Individualized Aerobic Exercise Prescription as Part of a Comprehensive Physical Therapy Treatment During Systemic Chemotherapy: A Case Report

Background: Cardiovascular disease (CVD) is commonly seen in cancer survivors. Multiple treatment modalities for breast cancer can cause cardiotoxicity during or even decades after treatment. Aerobic exercise has been well documented to treat non-cancer-related CVD; however, research regarding optimal dosing within the cancer population is needed. This case report discusses the examination, evaluation, and treatment of a patient with breast cancer receiving potentially cardiotoxic chemotherapy. Case Description: This patient presented with decreased cardiorespiratory fitness, elevated heart rate, and shortness of breath when climbing the stairs after completing systemic chemotherapies doxorubicin and cyclophosphamide. She was preparing to start paclitaxel treatments and was at risk for further deconditioning and neurotoxic side effects from this treatment. Additionally, she had developed an anal fissure which further negatively affected her quality of life. A low-intensity aerobic exercise program was chosen for this patient with the utilization of her smart watch to ensure she was exercising at her prescribed target heart rate. Outcomes: The patient demonstrated a 7-mL/kg/min increase in peak volume of oxygen consumption following a 12-week physical therapy program. She reported decreased fatigue levels, an ability to climb up and down the steps carrying a laundry basket without reports of her heart racing, and reduced pain with her anal fissure. Discussion and Conclusion: This case highlights how implementation of a low-intensity, individualized aerobic exercise program prescribed as a progressive weekly target heart rate contributed to positive outcomes in cardiorespiratory fitness during systemic chemotherapy.