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01-07-2018 | Original Article

Cardiorespiratory fitness and adiposity in breast cancer survivors: is meeting current physical activity recommendations really enough?

Authors: Alejandro Santos-Lozano, Javier Ramos, Alejandro Alvarez-Bustos, Blanca Cantos, Lidia B. Alejo, Itziar Pagola, Ana Soria, Constanza Maximiano, Carmen Fiuza-Luces, Luisa Soares-Miranda, Alejandro Lucia, Ana Ruiz-Casado

Published in: Supportive Care in Cancer | Issue 7/2018

Abstract

Purpose

Breast cancer (BC) survivors are becoming increasingly predisposed to cardiovascular disease (CVD) mortality. Low cardiorespiratory fitness and physical activity (PA) levels, as well as high values of adiposity indices, contribute to CVD risk. We evaluated adiposity, cardiorespiratory profile, and PA levels in two independent cohorts of BC survivors.

Methods

Data were collected from two groups (99% women) from different areas of Madrid (Spain): group 1, n = 110, age 51.4 ± 9.7 years, median time from diagnosis 365 days (95% confidence interval [CI], 354–401), and group 2, n = 93, age 54.7 ± 8.9 years, 1714 days (95% CI, 1502–1938). We estimated peak oxygen uptake (VO_2peak) and measured body mass index (BMI), waist circumference (WC), waist-to-hip index, and accelerometry-determined PA.

Results

Both groups had values of BMI in the overweight range (25.3 ± 4.3 and 27.1 ± 5.1 kg/m², p = 0.003). Estimated VO_2peak levels were lower in group 2 than in group 1 (28.1 ± 9.1 and 23.7 ± 8.8 ml/kg/min, p < 0.001), although levels in both groups were low. Yet, the majority of participants in both groups (81 and 88%, p = 0.234) met international PA recommendations (235 ± 196 and 351 ± 173 min/week of moderate–vigorous PA, p < 0.001). Both groups had very low levels of vigorous PA. These results were essentially independent of type of treatment (anthracycline/radiotherapy).

Conclusions

We found a poor cardiorespiratory profile in two independent BC cohorts that differed in median time from diagnosis (as well in socioeconomic status), supporting the notion that implementation of PA (possibly focusing on vigorous PA) and dietary intervention is urgently needed in this patient population.

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Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JW, Comber H, Forman D, Bray F (2013) Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer 49(6):1374–1403. https://doi.org/10.1016/j.ejca.2012.12.027 CrossRefPubMed

Allemani C, Weir HK, Carreira H, Harewood R, Spika D, Wang XS, Bannon F, Ahn JV, Johnson CJ, Bonaventure A, Marcos-Gragera R, Stiller C, Azevedo e Silva G, Chen WQ, Ogunbiyi OJ, Rachet B, Soeberg MJ, You H, Matsuda T, Bielska-Lasota M, Storm H, Tucker TC, Coleman MP, Group CW (2015) Global surveillance of cancer survival 1995-2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet 385(9972):977–1010. https://doi.org/10.1016/S0140-6736(14)62038-9 CrossRefPubMed

Runowicz CD, Leach CR, Henry NL, Henry KS, Mackey HT, Cowens-Alvarado RL, Cannady RS, Pratt-Chapman ML, Edge SB, Jacobs LA, Hurria A, Marks LB, LaMonte SJ, Warner E, Lyman GH, Ganz PA (2016) American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline. CA Cancer J Clin 66(1):43–73. https://doi.org/10.3322/caac.21319 CrossRefPubMed

Boerman LM, Maass S, van der Meer P, Gietema JA, Maduro JH, Hummel YM, Berger MY, de Bock GH, Berendsen AJ (2017) Long-term outcome of cardiac function in a population-based cohort of breast cancer survivors: a cross-sectional study. Eur J Cancer 81:56–65. https://doi.org/10.1016/j.ejca.2017.05.013 CrossRefPubMed

Murtagh G, Lyons T, O’Connell E, Ballot J, Geraghty L, Fennelly D, Gullo G, Ledwidge M, Crown J, Gallagher J, Watson C, McDonald KM, Walshe JM (2016) Late cardiac effects of chemotherapy in breast cancer survivors treated with adjuvant doxorubicin: 10-year follow-up. Breast Cancer Res Treat 156(3):501–506. https://doi.org/10.1007/s10549-016-3781-4 CrossRefPubMed

Jones LW, Haykowsky M, Peddle CJ, Joy AA, Pituskin EN, Tkachuk LM, Courneya KS, Slamon DJ, Mackey JR (2007) Cardiovascular risk profile of patients with HER2/neu-positive breast cancer treated with anthracycline-taxane-containing adjuvant chemotherapy and/or trastuzumab. Cancer Epidemiol Biomark Prev 16(5):1026–1031. https://doi.org/10.1158/1055-9965.EPI-06-0870 CrossRef

Jones LW, Habel LA, Weltzien E, Castillo A, Gupta D, Kroenke CH, Kwan ML, Quesenberry CP Jr, Scott J, Sternfeld B, Yu A, Kushi LH, Caan BJ (2016) Exercise and risk of cardiovascular events in women with nonmetastatic breast cancer. J Clin Oncol 34(23):2743–2749. https://doi.org/10.1200/JCO.2015.65.6603 CrossRefPubMedPubMedCentral

Abdel-Qadir H, Austin PC, Lee DS, Amir E, Tu JV, Thavendiranathan P, Fung K, Anderson GM (2017) A population-based study of cardiovascular mortality following early-stage breast cancer. JAMA Cardiol 2(1):88–93. https://doi.org/10.1001/jamacardio.2016.3841 CrossRefPubMed

Gernaat SAM, Ho PJ, Rijnberg N, Emaus MJ, Baak LM, Hartman M, Grobbee DE, Verkooijen HM (2017) Risk of death from cardiovascular disease following breast cancer: a systematic review. Breast Cancer Res Treat 164(3):537–555. https://doi.org/10.1007/s10549-017-4282-9 CrossRefPubMedPubMedCentral

10.

Sardar P, Kundu A, Chatterjee S, Nohria A, Nairooz R, Bangalore S, Mukherjee D, Aronow WS, Lavie CJ (2017) Long-term cardiovascular mortality after radiotherapy for breast cancer: a systematic review and meta-analysis. Clin Cardiol 40(2):73–81. https://doi.org/10.1002/clc.22631 CrossRefPubMed

11.

Armenian SH, Xu L, Ky B, Sun C, Farol LT, Pal SK, Douglas PS, Bhatia S, Chao C (2016) Cardiovascular disease among survivors of adult-onset cancer: a community-based retrospective cohort study. J Clin Oncol 34(10):1122–1130. https://doi.org/10.1200/JCO.2015.64.0409 CrossRefPubMedPubMedCentral

12.

Lajous M, Mozaffarian D, Mozaffarian R, Schrag D, Adami HO (2011) Lifestyle prescriptions for cancer survivors and their communities. J Intern Med 269(1):88–93. https://doi.org/10.1111/j.1365-2796.2010.02273.x CrossRefPubMed

13.

Knobf MT, Coviello J (2011) Lifestyle interventions for cardiovascular risk reduction in women with breast cancer. Curr Cardiol Rev 7(4):250–257CrossRefPubMed

14.

Ross R, Blair SN, Arena R, Church TS, Despres JP, Franklin BA, Haskell WL, Kaminsky LA, Levine BD, Lavie CJ, Myers J, Niebauer J, Sallis R, Sawada SS, Sui X, Wisloff U, American Heart Association Physical Activity Committee of the Council on L, Cardiometabolic H, Council on Clinical C, Council on E, Prevention, Council on C, Stroke N, Council on Functional G, Translational B, Stroke C (2016) Importance of assessing cardiorespiratory fitness in clinical practice: a case for fitness as a clinical vital sign: a scientific statement from the American Heart Association. Circulation 134(24):e653–e699. https://doi.org/10.1161/CIR.0000000000000461 CrossRefPubMed

15.

Schenck-Gustafsson K (2009) Risk factors for cardiovascular disease in women. Maturitas 63(3):186–190. https://doi.org/10.1016/j.maturitas.2009.02.014 CrossRefPubMed

16.

Kodama S, Saito K, Tanaka S, Maki M, Yachi Y, Asumi M, Sugawara A, Totsuka K, Shimano H, Ohashi Y, Yamada N, Sone H (2009) Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA 301(19):2024–2035. https://doi.org/10.1001/jama.2009.681 CrossRefPubMed

17.

Ruiz-Casado A, Verdugo AS, Solano MJ, Aldazabal IP, Fiuza-Luces C, Alejo LB, del Hierro JR, Palomo I, Aguado-Arroyo O, Garatachea N, Cebolla H, Lucia A (2014) Objectively assessed physical activity levels in Spanish cancer survivors. Oncol Nurs Forum 41(1):E12–E20. https://doi.org/10.1188/14.ONF.E12-E20 CrossRefPubMed

18.

World Health Organization (2010) Global recommendations on physical activity for health. Geneva, Switzerland. http://apps.who.int/iris/bitstream/10665/44399/1/9789241599979_eng.pdf

19.

Santos-Lozano A, Marin PJ, Torres-Luque G, Ruiz JR, Lucia A, Garatachea N (2012) Technical variability of the GT3X accelerometer. Med Eng Phys 34(6):787–790. https://doi.org/10.1016/j.medengphy.2012.02.005 CrossRefPubMed

20.

Freedson PS, Melanson E, Sirard J (1998) Calibration of the computer science and applications, Inc. accelerometer. Med Sci Sports Exerc 30(5):777–781CrossRefPubMed

21.

Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren WM, Albus C, Benlian P, Boysen G, Cifkova R, Deaton C, Ebrahim S, Fisher M, Germano G, Hobbs R, Hoes A, Karadeniz S, Mezzani A, Prescott E, Ryden L, Scherer M, Syvanne M, Op Reimer WJ, Vrints C, Wood D, Zamorano JL, Zannad F, European Association for Cardiovascular P, Rehabilitation, European Guidelines on Cardiovascular Disease Prevention in Clinical Practice (Version 2012) (2012) European guidelines on cardiovascular disease prevention in clinical practice (version 2012) : the fifth joint task force of the European society of cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Int J Behav Med 19(4):403–488. https://doi.org/10.1007/s12529-012-9242-5 CrossRefPubMed

22.

Stewart A, Marfell-Jones M, Olds T, Ridder H (2011) International standards for anthropometric assessment. ISAK, Lower Hutt

23.

Kline GM, Porcari JP, Hintermeister R, Freedson PS, Ward A, McCarron RF, Ross J, Rippe JM (1987) Estimation of VO2max from a one-mile track walk, gender, age, and body weight. Med Sci Sports Exerc 19(3):253-259CrossRef

24.

Ruiz-Ruiz J, Mesa JL, Gutierrez A, Castillo MJ (2002) Hand size influences optimal grip span in women but not in men. J Hand Surg Am 27(5):897–901. https://doi.org/10.1053/jhsu.2002.34315 CrossRefPubMed

25.

Estruch R, Ros E, Salas-Salvado J, Covas MI, Corella D, Aros F, Gomez-Gracia E, Ruiz-Gutierrez V, Fiol M, Lapetra J, Lamuela-Raventos RM, Serra-Majem L, Pinto X, Basora J, Munoz MA, Sorli JV, Martinez JA, Martinez-Gonzalez MA, Investigators PS (2013) Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 368(14):1279–1290. https://doi.org/10.1056/NEJMoa1200303 CrossRefPubMed

26.

WHO technical report series (2000) Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 894:i-xii:1–253

27.

World Cancer Research Fund / American Institute for Cancer Research (2007) Food, nutrition, physical activity, and the prevention of cancer: a global perspective. AICR, Washington DC

28.

Oga EA, Eseyin OR (2016) The obesity paradox and heart failure: a systematic review of a decade of evidence. J Obes 2016:9040248(1):9. https://doi.org/10.1155/2016/9040248 CrossRef

29.

Kalantar-Zadeh K, Horwich TB, Oreopoulos A, Kovesdy CP, Younessi H, Anker SD, Morley JE (2007) Risk factor paradox in wasting diseases. Curr Opin Clin Nutr Metab Care 10(4):433–442. https://doi.org/10.1097/MCO.0b013e3281a30594 CrossRefPubMed

30.

Playdon MC, Bracken MB, Sanft TB, Ligibel JA, Harrigan M, Irwin ML (2015) Weight gain after breast cancer diagnosis and all-cause mortality: systematic review and meta-analysis. J Natl Cancer Inst 107(12):djv275. https://doi.org/10.1093/jnci/djv275 CrossRefPubMedPubMedCentral

31.

Fletcher GF, Balady GJ, Amsterdam EA, Chaitman B, Eckel R, Fleg J, Froelicher VF, Leon AS, Pina IL, Rodney R, Simons-Morton DA, Williams MA, Bazzarre T (2001) Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association. Circulation 104(14):1694–1740. https://doi.org/10.1161/hc3901.095960 CrossRefPubMed

32.

Vainshelboim B, Muller J, Lima RM, Nead KT, Chester C, Chan K, Kokkinos P, Myers J (2017) Cardiorespiratory fitness, physical activity and cancer mortality in men. Prev Med 100:89–94. https://doi.org/10.1016/j.ypmed.2017.04.014 CrossRefPubMed

33.

Peel AB, Thomas SM, Dittus K, Jones LW, Lakoski SG (2014) Cardiorespiratory fitness in breast cancer patients: a call for normative values. J Am Heart Assoc 3(1):e000432. https://doi.org/10.1161/JAHA.113.000432 CrossRefPubMedPubMedCentral

34.

Peel JB, Sui X, Adams SA, Hebert JR, Hardin JW, Blair SN (2009) A prospective study of cardiorespiratory fitness and breast cancer mortality. Med Sci Sports Exerc 41(4):742–748. https://doi.org/10.1249/MSS.0b013e31818edac7 CrossRefPubMedPubMedCentral

35.

Jensen MT, Holtermann A, Bay H, Gyntelberg F (2016) Cardiorespiratory fitness and death from cancer: a 42-year follow-up from the Copenhagen Male Study. Br J Sports Med 51(18):1364–1369. https://doi.org/10.1136/bjsports-2016-096860 CrossRefPubMed

36.

Peel JB, Sui X, Matthews CE, Adams SA, Hebert JR, Hardin JW, Church TS, Blair SN (2009) Cardiorespiratory fitness and digestive cancer mortality: findings from the aerobics center longitudinal study. Cancer Epidemiol Biomark Prev 18(4):1111–1117. https://doi.org/10.1158/1055-9965.EPI-08-0846 CrossRef

37.

Farrell SW, Finley CE, McAuley PA, Frierson GM (2011) Cardiorespiratory fitness, different measures of adiposity, and total cancer mortality in women. Obesity (Silver Spring) 19(11):2261–2267. https://doi.org/10.1038/oby.2010.345 CrossRef

38.

Garatachea N, Santos-Lozano A, Sanchis-Gomar F, Fiuza-Luces C, Pareja-Galeano H, Emanuele E, Lucia A (2014) Elite athletes live longer than the general population: a meta-analysis. Mayo Clin Proc 89(9):1195–1200. https://doi.org/10.1016/j.mayocp.2014.06.004 CrossRefPubMed

39.

Keats MR, Cui Y, Grandy SA, Parker L (2017) Cardiovascular disease and physical activity in adult cancer survivors: a nested, retrospective study from the Atlantic PATH cohort. J Cancer Surviv 11(2):264–273. https://doi.org/10.1007/s11764-016-0584-x CrossRefPubMed

40.

Nagy AC, GulAcsi BP, CserEp Z, Hangody L, Forster T (2017) Late cardiac effect of anthracycline therapy in physically active breast cancer survivors—a prospective study. Neoplasma 64(1):92–100. https://doi.org/10.4149/neo_2017_111 CrossRefPubMed

41.

Sanchis-Gomar F, Lucia A, Yvert T, Ruiz-Casado A, Pareja-Galeano H, Santos-Lozano A, Fiuza-Luces C, Garatachea N, Lippi G, Bouchard C, Berger NA (2015) Physical inactivity and low fitness deserve more attention to alter cancer risk and prognosis. Cancer Prev Res (Phila) 8(2):105–110. https://doi.org/10.1158/1940-6207.CAPR-14-0320 CrossRef

42.

Katzmarzyk PT, Church TS, Craig CL, Bouchard C (2009) Sitting time and mortality from all causes, cardiovascular disease, and cancer. Med Sci Sports Exerc 41(5):998–1005. https://doi.org/10.1249/MSS.0b013e3181930355 CrossRefPubMed

43.

Barlow CE, Shuval K, Balasubramanian BA, Kendzor DE, Pettee Gabriel K (2016) Sitting time, physical activity, and cardiorespiratory fitness: Cooper Center Longitudinal Study Cohort. J Phys Act Health 13(1):17–23. https://doi.org/10.1123/jpah.2014-0430 CrossRefPubMed

44.

Johnson CB, Davis MK, Law A, Sulpher J (2016) Shared risk factors for cardiovascular disease and cancer: implications for preventive health and clinical care in oncology patients. Can J Cardiol 32(7):900–907. https://doi.org/10.1016/j.cjca.2016.04.008 CrossRefPubMed

45.

Koene RJ, Prizment AE, Blaes A, Konety SH (2016) Shared risk factors in cardiovascular disease and cancer. Circulation 133(11):1104–1114. https://doi.org/10.1161/CIRCULATIONAHA.115.020406 CrossRefPubMedPubMedCentral

46.

Kroenke CH, Chen WY, Rosner B, Holmes MD (2005) Weight, weight gain, and survival after breast cancer diagnosis. J Clin Oncol 23(7):1370–1378. https://doi.org/10.1200/JCO.2005.01.079 CrossRefPubMed

47.

Jones LW, Courneya KS, Mackey JR, Muss HB, Pituskin EN, Scott JM, Hornsby WE, Coan AD, Herndon JE 2nd, Douglas PS, Haykowsky M (2012) Cardiopulmonary function and age-related decline across the breast cancer survivorship continuum. J Clin Oncol 30(20):2530–2537. https://doi.org/10.1200/JCO.2011.39.9014 CrossRefPubMedPubMedCentral

48.

Jones LW, Haykowsky M, Pituskin EN, Jendzjowsky NG, Tomczak CR, Haennel RG, Mackey JR (2007) Cardiovascular reserve and risk profile of postmenopausal women after chemoendocrine therapy for hormone receptor--positive operable breast cancer. Oncologist 12(10):1156–1164. https://doi.org/10.1634/theoncologist.12-10-1156 CrossRefPubMed

49.

Lakoski SG, Jones LW, Krone RJ, Stein PK, Scott JM (2015) Autonomic dysfunction in early breast cancer: incidence, clinical importance, and underlying mechanisms. Am Heart J 170(2):231–241. https://doi.org/10.1016/j.ahj.2015.05.014 CrossRefPubMedPubMedCentral

50.

Parise CA, Caggiano V (2013) Disparities in race/ethnicity and socioeconomic status: risk of mortality of breast cancer patients in the California Cancer Registry, 2000-2010. BMC Cancer 13(1):449. https://doi.org/10.1186/1471-2407-13-449 CrossRefPubMedPubMedCentral

51.

Clark AM, DesMeules M, Luo W, Duncan AS, Wielgosz A (2009) Socioeconomic status and cardiovascular disease: risks and implications for care. Nat Rev Cardiol 6(11):712–722. https://doi.org/10.1038/nrcardio.2009.163 CrossRefPubMed

Title: Cardiorespiratory fitness and adiposity in breast cancer survivors: is meeting current physical activity recommendations really enough?
Authors: Alejandro Santos-Lozano
Javier Ramos
Alejandro Alvarez-Bustos
Blanca Cantos
Lidia B. Alejo
Itziar Pagola
Ana Soria
Constanza Maximiano
Carmen Fiuza-Luces
Luisa Soares-Miranda
Alejandro Lucia
Ana Ruiz-Casado
Publication date: 01-07-2018
Publisher: Springer Berlin Heidelberg
Published in: Supportive Care in Cancer / Issue 7/2018
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-018-4055-y

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