Exercise for the Prevention of Anthracycline-Induced Functional Disability and Cardiac Dysfunction: The BREXIT Study
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Le résumé fourni par la source
Background: Breast cancer survivors treated with anthracycline-based chemotherapy (AC) have increased risk of functional limitation and cardiac dysfunction. We conducted a 12-month randomized controlled trial in 104 patients with early-stage breast cancer scheduled for AC to determine whether 12 months of exercise training (ExT) could attenuate functional disability (primary end point), improve cardiorespiratory fitness (VO 2 peak), and prevent cardiac dysfunction. Methods: Women 40 to 75 years of age with stage I to III breast cancer scheduled for AC were randomized to 3 to 4 days per week aerobic and resistance ExT for 12 months (n=52) or usual care (UC; n=52). Functional measures were performed at baseline, at 4 weeks after AC (4 months), and at 12 months, comprising: (1) cardiopulmonary exercise testing to quantify VO 2 peak and functional disability (VO 2 peak ≤18.0 mL·kg −1 ·min −1 ); (2) cardiac reserve (response from rest to peak exercise), quantified with exercise cardiac magnetic resonance measures to determine changes in left and right ventricular ejection fraction, cardiac output, and stroke volume; (3) standard-of-care echocardiography-derived resting left ventricular ejection fraction and global longitudinal strain; and (4) biochemistry (troponin and BNP [B-type natriuretic peptide]). Results: Among 104 participants randomized, greater study attrition was observed among UC participants ( P =0.031), with 93 women assessed at 4 months (ExT, n=49; UC, n=44) and 87 women assessed at 12 months (ExT, n=49; UC, n=38). ExT attenuated functional disability at 4 months (odds ratio, 0.32 [95% CI, 0.11–0.94]; P =0.03) but not at 12 months (odds ratio, 0.27 [95% CI, 0.06–1.12]; P =0.07). In a per-protocol analysis, functional disability was prevented entirely at 12 months among participants adherent to ExT (ExT, 0% versus UC, 20%; P =0.005). Compared with UC at 12 months, ExT was associated with a net 3.5-mL·kg −1 ·min −1 improvement in VO 2 peak that coincided with greater cardiac output, stroke volume, and left and right ventricular ejection fraction reserve ( P <0.001 for all). There was no effect of ExT on resting measures of left ventricular function. Postchemotherapy troponin increased less in ExT than in UC (8-fold versus 16-fold increase; P =0.002). There were no changes in BNP in either group. Conclusions: In women with early-stage breast cancer undergoing AC, 12 months of ExT did not attenuate functional disability, but provided large, clinically meaningful benefits on VO 2 peak and cardiac reserve. Registration: URL: https://www.anzctr.org.au/ ; Unique identifier: ACTRN12617001408370.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Exercise for the Prevention of Anthracycline-Induced Functional Disability and Cardiac Dysfunction: The BREXIT Study
- Date Crossref
- 14/02/2023
- Éditeur
- Ovid Technologies (Wolters Kluwer Health)
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Baker Heart and Diabetes Institute A.L.G.) pays non établi dans la noticeOrganisation à but non lucratif
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The University of Melbourne A.L.G.) pays non établi dans la noticeUniversité ou école supérieure
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Institute of Health Economics pays non établi dans la noticeOrganisation à but non lucratif
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Cabrini Hospital pays non établi dans la noticeÉtablissement de santé
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Monash Health pays non établi dans la noticeÉtablissement de santé
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Monash University pays non établi dans la noticeUniversité ou école supérieure
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Melbourne Health pays non établi dans la noticeÉtablissement de santé
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Peter MacCallum Cancer Centre pays non établi dans la noticeÉtablissement de santé
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KU Leuven pays non établi dans la noticeUniversité ou école supérieure
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Deakin University pays non établi dans la noticeUniversité ou école supérieure
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St Vincent's Hospital Melbourne pays non établi dans la noticeÉtablissement de santé
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Faculty of Nursing Baker Heart and Diabetes Institute pays non établi dans la noticeUniversité ou école supérieure
A.L.G.) — Baker Heart and Diabetes Institute, A.L.G.) — The University of Melbourne et Institute of Health Economics, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.