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Reduced cardiorespiratory fitness (CRF) is a major determinant of cardiovascular morbidity and cancer survival. In this review we discuss cancer- induced disturbances of parenchymal, cellular, and mitochondrial function, which limit CRF and may be antagonized and attenuated through exercise training. We show the impact of CRF on cancer survival and its attenuating effects on cardiotoxicity of cancer-related treatment. Tailored exercise programs are not yet available for each tumor entity as several trials were performed in heterogeneous populations without adequate cardiopulmonary exercise testing (CPET) prior to exercise prescription and with a wide variation of exercise modalities. There is emerging evidence that exercise may be a crucial pillar in cancer treatment and a tool to mitigate cardiotoxic treatment effects. We discuss modalities of aerobic exercise and resistance training and their potential to improve CRF in cancer patients and provide an example of a periodization model for exercise training in cancer.<\/jats:p>","DOI":"10.1007\/s00395-024-01034-4","type":"journal-article","created":{"date-parts":[[2024,2,14]],"date-time":"2024-02-14T11:02:11Z","timestamp":1707908531000},"page":"35-55","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Exercise, cancer, and the cardiovascular system: clinical effects and mechanistic insights"],"prefix":"10.1007","volume":"120","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6732-0939","authenticated-orcid":false,"given":"Simon","family":"Wernhart","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tienush","family":"Rassaf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,2,14]]},"reference":[{"key":"1034_CR1","unstructured":"(2024) DiGA ProHerz. 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However, this is not the case, the article is part of a special issue. This bug has been fixed.","order":7,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"SW reports no conflicts of interest. TR reports honoraria for lectures and advisory board activities for Bayer, AstraZeneca, Daiichi Sankyo, Pfizer. TR is co-founder of Mycor, a start-up focusing on the development of algorithms to detect amyloidosis. 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