Cardiac autonomic dysfunction in patients with cancer: exploring the role of physical exercise

PURPOSE: Cardiovascular diseases are a leading cause of non-cancer mortality among patients with cancer, with cardiac autonomic dysfunction identified as a significant predictor of future cardiovascular conditions. Despite the importance of autonomic dysfunction as a prognostic marker being well-established in healthy individuals and other chronic conditions, its role in patients with cancer remains underexplored. This narrative review aims to synthesize existing literature on the role of cardiac autonomic dysfunction in patients with cancer and explore the potential of physical exercise as a non-pharmacological intervention to modulate the autonomic nervous system positively. METHODS: This review examines methods for assessing cardiac autonomic dysfunction, the factors contributing to its dysregulation, and the prognostic role of heart rate variability. It also analyzes current evidence on the effectiveness of various physical exercise modalities, including aerobic, resistance training, and mind-body interventions, in modulating autonomic function. RESULTS: Patients with cancer are exposed to disease-related, lifestyle, and physiological factors that impair autonomic regulation. This dysfunction is associated with worse outcomes, such as increased mortality and disease progression. Preliminary evidence suggests that physical exercise, particularly a combination of aerobic and resistance training, as well as yoga, may improve heart rate variability and mitigate sympathovagal imbalance in patients. CONCLUSION: While research on the effects of physical exercise on autonomic modulation in cancer patients is still limited, early findings show promise. Further studies are needed to fully understand the mechanisms through which exercise improves cardiac autonomic function and its long-term benefits in oncology, positioning this as a novel area of research.