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Meta-Analysis
. 2024 Aug;18(4):1309-1324.
doi: 10.1007/s11764-023-01372-7. Epub 2023 Apr 20.

Efficacy of exercise training for improving vascular dysfunction in people with cancer: a systematic review with meta-analyses

Natalie K Vear  1   2   3 , Yubin Moon  4 , Gregore I Mielke  5 , Tina L Skinner  6 , Jeff S Coombes  7   6 , Alexandra L McCarthy  4   8 , Claudia R Abbott  4 , Tom G Bailey  4   7   6
Affiliations
Meta-Analysis

Efficacy of exercise training for improving vascular dysfunction in people with cancer: a systematic review with meta-analyses

Natalie K Vear et al. J Cancer Surviv. 2024 Aug.

Abstract

Purpose: Cancer treatments exert vascular toxic effects that can lead to the development of cardiovascular disease. Exercise training has the potential to prevent or reduce cancer treatment-induced damage to vascular structure and function. This systematic review with meta-analyses aimed to determine the isolated effects of exercise training on vascular outcomes in people with cancer.

Methods: Seven electronic databases were searched on 20 September 2021 to identify randomised controlled trials, quasi-randomised trials, pilot and cohort studies. Included studies implemented a structured exercise intervention and assessed vascular structure and/or function in people during or following cancer treatment. Meta-analyses examined the effects of exercise training on endothelial function (via brachial artery flow-mediated dilation) and arterial stiffness (via pulse wave velocity). Methodological quality was assessed using the Cochrane Quality Assessment tool and modified Newcastle-Ottawa Quality Appraisal tool. Grading of Recommendations, Assessment, Development and Evaluations framework was used to assess the certainty of evidence.

Results: Ten studies (discussed across 11 articles) met the inclusion criteria. Methodological quality of the included studies was moderate (71% average). Exercise improved vascular function when compared to control (standardised mean difference = 0.34, 95% CI (0.01, 0.67); p = 0.044: studies = 5, participants = 171), but not pulse wave velocity (standardised mean difference = - 0.64, 95% CI (- 1.29, 0.02); p = 0.056: studies = 4, participants = 333). The certainty of evidence was moderate for flow-mediated dilation and low for pulse wave velocity.

Conclusions: Compared to usual care, exercise training significantly improves flow-mediated dilation (endothelial function) but not pulse wave analysis, in people treated for cancer.

Implications for cancer survivors: Exercise may improve vascular health in individuals during and following cancer treatment.

Keywords: Cardiotoxicity; Carotid intima-media thickness; Exercise physiology; Neoplasms; Physical activity; Pulse wave analysis.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram. Adapted from Page et al., [34]. CINAHL Cumulative Index to Nursing and Allied Health Literature, PEDro Physiotherapy Evidence Database
Fig. 2
Fig. 2
Risk of bias traffic light plot
Fig. 3
Fig. 3
Forest plots of flow-mediated dilation and pulse wave velocity in usual care vs. exercise intervention. Data depicts the standardised mean difference and 95% CI for a flow-mediated dilation and b pulse wave velocity (combined central and peripheral) in individual studies and pooled estimates. CI confidence intervals, CON control (usual care) group, HIIT high-intensity interval training, MICT continuous low-to-moderate intensity training, PWV pulse wave velocity, SMD standardised mean difference
See this image and copyright information in PMC

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