Does center-based cardiac rehabilitation improve peak oxygen consumption in adult cancer survivors with high cardiovascular risk compared to community-based exercise training?
Center-based cardiac rehabilitation significantly improves cardiorespiratory fitness, blood pressure, and quality of life compared to community-based exercise in high-risk cancer survivors.
Importance: Cardiovascular disease is a leading cause of morbidity in cancer survivors, which makes strategies aimed at mitigating cardiovascular risk a subject of major contemporary importance. Objective: To assess whether a center-based cardiac rehabilitation (CBCR) framework compared with usual care encompassing community-based exercise training (CBET) is superior for cardiorespiratory fitness improvement and cardiovascular risk factor control among cancer survivors with high cardiovascular risk. Design, Setting, and Participants: This prospective, single-center, randomized clinical trial (CORE trial) included adult cancer survivors who had exposure to cardiotoxic cancer treatment and/or previous cardiovascular disease. Enrollment took place from March 1, 2021, to March 31, 2022. End points were assessed at baseline and after the 8-week intervention. Interventions: Participants were randomly assigned in a 1:1 ratio to 8 weeks of CBCR or CBET. The combined aerobic and resistance exercise sessions were performed twice a week. Main Outcomes and Measures: The powered primary efficacy measure was change in peak oxygen consumption (V̇o2) at 2 months. Secondary outcomes included handgrip maximal strength, functional performance, blood pressure (BP), body composition, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), lipid profile, plasma biomarker levels, physical activity (PA) levels, psychological distress, quality of life (QOL), and health literacy. Results: A total of 75 participants completed the study (mean SD age, 53.6 12.3 years; 58 77.3% female), with 38 in the CBCR group and 37 in the CBET group. Participants in CBCR achieved a greater mean (SD) increase in peak V̇o2 than those in CBET (2.1 2.8 mL/kg/min vs 0.8 2.5 mL/kg/min), with a between-group mean difference of 1.3 mL/kg/min (95% CI, 0.1-2.6 mL/kg/min; P = .03). Compared with the CBET group, the CBCR group also attained a greater mean (SD) reduction in systolic BP (-12.3 11.8 mm Hg vs -1.9 12.9 mm Hg; P < .001), diastolic BP (-5.0 5.7 mm Hg vs -0.5 7.0 mm Hg; P = .003), and BMI (-1.2 0.9 vs 0.2 0.7; P < .001) and greater mean (SD) improvements in PA levels (1035.2 735.7 metabolic equivalents METs/min/wk vs 34.1 424.4 METs/min/wk; P < .001), QOL (14.0 10.0 points vs 0.4 12.9 points; P < .001), and health literacy scores (2.7 1.6 points vs 0.1 1.4 points; P < .001). Exercise adherence was significantly higher in the CBCR group than in the CBET group (mean SD sessions completed, 90.3% 11.8% vs 68.4% 22.1%; P < .001). Conclusion and Relevance: The CORE trial showed that a cardio-oncology rehabilitation model among cancer survivors with high cardiovascular risk was associated with greater improvements in peak V̇o2 compared with usual care encompassing an exercise intervention in a community setting. The CBCR also showed superior results in exercise adherence, cardiovascular risk factor control, QOL, and health literacy. Trial Registration: ClinicalTrials.gov Identifier: NCT05132998.
Viamonte et al. (Wed,) studied this question.