title: Pre-exercise participation cardiovascular screening in a heterogeneous cohort of adult cancer patients.
abstract: BACKGROUND
  The purpose of this study was to investigate the extent of pre-exercise participation ("preparticipation") health screening in a heterogeneous cohort of adult cancer patients.
  
  
  METHODS
  Patients (n = 413) with histologically confirmed solid or hematologic malignancy were categorized into preparticipation health screening risk stratification based on American College Sports Medicine (ACSM) recommendations. Risk of an exercise-related event was evaluated during a symptom-limited cardiopulmonary exercise test (CPET) with 12-lead electrocardiography (ECG).
  
  
  RESULTS
  Participant risk was categorized as low risk (n = 59, 14%), moderate risk (n = 217, 53%), and high risk (n = 137, 33%). Mean peak oxygen consumption was 21.7 ± 6.7 mL/kg(-1) per minute(-1) or 19.5 ± 21.7% below age- and sex-predicted sedentary values. No major serious adverse events or fatal events were observed during CPET procedures. A total of 31 positive ECG tests were observed, for an event rate of 8%. ACSM risk stratification did not predict the risk of a positive test. Age, statin use, antiplatelet therapy use, cardiovascular disease, prior treatment with anthracycline or radiation therapy, and being sedentary were predictors of a positive test (all p < .10).
  
  
  CONCLUSIONS
  The patient risk-stratification profile strongly suggests that the use of formalized preparticipation health screening is required in all oncology scenarios; however, risk of an exercise-induced event is low, suggesting that the use of exercise testing is not required for pre-exercise clearance in the majority of patients.
authors: Duke University Medical Center, Durham, North Carolina, USA; School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada; Memorial Sloan Kettering Cancer Center, New York, New York, USA.
authors: Aarti A
authors: AA
authors: Kenjale
authors: Duke University Medical Center, Durham, North Carolina, USA; School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada; Memorial Sloan Kettering Cancer Center, New York, New York, USA.
authors: Whitney E
authors: WE
authors: Hornsby
authors: Duke University Medical Center, Durham, North Carolina, USA; School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada; Memorial Sloan Kettering Cancer Center, New York, New York, USA.
authors: Theresa
authors: T
authors: Crowgey
authors: Duke University Medical Center, Durham, North Carolina, USA; School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada; Memorial Sloan Kettering Cancer Center, New York, New York, USA.
authors: Samantha
authors: S
authors: Thomas
authors: Duke University Medical Center, Durham, North Carolina, USA; School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada; Memorial Sloan Kettering Cancer Center, New York, New York, USA.
authors: James E
authors: JE
authors: Herndon
authors: Duke University Medical Center, Durham, North Carolina, USA; School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada; Memorial Sloan Kettering Cancer Center, New York, New York, USA.
authors: Michel G
authors: MG
authors: Khouri
authors: Duke University Medical Center, Durham, North Carolina, USA; School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada; Memorial Sloan Kettering Cancer Center, New York, New York, USA.
authors: Amy R
authors: AR
authors: Lane
authors: Duke University Medical Center, Durham, North Carolina, USA; School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada; Memorial Sloan Kettering Cancer Center, New York, New York, USA.
authors: Caroline E
authors: CE
authors: Bishop
authors: Duke University Medical Center, Durham, North Carolina, USA; School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada; Memorial Sloan Kettering Cancer Center, New York, New York, USA.
authors: Neil D
authors: ND
authors: Eves
authors: Duke University Medical Center, Durham, North Carolina, USA; School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada; Memorial Sloan Kettering Cancer Center, New York, New York, USA.
authors: Jeffrey
authors: J
authors: Peppercorn
authors: Duke University Medical Center, Durham, North Carolina, USA; School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada; Memorial Sloan Kettering Cancer Center, New York, New York, USA.
authors: Pamela S
authors: PS
authors: Douglas
authors: Duke University Medical Center, Durham, North Carolina, USA; School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada; Memorial Sloan Kettering Cancer Center, New York, New York, USA jonesl3@mskcc.org.
authors: Lee W
authors: LW
authors: Jones
mesh_terms: D000368:Aged; D002319:Cardiovascular System / Q000503:physiopathology; D004562:Electrocardiography; D015444:Exercise; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D010101:Oxygen Consumption; D010361:Patients; D018570:Risk Assessment
keywords: Adverse events; Cancer; Exercise tolerance testing; Oncology; Pre-exercise clearance; Safety