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FIRST LOOK: Exercise Prescription to Improve Cardiovascular and Cancer Outcomes in Cancer Survivors

Exercise prescription upon completion of cancer therapies could improve fitness, as well as cardiovascular and cancer outcomes for select cancer survivors. Given the growing population of cancer survivors, exercise prescription has tremendous clinical and commercial potential.

Advances in cancer care have achieved significant improvements in cancer survival, such that the population of cancer survivors in the United States now exceeds 14 million. Many cancer therapies are associated with adverse cardiovascular outcomes in survivors. In addition, prevalent deconditioning and impaired cardiopulmonary fitness undermine quality of life among survivors of adult and pediatric cancers.

Studies have demonstrated improvements in cardiopulmonary fitness in cancer survivors achieved through exercise interventions. Cardiac rehabilitation is a lifestyle program that has established benefits in a range of cardiovascular diseases. This proposal suggests that specifically tailored, exercise-based cardiac rehabilitation should also be considered for select survivors following completion of cancer therapies. This program would promote physical fitness, tackle deconditioning, facilitate education regarding increased cardiovascular risk conferred by cancer therapies, and empower patients with risk reduction strategies. The author’s research has shown that every 1 metabolic equivalent (MET) increase in exercise capacity is associated with 25%, 26%, and 17% respective reductions in adjusted risk of all-cause death, cancer death, and cardiovascular death, in a large cohort of cancer survivors (Figures). These data highlight potential prognostic gains that may be achieved by exercise prescription in cancer survivors. Furthermore, this research has identified predictors of impaired exercise capacity in cancer patients that would direct patient selection for this intervention.

Given the growing ‘at risk’ population of cancer survivors who would potentially benefit, exercise prescription has significant commercial potential. There is a strong case to achieve insurance coverage for this program for select patients, which would offer an additional source of revenue for hospitals. Moreover, many cancer patients motivated to regain their fitness following cancer therapies would appreciate the opportunity to pay out-of-pocket for physician-directed tailored rehabilitation programs offered either through hospitals or private gyms.