Can Exercise Reduce the Autonomic Dysfunction of Patients With Cancer and Its Survivors? A Systematic Review and Meta-Analysis

Abstract

Background: Cancer therapies have increased patient survival rates, but side effects such as cardiotoxicity and neurotoxicity can lead to autonomic nervous and cardiovascular system dysfunction. This would result in a decrease in parasympathetic activity and the enhancement of sympathetic activity. Heart rate variability (HRV), which reflects autonomic modulation, is a valuable physiological tool since it correlates with cancer-related fatigue, stress, depression, and mortality in patients with cancer. Objective: This study aimed to analyze the effects of exercise programs on the autonomic modulation, measured by the HRV of patients with cancer and its survivors. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the quality of the articles was assessed with the Physiotherapy Evidence Database (PEDro) scale. The meta-analysis statistic procedure was performed by using RevMan software version 5.3. Results: From the 252 articles found, six studies were included in the review involving 272 participants aged 30–75 years. Exercise programs had a mean length of 10.4 ± 4.6 weeks, a frequency of 3 ± 1.4 days/week, and a mean duration of 78 ± 23.9 min. In time-domain HRV measures, exercise may increase in the SD of normal-to-normal intervals [p < 0.00001, with a mean difference (MD) of 12.79 ms from 9.03 to 16.55] and a decreased root mean square of successive R–R interval differences (p = 0.002, with an MD of 13.08 ms from 4.90 to 21.27) in comparison with control groups (CG). The frequency-domain data reveal that the exercise group (EG) improve significantly more than the CGs in low frequency [absolute power: p < 0.0001, with a standardized mean difference (SMD) of 0.97 from 0.61 to 1.34; relative power: p = 0.04, with an MD = −7.70 from −15.4 to −0.36], high-frequency [absolute power: p = 0.001, with a SMD of 1.49 from 0.32 to 2.66; relative power: p = 0.04, with an MD of 8.00 normalized units (n.u.) from 0.20 to 15.80], and low-to-high frequency ratio (p = 0.007 with an MD of −0.32 from −0.55 to −0.09). Conclusion: Exercise programs could lead to positive effects on the autonomic modulation of patients with cancer and its survivors. More beneficial changes may occur with resistance and endurance workouts. However, due to the low number of interventions performed, further research is needed to substantiate the findings and to provide additional insights regarding the exercise intensity required to increase the autonomic modulation of the patient.