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Purpose: Bleomycin, etoposide, and cisplatin combination chemotherapy (BEP) improves the survival of patients with testicular cancer, but is associated with potentially life-threatening toxicities like pneumonitis and thromboembolic events. This study explored the effects of physical exercise in patients with testicular cancer during or after BEP-chemotherapy on pulmonary and vascular endothelial toxicity., Methods: In this post hoc analysis of a multicenter randomized clinical trial (NCT01642680), patients with metastatic testicular cancer scheduled to receive BEP-chemotherapy were randomized to a 24-week exercise intervention, initiated during (group A) or after BEP-chemotherapy (group B). Endpoints were pulmonary function (forced vital capacity (FVC), forced expiratory volume in one second (FEV1), lung transfer-coefficient and transfer factor for carbon monoxide (KCO, DLCO) and markers of vascular endothelial dysfunction (von Willebrand factor (vWF) and factor VIII)., Results: Thirty patients were included. Post-chemotherapy, patients declined less in FVC, FEV1 and DLCO in group A compared to group B. Post-chemotherapy, vWF and factor VIII were significantly lower in group A compared to group B. After completion of exercise, started either during BEP-chemotherapy or thereafter, no between-group differences were found. At 1-year post-intervention, significant between-group differences were found in favour of group A in DLCO and KCO., Conclusions: Patients who exercised during BEP-chemotherapy better preserved FVC, FEV1 and DLCO, measured directly post-chemotherapy and 1-year post-intervention (DLCO, KCO). This coincided with less increase in vWF and factor VIII measured directly post-chemotherapy. These data support a beneficial role of a physical exercise intervention during BEP-chemotherapy on pulmonary and vascular damage in patients with testicular cancer., Trial Registry: Optimal Timing of Physical Activity in Cancer Treatment (ACT) Registry URL: https://clinicaltrials.gov/ct2/show/NCT01642680 ., Trial Registration Number: NCT01642680., (© 2023. The Author(s).)

Background: Despite the widely acknowledged benefit of exercise for patients with cancer, little evidence on the optimal timing of exercise on adverse effects of cancer treatment is available., Objectives: The aim of this study was to determine whether an exercise intervention initiated during chemotherapy is superior to an intervention initiated after chemotherapy for improving long-term cardiorespiratory fitness (peak oxygen uptake [VO 2peak ])., Methods: In this prospective, randomized clinical trial, patients scheduled to receive curative chemotherapy were randomized to a 24-week exercise intervention, initiated either during chemotherapy (group A) or afterward (group B). The primary endpoint was VO 2peak 1 year postintervention. Secondary endpoints were VO 2peak postintervention, muscle strength, health-related quality of life (HRQoL), fatigue, physical activity, and self-efficacy. Between-group differences were calculated using intention-to-treat linear mixed-models analyses., Results: A total of 266 patients with breast (n = 139), testicular (n = 95), and colon cancer (n = 30) as well as lymphoma (n = 2) were included. VO 2peak immediately postintervention and 1 year postintervention did not differ between the 2 groups. Immediately postchemotherapy, patients in group A exhibited significantly lower decreases in VO 2peak (3.1 mL/kg/min; 95% CI: 2.2-4.0 mL/kg/min), HRQoL, and muscle strength and reported less fatigue and more physical activity than those in group B., Conclusions: Exercise can be safely performed during chemotherapy and prevents fatigue and decreases in VO 2peak , muscle strength, and HRQoL, in addition to hastening the return of function after chemotherapy. Also, if exercise cannot be performed during chemotherapy, a program afterward can enable patients to regain the same level of function, measured 1 year after completion of the intervention. (Optimal Timing of Physical Activity in Cancer Treatment [ACT]; NCT01642680)., Competing Interests: This work was supported by the Dutch Cancer Society, Alpe d’HuZes (grant DCS 2011-5265). The funder had no role in the design, data collection, management, analysis, interpretation, report writing, and decision to submit the manuscript. Dr Hummel has patents, royalties, and other intellectual properties with Us2.ai (institutional). Dr van der Meer has received research funding from Vifor Pharma (institutional), AstraZeneca (institutional), Ionis (institutional), and Pfizer (institutional); and has received payments or honoraria from Vifor Pharma (institutional), Novartis (institutional), and Pharmacosmos (institutional). Dr Nijland has received research funding from Takeda (institutional) and Roche (institutional); and has performed consulting in an advisory role for Genmab (institutional). Dr de Vries has received research funding from Amgen (institutional), AstraZeneca (institutional), Bayer (institutional), Chugai Pharma (institutional), Crescendo (institutional), CytomX (institutional), Therapeutics (institutional), G1 Therapeutics (institutional), Genentech (institutional), Nordic Nanovector (institutional), Radius Health (institutional), Regeneron, Roche (institutional), Servier (institutional), and Synthon (institutional); and has performed consulting in an advisory role for Daiichi Sankyo (institutional), the National Surgical Adjuvant Breast and Bowel Project (institutional), and Sanofi (institutional). Dr Gietema has received research funding from Abbvie (institutional), Roche (institutional), and Siemens (institutional). Dr Walenkamp has received a grant from the Dutch Cancer Society (institutional); has received research funding from Abbvie (institutional), Bristol Myers Squibb (institutional), Genzyme (institutional), Karyopharm Therapeutics (institutional), and Roche (institutional); and has performed consulting in an advisory role for Polyphor (institutional), Ipsen (institutional), Karyopharm (institutional), and Novartis (institutional). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2022 The Authors.)

Background: Adjuvant endocrine therapy (ET) in patients with breast cancer (BC) increases the risk of becoming less physically active. Physical inactivity is associated with a higher risk of treatment-related side effects and mortality. This study investigated whether supervised exercise increased the proportion of patients adhering to the national physical activity (PA) guideline during adjuvant ET in overweight or obese BC patients., Methods: This multicentre single-arm clinical trial included patients with BC participating in a 12-week supervised exercise intervention. An accelerometer measured moderate to vigorous PA (MVPA) at baseline (T0), after 12 (T1) and 26 weeks (T2). The primary endpoint was change in the proportion of patients with weekly ≥150 min of MVPA at T1 compared to T0. Secondary endpoints were adherence to PA guideline at T2, metabolic syndrome (MetS), body composition, health-related quality of life (HRQoL) and BC-specific functioning and symptoms, self-reported PA, self-efficacy, exercise motivation and satisfaction with life., Results: 141 patients with a median age of 61 years and a mean BMI of 31.3 participated. Adherence to the PA guideline increased from 38.3% at T0, to 40.4% at T1 (p = .112) and 44.7% at T2 (p = .003). MetS, body composition, HRQoL, BC-specific functioning and symptoms (i.e. fatigue, dyspnoea), self-reported PA, self-efficacy, exercise motivation and satisfaction with life improved significantly over time., Conclusions: Supervised exercise increased the proportion of BC patients adhering to the PA guideline over time. Furthermore, MetS, body composition, HRQoL and symptoms improved. Our findings highlight the clinical relevance of supervised exercise during ET in overweight BC patients., Clinical Trial Information: (NCT02424292)., Competing Interests: Declaration of competing interest All authors have nothing to disclose., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)