Review The benefits of exercise in cancer patients and the criteria for exercise prescription in cardio-oncology Flavio D’Ascenzi 1,2 , Francesca Anselmi 1 , Caterina Fiorentini 1 , Roberta Mannucci 3 , Marco Bonifazi 4 and Sergio Mondillo 1 Abstract Cancer and cardiovascular diseases are the leading causes of death in high-income countries. Cardiovascular complica- tions can be found in cancer patients, being the result of so-called ‘cardio-toxicity’. Therefore, it becomes essential to thoroughly investigate the origin of cardiac damage and the strategy to prevent it or to reverse the negative remodelling associated with cardiotoxicity. In this review the beneficial effects of physical exercise in cancer patients were analysed, particularly to prevent cardio-toxicity before its clinical manifestation. According to the relevance of exercise, we suggest strategies for exercise prescription with a tailored approach in these patients. In conclusion, physical exercise seems to be a promising and effective treatment for cancer patients during and after therapy and seems to counteract the negative effects induced by drugs on the cardiovascular system. Exercise prescription should be tailored according to patient’s individual characteristics, to the drugs administered, to the personal history, and to his/her response to exercise, taking into account that different types of training can be prescribed according also to the patient’s choice. A cardiological evaluation including exercise testing is essential for an appropriate prescription of exercise in these patients. Keyword Exercise, oncology, training, prevention, cardiotoxicity Received 10 June 2019; accepted 19 August 2019 Cancer and cardiovascular disease: a common disease Cancer and cardiovascular diseases are the leading causes of death in high-income countries. The Global Initiative for Cancer Registry Development estimated that there were 18.1 m new cancer cases and 9.6 m cancer deaths in 2018. 1 Cancer and cardiovascular dis- orders share common risk factors, including aging and unhealthy lifestyle such as smoking habit, alcohol abuse, unbalanced fat diet and physical inactivity. The overlap of risk factors leads to a common strategy of prevention, primarily focused on the management of lifestyle changes and the practice of regular exercise. Indeed, being physically active reduces the incidence of cancer by 48% and the mortality due to cancer by 27%. 2 Furthermore, cardiovascular complications found in cancer patients are the result of toxicity induced by drugs administered for cancer treatment, so-called ‘cardio-toxicity’. In addition to pharmaco- logical cardiac protection during cancer therapy, it becomes essential to thoroughly investigate the origin of cardiac damage and the strategy to prevent it or to reverse the negative remodelling associated with cardiotoxicity. Exercise is able to reduce some negative effects due to chemotherapy such as fatigue, pulmonary and immune system dysfunction, lymphoedema and toxicity for the heart. 3 In this review we report the beneficial effects of physical exercise (PE) in cancer patients to prevent cardio-toxicity 1 Department of Medical Biotechnologies, University of Siena, Italy 2 Department of Medicine, University of Pittsburgh, USA 3 Institute for Health, University of Pittsburgh Medical Center, C. Terme (Siena), Italy 4 Department of Medicine, Science, and Neurosciences, University of Siena, Italy Corresponding author: Flavio D’Ascenzi, Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale M. Bracci, 16, 53100 Siena, Italy. Email: flavio.dascenzi@unisi.it European Journal of Preventive Cardiology 0(00) 1–13 ! The European Society of Cardiology 2019 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/2047487319874900 journals.sagepub.com/home/cpr