Development and Dissemination of Exercise Prescription and Intervention for Cancer Populations

Kaohsiung Medical University Chung-Ho Memorial Hospital150 enrolled

Overview

The purpose of this study is to establish a safe and systematic exercise assessment and prescription program for cancer survivors. It can be challenging for cancer patients to start exercising due to various health risks, so this study aims to create a personalized and easily reproducible workflow. The study will include cancer patients who have completed their primary curative treatments at least 2 months ago. Participants will undergo a comprehensive health and fitness evaluation led by a study physician. This evaluation includes: * A review of medical history and cardiovascular risk. * Functional physical fitness tests. * Cardiopulmonary Exercise Testing (CPET) to carefully evaluate heart and lung function during physical exertion. * A musculoskeletal ultrasound, if deemed necessary. Based on these combined results, the medical team will determine each participant's exercise risk level and design a personalized exercise prescription. Participants will then be assigned to an appropriate and safe exercise setting. To ensure safety and maximize health benefits, the study includes a continuous tracking system. Participants will report their exercise progress every 4 weeks and undergo a full reassessment every 3 months. The medical team will use this feedback to safely adjust the participant's risk level and exercise prescription over time.

This study is designed as a single-arm, open-label interventional research project. The primary objective is to establish and implement a systematic, institution-based exercise prescription protocol tailored for cancer survivors. The clinical pathway initiates with patient referral and preliminary screening conducted by collaborating physicians or case managers. Eligible participants then undergo a physiatrist-led, multi-faceted pre-exercise evaluation. This comprehensive assessment integrates a medical history review, cardiovascular risk profiling, functional physical fitness testing, and Cardiopulmonary Exercise Testing (CPET). Additionally, musculoskeletal ultrasound examinations are performed when deemed clinically necessary to objectively evaluate the participant's physical condition. Based on the integrated assessment results, physiatrists stratify participants into high, moderate, or low exercise risk categories. Individualized exercise prescriptions are then formulated according to the assigned risk level, detailing the required exercise modalities-including aerobic exercise, resistance training, and flexibility exercises-as well as the specific intensity, frequency, duration, and safety precautions. During the implementation phase, participants execute the prescribed exercise program while utilizing standardized weekly training logs to record their progress. The protocol incorporates an adverse event reporting and data feedback mechanism to ensure continuous safety monitoring and intervention quality. To maintain a dynamic care model, clinical data collection and comprehensive reassessments occur at three distinct time points: baseline (T0), the third month of the intervention (T1), and the sixth month of the intervention (T2). These periodic three-month re-evaluations facilitate the continuous adjustment of both the risk stratification and the personalized exercise prescription, ensuring the intervention remains safe, accurate, and effective.

Interventions

structured exercise trainingOTHER

This study utilizes a "Personalized Precision Exercise Training Program." Following baseline Cardiopulmonary Exercise Testing (CPET) and comprehensive fitness assessments, physicians prescribe individualized regimens adhering to ACSM guidelines for cancer survivors, applying the FITT principle: * Aerobic Exercise: 3-5 days/week at moderate intensity, tailored to treatment tolerance. ≥30 mins/session, flexibly adjusted for treatment side effects. Focuses on rhythmic activities (walking, cycling). * Resistance Training: 2-3 days/week (48h rest per muscle group) at 60-80% 1-RM or a load for 6-15 reps. Employs progressive overload without requiring muscular failure. Involves 8-10 major muscle groups; ≥1 set/exercise, ≥6 reps/set, with ≥60s rest between sets. Modalities adapt to patient status. * Flexibility Training: ≥2-3 days/week (up to daily). Static stretches (10-30s hold, 2-4 reps, stretching to mild discomfort but avoiding pain) covering all major muscles.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 80 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Aged 18 to 80 years. 2. Cancer Cohorts: Pathologically confirmed diagnosis of AJCC TNM stage I-III, and having completed curative-intent treatment (including surgery ± adjuvant chemotherapy/radiotherapy, etc) for at least 2 months. 3. Cancer cohort must have an Eastern Cooperative Oncology Group (ECOG) Performance Status score of 0-2. 4. Ability to comply with weekly structured exercise training (3-4 professionally supervised sessions per week) and willingness to accept telephone follow-ups or report exercise status via exercise logs/wearable devices. 5. Self-reported failure to meet the following physical activity guidelines within the past 3 months: at least 150 minutes of moderate-intensity aerobic exercise per week OR at least 75 minutes of vigorous-intensity aerobic exercise per week; AND no regular resistance training (≥ 2 sessions per week) within the past 3 months. Exclusion Criteria: 1. Cardiovascular instability: History of acute coronary syndrome (ACS), myocardial infarction (MI), acute exacerbation of heart failure, or hospitalization for heart failure within the past 3 months; unstable angina; uncontrolled arrhythmia; or uncontrolled hypertension (resting blood pressure \> 180/110 mmHg). 2. Hypoxemia: Resting oxygen saturation (SpO2) \< 90%. 3. Metabolic instability: Severe hypoglycemic event or diabetic ketoacidosis (DKA) within the past 3 months. 4. Musculoskeletal or neurological risks: Unstable bone metastasis or bone metastasis with a high risk of fracture; recent major fracture or orthopedic surgery where weight-bearing is not yet permitted; or other severe neuromuscular diseases that compromise the safety of exercise. 5. Hematological risks: Thrombocytopenia (Platelet count \< 50,000/μL), severe anemia (Hemoglobin \[Hb\] \< 8 g/dL), or neutropenia (Absolute Neutrophil Count \[ANC\] \< 1,000/μL). 6. Deemed unsuitable for exercise intervention as determined by clinical assessment from the attending physician or study investigator. 7. Concurrent participation in other formal exercise or weight-loss intervention programs. 8. Inability to comprehend or complete the informed consent form, or inability to comply with the study procedures.

Outcomes

Primary Outcomes

Dominant Handgrip Strength Test

The participant is evaluated in a seated or standing position with the shoulder adducted, the elbow flexed at approximately 90 degrees, and the forearm and wrist in a neutral position. Using a calibrated handgrip dynamometer, the participant performs a maximal voluntary contraction (MVC) with the dominant hand for approximately 3 seconds. The test is repeated 3 times with at least a 30-second rest interval between trials. The highest value obtained from the three trials is recorded as the final result.