Aerobic Exercise as a Cardioprotective Strategy in Breast Cancer Patients Undergoing Anthracycline-Based Chemotherapy

Abstract

Background: Advances in breast cancer diagnosis and treatment have significantly extended patient survival, leading to this cancer being increasingly viewed as a chronic disease. However, the use of classic anthracycline-based chemotherapy is associated with a high risk of cardiotoxicity. With extended survival post-therapy, cardiovascular complications emerge as the leading non-oncological cause of mortality among breast cancer survivors Aim: Summary of the current state of knowledge regarding the role and mechanisms of aerobic training as a cardioprotective strategy in breast cancer patients undergoing anthracycline chemotherapy. Materials and methods: Analysis of contemporary scientific literature, preclinical studies, and guidelines from international oncology and cardiology societies (e.g., ASCO, ACS, ICOS-CORE). Results: Anthracyclines damage the myocardium and microcirculation by interacting with topoisomerase IIβ (TOP2B), activating the TGF-β/Smad3 axis, and generating oxidative stress. Aerobic exercise effectively mitigates this cardiotoxicity at the cellular level by strengthening antioxidant defense systems, preserving mitochondrial ultrastructure, promoting biogenesis, and inhibiting apoptotic pathways and myocardial atrophy. Implementing regular exercise during treatment improves therapy tolerance, VO2 peak, and vascular and muscular function. Conclusions: Regular, structured aerobic training (exercise preconditioning) demonstrates a strong, multifaceted cardioprotective effect. Cardio-oncology rehabilitation programs (CORE) should be an integral component of oncology care and a further research focus.