Supervised, Multimodal Exercise: The Chemotherapy Supportive Therapy That Almost Does It All

Abstract

Delivery of full chemotherapy dose intensity with minimization of adverse chemotherapy-related events is a primary quality of care indicator in medical oncology. Clinical oncology professionals are also increasingly recognizing patient quality of life as a vital component of cancer care [1]. As such, a therapy that could maximize delivery of chemotherapy relative dose intensity (RDI), reduce treatment toxicities, and improve quality of life, with positive side effects of improved physical fitness, reduced anxiety and depression, and extended overall survival, would likely be prescribed by every medical oncologist in every cancer treatment center. Although such a therapy does not currently exist, Mijwel et al. report on a therapy that comes close in this issue of The Oncologist [2].In this article, Mijwel et al. report results of the OptiTrain trial, a 3-arm randomized trial of two different exercise interventions versus usual care, on rates of chemotherapy completion, hospitalization, and hematological toxicity [2]. The trial compared 16 weeks of high-intensity aerobic interval training (three sets of 3 minutes with 1-minute recovery) combined with either resistance training (RT-HIIT) or moderate-intensity aerobic training (AT-HIIT) to usual cancer care. Although this may sound challenging for patients, the exercise sessions took place only twice per week for 60 minutes and were closely supervised in an in-hospital exercise clinic. Patients in the exercise programs, many of whom had comorbid conditions, attended approximately two thirds of offered exercise sessions throughout chemotherapy and were typically able to complete the exercise prescription at the sessions they attended.One of the most compelling clinical outcomes of exercise for oncology care providers is thought to be the potential for exercise interventions to enhance patient tolerance of chemotherapy and thereby delivery of the planned RDI [3]. Although the rationale for exercise training-related improvement of RDI is robust (preservation of muscle mass and physical function should enhance tolerance), the current research evidence is not. A recent systematic review reported that none of the eight randomized exercise trials that have evaluated RDI have reported clinically relevant effects, although two had statistically significant effects [4]. In line with these results, the high-quality, multimodal OptiTrain interventions did not have an impact on RDI, despite the RT-HIIT intervention achieving the proposed biologic mechanism of enhanced muscle mass, strength, and physical fitness. There was no difference between either exercise group and usual care in achieved RDI, prevalence of a single dose reduction, or percentage of participants receiving ≥85% of RDI [2]. Receipt of >85% of RDI is a known threshold for achievement of chemotherapy effectiveness [5]. Notably, although approximately one quarter of all patients in the OptiTrain trial required at least one single chemotherapy dose reduction, the majority (83%) still received >85% RDI, likely thanks ...

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