Chemo Ages the Heart. Can Exercise Reverse the Clock?

One in eight women will be diagnosed with breast cancer, but thanks to advances in treatment and early diagnosis, the five-year survival rate is now around 90%. But as more survivors age, the long-term side effects of life-saving treatments are becoming clearer.

“As we’ve gotten better at dealing with breast cancer, we’re realizing that chemotherapy – which is essential and contributes to survival in this disease – can also harm the cardiovascular system,” said Sid Angadi, an associate professor of kinesiology in the University of Virginia’s School of Education and Human Development.

Angadi is a cardiovascular exercise physiologist by training. His research focuses on using exercise as a therapy to protect against chemotherapy-induced toxicity to the heart and muscle.

“If you take a 50-year-old woman who has survived breast cancer post-chemotherapy, her cardiovascular system resembles that of a 60-year-old,” he said. “Essentially, think of this as chemotherapy-induced accelerated aging.”

Portrait of Sid Angadi

Sid Angadi, an associate professor of kinesiology, is studying the use of exercise as a therapy to protect the heart and muscle against chemotherapy-induced toxicity. (Contributed photo)

Angadi and UVA Health partners in oncology, cardiology and public health sciences are researching whether a targeted exercise program could halt accelerated aging before it begins.

Exercise is an “exquisitely targeted treatment,” said Angadi, which makes it especially attractive for battling the effects of chemotherapy. While supplements don’t differentiate between healthy heart cells and cancer cells, exercise improves heart, lung and muscle function in a targeted fashion and builds up tissue reserves to withstand the onslaught of chemotherapy.

Angadi and his partners were curious whether beginning exercise prior to chemotherapy could precondition the heart, protecting cells that would otherwise die during chemotherapy.

An initial study in rats proved promising: Slightly less than 10% of rats who paired chemotherapy with exercise died of heart failure, compared to about 50% of the control group rats, which received the same chemotherapy but no exercise.

Angadi and colleagues are now testing this hypothesis in women with breast cancer. In an ongoing study funded by UVA Cancer Prevention & Population Health and iPrecision Immunomedicine, 48 patients were prescribed exercise to begin one week before starting chemotherapy.

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After an initial assessment, researchers gave participants an exercise routine tailored to their personal fitness level, then equipment like an in-home bike or new walking shoes to make keeping up with the routine as easy as possible. Exercising at home instead of in a supervised lab setting reduces the time and cost of completing the program.

Researchers are tracking their exercise remotely with activity monitors, making sure they remain active without pushing themselves too hard. They are recording outcomes including cardiorespiratory fitness, cardiac function and quality of life.

“What is often forgotten about cardiovascular disease – and especially severe forms like heart failure – is that from a death and disability perspective, it’s as bad, if not worse, than a lot of cancers,” Angadi said. “It would be good for these patients if we can not only elongate the lifespan, but also maintain health span.”

If cancer survival rates continue to improve, supportive treatments will only become more important. Angadi is also pursuing similar research with gynecological cancers and exploring if exercise could protect the immune system from chemotherapy-induced accelerated aging as well.

Media Contact

Laura Hoxworth

School of Education and Human Development