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J Clin Oncol. 2014 Nov 10;32(32):3643-50. doi: 10.1200/JCO.2014.56.7511. Epub 2014 Oct 13.

Exercise and risk of major cardiovascular events in adult survivors of childhood hodgkin lymphoma: a report from the childhood cancer survivor study.

Author information

1
Lee W. Jones, Emily Tonorezos, Charles A. Sklar, Kevin C. Oeffinger, the Memorial Sloan Kettering Cancer Center, New York, NY; Qi Liu, Yutaka Yasui, University of Alberta, Edmonton, Alberta, Canada; Gregory T. Armstrong, Kirsten K. Ness, Leslie L. Robison, St. Jude Children's Research Hospital, Memphis, TN; Katie Devine, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Luisa Soares-Miranda, Research Center in Physical Activity Health and Leisure, University of Porto, Porto, Portugal; Pamela S. Douglas, Duke University Medical Center, Durham, NC. jonesl3@mskcc.org.
2
Lee W. Jones, Emily Tonorezos, Charles A. Sklar, Kevin C. Oeffinger, the Memorial Sloan Kettering Cancer Center, New York, NY; Qi Liu, Yutaka Yasui, University of Alberta, Edmonton, Alberta, Canada; Gregory T. Armstrong, Kirsten K. Ness, Leslie L. Robison, St. Jude Children's Research Hospital, Memphis, TN; Katie Devine, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Luisa Soares-Miranda, Research Center in Physical Activity Health and Leisure, University of Porto, Porto, Portugal; Pamela S. Douglas, Duke University Medical Center, Durham, NC.

Abstract

PURPOSE:

Survivors of Hodgkin lymphoma (HL) are at increased risk of treatment-related cardiovascular (CV) events; whether exercise modifies this risk is unknown.

METHODS:

Survivors of HL (n = 1,187; median age, 31.2 years) completed a questionnaire evaluating vigorous-intensity exercise behavior. CV events were collected in follow-up questionnaires and graded according to Common Terminology Criteria for Adverse Events (version 4.03). The primary end point was incidence of any major (grade 3 to 5) CV event. Poisson regression analyses were used to estimate the association between exercise exposure (metabolic equivalent [MET] hours/week(-1)) and risk of major CV events after adjustment for clinical covariates and cancer treatment.

RESULTS:

Median follow-up was 11.9 years (range, 1.7 to 14.3 years). Cumulative incidence of any CV event was 12.2% at 10 years for survivors reporting 0 MET hours/week(-1) compared with 5.2% for those reporting ≥ 9 MET hours/week(-1). In multivariable analyses, the incidence of any CV event decreased across increasing MET categories (Ptrend = .002). Compared with survivors reporting 0 MET hours/week(-1), the adjusted rate ratio for any CV event was 0.87 (95% CI, 0.56 to 1.34) for 3 to 6 MET hours/week(-1), 0.45 (95% CI, 0.26 to 0.80) for 9 to 12 MET hours/week(-1), and 0.47 (95% CI, 0.23 to 0.95) for 15 to 21 MET hours/week(-1). Adherence to national vigorous intensity exercise guidelines (ie, ≥ 9 MET hours/week(-1)) was associated with a 51% reduction in the risk of any CV event in comparison with not meeting the guidelines (P = .002).

CONCLUSION:

Vigorous exercise was associated with a lower risk of CV events in a dose-dependent manner independent of CV risk profile and treatment in survivors of HL.

PMID:
25311213
PMCID:
PMC4220043
DOI:
10.1200/JCO.2014.56.7511
[Indexed for MEDLINE]
Free PMC Article

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