Feasibility, Safety, and Preliminary Efficacy of Very Low-Volume Interval Training in Advanced Cancer Patients

Abstract

Purpose: High-intensity interval training (HIIT) has been shown to improve cardiorespiratory fitness (CRF) and health-related outcomes in various chronic diseases, including cancer. However, data on feasibility and efficacy of HIIT in advanced cancer patients are still sparse, presumably because of safety concerns, like suspected immunosuppression after vigorous exercise. This randomized, sham-intervention controlled study aimed to investigate feasibility, safety, and preliminary efficacy of very low-volume HIIT (LOW-HIIT) in advanced cancer patients.

Methods: Twenty-seven patients (55.4 ± 13.2 yr) with different advanced cancers (Union for International Cancer Control [UICC] III/IV) were randomly allocated to LOW-HIIT ( n = 13), consisting of 5 × 1 min cycle ergometer intervals (14 min per session total duration) at 80% to 95% HR peak (two sessions per week for 12 wk), or a sham intervention ( n = 14) performing light physical mobilization exercises (SHAM). Primary outcomes were attrition and attendance rates, with values of ≤25% and ≥80%, respectively, considered acceptable. Secondary outcomes were safety, protocol fidelity, physiological (including CRF measures) and patient-reported outcomes (including fatigue and quality of life).

Results: One of 13 patients (8%) receiving LOW-HIIT dropped out. Mean attendance rate was ~93%. The prescribed minimum exercise intensity was consistently reached by all patients. Low-volume HIIT was well tolerated and not associated with any serious adverse event nor with increased infection susceptibility. There were no biochemical signs of acute immunosuppression after LOW-HIIT. Contrarily, differentiation and degranulation of natural killer cells was acutely increased postexercise. Low-volume HIIT improved CRF measures including peak oxygen uptake, self-reported fatigue, physical, and social functioning. No significant changes occurred in the SHAM group.

Conclusions: Low-volume HIIT can be regarded as feasible and safe in advanced cancer patients. Our preliminary data indicate favorable acute effects on NK-cells and beneficial chronic adaptations in CRF, fatigue, and aspects of quality of life.

Trial registration: ClinicalTrials.gov NCT04065815.

Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American College of Sports Medicine.

Figures

FIGURE 1

Schematic illustration of study design. Blood draws in week 4 and week 8 before exercise session.

FIGURE 2

Study flowchart.

FIGURE 5

Individual heart rate responses and chronic adaptations to LOW-HIIT. Individual mean heart rate responses during exercise intervals in weeks 1 to 4, weeks 5 to 8, and weeks 9 to 12 (full line indicates minimum required heart rate [≥80% HRpeak), dashed lines indicate lower bounds of the intended heart rates for weeks 5 to 8 [≥85% HRpeak] and week 9 to 12 [≥90% HRpeak] (A), individual changes in maximal oxygen uptake (B), individual changes in VT (C), individual changes in FACIT score (D), individual changes in physical functioning (E), and individual changes in social functioning (F).

FIGURE 3

Acute responses of leukocytes (A), lymphocytes (B), monocytes (C), and neutrophils (D) to LOW-HIIT.

FIGURE 4

Acute responses of NK cells to LOW-HIIT. NK cell degranulation after contact with K562 and BL-41 cells within 60-min postexercise (A), NK cell degranulation preexercise vs 60-min postexercise (B), NK cell differentiation within 60-min postexercise (C), and NK cell differentiation preexercise vs directly postexercise (D). *Significant difference (P < 0.05) preexercise vs. 60-min postexercise; **Significant difference (P < 0.01) preexercise vs directly postexercise.