart rate recovery (HRrecovery), and aerobic fitness were measured at enrollment, end of chemotherapy ± radiation, and 10 and 20 weeks after treatment.
Results
During chemotherapy, HRrest increased in a parabolic manner within a single treatment and with increasing treatment dose, whereas systolic and diastolic blood pressure decreased linearly across treatments. Tachycardia and hypotension were present in 32%–51% of participants. Factors associated with weekly changes during chemotherapy included receiving anthracyclines or trastuzumab, days since last treatment, hematocrit, and exercise attendance. Receipt of anthracyclines, trastuzumab, and left‐sided radiation individually predicted impairments of HRrest and HRrecovery during chemotherapy ± radiation; however, aerobic fitness change and at least twice‐weekly exercise attendance predicted improvement. By 10 weeks after treatment, HRrest and blood pressure were not different from prechemotherapy.
Conclusion
In this study, chemotherapy resulted in increased HRrest and tachycardia, as well as decreased blood pressure and hypotension. Anthracyclines, trastuzumab, and left‐sided radiation were associated with HRrest elevations and impairments of HRrecovery, but exercise training at least twice a week appeared to mitigate these changes.
Implications for Practice
This study characterized changes in clinically accessible measures with well‐established prognostic value for cardiovascular disease, and investigated associations with cardiotoxic treatments and the positive influence of exercise. The chemotherapy‐related incremental increase in resting heart rate, with tachycardia occurring in one third of patients, and decrease in blood pressure, with hypotension occurring in one half of the patients, is relevant to oncology practitioners for clinical examination or patient report of related symptoms (i.e., dizziness). The weekly dose of two 60‐minute sessions of moderate‐intensity aerobic and resistance exercise that was identified as protective of cardiovascular autonomic impairments can easily be prescribed to patients by oncologists.
摘要
背景。心血管自主神经功能障碍是心血管疾病的早期指标。针对乳腺癌的蒽环类药物化疗和左侧放疗与自主神经功能的负面变化有关。本研究的目的是描述在乳腺癌治疗过程中心血管自主神经功能临床指标的变化，及这些指标与运动训练之间的关联。
受试者、材料和方法。接受辅助化疗的 73 名患者在化疗 ± 放疗期间及 20 周之后参加了不同程度的指导性有氧及抗阻运动。化疗期间每周测量静息心率 (HRrest) 和血压。我们会在报名时、化疗 ± 放疗结束时，以及治疗后 10 周和 20 周测量 HRrest、运动心率恢复 (HRrecovery) 和有氧适能。
结果。在化疗期间，HRrest 在单次治疗中以抛物线形式随着治疗剂量的增加而增加，而收缩压和舒张压会在治疗过程中呈线性下降。有 32%‐51% 的参与者出现心动过速和低血压。与化疗期间每周变化相关的因素包括接受蒽环类药物或曲妥单抗、上次治疗后的天数、血细胞比容和参加运动的人数。接受蒽环类药物、曲妥单抗和左侧放疗分别预示出化疗 ± 放疗期间 HRrest 和 HRrecovery的障碍；但是，有氧健身的变化和每周至少两次的运动预计会有所改善。到治疗后 10 周，HRrest 和血压与化疗前相比没有分别。
结论。在本研究中，化疗导致 HRrest 增加、心动过速、血压下降和低血压。蒽环类药物、曲妥单抗和左侧放疗与 HRrest 升高和 HRrecovery 障碍有关，但每周进行两次运动似乎可以减缓这些变化。
对实践的启示:本研究根据心血管疾病的确定预后值来表现临床上可利用措施的变化，同时研究了与心脏毒性治疗和运动的积极影响之间的关联。与化疗相关的静息心率逐步增加，导致 1/3 的患者出现心动过速，血压降低，导致 1/2 患者出现低血压，这些均与肿瘤医生进行临床检查或患者报告相关症状(即头晕)相关。肿瘤医生可轻易给患者开具处方，每周进行两次 60 分钟的中等强度有氧及抗阻运动，这些运动被认为可以避免心血管自主神经损伤。
Treatment for breast cancer, including chemotherapy and radiation can have cardiovascular side effects. This study's objectives were to characterize changes in, and the association of exercise training with, clinical indices of cardiovascular autonomic function across the trajectory of breast cancer therapy.</abstract><cop>Hoboken, USA</cop><pub>John Wiley & Sons, Inc</pub><pmid>30257888</pmid><doi>10.1634/theoncologist.2018-0049</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1083-7159 |
| ispartof | The oncologist (Dayton, Ohio), 2019-02, Vol.24 (2), p.273-284 |
| issn | 1083-7159 1549-490X |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6369953 |
| source | MEDLINE; Oxford Journals Open Access Collection; EZB-FREE-00999 freely available EZB journals; Wiley Online Library All Journals; PubMed Central |
| subjects | Adult Aged Autonomic Nervous System Diseases - etiology Blood pressure Breast neoplasms Breast Neoplasms - complications Breast Neoplasms - pathology Breast Neoplasms - therapy Cardiovascular Diseases - etiology Exercise Exercise - physiology Female Heart rate Humans Longitudinal Studies Middle Aged Symptom Management and Supportive Care |
| title | A Longitudinal Study of the Association of Clinical Indices of Cardiovascular Autonomic Function with Breast Cancer Treatment and Exercise Training |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-07T07%3A31%3A13IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=A%20Longitudinal%20Study%20of%20the%20Association%20of%20Clinical%20Indices%20of%20Cardiovascular%20Autonomic%20Function%20with%20Breast%20Cancer%20Treatment%20and%20Exercise%20Training&rft.jtitle=The%20oncologist%20(Dayton,%20Ohio)&rft.au=Kirkham,%20Amy%20A.&rft.date=2019-02&rft.volume=24&rft.issue=2&rft.spage=273&rft.epage=284&rft.pages=273-284&rft.issn=1083-7159&rft.eissn=1549-490X&rft_id=info:doi/10.1634/theoncologist.2018-0049&rft_dat=%3Cproquest_pubme%3E2113267490%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2113267490&rft_id=info:pmid/30257888&rfr_iscdi=true |