Moderate intensity continuous and high intensity interval training as strategy cardioprotective on cardiotoxicity induced by cancer. Randomized clinical trial
Authors: Lara Vargas J A , Pereira-Rodriguez J E , Penaranda Florez D G , Galdino G , Xavier-Santos G , Pereira-Rodriguez P , Pereira-Rodriguez R , Ceballo-Portilla F , Diaz-Bravo M 
Published: October 2022

Abstract

Introduction
The adverse physiological consequences of cancer therapy have been recognized for some years. However, Cardio-Oncology aims to detect and manage cardiac dysfunction induced by cancer treatment (Cardiotoxicity) and one of the strategies used is physical exercise, which has shown benefits in cardiovascular fitness in patients with cancer; therefore, this clinical trial has like objective determine the effects cardiovascular of Moderate Intensity Continuous Training (MICT) and High Intensity Interval Training (HIIT) on cardiotoxicity induced for antitumoral treatment.

Methodology
Randomized controlled trial of 3 years and 4 months with a sample of 753 stage II cancer patients (Prostate cancer, breast, colorectal, thyroid, cervico-uterine, lung, stomach, liver) distributed in 3 groups (MICT, HIIT and control group). Echocardiogram, cardiac biomarkers, stress test, clinical and hemodynamic parameters, risk factors, hematological samples for blood glucose and lipid profile were identified. In addition, 6-minute walk, anthropometry, quality of life, fatigue, sarcopenia, depression, anxiety. The tests were performed before and after 36 session of 70-minute training, 3 times per week. A database was created with results of tests and questionnaires pre and post training. Then, descriptive statistics were carried out to estimate, the normality of the data was assessed by the Kolmogorov-Smirnov test and the indication of specificity was evident for all analyzes. Also, through the Tukey test, the ANOVA analysis of variance (two-way analysis of variance) was used, and subsequently, post hoc tests to assess the characteristics of the different age groups, gender and anthropometry. In all cases, a significance level was 5% (p= &lt;0.05).

Results
After exercise program, there was an increase in ejection fraction (EG1: 37±3 vs 41±3; EG2: 39±4 vs 47±5; CG: 40±3 vs 40±1; p&lt;0.05). In fact, higher values were observed in Vo2p for experimental group 2-HIIT (7.7±6.4 vs 9.8±3.9) compared to experimental group 1-MICT (8.0±4 vs 8.5±3) and control group (9.0±5.6 vs 9.2±3.9). Likewise, in the values of the systolic blood pressure (139±11 vs 129±2), diastolic blood pressure (86±6 vs 80±1), maximum heart rate (168±11 vs 179±8) and quality of life (109±12 vs 76.5±10). It was possible to show significant changes in all variables of the HIIT and MICT groups (p= &lt;0.05) compared to the control group.

Conclusions
HIIT and MICT in cancer patients improved the ventricular ejection fraction, hemodynamic parameters, exercise tolerance, depression, anxiety, strength, vo2p, MHR, fatigue associated cancer and others variables like sarcopenia, lipidic profile and quality of life. In fact, it was possible to demonstrate greater benefits of HIIT compared to the MICT and control group. It's noteworthy that the control group without physical training, decreased the vo2 and muscular force and increased the sarcopenia, depression and anxiety.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Centro de Estudios e Investigaciόn FISICOL