Effects of Rowing on Cardiac Function in Breast Cancer Survivors: Sliding Seat Rowing vs. Fixed Seat Rowing

Ci a ion: Ga ala-González, J.; Real-Pé ez, M.; Gamboa-González, J.; Fe nández-Ga cía, J.C. E ec s o Rowing on Ca diac Func ion in B eas Cance Su i o s: Sliding Sea Rowing s. Fixed Sea Rowing. Appl. Sci. 2024,14, 6239. h ps://doi.o g/ 10.3390/app14146239 Academic Edi o s: And ea Fusco and Ba ba a Gilic Recei ed: 2 July 2024 Re ised: 15 July 2024 Accep ed: 16 July 2024 Published: 18 July 2024 Copy igh : © 2024 by he au ho s. Licensee MDPI, Basel, Swi ze land. This a icle is an open access a icle dis ibu ed unde he e ms and condi ions o he C ea i e Commons A ibu ion (CC BY) license (h ps:// c ea i ecommons.o g/licenses/by/ 4.0/). applied sciences A icle E ec s o Rowing on Ca diac Func ion in B eas Cance Su i o s: Sliding Sea Rowing s. Fixed Sea Rowing Juan Ga ala-González 1,2 , Ma eo Real-Pé ez 2,* , Juan Gamboa-González 2and JoséCa los Fe nández-Ga cía2,3 1Depa men o Physical Educa ion and Spo s, Uni e sidad de Se illa, 41013 Se illa, Spain; [email p o ec ed] 2Resea ching in Spo Science: G upo de in es igación (CTS-563) del Plan Andaluz de In es igación, Uni e sidad de Se illa, 41003 Se illa, Spain; [email p o ec ed] (J.G.-G.); [email p o ec ed] (J.C.F.-G.) 3Depa men o Didac ics o Languages, A s and Spo , Uni e sidad de Málaga, Andalucía-Tech, IBIMA, 29010 Málaga, Spain *Co espondence: ma eo. ealpe [email p o ec ed] Abs ac : This longi udinal s udy aimed o analyze he e ec s o a eam owing-based aining p og am on physical i ness and an h opome ic pa ame e s in emale b eas cance su i o s (n= 40; 56.78 ± 6.38 yea s). Pa icipan s we e di ided in o wo g oups: one owed in ixed sea owing (FSR) boa s (n= 20; 56.35 ± 4.89 yea s) and he o he in sliding sea owing (SSR) boa s (n= 20; 57.20 ± 7.7 yea s). Bo h g oups engaged in wo 75-min sessions pe week o 24 weeks. Signi - ican imp o emen s we e obse ed in bo h g oups in es ing hea a e (FSR: − 10.65 bpm; SSR: − 8.45 bpm), hea a e a he beginning o he 6-min walk es (6 MWT) (FSR: − 10.7 bpm; SSR: − 11.25 bpm), and hea a e a he end o he es (FSR: − 13.85 bpm; SSR: − 20.35 bpm). Blood p essu e imp o ed signi ican ly in bo h dias olic blood p essu e (FSR: −12.35 mmHg; SSR: −19.25 mmHg) and sys olic blood p essu e (FSR: − 13 mmHg; SSR: − 16.95 mmHg). Addi ionally, bo h g oups inc eased he dis ance co e ed in he 6 MWT (FSR: +63.05 m; SSR: +93.65 m). These esul s sugges ha a owing aining p og am is a iable and sa e ac i i y o emale b eas cance su i o s, imp o ing ca diac unc ion, blood p essu e, and ca dio espi a o y capaci y, pa icula ly in sliding sea boa s. Keywo ds: owing; b eas cance ; physical ac i i y; ca diac unc ion; exe cise 1. In oduc ion The e olu ion o scien i ic knowledge is changing he pa adigm o cance om di- agnosis and subsequen pha macological ea men o a holis ic and mul idisciplina y app oach ha ea s he indi idual h ough comp ehensi e he apeu ic p og ams. In his ega d, physical exe cise has been pos ula ed o play an impo an ole in p o ec ing agains cance [ 1 ]. As an example, i has been no ed ha he isk o b eas cance - ela ed mo ali y appea s o be signi ican ly lowe among su i o s who adop a physically ac i e ou ine, in con as o hose who lead a seden a y li es yle [2]. B eas cance ep esen s he mos p e alen ype o cance in women, wi h 2.3 million diagnoses in 2020, and is he leading cause o cance - ela ed dea hs in he emale popula ion on a global scale [ 3 ]. Despi e his, he su i al a e is close o 90% in mos coun ies, so he e is a high numbe o women who su i e he disease o a leas 5 yea s a e ini ial ea men [ 4 , 5 ]. Howe e , despi e his high su i al a e, i is impo an o no e ha he side e ec s associa ed wi h he disease and i s ea men , such as cance - ela ed a igue [ 6 ], lymphedema [ 7 ], ca dio ascula disease [ 8 , 9 ], loss o bone mass [ 10 ], o psychological p oblems such as anxie y o dep ession [ 11 ], can pe sis o long pe iods o ime, anging om mon hs o yea s. I we ocus on he side e ec s p oduced o exace ba ed by he ea men o oncological diseases, we ind ha ca dio ascula diseases and b eas cance sha e nume ous isk ac o s such as age, die , amily his o y, alcohol consump ion, obesi y and o e weigh , le el o physical ac i i y, and obacco use [ 8 ]. Ye , hey sha e an e en mo e ele an common isk Appl. Sci. 2024,14, 6239. h ps://doi.o g/10.3390/app14146239 h ps://www.mdpi.com/jou nal/applsci Appl. Sci. 2024,14, 6239 2 o 12 ac o , since cu en b eas cance ea men s, based on chemo he apy, adio he apy, and endoc ine he apies, ha e a po en ially dele e ious e ec ela ed o cance -induced ca - dio oxici y and, consequen ly, o he de elopmen o ca dio ascula disease [ 8 , 9 ]. The e o e, he e is a need o examine which ypes o complemen a y non-pha macological in e en- ions can help o educe he isk o de eloping ca dio ascula disease in emale b eas cance su i o s. The diagnosis o cance is o en accompanied by d as ic changes in a pe son’s li e. Taking in o accoun ha he li es yle adop ed can posi i ely in luence he chances o su i al o he disease [ 12 ], as well as p o ec agains he possible sequelae o ea men [ 13 , 14 ], scien i ic e idence has shown ha engaging in physical exe cise can educe he onse o symp oms associa ed wi h cance ea men and imp o e physical i ness and men al heal h [ 1 , 6 , 15 , 16 ]. This esea ch has shown ha a con olled aining p og am can p oduce signi ican imp o emen s in ae obic capaci y, as well as an inc ease in muscle mass and s eng h, in addi ion o imp o ing unc ionali y o he uppe limbs in women wi h b eas cance [ 17 – 20 ]. The majo i y o he s udies consul ed a i m ha physical ac i i y posi i ely in luences heal h s a us, mood, and body composi ion, posi i ely a ec ing he quali y o li e o su i o s [15,16,21–23]. Despi e he p o en bene i s o exe cise and i s posi i e impac on he heal h o women wi h b eas cance [ 1 , 8 , 24 , 25 ], he le el o physical ac i i y is signi ican ly educed du ing cance ea men [ 26 ], and emains e en lowe han i was be o e diagnosis [ 25 ]. Un o - una ely, s udies ha e shown ha women who ha e been diagnosed wi h b eas cance dec ease hei physical ac i i y by 11%, alling e en u he in hose who a e ea ed wi h chemo he apy (50%) and adio he apy (24%), compa ed o un ea ed women [ 26 ]. Fa igue, low mo i a ion, kinesiophobia, ea o lymphedema, and di icul ies in accessing spo s acili ies a e he main ba ie s o pa icipa ion in physical ac i i ies in cance pa ien s [4]. Addi ionally, we mus also conside ha pe sis en ch onic pain and senso y changes a e common sequelae ollowing b eas cance su ge y. S udies epo ha be ween 20% and 60% o women expe ience pe sis en pain, p ima ily el in he an e io ches , a ms, and axillae a e b eas cance su ge y, signi ican ly wo sening hei quali y o li e [ 27 , 28 ]. This pain has a neu opa hic cha ac e and is o en a ibu ed o he sec ioning o he in e cos ob achial ne e (ICBN), which equen ly occu s du ing ea men s in ol ing lympha ic axilla y dissec ion. This esul s in numbness o he uppe limb and ho acic wall, and es ic ion o uppe limb mo emen [ 29 , 30 ]. In his con ex , physical ac i i y and physiokine o he apy echniques can se e as undamen al ools in p e en ing associa ed p oblems and p ese ing mobili y and muscle s eng h, imp o ing unc ionali y, pos u e, and educing he isk o lymphedema in he a eas mos a ec ed by his disease [ 31 , 32 ]. The e o e, i is impo an o p omo e s a egies and ac i i ies ha encou age adhe ence o physical ac i i y, e en du ing he ea men o he disease [33]. Wi hin his con ex , p og ams based on owing ha e now eme ged as a possible non- pha macological he apy o amelio a e he side e ec s o cance and o slow he decline associa ed wi h cance and i s ea men [ 4 , 7 , 34 , 35 ]. Rowing is a wa e spo in which a boa is p opelled by he use o oa s. In his discipline, owe s use he oa s as second-deg ee le e s, mo ing hem in he opposi e di ec ion o he o wa d mo ion o he boa . Some o he bene i s associa ed wi h his ype o owing-based exe cise indica e an imp o emen in he physical condi ion o he pa icipan s [ 4 , 36 ], men al and psychological heal h [ 37 – 39 ], p e en ion o lymphedema [ 7 , 40 ], and ul ima ely, an imp o emen in he quali y o li e o women owe s [4,34,35]. I is impo an o no e ha he e a e wo main ypes o owing: sliding sea owing (SSR), cha ac e ized by mo emen o he sea s o acili a e leg h us , and ixed sea owing (FSR), in which he owe s emain in a s a ic sea du ing he exe cise [ 41 ]. The e a e clea biomechanical di e ences in he echnical mo emen s be ween he wo modali ies, pa icula ly wi h ega d o he uppe limbs. In FSR, o e head shoulde lexion is equi ed o execu e he necessa y mo emen s. In con as , in SSR, he mo emen o he a ms is pe o med a shoulde heigh , which helps o educe he s ain on he uppe ex emi ies and unk [35]. Appl. Sci. 2024,14, 6239 3 o 12 Rowing was chosen because i in ol es he muscles o bo h he uppe and lowe ex emi ies, as well as i ually e e y muscle in he body. Ne e heless, he dis inguishing ea u e ha se s i apa om mos o he spo s is he cyclic and al e na ing ac ion o lexion and ex ension o he uppe and lowe ex emi ies, as well as he in ol emen o he s abilizing muscles o he unk and back du ing he di e en phases o owing [42,43]. Cu en ly, limi ed e idence is a ailable on he impac o owing on ca diac unc ion and blood p essu e in b eas cance su i o s [ 44 ]. The e o e, he aim o he ollowing s udy will be o examine he in luence o a owing-based aining p og am on ca diac unc ion and ae obic capaci y in emale b eas cance su i o s, as well as o compa e he in luence o boa ype on he possible ca dio ascula adap a ions. 2. Ma e ials and Me hods 2.1. Design and Pa icipan s This esea ch is pa o concu en clinical ials. To suppo his, a 24-week aining egimen, conduc ed wice a week, was de eloped o use in bo h FSR and SSR boa s (Figu e 1). Va ious b eas cance suppo g oups we e app oached and gi en he oppo - uni y o pa icipa e in a ee 24-week owing p og am, which included physical e alua- ions a he beginning and conclusion o he p og am. The only c i e ia o pa icipa ion we e a his o y o b eas cance and app o al om hei oncologis o engage in mode a e physical ac i i y. Appl.Sci.2024,14,xFORPEERREVIEW3o 13  execu e henecessa ymo emen s.Incon as ,inSSR, hemo emen o  hea msispe - o meda shoulde heigh ,whichhelps o educe hes ainon heuppe ex emi iesand unk[35]. Rowingwaschosenbecausei in ol es hemuscleso bo h heuppe andlowe ex- emi ies,aswellas i uallye e ymusclein hebody.Ne e heless, hedis inguishing ea u e ha se si apa  ommos o he spo sis hecyclicandal e na ingac iono  lex- ionandex ensiono  heuppe andlowe ex emi ies,aswellas hein ol emen o  he s abilizingmuscleso  he unkandbackdu ing hediffe en phaseso  owing[42,43]. Cu en ly,limi ede idenceisa ailableon heimpac o  owingonca diac unc ion andbloodp essu einb eas cance su i o s[44].The e o e, heaimo  he ollowing s udywillbe oexamine hein luenceo a owing-based ainingp og amonca diac unc ionandae obiccapaci yin emaleb eas cance su i o s,aswellas ocompa e he in luenceo boa  ypeon hepossibleca dio ascula adap a ions. 2.Ma e ialsandMe hods 2.1.DesignandPa icipan s This esea chispa o concu en clinical ials.Tosuppo  his,a24-week aining egimen,conduc ed wiceaweek,wasde eloped o useinbo hFSRandSSRboa s(Fig- u e1).Va iousb eas cance suppo g oupswe eapp oachedandgi en heoppo uni y opa icipa eina ee24-week owingp og am,whichincludedphysicale alua ionsa  hebeginningandconclusiono  hep og am.Theonlyc i e ia o pa icipa ionwe ea his o yo b eas cance andapp o al om hei oncologis  oengageinmode a ephysical ac i i y.  Figu e1.Timelineo  hes udy.6MWT:6-minwalk es ;AM:an h opome icmeasu emen s. Thepa icipan s(n=40),aged56.78±6.38yea s,we e ec ui edon hecondi ion ha  heyhadbeendiagnosedwi hb eas cance 6.58±5.72yea sp e iously,wi h a ying deg eeso in ol emen andwi hsubsequen su ge y,asshowninTable1. Table1.Cha ac e is icso  hesample. B eas (%) Righ :37.5Le :57.5Bo h:5.0 S age(%) I:7.5II:37.5III:40.0IV:15.0 Su ge y(%) B eas Conse ing:50.0To alMas ec omy:42.5DoubleMas ec omy:7.5 A e  heini ialselec ion, hena u eo  hes udywasexplained o hepa icipan s, indica ing ha  hei anonymi ywouldbemain aineda all imes, ollowing hee hical conside a ionso Spo andExe ciseScienceResea ch[45]andwi h hep inciplesin- cludedin heDecla a iono Helsinki[46],whichde ine hee hicalguidelines o  esea ch inhumans.TheUni e si yo Malagap o ided heiden i ica ionnumbe  egis e ed o  Figu e 1. Timeline o he s udy. 6 MWT: 6-min walk es ; AM: an h opome ic measu emen s. The pa icipan s (n= 40), aged 56.78 ± 6.38 yea s, we e ec ui ed on he condi ion ha hey had been diagnosed wi h b eas cance 6.58 ± 5.72 yea s p e iously, wi h a ying deg ees o in ol emen and wi h subsequen su ge y, as shown in Table 1. Table 1. Cha ac e is ics o he sample. B eas (%) Righ : 37.5 Le : 57.5 Bo h: 5.0 S age (%) I: 7.5 II: 37.5 III: 40.0 IV: 15.0 Su ge y (%) B eas Conse ing: 50.0 To al Mas ec omy: 42.5 Double Mas ec omy: 7.5 A e he ini ial selec ion, he na u e o he s udy was explained o he pa icipan s, indica ing ha hei anonymi y would be main ained a all imes, ollowing he e hical conside a ions o Spo and Exe cise Science Resea ch [ 45 ] and wi h he p inciples included in he Decla a ion o Helsinki [ 46 ], which de ine he e hical guidelines o esea ch in humans. The Uni e si y o Malaga p o ided he iden i ica ion numbe egis e ed o he E hics Commi ee: 65-2020-H, and he pa icipan s (Figu e 2) p o ided w i en in o med consen . Th oughou he in e en ion and subsequen ly, we ac ed unde he p o isions o o ganic law 3/2018, o Decembe 5, on he P o ec ion o Pe sonal Da a and Gua an ee o Digi al Righ s, ega ding he p o ec ion o pe sonal da a unde Spanish legisla ion. Appl. Sci. 2024,14, 6239 4 o 12 Appl.Sci.2024,14,xFORPEERREVIEW4o 13  heE hicsCommi ee:65-2020-H,and hepa icipan s(Figu e2)p o idedw i enin- o medconsen .Th oughou  hein e en ionandsubsequen ly,weac edunde  hep o- isionso o ganiclaw3/2018,o Decembe 5,on heP o ec iono Pe sonalDa aandGua - an eeo Digi alRigh s, ega ding hep o ec iono pe sonalda aunde Spanishlegisla- ion.  Figu e2.A lowdiag amo  hesampleselec ed o  hiss udy. 2.2.Ins umen s ATani amodelBC730scale(Tani aCo po a ion,Tokyo,Japan),accu acy0.1kg,was used oweigh hesubjec s,andaSECAmodel213po ablemeasu ing od(SecaGmbH &Co.KG,Hambu g,Ge many),accu acy0.1cm,wasused omeasu eheigh .The6-min walk es wasused oe alua eca diac unc ion,whichisa alidand eliable es  ha  assessesape son’sca dio espi a o ycapaci ybymeasu ing hemaximumdis ance hey canwalkona la su acein6min.A  hesame ime,hea  a epe minu ewasmoni o ed immedia elybe o eanda e  inishing he es usingaPola H10ches s ap(Pola Elec o Oy,Kempele,Finland),whichwas i edbe o e hes a o  he es and ansmi ed he signal o hePOLAR able applica ion.Fo bloodp essu emeasu emen , heOm onM6 Com o ITb achialbloodp essu emoni o (Om onHeal hca eCo.,L d.,Kyo o,Japan) wasused,whichindica essys olicanddias olicbloodp essu eandpulse a epe minu e. 2.3.P ocedu e Amongall hewomenwhoexp essedin e es ,ase ieso physical i nessassessmen s we econduc ed.Wi hequi alen an h opome icmeasu emen s(weigh ,heigh ,BMI) and es  esul s,apa icipan wasassigned ooneg oup(FSRo SSR).Thepa icipan  wi h hemos compa able esul swasassigned o heo he g oup(SSRo FSR).Subjec s pa icipa ingin hes udyal eadyengagedinmode a eand egula physicalac i i y.The pa icipan swe e husdi idedin o wo ainingg oupswi hsimila cha ac e is ics(Table 2):   Figu e 2. A low diag am o he sample selec ed o his s udy. 2.2. Ins umen s A Tani a model BC730 scale (Tani a Co po a ion, Tokyo, Japan), accu acy 0.1 kg, was used o weigh he subjec s, and a SECA model 213 po able measu ing od (Seca GmbH & Co. KG, Hambu g, Ge many), accu acy 0.1 cm, was used o measu e heigh . The 6-min walk es was used o e alua e ca diac unc ion, which is a alid and eliable es ha assesses a pe son’s ca dio espi a o y capaci y by measu ing he maximum dis ance hey can walk on a la su ace in 6 min. A he same ime, hea a e pe minu e was moni o ed immedia ely be o e and a e inishing he es using a Pola H10 ches s ap (Pola Elec o Oy, Kempele, Finland), which was i ed be o e he s a o he es and ansmi ed he signal o he POLAR able applica ion. Fo blood p essu e measu emen , he Om on M6 Com o IT b achial blood p essu e moni o (Om on Heal hca e Co., L d., Kyo o, Japan) was used, which indica es sys olic and dias olic blood p essu e and pulse a e pe minu e. 2.3. P ocedu e Among all he women who exp essed in e es , a se ies o physical i ness assessmen s we e conduc ed. Wi h equi alen an h opome ic measu emen s (weigh , heigh , BMI) and es esul s, a pa icipan was assigned o one g oup (FSR o SSR). The pa icipan wi h he mos compa able esul s was assigned o he o he g oup (SSR o FSR). Subjec s pa icipa ing in he s udy al eady engaged in mode a e and egula physical ac i i y. The pa icipan s we e hus di ided in o wo aining g oups wi h simila cha ac e is ics (Table 2): Table 2. Desc ip i e analysis o s udy subjec s acco ding o aining g oup. TOTAL (SSR + FSR) Fixed Sea Rowing (FSR) Sliding Sea Rowing (SSR) Di e ence o Means (FSR-SSR) p Age (yea s) (SD) 56.78 (6.38) 56.35 (4.89) 57.2 (7.7) −0.85 (2.04) 0.679 Heigh (cm) (SD) 162.05 (5.59) 161.9 (4.91) 162.2 (6.33) −0.3 (1.79) 0.868 Weigh (kg) (SD) 69.49 (9.8) 72.05 (8.11) 66.92 (10.85) 3.22 (3.11) 0.307 BMI (kg/m2) (SD) 26.48 (3.58) 27.48 (2.73) 25.47 (4.09) 1.50 (1.18) 0.215 Res HR (bpm) (SD) 94.33 (11.81) 96.1 (11.54) 92.55 (11.51) 3.55 (3.91) 0.241 Ini ial Tes HR (bpm) (SD) 92.83 (12.76) 94.1 (14.21) 91.55 (10.58) 2.55 (4.05) 0.974 Final Tes HR (bpm) (SD) 139.5 (18.44) 141,75 (18.67) 137.25 (17.44) 4.5 (6.32) 0.888 Dias olic BP (mmHg) (SD) 160.03 (13.37) 158.25 (12.8) 161.8 (13.35) −3.55 (4.69) 0.405 Sys olic BP (mmHg) (SD) 100.78 (10.19) 100.55 (10.51) 101 (9.59) −0.45 (3.9) 0.856 6 MWT (m) (SD) 784.78 (103.64) 817.25 (51.1) 752.3 (127.37) 64.95 (44.43) 0.077 Appl. Sci. 2024,14, 6239 5 o 12 The 24-week owing aining p og am was di ided in o h ee 4-week s ages. These s ages p og essi ely inc eased in in ensi y and we e adjus ed h ough he pa icipan s’ subjec i e pe cep ion o e o using he Bö g scale [47]. • Ini ial phase wi h mobili y exe cises, p op iocep i e exe cises, and pos u al con ol exe cises. Main phase wi h owing aining. Final phase wi h s e ching. Bö g scale 5–6. • In e media e phase wi h mobili y exe cises, p op iocep i e exe cises, and pos u al con ol exe cises. Main phase wi h owing aining. Final phase wi h s e ching. Bö g scale 6–7. • Final phase wi h mobili y exe cises, p op iocep i e exe cises, and pos u al con ol exe cises. Main phase wi h owing aining. Final phase wi h s e ching. Bö g scale 7–8. Th oughou he p og am, he e we e 2 days o aining pe week. Each session las ed 75 min. These sessions we e supe ised by a aine who ensu ed a endance, co ec execu ion o he asks, and in ensi y o he sessions, in addi ion o excluding om he s udy hose subjec s who did no achie e a leas 90% pa icipa ion. Each aining session had he same s uc u e: 1. Ini ial pa pe o med wi h wa m-up, mobili y, p op iocep i e, and pos u al con ol exe cises, all pe o med in a mul ipu pose oom (5–10 min). 2. Cool down: Flexibili y exe cises o elax he muscles and b ing he body back o i s ini ial s a e a e he e o (10–15 min). 2.4. Da a Analysis All analyses we e pe o med wi h he IBM SPSS S a is ics 25 s a is ical package. The signi icance le el was se a p< 0.05. The adjus men o he di e en a iables o he no mal dis ibu ion was assessed by bo h g aphic p ocedu es and he Shapi o–Wilk es . To de e mine whe he he e we e di e ences as a esul o he owing aining un- de aken by he pa icipan s, he medians o each a iable p e- and pos -in e en ion we e analyzed using he Wilcoxon es o ela ed samples (pai ed da a). In addi ion, he g aphic analysis o he di e en a iables was pe o med using boxplo s o box and whiske plo s. To analyze whe he he e we e di e ences acco ding o he owing aining pe o med by he pa icipan s, he da a om he p e- es and pos - es measu emen s we e compa ed h ough he di e en es s. The es ima ed be ween-subjec ma ginal means (Boa *Measu emen ) and he s anda d de ia ion we e conside ed when quan i ying he in e ac ion be ween he a iables and hei longi udinal e olu ion h ough a epea ed- measu es ANOVA, applying he Bon e oni pos hoc es . 3. Resul s Table 3shows he e olu ion o he esul s ob ained a e ca ying ou he owing- based aining p o ocol aking in o accoun he measu emen s in bo h g oups. The e was a signi ican imp o emen in he mean alues o ca diac a iables, blood p essu e and ca dio espi a o y capaci y a e he in e en ion p og am. Table 3. Wi hin-subjec analysis o he s udy a iables a e he in e en ion p og am. P e-Tes (SD) Pos -Tes (SD) ∆p e-pos (SD) S uden ’s E ec Size p Res HR (bpm) 94.33 (11.81) 84.78 (11.27) −9.55 (7.29) 8.275 1.154 0.000 ** Ini ial Tes HR (bpm) 92.83 (12.76) 81.85/11.35) −10.97 (7.59) 9.145 1.2 0.000 ** Final Tes HR (bpm) 139.5 (18.44) 122.4 (19.17) −17.1 (15.69) 6.891 2.481 0.000 ** Dias olic BP (mmHg) 160.03 (13.37) 144.23 (18.6) −15.8 (16.36) 6.109 2.587 0.000 ** Sys olic BP (mmHg) 100.78 (10.19) 85.8 (9.8) −14.97 (10.86) 8.716 1.718 0.000 ** 6 MWT (m) 784.78 (103.64) 863.13 (108.75) +78.35 (62.57) −7.92 9.893 0.000 ** Bpm = bea s pe minu e; mmHg = millime es o me cu y; SD = s anda d de ia ion; MS = mean squa e. ** p< 0.001. Appl. Sci. 2024,14, 6239 6 o 12 I we look a he di e ences ob ained acco ding o he ype o essel used in he aining p og am (Table 4), we see ha bo h he subjec s who pe o med FSR and hose who pe o med SSR signi ican ly imp o ed all he pa ame e s ela ed o ca diac unc ion and ca dio espi a o y capaci y. Fu he mo e, in he SSR g oup, be e esul s we e ob ained a e he in e en ion p o ocol in all he a iables o he s udy compa ed o he FSR g oup (Ini ial HR, Final HR, Dias olic BP, Sys olic BP and he 6-min walk es [6 MWT]), excep in Res HR, which also shows a posi i e e olu ion. Table 4. Wi hin-subjec analysis o he s udy a iables acco ding o boa ype. Fixed Sea Rowing (FSR) Sliding Sea Rowing (SSR) In e ac ion E ec Boa Measu emen P e-Tes (SD) Pos -Tes (SD) ∆p e-pos P e-Tes (SD) Pos -Tes (SD) ∆p e-pos MS F p Res HR (bpm) 96.1 (11.54) 85.45 (11.28) − 10.65 92.55 (11.51) 84.1 (10.93) − 8.45 126.05 0.9 0.000 ** Ini ial es HR (bpm) 94.1 (14.21) 83.4 (12.86) −10.7 91.55 (10.58) 80.3 (8.99) − 11.25 65.02 0.39 0.000 ** Final es HR (bpm) 141,75 (18.67) 127.9 (22.38) − 13.85 137.25 (17.44) 116.9 (12.47) − 20.35 202.5 0.59 0.000 ** Dias olic BP (mmHg) 158.25 (12.8) 145.9 (17.32) − 12.35 161.8 (13.35) 142.55 (19.2) − 19.25 126.05 0.7 0.000 ** Sys olic BP (mmHg) 100.55 (10.51) 87.55 (8.11) −13 101 (9.59) 84.05 (10.73) − 16.95 2.02 0.02 0.000 ** 6 MWT (m) 817.25 (51.1) 880.3 (69.96) +63.05 752.3 (127.37) 845.95 (132.58) +93.65 42,185.02 4.25 0.000 ** In e ac ion E ec Boa Measu emen e e s o he in luence o he ype o boa used acco ding o he aining g oup on he a iables. Bpm = bea s pe minu e; mmHg = millime es o me cu y; 6 MWT = 6-min walk es ; SD = s anda d de ia ion; MS = mean squa e. ** p < 0.001. An in-dep h analysis o he esul s is shown in Figu e 3, conside ing he ype o boa used in he aining p o ocol and he e olu ion o he a iables associa ed wi h ca diac unc ion a es , be o e s a ing he 6 MWT and a he end o he es . Bo h g oups had signi ican imp o emen s in es ing hea a e (FSR: ∆p e-pos Res HR = − 10.65; p= 0.000; SSR: ∆p e-pos Res HR = − 8.45; p= 0.000), ini ial a e be o e he es (FSR: ∆p e-pos Ini ial HR = − 10.7; p= 0.000; SSR: ∆p e-pos Ini ial HR = − 11.25; p= 0.000) and inal a e a e he es (FSR: ∆p e-pos Final HR = − 13.85; p= 0.000; SSR: ∆p e-pos Final HR = − 20.35; p= 0.000). Appl.Sci.2024,14,xFORPEERREVIEW7o 13   Figu e3.Compa isono ca diac a iablesbe o eanda e  owing ainingacco ding oboa  ype. HR=hea  a e;FSR= ixedsea  owing;SSR=slidingsea  owing.*p<0.05;**p<0.001. Figu e4p o ides hebloodp essu emeasu emen sob ainedbe o eanda e  he6 MWT.Bo h heFSRandSSRg oupsshowedsigni ican imp o emen sinsys olic(FSR: Δ p e-pos Sys olicBP=−13;p=0.000;SSR:Δ p e-pos Sys olicBP=−16.25;p=0.000)anddias olic (FSR:Δ p e-pos Dias olicBP=−12.35;p=0.000;SSR:Δ p e-pos Dias olicBP=−19.25;p=0.000) bloodp essu e,al hough heseimp o emen swe esligh lyg ea e in hewomenwho owedin heSSRg oup.  Figu e4.Compa isono bloodp essu ebe o eanda e  owing ainingacco ding oboa  ype.BP =bloodp essu e;FSR= ixedsea  owing;SSR=slidingsea  owing.**p<0.001. 4.Discussion In ecen yea s, he apeu icp og amsbasedon owingha ebeenp oposedasa ype o non-pha macologicals a egy ha modula esad e seeffec sin emaleb eas cance  su i o sbyin ol ingmode a e-in ensi yphysicalexe cise ha combinesae obicand Figu e 3. Compa ison o ca diac a iables be o e and a e owing aining acco ding o boa ype. HR = hea a e; FSR = ixed sea owing; SSR = sliding sea owing. * p < 0.05; ** p< 0.001. Figu e 4p o ides he blood p essu e measu emen s ob ained be o e and a e he 6 MWT. Bo h he FSR and SSR g oups showed signi ican imp o emen s in sys olic (FSR: ∆p e-pos Sys olic BP = − 13; p= 0.000; SSR: ∆p e-pos Sys olic BP = − 16.25; p= 0.000) and dias olic (FSR: ∆p e-pos Dias olic BP = − 12.35; p= 0.000; SSR: ∆p e-pos Dias olic BP = − 19.25; Appl. Sci. 2024,14, 6239 7 o 12 p= 0.000) blood p essu e, al hough hese imp o emen s we e sligh ly g ea e in he women who owed in he SSR g oup. Appl.Sci.2024,14,xFORPEERREVIEW7o 13   Figu e3.Compa isono ca diac a iablesbe o eanda e  owing ainingacco ding oboa  ype. HR=hea  a e;FSR= ixedsea  owing;SSR=slidingsea  owing.*p<0.05;**p<0.001. Figu e4p o ides hebloodp essu emeasu emen sob ainedbe o eanda e  he6 MWT.Bo h heFSRandSSRg oupsshowedsigni ican imp o emen sinsys olic(FSR: Δ p e-pos Sys olicBP=−13;p=0.000;SSR:Δ p e-pos Sys olicBP=−16.25;p=0.000)anddias olic (FSR:Δ p e-pos Dias olicBP=−12.35;p=0.000;SSR:Δ p e-pos Dias olicBP=−19.25;p=0.000) bloodp essu e,al hough heseimp o emen swe esligh lyg ea e in hewomenwho owedin heSSRg oup.  Figu e4.Compa isono bloodp essu ebe o eanda e  owing ainingacco ding oboa  ype.BP =bloodp essu e;FSR= ixedsea  owing;SSR=slidingsea  owing.**p<0.001. 4.Discussion In ecen yea s, he apeu icp og amsbasedon owingha ebeenp oposedasa ype o non-pha macologicals a egy ha modula esad e seeffec sin emaleb eas cance  su i o sbyin ol ingmode a e-in ensi yphysicalexe cise ha combinesae obicand Figu e 4. Compa ison o blood p essu e be o e and a e owing aining acco ding o boa ype. BP = blood p essu e; FSR= ixed sea owing; SSR = sliding sea owing. ** p< 0.001. 4. Discussion In ecen yea s, he apeu ic p og ams based on owing ha e been p oposed as a ype o non-pha macological s a egy ha modula es ad e se e ec s in emale b eas cance su i o s by in ol ing mode a e-in ensi y physical exe cise ha combines ae obic and muscle s eng h aining [ 35 ]. The po en ial o his ac i i y lies in a iable, sus ainable, and sa e model ha can be ole a ed by di e en age g oups [ 7 , 35 , 44 ]. Consequen ly, ecen s udies ha e shown, a e 4 yea s o ollow-up, ha women who pa icipa ed in d agon boa aining we e able o main ain hei ca diac pa ame e s wi hin no mal anges o hei age (compa ed o heal hy ac i e indi iduals), despi e chemo he apy ea men , in addi ion o no de eloping any ype o ca diac condi ion du ing his pe iod [ 44 ]. O he s udies, conduc ed o e 12 weeks in his ype o essel, ha e epo ed a 30% imp o e- men in ca dio espi a o y capaci y, also measu ed h ough he 6 MWT [ 4 ]. Despi e hese imp o emen s, he e a e no s udies ha e i y which ype o boa is mo e sui able when designing no el he apeu ic p og ams based on owing ac i i y, since he muscle g oups and exe cise dynamics in ol ed in ixed sea owing di e om owing on a sliding sea . Wi h his in mind, s a is ically signi ican imp o emen s in ca diac unc ion, sys olic and dias olic blood p essu e, and ca dio espi a o y capaci y can be obse ed when analyz- ing he esul s o ou s udy. These imp o emen s a e implemen a ion o he in e en ion p o ocol occu in bo h he FSR g oup and he owe s who pa icipa ed in he SSR. When compa ing he g oups, a highe a e o imp o emen in es ing hea a e can be seen in he FSR g oup, while he emale b eas cance su i o s who pa icipa ed in he SSR g oup had g ea e imp o emen s in he a iables o hea a e be o e and a e he 6 MWT, sys olic and dias olic blood p essu e, and dis ance a eled in he 6 MWT (di ec ly co ela ed wi h he ca dio espi a o y capaci y and VO2max o he subjec s). Acco ding o he da a, al hough he owing ac i i y i sel can p omo e ca diac adap a ions ha op imize he unc ioning o he ca dio ascula sys em, wi h he SSR modali y, g ea e adap a ions occu compa a i ely conside ing he same ime span (12 weeks). Ca diac unc ion adap a ions we e also ound a e a 12-week in e en ion when we compa ed he esul s, ocusing on he a iables o ou s udy, wi h p e ious s udies ha used owing aining p og ams in b eas cance su i o s [ 48 ]. The esul s showed a 10% Appl. Sci. 2024,14, 6239 8 o 12 imp o emen in he sys olic and dias olic blood p essu e o he pa icipa ing women. These esul s a e consis en wi h o he owing s udies, such as hose by S e ani e al. [ 44 ], which showed signi ican imp o emen s in dias olic unc ion in women b eas cance su i o s ea ed wi h chemo he apy a e 4 yea s o d agon boa aining [ 44 ], o by Se a e al. [ 49 ], who ound ha a 16-week esis ance aining p og am imp o ed sys olic and dias olic blood p essu e by 5% in b eas cance su i o s. These esul s indica e he posi i e impac ha a p o essionally supe ised in e en ion p og am based on owing could ha e on myoca dial unc ion, e en in women p e iously ea ed wi h chemo he apy [44]. This is impo an because one o he main p oblems associa ed wi h oncological ea - men s is chemo he apy-induced ca dio oxici y, which has di ec and indi ec ad e se e ec s on he ca dio ascula sys em [ 9 , 50 , 51 ]. As an example, i has been shown ha he inci- dence o le en icula dys unc ion among pa ien s ea ed wi h ce ain an icance d ugs, such as high-dose doxo ubicin (700 mg/m 2 ), can each 48%. The incidence o myoca dial ischemia due o 5- luo ou acil (5-FU) can be as high as 10% [ 52 , 53 ]. Fu he mo e, be ween 26% and 93% o pa ien s wi h a senic ioxide show a p olonged QT in e al, and many de elop li e- h ea ening en icula achya hy hmias [ 54 ]. As a esul , chemo he apy- induced ca dio oxici y has been associa ed wi h ca dio ascula diseases such as myoca dial dys unc ion, hea ailu e, co ona y a e y disease, a hy hmias, a e ial hype ension, h omboembolic disease, pe iphe al ascula disease, pulmona y hype ension, and pe i- ca dial complica ions [9,55]. In his con ex , clinical ials in b eas cance su i o s based on pha macological s a e- gies (e.g., be a-blocke s, angio ensin-con e ing enzyme inhibi o s, e c.) ha e shown some bene i s in he ea men o ca dio ascula disease, bu also ad e se e ec s [ 8 ]. A owing- based aining p og am o e s a non-pha macological he apy ha can sa ely con ibu e o achie ing he goals p oposed by he Ame ican College o Spo s Medicine (ACSM), which ecommends ha cance su i o s pe o m a leas 150 min o mode a e physical ac i i y o 75 min o igo ous exe cise, as well as inco po a ing s eng h aining, wice a week [ 56 ]. Re iews, such as ha by S u geon e al. [ 10 ], sugges ha ae obic exe cise has a mode a e e ec on imp o ing ca diac unc ion in women wi h b eas cance , consis en wi h indings in disease- ee popula ions. Fu he mo e, Gonzalo-Encabo e al. [ 8 ] a e e iewing published s udies, ound ha 16 weeks o ae obic and esis ance aining can educe he isk o ca dio ascula disease by 15% in Hispanic and La ina b eas cance su i o s (a g ea e isk han he es o he popula ion o de eloping his ype o disease). Rowing is an ac i i y ha combines he bene i s o ae obic exe cise and s eng h aining and can ha e a bene icial e ec on ca dio ascula heal h in emale b eas cance su i o s [ 48 ]. In his s udy, we can see a di ec ly p opo ional ela ionship be ween ca dio espi a o y capaci y, hea a e, and blood p essu e in emale owe s who pa icipa ed in bo h aining g oups. Be e ca dio espi a o y capaci y imp o es he hea ’s abili y o main ain unc ion and pump blood wi h less e o [ 57 ]. Exe cise can also imp o e he egula ion o he au onomic ne ous sys em, educing he ac i i y o he sympa he ic ne ous sys em (which inc eases blood p essu e and hea a e) and inc easing ha o he pa asympa he ic ne ous sys em (which dec eases hea a e) [ 9 , 26 ]. Ou s udy showed an o e all imp o emen o 9–10 bea s less a es a e 12 weeks o aining. In addi ion, exe cise-induced imp o emen o endo helial unc ion [ 8 ] may lead o imp o ed a e ial heal h con ibu ing o he p e en ion o diseases such as hype ension. As we can see, a e 24 weeks o owing aining, dias olic blood p essu e dec eased o e all by 10%, while sys olic blood p essu e dec eased by 15%. Mo eo e , hese esul s we e mo e p ominen in he SSR g oup owing on a sliding sea boa han in he FSR g oup, which owed on a ixed sea boa . In ou case, we ha e used owing as a no el discipline since, p io o ou s udies, he e was no li e a u e on his ac i i y, which, like d agon boa ing, is conduc ed on wa e . Despi e being a minimally inju ious social spo ha exe cises he en i e body h ough symme ical mo emen , owing does no ha e he same adi ion as d agon boa ing [ 40 , 58 ]. Fu he mo e, ou coun y has a s ong adi ion o owing, no only a he compe i i e Appl. Sci. 2024,14, 6239 9 o 12 Olympic le el (sculling) bu also deeply oo ed in coas al cul u e and adi ion ( ixed sea owing). This is why we dis inguished hese wo g oups. On he o he hand, he isk o lymphedema ollowing axilla y su ge y, such as axilla y lymph node dissec ion, is a signi ican conce n o b eas cance pa ien s [ 59 ]. Engaging in physical ac i i ies, including owing, poses po en ial isks and bene i s. Rowing, which in ol es epe i i e uppe body mo emen s and conside able exe ion, can po en ially exace ba e lymphedema due o inc eased luid accumula ion and s ess on he lympha ic sys em. Howe e , con olled and supe ised physical ac i i ies ha e been shown o be bene icial in main aining lympha ic unc ion and educing he isk o lymphedema, imp o ing ci cula ion and ac ing on he muscle as a pump du ing muscle con ac ion, which p omo es enous and lympha ic d ainage [ 7 , 60 ]. I is c ucial o pa ien s o consul wi h heal hca e p o ide s o de elop pe sonalized exe cise p og ams ha conside he ype and ex en o su ge y, cu en physical condi ion, and isk ac o s o lymphedema. P ope echnique, g adual p og ession, and he use o comp ession ga men s du ing physical ac i i y can also help mi iga e he isks associa ed wi h owing and o he uppe body exe cises [7,58]. Despi e ad ances in esea ch on he ela ionship be ween physical exe cise and non- pha macological oncological he apy, he e is s ill insu icien scien i ic e idence o de elop an exe cise p esc ip ion o mos people wi h his disease [ 10 ]. Mo e esea ch is he e o e needed o unde s and how physical ac i i y and spo in e ac wi h he disease, wha he consequences a e o he indi idual and wha he bes s a egies a e o oncological ehabili a ion h ough exe cise [21,24]. The s eng h o his pionee ing s udy is he da a i p o ides on physical ac i i y and owing, no only demons a ing ha owing is a iable and sa e spo o b eas cance su i o s, bu also which ype o boa p oduces he g ea es posi i e changes in ca diac unc ion in he pa icipan s. Howe e , he s udy also has some limi a ions ela ed o he sample powe o he pa icipan s. Ou indings a e based on a ela i ely small sample, due o he e y speci ic popula ion encompassed by he s udy, he complexi y in i s ec ui men and subsequen ollow-up du ing he in e en ion p o ocol. 5. Conclusions The p esen s udy shows ha a owing-based he apeu ic p og am, combining ae obic and muscula s eng h exe cises, can be a iable and sa e s a egy o imp o e ca dio as- cula heal h in emale b eas cance su i o s. I has been demons a ed ha 24 weeks o owing aining can signi ican ly imp o e ca diac unc ion, blood p essu e, and ca - dio espi a o y capaci y, and may mi iga e he ad e se e ec s o ca dio oxici y induced by cance ea men s. These esul s a e pa icula ly no ewo hy in he g oup using SSR boa s, which showed g ea e ca dio ascula adap a ions compa ed o he g oup using FSR boa s. This no el s udy highligh s he impo ance o u he explo ing and alida ing he bene icial e ec s o physical exe cise in cance ehabili a ion, opening he doo o new non-pha macological he apeu ic s a egies o imp o e he heal h and well-being o his ulne able popula ion. Au ho Con ibu ions: Concep ualiza ion, J.G.-G. (Juan Ga ala-González), M.R.-P. and J.C.F.-G.; me hodology, J.G.-G. (Juan Ga ala-González) and J.G.-G. (Juan Gamboa-González); so wa e, M.R.-P.; alida ion, J.C.F.-G., J.G.-G. (Juan Ga ala-González) and J.G.-G. (Juan Gamboa-González); o mal analysis, M.R.-P.; in es iga ion, M.R.-P. and J.G.-G. (Juan Gamboa-González); esou ces, J.G.-G. (Juan Gamboa-González) and M.R.-P.; da a cu a ion, J.G.-G. (Juan Ga ala-González); w i ing—o iginal d a p epa a ion, M.R.-P. and J.G.-G. (Juan Gamboa-González); w i ing— e iew and edi ing, M.R.-P., J.G.-G. (Juan Ga ala-González) and J.C.F.-G.; isualiza ion, J.G.-G. (Juan Ga ala-González); supe ision, J.C.F.-G.; p ojec adminis a ion, J.G.-G. (Juan Ga ala-González). All au ho s ha e ead and ag eed o he published e sion o he manusc ip . Funding: This esea ch ecei ed no ex e nal unding.