Vol 27, No 2 (2022)
Research paper
Published online: 2022-03-17

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High-intensity aerobic interval training and resistance training are feasible in rectal cancer patients undergoing chemoradiotherapy: a feasibility randomized controlled study

Elise Piraux1, Gregory Reychler2, David Vancraeynest3, Xavier Geets4, Daniel Léonard5, Gilles Caty6
Rep Pract Oncol Radiother 2022;27(2):198-208.


Background: There has been growing evidence of the benefits of high-intensity aerobic interval training (HIIT) and resistance training (RES) for populations with cancer. However, these two modalities have not yet been performed alone in rectal cancer patients undergoing neoadjuvant chemoradiotherapy (NACRT). Therefore, this study aimed to determine the feasibility of HIIT and RES in rectal cancer patients undergoing NACRT.

Materials and methods: Rectal cancer patients set to undergo NACRT were randomly assigned to HIIT intervention, RES intervention, or the usual care. Feasibility of HIIT and RES was assessed by measuring recruitment rate, adherence (retention rate, attendance rate, and exercise sessions duration and intensity), and adverse events. Endpoints (changes in fatigue, health-related quality of life, depression, daytime sleepiness, insomnia, sleep quality, functional exercise capacity, and executive function) were assessed at baseline and at week 5.

Results: Among the 20 eligible patients, 18 subjects were enrolled and completed the study, yielding a 90% recruitment rate and 100% retention rate. Attendance at exercise sessions was excellent, with 92% in HIIT and 88% in RES. No exercise-related adverse events occurred. Conclusion: This study demonstrated that HIIT and RES are feasible in rectal cancer patients undergoing NACRT.

Trial registration: www.clinicaltrials.gov, NCT03252821 (date of registration: March 30, 2017)


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  1. Benson AlB, Venook AP, Al-Hawary MM, et al. Anal Carcinoma, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2018; 16(7): 852–871.
  2. Bosset JF, Collette L, Calais G, et al. EORTC Radiotherapy Group Trial 22921. Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med. 2006; 355(11): 1114–1123.
  3. Wang XS, Janjan NA, Guo H, et al. Fatigue during preoperative chemoradiation for resectable rectal cancer. Cancer. 2001; 92(6 Suppl): 1725–1732, doi: 10.1002/1097-0142(20010915)92:6+<1725::aid-cncr1504>3.0.co;2-d.
  4. West MA, Loughney L, Lythgoe D, et al. Effect of prehabilitation on objectively measured physical fitness after neoadjuvant treatment in preoperative rectal cancer patients: a blinded interventional pilot study. Br J Anaesth. 2015; 114(2): 244–251.
  5. Dhruva A, Paul SM, Cooper BA, et al. A longitudinal study of measures of objective and subjective sleep disturbance in patients with breast cancer before, during, and after radiation therapy. J Pain Symptom Manage. 2012; 44(2): 215–228.
  6. Herman JM, Narang AK, Griffith KA, et al. The quality-of-life effects of neoadjuvant chemoradiation in locally advanced rectal cancer. Int J Radiat Oncol Biol Phys. 2013; 85(1): e15–e19.
  7. Belloni S, Arrigoni C, Caruso R. Effects from physical exercise on reduced cancer-related fatigue: a systematic review of systematic reviews and meta-analysis. Acta Oncol. 2021; 60(12): 1678–1687.
  8. Campbell KL, Winters-Stone KM, Wiskemann J, et al. Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable. Med Sci Sports Exerc. 2019; 51(11): 2375–2390.
  9. Schumacher O, Luo H, Taaffe DR, et al. Effects of Exercise During Radiation Therapy on Physical Function and Treatment-Related Side Effects in Men With Prostate Cancer: A Systematic Review and Meta-Analysis. Int J Radiat Oncol Biol Phys. 2021; 111(3): 716–731.
  10. Steindorf K, Schmidt ME, Klassen O, et al. Randomized, controlled trial of resistance training in breast cancer patients receiving adjuvant radiotherapy: results on cancer-related fatigue and quality of life. Ann Oncol. 2014; 25(11): 2237–2243.
  11. Steindorf K, Wiskemann J, Ulrich CM, et al. Effects of exercise on sleep problems in breast cancer patients receiving radiotherapy: a randomized clinical trial. Breast Cancer Res Treat. 2017; 162(3): 489–499.
  12. Wiskemann J, Schmidt ME, Klassen O, et al. Effects of 12-week resistance training during radiotherapy in breast cancer patients. Scand J Med Sci Sports. 2017; 27(11): 1500–1510.
  13. Windsor PM, Nicol KF, Potter J. A randomized, controlled trial of aerobic exercise for treatment-related fatigue in men receiving radical external beam radiotherapy for localized prostate carcinoma. Cancer. 2004; 101(3): 550–557.
  14. Monga U, Garber SL, Thornby J, et al. Exercise prevents fatigue and improves quality of life in prostate cancer patients undergoing radiotherapy. Arch Phys Med Rehabil. 2007; 88(11): 1416–1422.
  15. Latrille M, Buchs NC, Ris F, et al. Physical activity programmes for patients undergoing neo-adjuvant chemoradiotherapy for rectal cancer: A systematic review and meta-analysis. Medicine (Baltimore). 2021; 100(51): e27754.
  16. Devin JL, Jenkins DG, Sax AT, et al. Cardiorespiratory Fitness and Body Composition Responses to Different Intensities and Frequencies of Exercise Training in Colorectal Cancer Survivors. Clin Colorectal Cancer. 2018; 17(2): e269–e279.
  17. Devin JL, Sax AT, Hughes GI, et al. The influence of high-intensity compared with moderate-intensity exercise training on cardiorespiratory fitness and body composition in colorectal cancer survivors: a randomised controlled trial. J Cancer Surviv. 2016; 10(3): 467–479.
  18. Thum JS, Parsons G, Whittle T, et al. High-Intensity Interval Training Elicits Higher Enjoyment than Moderate Intensity Continuous Exercise. PLoS One. 2017; 12(1): e0166299.
  19. Mugele H, Freitag N, Wilhelmi J, et al. High-intensity interval training in the therapy and aftercare of cancer patients: a systematic review with meta-analysis. J Cancer Surviv. 2019; 13(2): 205–223.
  20. Piraux E, Caty G, Renard L, et al. Effects of high-intensity interval training compared with resistance training in prostate cancer patients undergoing radiotherapy: a randomized controlled trial. Prostate Cancer Prostatic Dis. 2021; 24(1): 156–165.
  21. Moher D, Hopewell S, Schulz KF, et al. CONSORT, Consolidated Standards of Reporting Trials Group. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. BMJ. 2010; 340(8): c869–37.
  22. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982; 14(5): 377–381.
  23. Hawley-Hague H, Horne M, Skelton DA, et al. Review of how we should define (and measure) adherence in studies examining older adults' participation in exercise classes. BMJ Open. 2016; 6(6): e011560.
  24. Yellen SB, Cella DF, Webster K, et al. Measuring fatigue and other anemia-related symptoms with the Functional Assessment of Cancer Therapy (FACT) measurement system. J Pain Symptom Manage. 1997; 13(2): 63–74.
  25. Cella DF, Tulsky DS, Gray G, et al. The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J Clin Oncol. 1993; 11(3): 570–579.
  26. Radloff L. The CES-D Scale. Appl Psychol Meas. 2016; 1(3): 385–401.
  27. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991; 14(6): 540–545.
  28. Morin CM. Insomnia: Psychological Assessment and Management. Guilford Press, New York 1993.
  29. Buysse DJ, Reynolds CF, Monk TH, et al. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989; 28(2): 193–213.
  30. Holland AE, Spruit MA, Troosters T, et al. An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J. 2014; 44(6): 1428–1446.
  31. Schmidt K, Vogt L, Thiel C, et al. Validity of the six-minute walk test in cancer patients. Int J Sports Med. 2013; 34(7): 631–636.
  32. Sánchez-Cubillo I, Periáñez JA, Adrover-Roig D, et al. Construct validity of the Trail Making Test: role of task-switching, working memory, inhibition/interference control, and visuomotor abilities. J Int Neuropsychol Soc. 2009; 15(3): 438–450.
  33. Reitan RM. The relation of the trail making test to organic brain damage. J Consult Psychol. 1955; 19(5): 393–394.
  34. Hertzog MA. Considerations in determining sample size for pilot studies. Res Nurs Health. 2008; 31(2): 180–191.
  35. Morielli AR, Usmani N, Boulé NG, et al. A Phase I Study Examining the Feasibility and Safety of an Aerobic Exercise Intervention in Patients With Rectal Cancer During and After Neoadjuvant Chemoradiotherapy. Oncol Nurs Forum. 2016; 43(3): 352–362.
  36. Singh F, Galvão DA, Newton RU, et al. Feasibility and Preliminary Efficacy of a 10-Week Resistance and Aerobic Exercise Intervention During Neoadjuvant Chemoradiation Treatment in Rectal Cancer Patients. Integr Cancer Ther. 2018; 17(3): 952–959.
  37. Heldens AF, Bongers BC, de Vos-Geelen J, et al. Feasibility and preliminary effectiveness of a physical exercise training program during neoadjuvant chemoradiotherapy in individual patients with rectal cancer prior to major elective surgery. Eur J Surg Oncol. 2016; 42(9): 1322–1330.
  38. Egegaard T, Rohold J, Lillelund C, et al. Pre-radiotherapy daily exercise training in non-small cell lung cancer: A feasibility study. Rep Pract Oncol Radiother. 2019; 24(4): 375–382.
  39. Jekauc D. Enjoyment during Exercise Mediates the Effects of an Intervention on Exercise Adherence. Psychology. 2015; 06(01): 48–54.
  40. Bartlett JD, Close GL, MacLaren DPM, et al. High-intensity interval running is perceived to be more enjoyable than moderate-intensity continuous exercise: implications for exercise adherence. J Sports Sci. 2011; 29(6): 547–553.
  41. Martinez N, Kilpatrick MW, Salomon K, et al. Affective and Enjoyment Responses to High-Intensity Interval Training in Overweight-to-Obese and Insufficiently Active Adults. J Sport Exerc Psychol. 2015; 37(2): 138–149.
  42. Cavarretta D, Hall E, Bixby W. The acute effects of resistance exercise on affect, anxiety, and mood — practical implications for designing resistance training programs. Int Rev Sport Exercise Psych. 2018; 12(1): 295–324.
  43. Singh F, Newton RU, Baker MK, et al. Feasibility and Efficacy of Presurgical Exercise in Survivors of Rectal Cancer Scheduled to Receive Curative Resection. Clin Colorectal Cancer. 2017; 16(4): 358–365.
  44. Piraux E, Caty G, Aboubakar Nana F, et al. Effects of exercise therapy in cancer patients undergoing radiotherapy treatment: a narrative review. SAGE Open Med. 2020; 8: 2050312120922657.

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