The Effect Of Intra-infusion Exercise On Chemotherapy Side Effects; An Interim Analysis

PURPOSE: Chemotherapy treatment results in side effects that impact quality of life and physical activity behaviours. Aerobic exercise in parallel with chemotherapy reduces side effects particularly fatigue and improves quality of life. Our recent clinical pilot work has shown that an acute bout of aerobic exercise increases blood flow to tumours. Therefore, if exercise is performed as chemotherapy is delivered (intra-infusion exercise), the result may be increased drug delivery and potential improved treatment efficacy. Intra-infusion exercise also provides a supervised opportunity to overcome patient-reported barriers to exercise during a period where a patient would be otherwise sedentary. The aim of this ongoing randomised controlled trial is to determine the effects of aerobic intra-infusion exercise on chemotherapy side effects and physical activity behaviours. METHODS: Adults under 75 years receiving chemotherapy with stage I-III breast, colorectal or ovarian cancer, and ECOG 0-2 were eligible. Four chemotherapy sessions were included, cycle 1 (C1) a baseline and cycles 2-4 (C2-4) included exercise intervention or usual care. The exercise task was 20 minutes of moderate intensity cycling (40-50% heart rate reserve) during infusion. All participants received exercise education. A 7-day symptom diary (including Brief Fatigue Inventory (BFI) and Edmonton Symptom Assessment System (ESAS)) was completed following C1-C4 and an activity monitor worn. RESULTS: Nineteen participants have completed the trial (79% female) with no adverse events reported in either group. Physical symptoms increased across cycles in both groups (p = 0.003). 1-week mean ESAS physical symptoms total in the exercise group (C1 16 ± 9.8, C4 23 ± 13.7) and control group (C1 18 ± 7.1, C4 23 ± 12.7) were similar. No significant effects were seen for fatigue (BFI exercise C1 36 ± 18.8, C4 36 ± 22.6; control C1 31 ± 14.9, C4 35 ± 20.8) or step count (exercise C1 4974 ± 2143, C4 3936 ± 1976; control C1 5251 ± 3523, C4 4811 ± 4446). CONCLUSIONS: Intra-infusion exercise is safe and does not increase side effects in patients receiving chemotherapy. Expected increases in physical symptoms were observed without difference between usual care and exercise. Further analysis with ongoing recruitment will continue to examine any differences between groups.