A supervised remote exercise program improved the quality of life of patients with cancer undergoing immunotherapy, primarily by reducing cancer fatigue, according to findings from a secondary analysis of a phase II trial that will be presented at the 2026 ASCO Quality Care Symposium (Abstract 276).
“Fatigue is one of the most common symptoms related to both cancer and its treatment. This fatigue contributes to higher overall symptom burden and poorer quality of life, yet practical tools that reliably improve it remain limited. Exercise is actually one of the best evidence-based strategies we have to manage it, even though that can sound counterintuitive to many patients,” said lead study author Paulo Bergerot, MD, a medical oncologist at Hospital Santa Lúcia in Rio de Janeiro, Brazil.
Background and Study Methods
Researchers conducted a randomized controlled phase II trial of adult patients with cancer who were receiving immunotherapy. In the secondary analysis of the study, patients from across Brazil were randomly assigned 1:1 to receive either usual care or a 12-week remotely delivered exercise program. The exercise intervention included weekly exercise telehealth sessions led by a physiologist; individualized American College of Sports Medicine–based prescription; and provided daily aerobic, resistance, and mobility exercises. The weekly check-ins also provided both support and flexibility for the participants.
The researchers assessed outcomes at 12 weeks in comparison to baseline assessments of health-related quality-of-life through the Functional Assessment of Cancer Therapy-General (FACT-G) and Edmonton Symptom Assessment Scale (ESAS) questionnaires.
Key Findings
Of 70 patients who were randomly assigned to the analysis, 65 completed the 12-week assessment for outcomes. About 83% of the patients in the exercise intervention arm were consistently engaged for at least half of the 12-week time period.
An improvement was found in health-related quality-of-life measurements in 75.8% of patients who were in the exercise intervention arm vs 6.3% who were in the usual care arm (P = .001). Patients who participated in the exercise program experienced significant reductions in fatigue (β = –3.81; P < .001), as well as quality-of-life improvements (β = 11.65; P < .001).
Improvements in fatigue was independently associated with improvements in health-related quality-of-life (β = –1.42; P < .001).
When accounting for changes in fatigue, the impact of the exercise program on health-related quality-of-life was attenuated to β = 6.24—meaning that 47% of the health-related quality-of-life impact was due to the reductions in fatigue.
Participants in the exercise arm did not report any adverse events.
Going forward, the researchers hope to study whether the quality-of-life improvements can be sustained beyond the period of the study. Further studies are also needed to explore the findings in a broader patient population, the cost-effectiveness of the exercise program, and how best to implement the program in different health-care settings.
Expert Perspective
“Fatigue is among the most common and least well-managed problems for patients on immunotherapy, and exercise is one of the few interventions that have shown benefit. What stands out here is the telehealth delivery, which successfully reached patients too tired or remote for supervised programs. Notably, roughly half the quality-of-life benefit came from fatigue reduction, suggesting fatigue itself is a target worth measuring and treating. While this small phase II trial needs confirmation in a larger trial, the findings are encouraging and point to a delivery model that could scale,” stated Marcin Chwistek, MD, FAAHPM, Chief of the Supportive Oncology and Palliative Care Program at Fox Chase Cancer Center and an ASCO Expert in palliative care.
DISCLOSURES: The trial was funded internally. For full disclosures of the study authors, visit coi.asco.org.
