Highlights
- •Cancer predisposes individuals to cardiovascular disease (CVD)-related illness and death.
- •Exercise-based cardiac rehabilitation improved cardiorespiratory fitness in patients with CVD and cancer.
- •Cardiac rehabilitation completion improved survival in patients with CVD and cancer.
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
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Article info
Publication history
Published online: September 07, 2021
Accepted:
September 2,
2021
Received in revised form:
August 4,
2021
Received:
May 27,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
