Exercise therapy is a common supportive strategy in curative cancer treatment with strong evidence regarding its positive effects on, for example, cancer-related fatigue, health- related quality of life, and physical function. In the field of advanced cancer patients, knowledge about exercise as a useful supportive strategy is missing. The aim of this systematic review was to evaluate the feasibility and safety of exercise interventions as well as its effects on lowering the symptom burden. We included randomized controlled trials and nonrandomized controlled trials with advanced cancer patients receiving any type of exercise intervention. After an extensive literature search (in accordance to PRIMSA guidelines) in PubMed, Cochrane Library, and SPORTDiscus, 14 studies including 940 participants with different cancer entities were eligible. The results indicated the safety of exercise. In total, 493 participants received exercise interventions, with nine adverse events and no severe adverse events. The median recruitment rate was 68.33%, and adherence to exercise intervention was 86%. Further research with a high-quality and larger sample size is needed to clarify the potential of exercise with advanced cancer patients. Different advanced cancer entities have distinguished symptoms, and future research should construct entities-specific trial populations to figure out the best supportive exercise interventions.

Purpose: Patients with advanced pancreatic and biliary tract cancer (aPBC) frequently suffer from high symptom burden. Exercise can reduce treatment side effects and improve patient-related outcomes (PROMs). However, evidence from prospective studies regarding feasibility and efficacy in advanced settings are sparse. The primary aim of this prospective, randomized-controlled study was to evaluate the feasibility and effects of exercise (ET) in patients with aPBC. Methods: Patients with aPBC beyond first-line therapy were randomized according to the minimization procedure with stratification by gender, age, and loss of body weight in the past six months. The intervention group (IG) completed 3 training units/week for 8 weeks (1x supervised strength sessions, 2x individualized home-based sessions). Control group (CG) received recommendations on physical activity during cancer. Results: 41 patients (stage IV pancreatic or biliary tract cancer) were included no adverse events related to exercise occurred during the trial. Physical function increased significantly in IG in 5 out of 7 physical domains. Comparison of IG and CG at 8 weeks (t2) showed significant differences in favour of IG in leg press (p=0.001), bench press (p=0.011), sit-to-stand (p=0.001) and crunch (0.006). Constipation revealed a significant difference in favour of IG at t2 (p=0.033). Quality of life stabilized/increased in IG during the study period compared to a decrease in CG. Throughout/Over the 8 weeks, fatigue notably reduced in the IG (p=0.028). Conclusion: Exercise is safe and feasible in patients with aPBC undergoing further line therapy. Significant improvements in physical functioning and increased quality of life were achieved. German Clinical Trials Register ID: DRKS00021179; Registration date 15.05.2020

Objective: The study investigated the response of immune cells, particularly natural killer (NK) cells and innate lymphoid cells (ILCs), to acute exercise in adolescents and young adults (AYAs) undergoing cancer treatment, to lower their treatment burden and evaluate the value of exercise in this vulnerable cohort. Methods: An AYA cancer patient group (PG) (n = 20, 25 ± 7 years old) and an age-matched healthy control group (HG) (n = 20, 27 ± 5 years old) completed a twenty-minute high intensity interval training (HIIT) on a bicycle ergometer. Blood was taken at three timepoints during the intervention. Once immediately before (T0), once immediately after the intervention (T1), and after one-hour of recovery (T2). NK cells, ILCs, respectively their subpopulations, were determined by flow cytometry. Results: Total NK cells (PG: p = 0.023; HG: p = 0.004), CD56^dimNK cells (PG: p = 0.035; HG: p = 0.004), total ILCs (PG: p < 0.001; HG: p < 0.001), ILC1-like (PG: p = 0.001; HG: p = 0.004), ILC2 (PG: p = 0.006; HG: p = 0.003) and innate lymphoid cell precursors (ILCPs) (PG: p = 0.009; HG: p = 0.002) increased significantly from T0 to T1. CD56^brightNK cells (HG: p = 0.011) increased significantly only in the HG. From T1 to T2 total NK cells (PG: p < 0.001; HG: p < 0.001), CD56^dimNK cells (PG: p < 0.001; HG: p < 0.001), CD56^brightNK cells (PG: p < 0.001; HG: p < 0.001), ILC2 (PG: p = 0.035; HG: p = 0.007) and ILCPs (PG: p = 0.006; HG: p = 0.003) decreased significantly. ILC1-like maintained their elevated cell count plateau during the recovery phase. No significant differences were found for NKp44⁺ILC3 and for inter-group comparisons regarding the percentage changes of cell counts from T0 to T1 or T1 to T2. Younger age and higher heart rates (in percentage of age-predicted maximal heart rate) during the intervention were associated with an increased mobilization of immune cells, especially in NK cells and their subpopulations. Conclusion: We were able to show, that HIIT enhances the mobilization of NK cells and ILCs to the same extend in AYA cancer patients than in healthy controls. Our pilot study revealed, that exercise is likely to play an important role in the defense against pathogens and neoplastic cells and that AYA cancer patients might benefits from regular exercise programs during anti-cancer treatment. Trial registration: : The study was registered on 13.11.2022, registration number NCT05656651, in the international register of clinical trials https://www.clinicaltrials.gov/.

Purpose: Physical activity (PA) is recommended to improve advanced cancer patients’ (ACP) physical functioning, fatigue, and quality of life. Yet, little is known about ACPs’ attitude towards PA and its influence on fatigue and depressiveness over a longer period. This prospective, non-interventional cohort study examined ACPs’ fatigue, depression, motivation, and barriers towards PA before and after 12 months of treatment among ACP Methods: Outpatients with incurable cancer receiving treatment at a German Comprehensive Cancer Center reporting moderate/severe weakness/tiredness during self-assessment via MIDOS II were enrolled. Fatigue (FACT-F), depression (PHQ-8), cancer-related parameters, self-assessed PA behavior, motivation for and barriers against PA were evaluated (T0). Follow-up data was acquired after 12 months (T1) using the same questionnaire. Results: At follow-up, fatigue (p=0.017) and depressiveness (p=0.015) had increased in clinical relevant extent. Physically active ACP did not show significant progress of FACT-F (p=0.836) or PHQ-8 (p=0.799). Patient-reported barriers towards PA remained stable. Logistic regression analyses identified motivation as a positive predictor for PA at both time points (T0, β=2.152, p=0.017; T1, β =2.264, p=0.009). Clinically relevant depression was a negative predictor for PA at T0 and T1 (T0, β=−3.187, p=0.044; T1, β=−3.521, p=0.041). Conclusion: Our findings emphasize the importance of psychological conditions in physical activity behavior of ACP. Since psychological conditions seem to worsen over time, early integration of treatment is necessary. By combining therapy approaches of cognitive behavioral therapy and exercise in interdisciplinary care programs, the two treatment options might reinforce each other and sustainably improve ACPs’ fatigue, physical functioning, and QoL. Trial registration: German Register of Clinical Trials, DRKS00012514, registration date: 30.05.2017

Background The changing symptom burden is a major hurdle in the exercise therapy therapy of oncological palliative patients. The daily varying severity of symptoms makes it difficult to set an optimal training load and, in addition to motivation, represents a major barrier to participation in exercise therapy interventions. Training controlled by artificial intelligence (AI) could help to customize the training sessions and maintain the autonomy of palliative patients. Methods Five patients with advanced incurable cancer diagnosis underwent supervised exercise therapy as part of routine care. An electrocardiogram was recorded using a Polar H10 chest strap, from which cardiac and respiratory vital parameters were extracted. This led to a classification into three intensity levels via artificial intelligence using neural networks. Results Through the combination of respiratory and cardiac vital parameters, the AI-controlled training has a very high classification quality (F1-Score: 0.95 +/- 0.05). This combination achieves more accurate classification results than the individual data sets for cardiac parameters (0.93 +/- 0.06) and respiratory parameters (0.72 +/- 0.06). When taken into account, the baseline measurement has a positive effect on classification accuracy. Discussion This study represents the first investigation into the use of artificial intelligence to classify training intensities for patients in oncological palliative care. This vulnerable patient group can benefit from an objective recording of the stress level based on parameters of the cardiovascular system. It was possible to establish the validity of this exploratory study on cross-validation with only five patients. In the future, other parameters such as subjective perception, age, size and gender should be considered in order to further improve the classification. Thus, in an integrated system, individual training control is possible in real time.

Background: Lung cancer is one of the most common cancers in Germany, with around 56,000 new cases diagnosed in 2020. Approximately 65% are diagnosed at advanced stages, where symptoms such as fatigue, pain, dyspnea, and weight loss are prevalent. These patients often suffer from cardiovascular and pulmonary comorbidities, which interact with treatment toxicity, outcome and increase treatment costs. Although exercise therapy is proven to alleviate cancer-related symptoms and to improve quality of life, current lung cancer treatment guidelines fail to adequately prioritize its crucial role.Methods: The Better symptom contRol with Exercise in pAtients wiTH advanced non-small cell lung cancer (BREATH) study is a prospective, three-arm randomized controlled trial (RCT) designed to assess the impact of exercise therapy on patients with advanced NSCLC (stage IIIB-IV) who are receiving first- or second-line systemic therapy) in the palliative setting. Patients are randomized in a 2:1:1 ratio into a control group (receiving exercise recommendations) or one of two intervention arms: endurance training and breathing exercise or combined endurance and resistance training. The intervention groups will exercise twice a week for 12 weeks. The control group participants will be randomized again in a 1:1 ratio into one of the two intervention arms after completion of the control period. The study will assess outcomes at baseline, 12 weeks, and 24 weeks. The primary outcome is improvement of aerobic capacity (VO ₂ peak). Secondary outcomes include quality of life, fatigue, adherence to exercise and adverse events. Patient representatives were involved in all stages of protocol development.Discussion: The BREATH study addresses a significant gap in the current management of advanced lung cancer treatment by evaluating the impact of different exercise treatment protocols to reduce symptoms and improve clinical outcome. The study design and exercise program aim to enhance adherence and optimize patient related outcomes. The results of the BREATH study have the potential to influence future guidelines and improve the management of patients with advanced NSCLC.Trial registration ClinicalTrials.gov NCT registered on the 18. April 2024 (NCT06374160)