Altered Blood Flow Response to Small Muscle Mass Exercise in Cancer Survivors Treated With Adjuvant Therapy

Kaylin D Didier, Austin K Ederer, Landon K Reiter, Michael Brown, Rachel Hardy, Jacob Caldwell, Christopher Black, Michael G Bemben, Carl J Ade, Kaylin D Didier, Austin K Ederer, Landon K Reiter, Michael Brown, Rachel Hardy, Jacob Caldwell, Christopher Black, Michael G Bemben, Carl J Ade

Abstract

Background: Adjuvant cancer treatments have been shown to decrease cardiac function. In addition to changes in cardiovascular risk, there are several additional functional consequences including decreases in exercise capacity and increased incidence of cancer-related fatigue. However, the effects of adjuvant cancer treatment on peripheral vascular function during exercise in cancer survivors have not been well documented. We investigated the vascular responses to exercise in cancer survivors previously treated with adjuvant cancer therapies.

Methods and results: Peripheral vascular responses were investigated in 11 cancer survivors previously treated with adjuvant cancer therapies (age 58±6 years, 34±30 months from diagnosis) and 9 healthy controls group matched for age, sex, and maximal voluntary contraction. A dynamic handgrip exercise test at 20% maximal voluntary contraction was performed with simultaneous measurements of forearm blood flow and mean arterial pressure. Forearm vascular conductance was calculated from forearm blood flow and mean arterial pressure. Left ventricular ejection time index (LVETi) was derived from the arterial pressure wave form. Forearm blood flow was attenuated in cancer therapies compared to control at 20% maximal voluntary contraction (189.8±53.8 vs 247.9±80.3 mL·min-1, respectively). Forearm vascular conductance was not different between groups at rest or during exercise. Mean arterial pressure response to exercise was attenuated in cancer therapies compared to controls (107.8±10.8 vs 119.2±16.2 mm Hg). LEVTi was lower in cancer therapies compared to controls.

Conclusions: These data suggest an attenuated exercise blood flow response in cancer survivors ≈34 months following adjuvant cancer therapy that may be attributed to an attenuated increase in mean arterial pressure.

Keywords: arterial pressure; blood flow; cancer; exercise; exercise physiology.

© 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Figures

Figure 1
Figure 1
Forearm blood flow (A), forearm vascular conductance (B), and mean arterial pressure (C) responses during dynamic forearm exercise at 20% maximal voluntary contraction (MVC). Forearm blood flow response was significantly decreased in cancer survivors compared to controls. Mean arterial pressure response was lower in cancer survivors during exercise compared to controls, but not at rest. *P<0.05 versus control. Mean±SE.
Figure 2
Figure 2
Forearm blood flow response to handgrip exercise in individual cancer survivors and controls (A). Given that control participants were selected if their age and maximal voluntary contraction (MVC) were within 2.5 SDs of the means for the cancer survivor group, a representative female cancer survivor and control are also presented who were similar in both age and BMI (B). BMI indicates body mass index.
Figure 3
Figure 3
Left ventricular ejection time index (LVETi) derived from the arterial pressure waveform during dynamic forearm exercise at 20% maximal voluntary contraction (MVC). LVETi was significantly decreased in cancer survivors compared to controls. *P<0.05 versus control. Mean±SE.

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