Combined Aerobic and Resistance Exercise Training in Metastatic Renal Cell Carcinoma

Inclusion Criteria: * Histologically confirmed diagnosis of RCC * Patients being treated with standard of Programmed cell death protein 1 (anti-PD-1) or anti-PD-L1 immune-checkpoint inhibitor-containing standard of care regimen including patients who are about to start treatment or have been on treatment for a maximum of 4 weeks prior to signing consent * Metastatic Measurable disease, as defined by RECIST 1.1 * Eastern Cooperative Oncology Group (ECOG) performance status of 0-2 with a life expectancy ≥ six months * Physically able to enroll in the exercise program as determined by the treating medical oncologist and after review by Physical medicine and rehabilitation physicians at Johns Hopkins * Adequate bone marrow reserve and organ function measured within 28 days prior to administration of study treatment with the following key parameters: * Hematological: * Absolute neutrophil count ≥ 1.5 × 109/L * Platelets ≥ 100 × 109/L * Hemoglobin≥ 9.0 g/dL * Renal: * Serum Creatinine ≤ 1.5 x the upper limit of normal (ULN) or Calculated Creatinine clearance ≥ 30mL/min * Hepatic: * Total bilirubin ≤ 1.5 x ULN (Patients with known Gilbert disease who have serum bilirubin level ≤ 3 x ULN may be enrolled) * Serum Aspartate aminotransferase (AST) and serum Alanine aminotransferase (ALT) ≤ 2.5 x ULN (For patients with documented liver metastases AST and/or ALT ≤ 5 x ULN) Exclusion Criteria: * The presence of bone metastasis in the spine, pelvis, and lower limbs * Currently physically active or moderately active as determined by Leisure Score Index of Godin Leisure-Time Exercise Questionnaire (GSLTPAQ) * History of underlying cardiovascular, respiratory, musculoskeletal disease or joint problems that preclude moderate physical activity * Known underlying uncontrolled brain metastatic lesions requires steroids therapy and/or radiotherapy * Major surgery within four weeks prior to enrollment. * Radiotherapy for RCC 28 days prior to week 1 day 1