Effects of exercise during and after neoadjuvant chemoradiation on symptom burden and quality of life in rectal cancer patients: a phase II randomized controlled trial.
Level 2 - randomized trial
Phase II randomized controlled trial
PubMed 34841461 · doi:10.1007/s11764-021-01149-w
What was done
Thirty-six rectal cancer patients undergoing neoadjuvant chemoradiation (NACRT) were randomized to either usual care or an exercise intervention consisting of supervised high-intensity interval training during NACRT followed by unsupervised continuous exercise after NACRT. Patient-reported outcomes were assessed at baseline, post-NACRT, and presurgery using the M.D. Anderson Symptom Inventory and the European Organisation for Research and Treatment of Cancer QLQ-C30 and -CR29 questionnaires.
What was found
During NACRT, the exercise group experienced significantly worse outcomes compared to usual care in stool frequency (adjusted between-group difference, 25.8; 95% CI, 4.0 to 47.6; p = 0.022), role functioning (adjusted difference, -21.3; 95% CI, -41.5 to -1.1; p = 0.039), emotional functioning (adjusted difference, -11.7; 95% CI, -22.0 to -1.4; p = 0.028), and cognitive functioning (adjusted difference, -11.6; 95% CI, -19.2 to -4.0; p = 0.004). After NACRT, exercise significantly worsened diarrhea (adjusted difference, 1.2; 95% CI, 0.1 to 2.3; p = 0.030) and embarrassment (adjusted difference, 19.7; 95% CI, 7.4 to 32.1; p = 0.003) compared to usual care. Most negative effects dissipated after NACRT.
Why it matters
High-intensity exercise during pelvic chemoradiation can acutely exacerbate gastrointestinal toxicities and impair patient functioning, indicating that exercise prescriptions may need careful symptom monitoring or modification during active treatment.
Limits
The trial had a small sample size (n = 36) leading to wide confidence intervals. It evaluated a specific regimen (HIIT followed by continuous exercise) in rectal cancer patients undergoing chemoradiation, so findings may not generalize to other exercise types or oncology settings.
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- supports A study in rectal cancer patients found that an exercise intervention exacerbated radiation-induced skin irritation and diarrhea.