# Feasibility, Safety, and Preliminary Efficacy of Very Low-Volume Interval Training in Advanced Cancer Patients PMID: 35868017 Journal: Medicine and science in sports and exercise Published: 2022-11-01 Authors: Reljic D, Herrmann HJ, Jakobs B, Dieterich W, Mougiakakos D, Neurath MF, Zopf Y ## Question Is a 12-week, very low-volume HIIT protocol feasible and safe for advanced cancer patients, including with respect to acute immune responses, and does it show preliminary efficacy for cardiorespiratory fitness, fatigue, quality of life, and related physiological outcomes compared with sham exercise? ## Summary This 12-week randomized pilot study tested a very low-volume cycle-ergometer HIIT protocol in adults with UICC stage III or IV cancer receiving anticancer therapy. Compared with a sham light-mobilization program, LOW-HIIT had low attrition, high attendance, achieved the intended heart-rate intensity, produced no serious exercise-related adverse events, and improved cardiorespiratory fitness, fatigue, physical functioning, and social functioning. ## Population - Adults with UICC stage III or IV advanced cancer and ongoing anticancer therapy. - Sample size: 27 - Age: 55.4 +/- 13.2 years overall - Sex: 13 men and 14 women randomized - Fitness level: Generally poor cardiorespiratory fitness; mean baseline VO2peak 26.5 +/- 6.9 mL/kg/min - Health status: Advanced cancer, mostly UICC stage IV where UICC applied, receiving anticancer therapy ## Methodology - 12-week randomized, sham-intervention controlled pre-post feasibility pilot study - 12 weeks - University Hospital Erlangen research/training center; supervised cycle-ergometer sessions - Randomized and controlled study design. ## Protocol - LOW-HIIT. - Modality: Electronically braked cycle ergometer. - Work intervals: 1 minute at 80%-95% HRpeak. - Recovery: 1 minute low-intensity recovery. - Sets or repetitions: 5 intervals. - Intensity: Weeks 1-4: 80%-85% HRpeak; weeks 5-8: 85%-90% HRpeak; weeks 9-12: 90%-95% HRpeak. - Session duration: 14 minutes total: 2-minute warm-up, 5 x 1-minute intervals with 1-minute recoveries, 3-minute cooldown. - Frequency: 2 sessions per week with at least 1 rest day between sessions. - Program length: 12 weeks. - Progression: Patients adjusted cadence and/or resistance to reach progressively higher heart-rate targets. - SHAM. - Modality: Light physical mobilization exercises with inactive whole-body electromyostimulation setup. - Sets or repetitions: Two sets of light dynamic movements, 10 repetitions each. - Intensity: Light mobilization; electric current below muscle-contraction threshold. - Session duration: 20 minutes. - Frequency: 2 sessions per week. - Program length: 12 weeks. ## Outcomes ### Feasibility Status: improved LOW-HIIT met predefined feasibility criteria with 8% attrition and 92.5% +/- 9.7% attendance. Predefined acceptable thresholds were attrition <=25% and attendance >=80%. ### Safety Status: improved LOW-HIIT was not associated with serious adverse events, severe muscle soreness, clinically relevant creatine kinase disturbances, increased infection susceptibility, or biochemical signs of acute immunosuppression. ### Protocol fidelity Status: improved The prescribed minimum interval intensity was consistently reached, with mean interval heart rate 93% +/- 7% HRpeak. Average whole-session heart rate was 79% +/- 4% HRpeak. ### Relative VO2peak Status: improved LOW-HIIT increased relative VO2peak by 3.0 mL/kg/min, while SHAM had no significant change. Group-time interaction P=0.001; LOW-HIIT post hoc change 95% CI 1.8 to 4.0 mL/kg/min, P<0.001. ### Ventilatory threshold Status: improved LOW-HIIT increased ventilatory threshold by 2.5 mL/kg/min. Group-time interaction P<0.010; LOW-HIIT post hoc 95% CI 1.2 to 3.8 mL/kg/min, P<0.001. ### Fatigue and quality of life Status: improved LOW-HIIT improved FACIT fatigue score, physical functioning, and social functioning; SHAM showed no significant self-reported outcome changes. FACIT +7 points, 95% CI 1 to 13, P=0.010; physical functioning +8 points, 95% CI 1 to 15, P=0.022; social functioning +28 points, 95% CI 12 to 44, P=0.001. ### Acute immune response Status: mixed Blood-cell concentrations rose and fell after exercise without dropping below baseline; NK-cell degranulation increased 60 minutes postexercise and NK-cell composition shifted toward CD56dim cells immediately postexercise. No statistically significant differences in leukocyte, lymphocyte, neutrophil, or monocyte concentrations across four time points. ## Practical Insights - A very short supervised HIIT session with only 5 minutes of hard work can be feasible in a medically screened, vulnerable clinical population. - Heart-rate-monitored progression can verify that clinical participants actually reach target HIIT intensity. - For high-risk populations, low volume and strong supervision are central parts of the protocol, not incidental details. - Time-efficient HIIT may help address perceived barriers such as lack of time, fatigue, uncertainty about how to exercise, and lack of support. ## Limitations - Initial feasibility pilot with relatively small sample size. - Acute immune-marker responses were assessed only once after 6 weeks. - The intervention took place in a highly controlled and supervised clinical setting. - Recruitment rate could not be meaningfully evaluated. - Long-term effects on disease prognosis, survival, and tumor biology remain unknown. - Main-text data do not provide detailed values for all minor adverse events listed in supplement. ## Safety And Adherence - No serious adverse events occurred during training sessions in either group. - Minor adverse events and physical complaints were recorded, but most complaints occurred shortly after chemotherapy and were considered unrelated to the exercise interventions. - No severe muscle soreness or clinically relevant creatine kinase disturbances were observed. - The authors caution that safe use outside well-controlled clinical settings requires further evaluation and medical clarification. ## Original Sources - [PubMed](https://pubmed.ncbi.nlm.nih.gov/35868017/) (pubmed) - [DOI](https://doi.org/10.1249/MSS.0000000000002989) (doi) - [PMC full text](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9584051/) (full text) ## Agent Guidance Preserve the paper-level scope of this note. Do not generalize beyond the population, protocol, measured outcomes, and limitations above.