Understanding the Impact of Cancer Treatment on Cardiovascular Fitness

Cancer treatment, whether it involves chemotherapy, radiation, surgery, or immunotherapy, is undoubtedly life-saving or prolonging. However, the journey through these therapies can take a toll on the body in various ways, including your cardiovascular (CV) fitness [1]. While cancer treatments aim to eradicate or control the disease, they can also affect the heart and lungs, leading to a decline in cardiovascular health. I should stress that many of these changes are temporary and reversible.*

I thought it would be useful to discuss how cancer treatments impact cardiovascular fitness and suggest practical steps you can take to help improve or maintain your CV health during and after treatment.

The Impact of Cancer Treatments on CV Fitness [1,2]

1. Chemotherapy: Is designed to target and destroy rapidly dividing cells, which include not only cancer cells but also healthy cells, particularly those in the gastrointestinal tract, hair follicles, and bone marrow. Some chemotherapy drugs, like a group of therapies called anthracyclines, can lead to changes in the heart muscle, leading to conditions like chemotherapy-induced cardiotoxicity, which impairs the heart’s ability to pump blood effectively.

2. Radiotherapy: Especially when aimed at the chest area (such as for breast or lung cancer), can also lead to damage to the heart and blood vessels. The exposure to radiation can cause inflammation and scarring in the coronary arteries.

3. Surgical interventions: Depending on the type of cancer, surgery may be required to remove tumours or affected tissue. This can have a direct impact on physical activity levels, especially if the surgery is extensive or involves the chest, abdomen, or limbs. Post-surgical recovery often involves reduced mobility, which can further compromise cardiovascular fitness.

4. Immunotherapy and Targeted Therapy: Are newer cancer treatments that work by stimulating the immune system or targeting specific cancer cell mechanisms. Although they tend to have fewer cardiovascular side effects than chemotherapy or radiation, they can still cause inflammation in the body, leading to cardiovascular strain.

5. Physical deconditioning: Regardless of the type of cancer treatment, many patients experience fatigue, weakness, and reduced physical activity levels, which can lead to deconditioning. When you are not physically active, your cardiovascular system does not get the necessary stimulation to stay fit. This can result in a lowered ability to tolerate physical exertion, reduced stamina, and a heightened risk of cardiovascular disease.

How to Protect and Improve Cardiovascular Fitness During and After Cancer Treatment [3,4,5]

While cancer treatments may temporarily affect cardiovascular fitness, there are proactive steps you can take to protect your heart and improve overall cardiovascular health.

1. Engage in regular, moderate exercise: Physical activity is one of the most effective ways to combat the negative effects of cancer treatment on cardiovascular fitness [3]. Research has shown that regular exercise helps maintain or improve cardiovascular function, strengthens muscles, and boosts energy levels [3,5].

   • Aerobic exercises like walking, swimming, cycling, and dancing are especially beneficial for cardiovascular health. Aim for at least 150 minutes of moderate-intensity aerobic exercise per week, or as tolerated by your body.

   • Strength training can also help rebuild muscle mass that may have been lost during treatment. Focus on lighter weights or resistance bands and gradually increase intensity as you become stronger.

     
     

2. Consult with your healthcare team: Before beginning any exercise regimen, consult with your oncologist, cardiologist, or physiotherapist. They can help you tailor a fitness plan that suits your current health status and treatment plan. Monitoring your heart function during treatment may be necessary, particularly if you are undergoing chemotherapy or radiation to the chest.

   
   

3. Focus on nutrition: A well-balanced, heart-healthy diet is essential for maintaining cardiovascular fitness and overall health. Ensure you are getting a variety of nutrient-dense foods, such as:

   • Fruits and vegetables for vitamins, minerals, and antioxidants.

   • Whole grains for fibre, which can help maintain healthy cholesterol levels.

   • Lean proteins to support muscle repair and energy.

   • Healthy fats (like those found in nuts, seeds, and olive oil) to support heart health.

   Avoid excessive salt, sugar, and processed foods, which can exacerbate cardiovascular risk factors like high blood pressure and cholesterol levels.

   
   

4. Manage stress and prioritise mental health: The emotional toll of cancer and its treatment can be significant, and stress can have a negative impact on cardiovascular health. Chronic stress can contribute to high blood pressure, increased heart rate, and inflammation. To combat stress, consider practices such as:

   • Mindfulness meditation or deep breathing exercises to calm the mind.

   • Yoga to promote both physical and mental well-being.

   • Counselling or support groups to help manage emotional challenges.

     
     

5. Stay hydrated and rested: Dehydration and lack of rest can further strain the cardiovascular system, especially during cancer treatment. Drink plenty of water to support optimal bodily function, and aim to get 7-9 hours of sleep each night to allow your body to recover and rebuild.

   
   

6. Monitor your heart health: If you have received treatments that are known to affect heart function, such as chemotherapy or radiation, it’s essential to have regular checkups with a cardiologist. Blood pressure, cholesterol, and heart function should be regularly monitored, and any signs of cardiovascular problems (such as shortness of breath, chest pain, or swelling in the legs) should be promptly addressed.

In Summary

Cancer treatment can significantly impact cardiovascular fitness, but with the right approach, many of these effects can be mitigated or even reversed. Engaging in regular physical activity, eating a heart-healthy diet, managing stress, and working with your healthcare team are all important strategies for maintaining cardiovascular health during and after cancer treatment. By taking care of your heart, you can improve your overall quality of life, boost your energy, and increase your chances of long-term wellness.*

Remember, every recovery journey is unique, so listen to your body and prioritise your health every step of the way.

Engage in physical activity

*If you are worried about the impact of treatment on your heart, or have any concerns, always talk to your healthcare team.

References:

1.Lenneman CG, Sawyer DB. Cardio-oncology: an update on cardiotoxicity of cancer-related treatment. Circ Res. 2016; 118:1008–1020. 

2.Jones LW, et al. Cardiopulmonary function and age-related decline across the breast cancer survivorship continuum. J Clin Oncol. 2012; 30:2530–2537. 

3.Squires RW, et al. Exercise training and cardiovascular health in cancer patients. Curr Oncol Rep. 2018; 20:27.

4.Hurria A, et al. Cancer treatment as an accelerated aging process: assessment, biomarkers, and interventions. Am Soc Clin Oncol Educ Book. 2016; 35:e516–e522.

5. Scott JM, et al. Exercise therapy and cardiovascular toxicity in cancer. Circulation. 2018; 137:1176–1191.