A lactate threshold-based incremental treadmill training and assessment protocol (LACTOC) for managing treatment-induced cardiotoxicity in oncology patients
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Abstract
Cardiotoxicity represents a clinically significant complication in oncology patients, manifesting as cardiac dysfunction that impairs functional capacity and quality of life. Physical exercise has emerged as a promising intervention to mitigate treatment-related adverse effects; however, optimal exercise prescription for patients with cardiotoxicity remains poorly defined, as most existing protocols rely on heart rate percentages or peak oxygen consumption—methods imprecise in cardiovascularly compromised populations. This protocol describes the LACTOC program, a 4-week supervised treadmill exercise intervention comprising 12 sessions (three per week, 48-hour recovery intervals) in oncology patients with treatment-induced cardiotoxicity. Each session includes a warm-up (5 min at 3 km/h), a progressive incremental test with 3-minute stages and 1 km/h increments from 4 km/h until reaching 4 mmol/L blood lactate or 85% of theoretical maximal heart rate, and active recovery (5 min at 3 km/h). Comprehensive cardiovascular, metabolic, perceptual, and heart rate variability monitoring is integrated throughout. The protocol is expected to enable individualized exercise prescription based on objective metabolic thresholds, with session-by-session load adjustment guided by daily HRV assessment representing a methodological advance over conventional fixed-prescription approaches. This proposal is positioned as a promising framework for cardio-oncological rehabilitation, providing objective tools to guide safe and effective exercise prescription in patients with treatment-induced cardiotoxicity.
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