Health Sciences Faculty, University of Granada, Spain.
Sport and Health Research Center (IMUDs), Granada, Spain.
Phys Ther. 2021 Mar 3;101(3). doi: 10.1093/ptj/pzab014.
Therapeutic exercise is already used to ameliorate some of the side effects of cancer treatment. Recent studies examined its preventive potential regarding treatment-related toxicity, which can increase the risk of functional decline and lead to disease recurrence and death. This trial will examine whether the Tailored Therapeutic Exercise and Recovery Strategies (ATOPE) program, performed before treatment, can mitigate the onset and extent of cardiotoxicity beyond that achieved when the program is followed during treatment in recently diagnosed breast cancer patients.
The intervention has a preparatory phase plus 12 to 18 sessions of tailored, high-intensity exercise, and post-exercise recovery strategies. A total of 120 women recently diagnosed with breast cancer, at risk of cardiotoxicity due to anticancer treatment awaiting surgery followed by chemotherapy and/or radiotherapy, will be randomized to either group. In a feasibility study, measurements related to recruitment rate, satisfaction with the program, adherence to them, the retention of participants, safety, and adverse effects will be explored. In the main trial, the efficacy of these interventions will be examined. The major outcome will be cardiotoxicity, assessed echocardiographically via the left ventricular ejection fraction. Other clinical, physical, and anthropometric outcomes and biological and hormonal variables will also be assessed after diagnosis, after treatment, 1 year after treatment ends, and 3 years after treatment ends.
Given its potential effect on patient survival, the mitigation of cardiotoxicity is a priority, and physical therapists have an important role in this mitigation. If the ATOPE intervention performed before treatment returns better cardioprotection results, it may be recommendable that patients recently diagnosed follow this program.
The ATOPE program will highlight the need for a physical therapist intervention from the moment of diagnosis, in the prevention or mitigation of cardiotoxicity, in women with breast cancer. It could help physical therapists to establish an adequate therapeutic exercise dose adapted to breast cancer patients and to propose correct therapeutic exercise prescription according to the assimilation of the sessions.
治疗性运动已被用于改善癌症治疗的一些副作用。最近的研究检查了其预防治疗相关毒性的潜力，治疗相关毒性会增加功能下降的风险，并导致疾病复发和死亡。本试验将研究在接受治疗期间进行的个体化治疗性运动和恢复策略（ATOPE）方案是否可以减轻新近诊断为乳腺癌患者的心脏毒性的发生和程度，而不仅仅是在接受治疗时进行该方案。
该干预措施具有预备阶段，加上 12 至 18 次量身定制的高强度运动和运动后恢复策略。共有 120 名最近被诊断为乳腺癌的女性，由于抗癌治疗有发生心脏毒性的风险（由于手术、化疗和/或放疗），将被随机分为两组。在可行性研究中，将探讨与招募率、对该方案的满意度、对该方案的依从性、参与者的保留率、安全性和不良影响相关的测量。在主要试验中，将检查这些干预措施的疗效。主要结果将是通过左心室射血分数评估的心脏毒性。其他临床、身体和人体测量结果以及生物和激素变量也将在诊断后、治疗后、治疗结束后 1 年和治疗结束后 3 年进行评估。
鉴于其对患者生存的潜在影响，减轻心脏毒性是重中之重，物理治疗师在这方面发挥着重要作用。如果在治疗前进行的 ATOPE 干预措施能带来更好的心脏保护效果，那么建议最近诊断的患者遵循该方案。
ATOPE 方案将突出物理治疗师从诊断开始就介入的必要性，以预防或减轻乳腺癌患者的心脏毒性。它可以帮助物理治疗师为乳腺癌患者确定适当的治疗性运动剂量，并根据对运动的吸收情况提出正确的治疗性运动处方。
