Cardiotoxicity of Doxorubicin Treatment and Physical Activity: A Systematic Review

Abstract The present study investigated whether the practice of exercise has a protective effect against cardiac toxicity induced by doxorubicin (DOX). A systematic review of randomized clinical trials evaluating the role of exercise in the control or prevention of DOX-induced cardiotoxicity was performed in MEDLINE and LILACS databases. Studies that did not address the main subject of this review, did not mention physical exercise or DOX, studies that evaluated other types of anthracycline-induced toxicities only (muscle, hepatic and renal toxicity) or other effects of exercise on DOX toxicity (fatigue) were excluded. With respect to the variables related to aerobic exercise prescription, there was no direct relationship between the frequency of exercise and the results of the studies. Also, intensity of exercise was not decisive for preservation of cardiac function, although a more intense exercise was associated with improvements in the antioxidant system, which was not observed in studies on lower intensity exercises. No significant differences in exercise effects were observed when it was performed before, during or after the treatment. Therefore, aerobic exercise may exert a protective effect of cardiac functions when performed before, during or after treatment with DOX. However, the mechanisms of this effect are still unknown.

摘要 本研究探讨了运动干预对多柔比星（doxorubicin, DOX）诱导的心脏毒性的保护作用。研究通过检索MEDLINE与LILACS数据库，对评估运动在控制或预防DOX诱导心脏毒性方面作用的随机临床试验开展了系统综述。本研究排除以下几类文献：未涉及本综述核心主题、未提及体育锻炼或多柔比星的研究；仅评估蒽环类（anthracycline）药物诱导的其他类型毒性（肌肉毒性、肝毒性与肾毒性）的研究；以及仅探讨运动对DOX诱导毒性（如疲劳）的其他作用的研究。针对有氧运动处方相关变量的分析表明，运动频率与研究结果之间无直接关联。此外，运动强度对心脏功能的保护并非决定性因素——尽管高强度运动可改善抗氧化系统功能，但低强度运动相关研究未观察到此现象。在多柔比星治疗前、治疗期间或治疗后开展运动，其干预效果均无显著差异。因此，在多柔比星治疗的各个阶段开展有氧运动，均可对心脏功能发挥保护作用。但该保护作用的具体机制目前仍未明确。