title: Exercise and risk of major cardiovascular events in adult survivors of childhood hodgkin lymphoma: a report from the childhood cancer survivor study.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: Lee W
authors.initials: LW
authors.lastname: Jones
authors.affiliation: 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.
authors.forename: Qi
authors.initials: Q
authors.lastname: Liu
authors.affiliation: 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.
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Armstrong
authors.affiliation: 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.
authors.forename: Kirsten K
authors.initials: KK
authors.lastname: Ness
authors.affiliation: 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.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yasui
authors.affiliation: 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.
authors.forename: Katie
authors.initials: K
authors.lastname: Devine
authors.affiliation: 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.
authors.forename: Emily
authors.initials: E
authors.lastname: Tonorezos
authors.affiliation: 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.
authors.forename: Luisa
authors.initials: L
authors.lastname: Soares-Miranda
authors.affiliation: 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.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Sklar
authors.affiliation: 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.
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Douglas
authors.affiliation: 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.
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.affiliation: 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.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Oeffinger
mesh_terms: D000293:Adolescent; D000328:Adult; D002170:Canada / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002648:Child; D015897:Comorbidity; D015444:Exercise; D006689:Hodgkin Disease / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D017741:Survivors / Q000706:statistics & numerical data*; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult