Optimal Timing of a Physical Exercise Intervention to Improve Cardiorespiratory Fitness: During or After Chemotherapy

Gabriela G F van der Schoot; Harm L Ormel; Nico-Derk L Westerink; Anne M May; Sjoerd G Elias; Yoran M Hummel; Joop D Lefrandt; Peter van der Meer; Joost P van Melle; Boelo J Poppema; Joyce M A Stel; Annette W G van der Velden; Aline H Vrieling; Johan B Wempe; Marcel G Ten Wolde; Marcel Nijland; Elisabeth G E de Vries; Jourik A Gietema; Annemiek M E Walenkamp

doi:10.1016/j.jaccao.2022.07.006

Optimal Timing of a Physical Exercise Intervention to Improve Cardiorespiratory Fitness: During or After Chemotherapy

JACC CardioOncol. 2022 Oct 18;4(4):491-503. doi: 10.1016/j.jaccao.2022.07.006. eCollection 2022 Nov.

Authors

Gabriela G F van der Schoot¹, Harm L Ormel¹, Nico-Derk L Westerink¹, Anne M May², Sjoerd G Elias², Yoran M Hummel³, Joop D Lefrandt⁴, Peter van der Meer⁵, Joost P van Melle⁵, Boelo J Poppema^{1

6}, Joyce M A Stel⁷, Annette W G van der Velden⁸, Aline H Vrieling⁷, Johan B Wempe³, Marcel G Ten Wolde⁷, Marcel Nijland⁹, Elisabeth G E de Vries¹, Jourik A Gietema¹, Annemiek M E Walenkamp¹

Affiliations

¹ Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
² Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
³ Department of Pulmonary Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
⁴ Department of Vascular Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
⁵ Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
⁶ Department of Internal Medicine, Ommelander Hospital Groningen, Scheemda, the Netherlands.
⁷ Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
⁸ Department of Internal Medicine, Martini Hospital Groningen, Groningen, the Netherlands.
⁹ Department of Hematology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.

Abstract

Background: Despite the widely acknowledged benefit of exercise for patients with cancer, little evidence on the optimal timing of exercise on adverse effects of cancer treatment is available.

Objectives: The aim of this study was to determine whether an exercise intervention initiated during chemotherapy is superior to an intervention initiated after chemotherapy for improving long-term cardiorespiratory fitness (peak oxygen uptake [VO_2peak]).

Methods: In this prospective, randomized clinical trial, patients scheduled to receive curative chemotherapy were randomized to a 24-week exercise intervention, initiated either during chemotherapy (group A) or afterward (group B). The primary endpoint was VO_2peak 1 year postintervention. Secondary endpoints were VO_2peak postintervention, muscle strength, health-related quality of life (HRQoL), fatigue, physical activity, and self-efficacy. Between-group differences were calculated using intention-to-treat linear mixed-models analyses.

Results: A total of 266 patients with breast (n = 139), testicular (n = 95), and colon cancer (n = 30) as well as lymphoma (n = 2) were included. VO_2peak immediately postintervention and 1 year postintervention did not differ between the 2 groups. Immediately postchemotherapy, patients in group A exhibited significantly lower decreases in VO_2peak (3.1 mL/kg/min; 95% CI: 2.2-4.0 mL/kg/min), HRQoL, and muscle strength and reported less fatigue and more physical activity than those in group B.

Conclusions: Exercise can be safely performed during chemotherapy and prevents fatigue and decreases in VO_2peak, muscle strength, and HRQoL, in addition to hastening the return of function after chemotherapy. Also, if exercise cannot be performed during chemotherapy, a program afterward can enable patients to regain the same level of function, measured 1 year after completion of the intervention. (Optimal Timing of Physical Activity in Cancer Treatment [ACT]; NCT01642680).

Keywords: HIIT, high-intensity interval training; HRQoL, health-related quality of life; MET-h, the amount of kcal burnt per kilogram body weight per hour; PASE, Physical Activity Scale for the Elderly; SAE, serious adverse event(s); UMCG, University Medical Center Groningen; VO2peak, peak oxygen uptake; cardiorespiratory fitness; chemotherapy; fatigue; muscle strength; physical exercise; quality of life.

Associated data

ClinicalTrials.gov/NCT01642680