Exercise Interventions for the Prevention and Treatment of Anthracycline-Induced Cardiotoxicity in Women with Breast Cancer: A Systematic Review

Anthracyclines have been one of the standard therapies for breast cancer (BC), and dose-related cardiotoxicity is one serious side effect. Exercise is an effective strategy for the prevention and management of BC, endorsed by experts in both exercise and oncology. However, there is a great deal of confusion about the effectiveness of exercise on anthracycline-induced cardiotoxicity and the exercise prescription (i.e., timing, type, and intensity) for cardiotoxicity, which limits its application in clinical settings. The aim of this article is to review the safety of exercise in BC patients receiving anthracyclines and its effectiveness in preventing cardiotoxicity. Six electronic databases were searched using terms related to exercise, BC, anthracyclines, and cardiotoxicity for retrieving clinical randomized controlled trials in either Chinese or English. A summary of the included literature was also provided. Of 202 records screened, 10 were eligible. A total of 434 BC patients (stage I–IIIC, mean age ranged from 43.5 to 52.4 years) were included. The main findings were that: (1) Acute (a single bout) moderate-to-vigorous aerobic exercise could prevent NT-proBNP elevation beyond the threshold of acute myocardial injury; (2) Long-term (> 8 weeks) moderate-to-high intensity aerobic exercise (continuous or interval) could improve or maintain left ventricular ejection fraction and cardiorespiratory fitness in BC patients. However, the optimal timing, type, and intensity of exercise for people with BC to prevent cardiotoxicity remain unclear. Moderate-to-vigorous intensity exercise may be an effective non-pharmacological approach to mitigate cardiotoxicities induced by anthracyclines in women with BC. However, the optimal exercise prescription for preventing cardiotoxicity remains unclear.