Neuro-oncology · 2025
Enhancing cardiorespiratory fitness and quality of life in high-grade glioma through an intensive exercise intervention during chemotherapy: Proof of concept.
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Jost-Engl Johanna, Ketter Ralf, Brandt Ralf, Völker Klaus, Gerß Joachim, Jetschke Kathleen, Weiss Lucas Carolin, Baumann Freerk T, Lepper Philipp M, Urbschat Steffi, Stummer Walter, Wiewrodt Rainer, Wiewrodt Dorothee, MMH Trial Investigators
Аннотация
BACKGROUND: High-grade glioma (HGG) patients experience enormous disease burden both from tumor- and treatment-related symptoms. Exercise can improve physical fitness and quality of life (QoL); yet experience in neuro-oncology, especially with high-intensity exercise, remains limited. This study evaluated feasibility, safety, and efficacy of the intensive, structured 16-week strength and endurance program, "Active in Neuro-Oncology" (ActiNO) for HGG patients undergoing chemotherapy.
METHODS: In this prospective, oligocentric, single-arm proof-of-concept trial, 54 HGG patients participated in ActiNO, with twice-weekly supervised exercise sessions. The primary endpoint was cardiorespiratory fitness, assessed via physical working capacity (PWC75%)-the workload (W/kg body weight) achieved at 75% of age-adjusted maximum heart rate during a maximal cardiopulmonary exercise test. Secondary endpoints included peak oxygen uptake (VO2peak), peak power output (Ppeak), and QoL (EORTC QLQ-C30). Analyses focused on within-subject changes from pre- to post-intervention. Additionally, comparisons to normative data were performed. Feasibility was assessed via accrual, adherence, and attrition; safety via adverse event monitoring (CTCAE).
RESULTS: Program tolerance was high, with few exercise-related adverse events (all CTCAE grade 1-2). Over 16 weeks, significant improvements were observed in PWC75% (1.023-1.256 W/kg BW, +23%), VO2peak (23.04-26.09 ml/min/kg BW, +13%), and Ppeak (1.771-2.104 W/kg BW, +19%). QoL, including global health and physical functioning, improved, reaching normative values. Adherence was high (85%), though attrition was 48%, mainly due to disease progression or physical constraints.
CONCLUSIONS: High-intensity exercise is feasible and safe in HGG patients undergoing chemotherapy. The observed improvements in physical fitness and QoL support incorporating structured exercise into neuro-oncology care.
METHODS: In this prospective, oligocentric, single-arm proof-of-concept trial, 54 HGG patients participated in ActiNO, with twice-weekly supervised exercise sessions. The primary endpoint was cardiorespiratory fitness, assessed via physical working capacity (PWC75%)-the workload (W/kg body weight) achieved at 75% of age-adjusted maximum heart rate during a maximal cardiopulmonary exercise test. Secondary endpoints included peak oxygen uptake (VO2peak), peak power output (Ppeak), and QoL (EORTC QLQ-C30). Analyses focused on within-subject changes from pre- to post-intervention. Additionally, comparisons to normative data were performed. Feasibility was assessed via accrual, adherence, and attrition; safety via adverse event monitoring (CTCAE).
RESULTS: Program tolerance was high, with few exercise-related adverse events (all CTCAE grade 1-2). Over 16 weeks, significant improvements were observed in PWC75% (1.023-1.256 W/kg BW, +23%), VO2peak (23.04-26.09 ml/min/kg BW, +13%), and Ppeak (1.771-2.104 W/kg BW, +19%). QoL, including global health and physical functioning, improved, reaching normative values. Adherence was high (85%), though attrition was 48%, mainly due to disease progression or physical constraints.
CONCLUSIONS: High-intensity exercise is feasible and safe in HGG patients undergoing chemotherapy. The observed improvements in physical fitness and QoL support incorporating structured exercise into neuro-oncology care.