Cancer and cardiovascular disease: The impact of cardiac rehabilitation and cardiorespiratory fitness on survival

Tamara Williamson; Chelsea Moran; Daniele Chirico; Ross Arena; Cemal Ozemek; Sandeep Aggarwal; Tavis Campbell; Deepika Laddu

doi:10.1016/j.ijcard.2021.09.004

Cancer and cardiovascular disease: The impact of cardiac rehabilitation and cardiorespiratory fitness on survival

Int J Cardiol. 2021 Nov 15:343:139-145. doi: 10.1016/j.ijcard.2021.09.004. Epub 2021 Sep 8.

Authors

Tamara Williamson¹, Chelsea Moran¹, Daniele Chirico², Ross Arena³, Cemal Ozemek⁴, Sandeep Aggarwal⁵, Tavis Campbell⁶, Deepika Laddu⁷

Affiliations

¹ Department of Psychology, University of Calgary, Calgary, AB, Canada.
² TotalCardiology™ Rehabilitation, Calgary, AB, Canada; TotalCardiology Research Network, Calgary, AB, Canada; Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.
³ Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA; Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA.
⁴ Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA; Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA.
⁵ TotalCardiology™ Rehabilitation, Calgary, AB, Canada; TotalCardiology Research Network, Calgary, AB, Canada; Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA.
⁶ Department of Psychology, University of Calgary, Calgary, AB, Canada; TotalCardiology Research Network, Calgary, AB, Canada; Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA; Libin Cardiovascular Institute, University of Calgary, Calgary, Canada.
⁷ TotalCardiology Research Network, Calgary, AB, Canada; Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA; Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA. Electronic address: dladdu@uic.edu.

Abstract

Background: Cancer survivors are at increased risk for cardiovascular disease (CVD)-related morbidity and mortality. Exercise-based cardiac rehabilitation (CR) programs improve CVD risk factors, including cardiorespiratory fitness (CRF). The purpose of this study was to investigate: (1) the association between CR completion and survival, and (2) whether CRF improvements translate to increased survival among patients with comorbid cancer and CVD.

Methods: Patients with CVD and pre-existing cancer (any type) were referred to a 12-week exercise-based CR program between 01/1996 and 03/2016. Peak metabolic equivalents (METs) were assessed by graded exercise test pre-CR and at 12-weeks. Kaplan-Meier survival and multivariate cox regressions were performed to evaluate impact of CR completion and clinically-meaningful CRF improvements [ΔMETs≥1] on survival, adjusting for relevant covariates.

Results: Among 442 patients with CVD and cancer referred to CR (67 ± 10 years; 22% women), 361 (82%) completed CR. 102 deaths were recorded during the 12-year observation period. Compared to patients who did not complete CR, patients with comorbid cancer who completed CR demonstrated a survival advantage (63% vs 80.1%, p < .001). CRF improved among completers during the 12-week program (mean change = 0.87 ± 0.93 METs, p < .001); 41% experienced a clinically-meaningful ΔMETs≥1. A survival advantage was not observed in completers who experienced a ΔMETs≥1 improvement (p = .254).

Conclusion: Completing a 12-week exercise-based CR program improved CRF and increased survival in patients with CVD and comorbid cancer. The results highlight the survival benefits of completing a CR program among CVD patients who experience added barriers imposed by cancer treatment and survival.

Keywords: Cardiac rehabilitation; Cardio-oncology; Cardiorespiratory fitness; Cardiovascular disease; Exercise capacity; Survival; cancer.

MeSH terms

Cardiac Rehabilitation*
Cardiorespiratory Fitness*
Cardiovascular Diseases* / diagnosis
Exercise Test
Exercise Therapy
Female
Humans
Male
Neoplasms*

Grants and funding

K01 HL148503/HL/NHLBI NIH HHS/United States