Tamara Williamson1, Chelsea Moran1, Daniele Chirico2, Ross Arena3, Cemal Ozemek4, Sandeep Aggarwal5, Tavis Campbell6, Deepika Laddu7. 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.
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.
Authors: T Y Goraya; S J Jacobsen; P A Pellikka; T D Miller; A Khan; S A Weston; B J Gersh; V L Roger Journal: Ann Intern Med Date: 2000-06-06 Impact factor: 25.391
Authors: Sidney C Smith; Emelia J Benjamin; Robert O Bonow; Lynne T Braun; Mark A Creager; Barry A Franklin; Raymond J Gibbons; Scott M Grundy; Loren F Hiratzka; Daniel W Jones; Donald M Lloyd-Jones; Margo Minissian; Lori Mosca; Eric D Peterson; Ralph L Sacco; John Spertus; James H Stein; Kathryn A Taubert Journal: Circulation Date: 2011-11-03 Impact factor: 29.690
Authors: Kathleen M Sturgeon; Lei Deng; Shirley M Bluethmann; Shouhao Zhou; Daniel M Trifiletti; Changchuan Jiang; Scott P Kelly; Nicholas G Zaorsky Journal: Eur Heart J Date: 2019-12-21 Impact factor: 29.983
Authors: Sherry L Grace; Paul Poirier; Colleen M Norris; Garth H Oakes; Deborah S Somanader; Neville Suskin Journal: Can J Cardiol Date: 2014-04-12 Impact factor: 5.223
Authors: Kim L Dittus; Susan G Lakoski; Patrick D Savage; Nathan Kokinda; Michael Toth; Diane Stevens; Kimberly Woods; Patricia OʼBrien; Philip A Ades Journal: J Cardiopulm Rehabil Prev Date: 2015 Mar-Apr Impact factor: 2.081
Authors: Jessica M Scott; Emily C Zabor; Emily Schwitzer; Graeme J Koelwyn; Scott C Adams; Tormod S Nilsen; Chaya S Moskowitz; Konstantina Matsoukas; Neil M Iyengar; Chau T Dang; Lee W Jones Journal: J Clin Oncol Date: 2018-06-12 Impact factor: 44.544