[en] This thesis project investigates the effectiveness of a cardio-oncology rehabilitation program based on exercise to prevent cardiovascular diseases and other functional complications in women with non-metastatic breast cancer (stages I-III) during cardiotoxic treatment with anthracyclines and/or anti-HER2 receptor antibodies. The motivation for this study arises from the increased cardiovascular risk associated both with both the cancer disease itself and the cardiotoxic effects of certain treatments used. While these treatments aim to improve survival, they generate adverse side effects that negatively affect patients' quality of life. The main results of this thesis are divided into three phases: an experimental phase, a transference phase, and a dissemination phase. In the experimental phase, the ONCORE randomized clinical trial was conducted in the setting of a tertiary-level university hospital (University Clinical Hospital of Santiago de Compostela), which included a sample of 122 women with early-stage breast cancer (I-III) undergoing treatment with cardiotoxic chemotherapy (anthracyclines and/or anti-HER2 antibodies). Participants were randomized to participate in the supervised exercise-based cardio-oncology rehabilitation program (intervention group) or telephone follow-up and exercise counselling (control group), with a total study duration of 44 months (01/08/2018 start - 30/03/2022 end). This study resulted in the publication of two scientific articles: the study protocol (article 1) and the original study with the main trial results of the trial (article 2). The most relevant findings of the trial suggest that these programs are safe and could help attenuate the decline in left ventricular ejection fraction in women with breast cancer during cardiotoxic treatment, as well as reduce body mass index in patients with obesity. In the transference phase, firstly, the ReCO program was adapted for inclusion in the hospital's own service portfolio. In addition, to facilitate the functional 22 assessment of participants in the care program and thus promote its implementation, a cross-sectional study was carried out based on ONCORE trial data that investigated the relationship between the number of repetitions performed in the 30-second sit-tostand test (30STS) and peak oxygen consumption assessed by the cardiopulmonary exercise testing on a cycloergometer. The result was the creation of an equation (called the "ONCORE equation") that allows estimation of peak oxygen consumption based on the more accessible 30STS test and patient's weight. The results of this study are reported in the third scientific article of this doctoral thesis. Thirdly, the scientific dissemination phase has sought to share the results of the research in both the academic and social spheres. The activities carried out include the development of educational material for patients on exercise and healthy habits; presentation of scientific communications at congresses in the fields of Physical Therapy, Cardiology, and Oncology; the organization and/or participation in scientific dissemination and training activities aimed at both patients and professionals; as well as the dissemination of results through social networks and media. This thesis project has been enriched by teaching collaboration at the University of A Coruña (UDC) and the University of Málaga (UMA) in subjects related to the research area. In addition, during this period, the PhD student has carried out three research stays: two of national character in the Department of Physical Therapy in UMA (21/10/2022 - 24/04/2023 and 18/09/2023 - 28/03/2024); and an international stay at the Higher School of Health in the University of Aveiro (Portugal, 01/04/2024 - 03/07/2024), in which she had the opportunity to participate in scientifictechnical activities related to cardiac and cardio-oncology rehabilitation. These stays allowed her to learn about different work approaches and to establish links with research groups with extensive experience in the framework of this thesis.

[gl] Este proxecto de tese investiga a efectividade dun programa de rehabilitación cardio-oncolóxica baseado en exercicio para previr enfermidades cardiovasculares e outras complicacións funcionais en mulleres con cancro de mama non-metastásico (estadios I-III) durante o tratamento cardiotóxico con antraciclinas e/ou anticorpos anti- receptor 2 do factor de crecemento epidérmico humano (HER2). A motivación deste estudo xorde do aumento do risco cardiovascular asociado tanto á propia enfermidade oncolóxica, así como aos efectos cardiotóxicos de determinados tratamentos empregados. Aínda que estes tratamentos buscan mellorar a supervivencia, xeran efectos secundarios adversos que afectan negativamente na calidade de vida das pacientes. Os resultados principais desta tese divídense en tres fases: unha fase experimental, unha fase de transferencia e unha fase de divulgación. Na fase experimental levouse a cabo o ensaio clínico aleatorizado ONCORE, na contorna dun hospital universitario de terceiro nivel asistencial, o Hospital Clínico Universitario de Santiago de Compostela (CHUS), que incluíu unha mostra de 122 mulleres con cancro de mama en estadios iniciais (I-III) baixo tratamento con quimioterapia cardiotóxica (antraciclinas e/ou anticorpos anti-HER2). As participantes foron aleatorizadas a participar no programa de rehabilitación cardio-oncolóxica baseado en exercicio supervisado (grupo intervención) ou ben seguimento telefónico e consello de exercicio (grupo control), cunha duración total do estudo de 44 meses (01/08/2018 inicio-30/03/2022 fin). Este estudo resultou na publicación de dous artigos científicos: o protocolo do estudo (artigo 1) e o estudo orixinal cos resultados principais do ensaio (artigo 2). Os achados máis relevantes do ensaio suxiren que estes programas son seguros e poderían axudar a atenuar o declive da fracción de exección do ventrículo esquerdo en mulleres con cancro de mama durante o tratamento cardiotóxico, así como a reducir o índice de masa corporal en pacientes con obesidade. Na fase de transferencia destaca, en primeiro lugar, a adaptación do programa ReCO para a súa inclusión na carteira de servizos do propio hospital. Ademais, para facilitar a valoración funcional das participantes no programa asistencial e así promover a súa implementación, desenvolveuse un estudo transversal baseado en datos do ensaio ONCORE que investigou a relación entre o número de repeticións realizadas na proba 30 segundos sit-to-stand (30STS) e o consumo pico de osíxeno avaliado mediante a proba de esforzo cardiopulmonar en cicloergómetro. O resultado foi a obtención dunha ecuación (denominada "ecuación ONCORE") que permite estimar o consumo pico de osíxeno a partir da máis accesible proba 30STS e o peso da paciente. Os resultados deste estudo atópanse recollidos no terceiro artigo científico desta tese de doutoramento. En terceiro lugar, a fase de divulgación científica buscou difundir os resultados da investigación tanto no ámbito académico como social. Entre as actividades desenvolvidas inclúense a elaboración de material educativo para pacientes sobre exercicio e hábitos saudables, a presentación de comunicacións científicas en congresos do ámbito da fisioterapia, a cardioloxía e a oncoloxía, a organización e/ou participación en actividades de divulgación científica e formación dirixidas tanto a pacientes como a profesionais, así como a difusión dos resultados a través de redes sociais e medios de comunicación. Este proxecto de tese enriqueceuse mediante a colaboración docente na Universidade da Coruña (UDC) e na Universidade de Málaga (UMA) en materias relacionadas coa área de investigación. Ademais, durante este período a doutoranda realizou tres estadías de investigación: dúas de carácter nacional no Departamento de Fisioterapia da UMA (21/10/2022 - 24/04/2023 e 18/09/2023 - 28/03/2024); e unha estadía internacional na Escola Superior de Saúde da Universidade de Aveiro (Portugal, 01/04/2024 - 03/07/2024), onde tivo a oportunidade de participar en actividades científico-técnicas relacionadas coa rehabilitación cardíaca e cardiooncolóxica. Ambas as estadías permitiron coñecer diferentes enfoques de traballo e establecer vínculos con grupos de investigación cunha ampla experiencia no marco desta tese.