Conceptual development of an intensive exercise program for glioma patients (ActiNO): summary of clinical experience

Abstract

Purpose Exercise proved to reduce cancer-related symptoms and prolong survival in some cancer types. However, brain tumor patients are often advised against strenuous exercise. Here, we summarize our experience with a submaximal exercise program for glioma patients: ActiNO (Active in Neuro-Oncology). Methods Glioma patients were invited to participate in the program. Since 2011, a sports scientist individualized two one-hour sessions per week adapted to the patients’ symptoms. One session consisted of bicycle ergometry (average workload: 75% of maximum heart rate), the other of whole-body resistance training. Both sessions were further complimented by coordinative elements. Cardiorespiratory fitness was assessed using the ”Physical Work Capacity” procedure. Patients were followed up regularly to assess adherence to the program and disease activity. Results Until December 2019, 45 glioma patients, median-aged 49 years (IQR 42–59), were included in the analysis. Most patients suffered from glioblastoma (58%), followed by diffuse lower-grade astrocytoma (29%). In overall 1828 training sessions, two minor epileptic events occurred (1 speech arrest; 1 focal seizure). During fitness assessment, all patients achieved at least 75% of their age-adjusted maximum heart rate. Peak workload averaged 172 W (95% CI 156–187). Median survival of participating glioblastoma patients was 24.1 months (95% CI 8.6–39.5). Conclusion This supervised training program with submaximal exertion was feasible and safe in glioma regardless of WHO grading. Based on these experiences, we initiated a prospective multicenter study to objectify improvements in physical performance and quality of life in patients with glioblastoma.

Maximal cardiopulmonary exercise testing in glioblastoma patients undergoing chemotherapy: assessment of feasibility, safety, and physical fitness status

“…Just in one case, a short, transient, minor post-test dizziness occurred, with no intervention required. These results align with our previous work, using less sophisticated assessment in a retrospective design [ 7 ]. As of now, apart from one study [ 24 ], there have been no known investigations in which GBM patients were subjected to maximal stress during CPET.…”

“…CPET in patients with GBM undergoing chemotherapy. The data presented in this paper were collected as part of the baseline assessment of an ongoing prospective study in malignant glioma (ClinicalTrials NCT05015543) that aims to investigate the impact of a 16-week exercise program “ActiNO” [ 7 ] primarily on the physical performance in this patient population (abbreviated “MMH”: M obil M it H irntumor (German); English: active with brain tumor). The study was approved by the local ethics committee (file number: 2015–087-f-S).…”

“…1 . To examine the hypothesis derived from our previous investigation, the protocol utilized in the present study closely resembled the methodology employed in our previous report (e.g., 25 Watt increments) [ 7 ], albeit with some distinctions. Due to the absence of a spiroergometric system in our previous study, the pulse-related power in watts at 75% of age-adjusted HRmax, known as Physical Work Capacity (PWC) assessed patients’ physical performance.…”

“…Table 2 )). Moreover, the present study involved PWC using the same procedure as described in a previous paper [ 7 ].…”

“…Further, limited studies, especially in GBM, hinder definitive exercise guidelines. To address this gap we aimed to accurately create and evaluate an exercise intervention program in GBM, building upon our experience spanning over a decade with training brain tumor patients [ 7 ] with various grades and treatment regimens. In this retrospective analysis, we demonstrated the feasibility and safety of intensive exercise in GBM patients who had undergone surgery and chemoradiation, and who concomitantly received adjuvant chemotherapy [ 7 ].…”