# High-intensity aerobic interval training and resistance training are feasible in rectal cancer patients undergoing chemoradiotherapy: a feasibility randomized controlled study PMID: 36299392 Journal: Reports of Practical Oncology and Radiotherapy Published: 2022-05-19 Authors: Piraux E, Reychler G, Vancraeynest D, Geets X, Léonard D, Caty G ## Question Can HIIT and resistance training be delivered feasibly and safely during neoadjuvant chemoradiotherapy in rectal cancer patients, and are either superior to usual care for physical or psychological impairments related to treatment? ## Summary This single-center randomized feasibility study tested whether supervised high-intensity aerobic interval training or resistance training could be delivered during five weeks of neoadjuvant chemoradiotherapy for localized rectal cancer. Eighteen patients were randomized equally to HIIT, resistance training, or usual care. Recruitment, retention, and attendance were high, all HIIT participants reached the prescribed heart-rate target during high-intensity bouts, and no exercise-related adverse events occurred. The study was too small to determine efficacy, and measured physical and psychological outcomes mostly did not differ between groups. ## Population - Eighteen adults with localized rectal cancer scheduled for long-course neoadjuvant chemoradiotherapy; patients doing regular exercise or with contraindicating uncontrolled disease were excluded. - Sample size: 18 - Age: Median 62.0 years overall; group medians 64.5, 61.0, and 61.5 years. - Sex: 72% male overall. - Fitness level: Regular exercisers excluded; baseline 6-minute walk medians were 463.0 m usual care, 581.5 m HIIT, and 498.0 m resistance training. - Health status: Localized stage II or III rectal cancer undergoing 45 Gy in 25 fractions with concurrent capecitabine or 5-FU. ## Methodology - Single-center, three-arm randomized controlled feasibility study - 5 weeks - Radiotherapy and Physical Medicine and Rehabilitation departments at Cliniques universitaires Saint-Luc, Brussels - Randomized and controlled study design. ## Protocol - HIIT. - Modality: Cycle ergometer. - Work intervals: 60 s at cadence 90-100 rpm and >=85% theoretical maximal heart rate. - Recovery: 60 s unloaded active rest at cadence 50-60 rpm. - Sets or repetitions: 8 intervals initially, progressing to 15 intervals. - Intensity: >=85% theoretical maximal heart rate during high-intensity bouts; warm-up/cool-down 65-70% theoretical maximal heart rate. - Session duration: 26-40 min including 5 min warm-up and 5 min cool-down. - Frequency: 3 sessions/week. - Program length: 5 weeks. - Progression: Intervals increased weekly based on target heart rate and effort perception; power output increased until target intensity was reached. - Resistance training and usual care. - Modality: Resistance training or physical activity advice. - Sets or repetitions: Resistance training: 1-3 sets of 8-12 repetitions of eight exercises. - Intensity: Resistance training at RPE 4-6 on modified Borg scale; usual care received WHO physical activity and health information. - Session duration: Resistance training 30-40 min. - Frequency: Resistance training 3 sessions/week. - Program length: 5 weeks. - Progression: Resistance training individually adjusted based on perceived exertion to prevent overload. ## Outcomes ### Recruitment Status: improved Eighteen of 20 eligible patients enrolled, yielding a 90% recruitment rate. ### Retention Status: improved All randomized patients completed the study, yielding 100% retention. ### Attendance Status: improved Attendance was 92% in HIIT (77/84 sessions) and 88% in resistance training (74/84 sessions). ### HIIT intensity adherence Status: improved All HIIT participants reached the target heart rate during high-intensity bouts. ### Exercise-related adverse events Status: no clear change No exercise-related adverse events occurred in either exercise group. ### Physical and psychological outcomes Status: mixed No measured outcome significantly differed between groups except social/family well-being, which changed more favorably in resistance training than HIIT. FACT-G social/family well-being change differed between RES and HIIT (p = 0.017; table p = 0.022). ### Functional exercise capacity Status: no clear change 6-minute walk test percentage change did not significantly differ between groups. p = 0.236 for between-group percentage change. ## Practical Insights - In carefully screened, supervised rectal cancer patients, 60 s cycle-ergometer HIIT intervals at >=85% theoretical maximal heart rate were feasible during chemoradiotherapy. - A 1:1 work-recovery ratio and progression from 8 to 15 intervals provide a concrete clinical interval structure. - Embedding sessions immediately after radiotherapy and near the radiotherapy department may improve attendance. - For consumer translation, this is safety-boundary evidence requiring medical screening and supervision rather than a direct home-workout template. ## Limitations - Small feasibility sample with six participants per group. - Underpowered to evaluate effects on physical and psychological outcomes. - Participants and evaluator were not blinded. - Single-center clinical setting. - No longer-term follow-up was reported. ## Safety And Adherence - No exercise-related adverse events occurred. - No HIIT participant was excluded because of abnormal cardiac stress test. - Intense diarrhea and fatigue were common reasons for missed sessions. - Authors reported gastrointestinal symptoms did not worsen directly after radiotherapy and HIIT did not appear to influence bowel activation more than resistance training. ## Original Sources - [PubMed](https://pubmed.ncbi.nlm.nih.gov/36299392/) (pubmed) - [DOI](https://doi.org/10.5603/RPOR.a2022.0036) (doi) - [PMC full text](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9591035/) (full text) ## Agent Guidance Preserve the paper-level scope of this note. Do not generalize beyond the population, protocol, measured outcomes, and limitations above.