ISEO – Inaugural Conference July 22nd & 23rd 2026 - organized by DKFZ

22 Jul 2026, 08:00 → 23 Jul 2026, 18:30 Europe/Berlin

Heidelberg Congress Center

Joachim Wiskemann (Universitätsklinikum Heidelberg), Karen Steindorf (Deutsches Krebsforschungszentrum)

nicht befüllen

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Wednesday 22 July

08:00 Welcome & Registration

Remarks: Opening (Hall 2)

Conveners: Joachim Wiskemann (Universitätsklinikum Heidelberg), Karen Steindorf (Deutsches Krebsforschungszentrum), Kathryn Schmitz (UPMC Hillman Cancer Center)

Keynote: Kerry Courneya - Hidden Secrets and Insights of the "CHALLENGE" to improve Cancer-Related Survival with exercise (Hall 2)

Convener: Kerry S. Courneya (Faculty of Kinesiology, Sport, and Recreation, College of Health Sciences, University of Alberta, Edmonton, Canada)

1 Kerry Courneya - Hidden Secrets and Insights of the "CHALLENGE" to improve Cancer-Related Survival with exercise

Speaker: Kerry S. Courneya (Faculty of Kinesiology, Sport, and Recreation, College of Health Sciences, University of Alberta, Edmonton, Canada)

Courneya-ISEO-2026.ppt

10:15 Networking Break

Oral Session 1: Prehabilitation and Perioperative (Hall 2)

Chairs: Robert Newton & Christoph Michalski

2 Effects of prehabilitation on exercise capacity and patient-reported outcomes in patients with cancer: Results from pooled analysis of individual patient data of nine RCTs

PURPOSE This study examines the effect of preoperative exercise training (prehabilitation) on exercise capacity and patient-reported outcomes (PROs) (quality of life (QoL), physical function, fatigue, anxiety, and depression) in patients with cancer.

METHODS We pooled individual patient data from nine randomized controlled trials (n=733 patients) available through the POLARIS database, including studies on gastrointestinal, genitourinary, respiratory, or mixed cancers. Linear mixed models were used to assess intervention effects on exercise capacity (VO2peak and 6-minute walk distance) and PROs: general QoL, physical function, fatigue, anxiety and depression (expressed as z-scores). Outcomes were measured at four time points: baseline (T0), after the intervention and before surgery (T1), 4-6 weeks post-surgery (T2) and 3-4 months post-surgery (T3).

RESULTS Patients (mean age 69.2 ±10.6 years) were originally randomized to a prehabilitation intervention (n=369) and control group (n=364). Of the nine studies, six included resistance training and three did not. Seven incorporated supervised exercise, while two were entirely home-based. Intervention duration ranged from 2 to 8 weeks. Compared with controls, the intervention group showed a significantly higher exercise capacity at T1 (β=0.25, 95%CI= 0.16;0.35) and T2 (β=0.19, 95%CI 0.02;0.37) with no significant differences at T3. At T1, fatigue was significantly lower in the intervention group compared to the control group (β=-0.26, 95%CI -0.45;-0.06), but this difference did not persist post-surgery. In the intervention group, symptoms of anxiety (β=-0.27, 95%CI -0.53;-0.02) and depression (β=-0.33, 95%CI -0.57;-0.09) were significantly lower at T2 compared to controls, but not at T1 and T3. No significant differences between groups were observed for general QoL or physical function.

CONCLUSION Prehabilitation improves exercise capacity and psychological well-being, with limited durability of effects after surgery. In further analyses we will explore whether these effects vary by demographic, clinical, and intervention-related characteristics, to guide further tailoring of prehabilitation strategies.

Speaker: Lilian Manning (Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands)

3 Multimodal home-based prehabilitation for colorectal cancer patients with short surgery wait times: a pilot service and retrospective case-controlled study

BACKGROUND:
Prehabilitation is a needs based personalised intervention before and during cancer treatment to optimise physical, psychological and nutritional status supported by behaviour change psychology. Enhanced readiness and tolerance of treatments may reduce complications, hospital length of stay (LOS), improve recovery and/or quality of life (QoL) and decrease cost of care. Short wait times for colorectal cancer surgery creates challenges for implementing prehabilitation guidelines. This pilot service evaluated the feasibility of multimodal home-based high intensity interval training (HIIT) with high frequency (>5 days/week) to optimise patients within short surgery wait times (<4 weeks).
METHODS:
Twenty-six patients received personalised home-based structured exercise, breathing and pelvic floor exercises, dietetic and psychological support. Each patient was retrospectively matched with two non-intervention patients based on age at surgery, sex, and surgical procedure. Outcomes: LOS and cost of care, functional walking capacity (6MWT), sit-to-stand test, body-composition, self-efficacy for exercise, anxiety/depression (PHQ-4), malnutrition status (PG-SGA), QoL (EQ-5D-5L), adherence, sedentary behaviour, affect regulation and patient satisfaction. Distribution dependant appropriate statistics (mean±SD; median/range; paired t-tests; p < .05).
RESULTS:
Patients who had higher intervention adherence had improved physical, nutritional and psychological scores in comparison to those who had moderate and low adherence. LOS was reduced and resulted in a cost neutral service. The intervention was safe and enjoyable and patient satisfaction was very high. No adverse events occurred.
CONCLUSION:
Multimodal home-based HIIT prehabilitation with high frequency appears feasible and safe to be implemented unsupervised and at scale within reduced surgery wait times. Behaviour change psychology to promote adherence is essential in home-based settings. Optimal results may require >4 weeks of physical exercise and early referral is vital. A larger RCT is required to confirm these initial findings.

Speaker: Talitha de Klerk (Edinburgh Napier University)

ISEO Presentation TDK ENU 22 July 1045.pptx

4 Effect of a Personalized Perioperative Exercise Program on Physical Function, Fatigue, and Quality of Life in Lung Cancer Surgery: Results of the PEP Phase III Randomized Trial

Background: Exercise interventions benefit surgical lung cancer patients, but many are resource intensive and follow a one-size-fits-all design. The Precision-Exercise-Prescription (PEP) trial is a clinic-aligned, personalized perioperative exercise program with remote monitoring that previously showed improved physical function in women and reduced fatigue across groups at 2 months post-surgery. This longitudinal analysis evaluates effects of the PEP program on physical function, fatigue, and quality of life at 6 months post-surgery.

Methods: The PEP Study enrolled adults with primary (stages I–IIIa) or oligometastatic lung cancer undergoing surgery. Participants were randomized to the PEP exercise intervention or standard care between November 2017 and 2021, with follow-up through November 2022. The personalized intervention, tailored to Activity Measure for Post-Acute Care (AMPAC) mobility scores, was prescribed and remotely monitored by a physical therapist starting approximately two weeks before surgery and continuing postoperatively. Standard care consisted of spirometer use and general exercise encouragement without a structured program. Physical function (6-minute walk test), fatigue (FACIT-F), and overall quality of life (Functional Assessment of Cancer Therapy–Lung) were assessed at baseline and 6 months, and within- and between-group changes were analyzed.

Results: A total of 182 patients (exercise: n=92; standard care: n=90) were included. Patients in the exercise group showed a modest, non-significant increase in 6MW distance from baseline to 6 months (467±12m to 476±19m, p=0.51), whereas the standard care group demonstrated a marginally significant decline (481±11m to 450±20m, p=0.06). However, the between-group difference in change was not statistically significant (p=0.09). No significant differences in changes in fatigue or overall quality of life were observed from baseline to 6 months (p>0.05).

Conclusions: The PEP exercise program yielded modest within-group improvements in physical function from baseline to 6 months post-surgery, but did not produce significant between-group benefits compared with standard care for fatigue and quality of life.

Speaker: Victoria Bandera (University of Utah Huntsman Cancer Institute)

Bandera_ISEO_Oral Session 1.pptx

5 Multidisciplinary Prehabilitation and Rehabilitation for Improving Postoperative Complications in Patients with Colon Cancer: The OncoFit Randomized Controlled Trial

INTRODUCTION
Colon cancer is the third most common malignancy worldwide, with more than 1.1 million new cases diagnosed annually. Surgical resection remains the cornerstone of curative treatment, but induces a substantial physiological stress response, often leading to postoperative complications. While multidisciplinary prehabilitation has shown benefits in reducing major complications rate, evidence regarding the combined effect of structure multidisciplinary prehabilitation and rehabilitation program on postoperative outcomes remains limited.

OBJECTIVE
To evaluate the effects of a multidisciplinary prehabilitation and rehabilitation program (PPP) on postoperative complications and clinical prognosis in patients undergoing colon cancer resection.

METHODS
Ninety patients were randomized to either the usual care group (n=46) or the PPP group (n=44). The intervention consisted on a multidisciplinary prehabilitation (4 weeks) and rehabilitation (12 weeks) program including: (i) supervised concurrent exercise training, (ii) dietary behaviour change and (iii) psychological support. Postoperative outcomes were assessed using the comprehensive complication index (CCI), the proportion of patients experiencing complications (%), and the hospital length of stay.

RESULTS
The PPP exhibited significantly lower CCI scores compared with the control group (median [IQR]: 0.00 [0.00 – 12.20] vs 8.70 [0.00 – 20.90]; P = 0.014), a lower incidence of postoperative complications (40.9% vs 71.7%; P = 0.004; OR = 0.273), and a shorter hospital length of stay (median [IQR]: 5 days [4-6] vs 6 days [4-6]; P = 0.029).

CONCLUSION
A multidisciplinary prehabilitation and rehabilitation programs substantially reduces the severity and incidence of postoperative complications and shortens hospital stay in patients undergoing colon cancer resection.

Speaker: Manuel Fernandez-Escabias (Department of Physiology, Faculty of Medicine, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain)

6 Effects of Perioperative Exercise on Patients with Gastroesophageal Cancer: A Systematic Review and Meta-Analysis

Background
Gastric and esophageal cancers remain major contributors to global cancer mortality, and surgical treatment is frequently associated with substantial morbidity and delayed postoperative recovery. Reduced cardiorespiratory fitness and muscle strength are strongly linked to postoperative complications and prolonged length of hospital stay (LOS), potentially impairing treatment continuity and prognosis. Although exercise interventions may improve these outcomes, evidence from randomized controlled trials (RCTs) in gastroesophageal cancer (GEC) remains limited, with prior meta-analyses largely focused on physiotherapy-based approaches rather than conventional exercise.

Objective
To evaluate the effects of pre-, post-, and peri-operative exercise interventions on functional and clinical outcomes in patients undergoing surgery for gastroesophageal cancer.

Methods
A systematic review and meta-analysis of RCTs was conducted. Of 22 eligible trials, 12 were included in the quantitative synthesis. Risk of bias was assessed using the Cochrane RoB 2 tool. Outcomes included VO₂max/peak, 6-minute walk distance (6MWD), handgrip strength (HGS), length of hospital stay (LOS), major postoperative complications (Clavien–Dindo ≥ III), and 30-day hospital readmission.

Results
Exercise interventions significantly improved functional capacity, including VO₂max/peak (mean difference [MD]: +3.31 mL/kg/min; 95% CI: 0.47–6.14) and 6MWD (MD: +39.85 m; 95% CI: 7.40–72.30). HGS improved significantly in pre-operative exercise programs (MD: +2.23 kg; 95% CI: 0.56–3.90) but not in postoperative or mixed-timing interventions. Exercise significantly reduced postoperative LOS by 1.81 days (95% CI: −3.48 to −0.14). Reductions in major complications (RR: 0.74) and hospital readmission (RR: 0.73) did not reach statistical significance but consistently favored exercise. Overall risk of bias was rated as low to some concerns.

Conclusions
Exercise interventions improve functional outcomes and reduce hospital stay in patients undergoing GEC surgery, supporting their role as a safe and clinically relevant adjunct to perioperative care.

Funding
This research was supported by Korea Research Foundation (2024S1A5C3A0204344912) and funded by the National Research Foundation of Korea (NRF- 20241A5C3A02043449).

Speaker: Sungwoo Lee (Exercise Medicine and Rehabilitation Laboratory, Yonsei Uiversity)

ISEO Oral Presentation_260722_SWLee.pptx

Oral Session 2: Remote Training (Forum 1)

Chairs: Anne May & Anna Campbell

7 Impact of telehealth exercise intervention on muscle strength, cardiorespiratory fitness, and quality of life in patients with cancer: a systematic review with meta-analysis

Introduction
Cardiorespiratory fitness (CRF), muscle strength are prognostic factors in cancer. Although exercise can improve these parameters, many patients remain insufficiently, especially due to the lack of accessible services. Telehealth interventions overcomes these obstacles, although concerns remains about its effectiveness. This meta-analysis primarily aims to determine the impact of exercise delivered via telehealth on CRF, strength, and quality of life (QoL) in patients with cancer.

Methods
A systematic search on PubMed/MEDLINE, Scopus, Web of Science, CINAHL, and Cochrane was conducted. Randomized controlled trials testing the impact of exercise delivered by telehealth on CRF, upper- and lower-limb strength, and QoL were included. To quantify the magnitude of change a random-effects meta-analysis was conducted.

Results
Twenty-eight studies were included, comprising 2,212 patients (mean age 56.6 ± 8.6 years; BMI 28.3 ± 5.1 kg/m²). The sample included individuals with breast, prostate, and various mixed cancer types, mostly diagnosed with stage I–III disease. Telehealth-delivered exercise produced significant improvements in CRF (SMD = 0,204; p = 0,0007) and lower-limb strength (SMD = 0,41; p = 0,016). No significant effects emerged for upper-limb strength (SMD = 0,01; p = 0,94), QoL (SMD = 0,09; p = 0,566), and physical function (SMD = 0,26; p = 0,134). Stratifying for telehealth mode, eHealth interventions showed greater benefits for CRF and lower limb strength, wearable device for CRF and gaming for physical functioning. About exercise type, aerobic training revealed larger improvements in CRF and combined interventions (aerobic + resistance) in CRF, lower-limb strength and physical functioning.

Conclusion
Telehealth-delivered exercise significantly improve CRF and lower-limb strength in patients with cancer, although effects on QoL and upper-limb strength remain limited. Overall, these findings support telehealth as a promising strategy to improve key fitness outcomes while underscoring the need for more targeted and standardized interventions.

Speaker: Gloria Adamoli (Università di Verona)

8 Effects of a 12-Week Live-Remote Exercise Intervention for Cancer Survivors: Findings from a Randomised Controlled Trial

Purpose
Exercise provides important benefits for cancer survivors, yet participation remains low due to barriers such as time demands, travel distance, and limited access to appropriate services. Supervised live-remote delivery may help address these barriers while retaining professional support. This trial evaluated the effects of a 12-week live-remote supervised exercise intervention on health-related quality of life (HRQoL) and other patient-reported and physiological outcomes in survivors of breast, prostate, and colorectal cancer.

Methods
Between January 2022 and December 2023, 200 participants (mean age 58.5 ± 10.4 years; 62% women) were randomised to a live-remote exercise intervention or usual care. Half had been treated for breast cancer, 23% for prostate cancer, and 26% for colorectal cancer. The intervention comprised twice-weekly, 60-minute virtual group sessions (≤8 participants) delivered for 12 weeks by upskilled personal trainers. Assessments occurred at baseline, post-intervention (3 months), and 6 months. The primary outcome was overall HRQoL (EORTC QLQ-C30). Secondary outcomes included self-reported physical functioning, cardiorespiratory fitness (VO₂max), strength, and physical activity. Exploratory analyses examined potential moderating factors and descriptive patterns of absolute change by baseline health status.

Results
Median attendance was 75%, with no serious adverse events. No between-group difference was observed for overall HRQoL. At 3 months, compared with usual care, the intervention group showed greater improvements in self-reported physical functioning (ES 0.31, p≤0.001), sit-to-stand performance (ES=0.22, p=0.003), VO₂max (ES=0.12, p=0.045), upper-body strength (ES=0.17, p=0.010), and physical activity (aerobic ES=0.57; resistance ES=1.03; both p<0.001). Most effects were not sustained at 6 months. Exploratory findings suggest that women, participants receiving endocrine therapy, and those with lower baseline HRQoL or fitness appeared to show greater improvements.

Conclusions
Supervised live-remote exercise improved physical function, fitness, strength, and physical activity, with no significant change in overall HRQoL. Exploratory findings indicate that some subgroups may derive greater benefit.

Speaker: Melissa Kotte (Karolinska Institutet)

ISEO presentation_Melissa Kotte 2207.pptx

9 Trainer Perspectives on Feasibility, Quality, and Barriers of Live-Remote Exercise Delivery in the PREFERABLE II LION Randomized Controlled Trial

Background: LION is a multinational randomized controlled trial (RCT) investigating the effects of a live-remote exercise program in individuals who self-report fatigue, emotional distress, low physical functioning, and/or neuropathy after curative cancer treatment. The 12-week program consists of resistance and aerobic training (2x/week) and sessions targeting the participant’s most burdensome side effect (1x/week; which may include yoga-based, relaxation, balance, agility and/or hand exercises). As live-remote training is not yet widely implemented in oncology, an evaluation study was conducted to inform the development of educational materials and recommendations that support its safe delivery.

Methods: All trainers involved in the LION-RCT were invited to complete an online questionnaire assessing their experiences with supervising participants in this program.

Results: Twenty-three of 25 LION trainers completed the survey. They had a median of 6.5 years of professional experience and 2.8 years in oncology. At the time of analysis, more than 1700 LION-training sessions had been delivered. Overall, trainers rated IT-related implementation as manageable for both participants (mean±SD, 3.22±1.18) and themselves (3.61±0.97; 1=with a lot of difficulty, 5=very easily). Trainers found the resistance, yoga-based, balance, and hand exercises easy to deliver live-remotely (means≥4.10), whereas aerobic training (3.43±1.08) and agility training (3.12±1.22) were more difficult but still feasible. Challenges in monitoring training stimulus (2.65±0.81), adjusting intensity (2.48±0.93), and correcting posture (2.61±0.87) occurred occasionally (1=never, 5=very often). Most exercise components were considered equally or more effective when delivered live-remotely compared to in-person training. However, 52% and 71%, respectively, believed live-remote resistance training and agility training to be less effective. Additional insights into perceived barriers and strengths of live-remote exercise programs will be presented at the conference.

Discussion: Live-remote exercise delivery is well accepted by the trainers in the LION-RCT. However, aerobic and agility training seem more difficult to implement in a live-remote format and need further attention.

Speaker: Jana Müller (Exercise Oncology Research Group, Department of Medical Oncology, Heidelberg University Hospital, Medical Faculty Heidelberg, Heidelberg University, National Center for Tumor Diseases Heidelberg, a partnership between DKFZ and Heidelberg University Hospital, Heidelberg, Germany)

10 coACTIF: Real-world reach and effectiveness of virtual group-based multimodal prehabilitation for people with cancer and their caregivers

Background Multimodal prehabilitation can optimize physical, nutritional, and psychological health in people with cancer, reduce treatment-related side effects, and support recovery; it may also benefit caregivers, who frequently report stress, anxiety, fatigue, reduced functioning and often feel abandoned by the system. We developed coACTIF (COllectively ACTive and InFormed upon cancer diagnosis), an innovative virtual, group-based multimodal prehabilitation program for patients and caregivers, and present preliminary findings.

Methods This pragmatic, multicentre, hybrid implementation–effectiveness study uses a pre–post design across three hospital centres in Quebec. Patients scheduled for cancer-related surgery in ≥2 weeks and their caregivers (if interested) were recruited. Participants completed a virtual fitness assessment with a qualified exercise professional and self-report questionnaires pre (T1) and post (T2) intervention; implementation and effectiveness were assessed using RE-AIM. The intervention comprised supervised synchronous group exercise (3×60 min/week) plus educational content via the coactif.ca website covering physical activity, nutrition, well-being, sleep, motivation, and self-management strategies. Pre–post changes were analyzed using paired Student’s t tests (or Wilcoxon signed-rank tests) and Cohen’s d.

Results Overall, 571 referrals were received; 295 (49.1%) were eligible and 116 patients were enrolled (69.8% female), including 20% with a caregiver (n=23; 73.9% female), for a total of 139 participants. At abstract submission, most participants had completed pre–post questionnaires (n=107) and kinesiology evaluations (n=109). Physical function improved based on the 2-min step test from M(SD)=75.5(22.1) to 91.9(20.0), p<0.001; d(95%CI)=0.72(0.58–0.87)) and the 30-s sit-to-stand test, from 12.6(3.6) to 13.6(3.9), p=0.001; d(95%CI)=0.22(0.07–0.36)). Stress (Perceived Stress Scale) decreased from 15.6(6.5) to 14.2(6.0), p=0.029; d(95%CI)=-0.21(-0.37–0.05)) and self-management capacity (Partners in Health) increased from 6.8(1.1) to 7.0(0.9), p=0.005; d(95%CI)=0.21(0.05–0.37)); fatigue, anxiety and depressive symptoms remained stable.

Conclusion These preliminary results suggest coACTIF may improve physical, mental, and behavioural functioning and could further inform scalable implementation across various oncology settings.

Speaker: Isabelle Doré (Université de Montréal)

11 The Effects of a Remote Diet and Exercise Intervention and Behavioral Change Constructs on Health Behaviors in the Prostate 8-II Randomized Controlled Trial

Purpose: We evaluated if diet or exercise habits changed in a randomized controlled trial (RCT) of a remote behavior intervention vs. control, in men with prostate cancer. We assessed associations of behavioral change constructs with health behaviors.
Methods: Prostate 8-II is a RCT testing a remote diet and exercise intervention among 202 men with prostate cancer, opting for surgery at primary treatment, and not meeting all exercise/diet recommendations. The intervention included an interactive website, text messages, and health coaching. The control arm received print education. We used mixed effects models to assess intervention effects on the P8 diet score (higher=healthier) and meeting moderate to vigorous physical activity (MVPA) and P8-II resistance exercise guidelines (2+ d/wk, 8 exercises/session) at 6 and 12 months. We examined cross-sectional associations between baseline behavior constructs (social support, self-efficacy, perceived barriers, and use of change strategies) and baseline diet and exercise behaviors using multivariable linear and logistic regression.
Results: Among those with two-timepoint survey data, men randomized to the intervention (N~79) vs. control (N~83) increased their P8 diet score (p<0.001). A greater proportion of those randomized to exercise (N~91) vs. control (N~97) made improvements in meeting the resistance exercise recommendation (p=0.004); the exercise intervention did not improve MVPA between arms. At baseline, reporting more barriers was associated with lower step count (assessed via Actigraph GT3X+ accelerometers) and being less likely to meet MVPA guidelines; and use of change strategies was positively associated with MVPA guidelines. Higher self-efficacy for healthy eating was positively associated with P8 diet score.
Conclusions: The P8-II intervention increased the adoption of a prostate cancer-specific healthy diet and resistance exercise (vs. control). Future study will examine if changes in behavior were modified by behavioral constructs and evaluate the effect of the intervention on prostate-specific antigen levels.

Speaker: Stacey Kenfield (University of California, San Francisco (UCSF))

11:45 Lunch Break

Poster Session 1.1: Innovative Trials (Posterarea 1)

12 A phase III, multi-state, randomised controlled trial evaluating the addition of exercise or compression therapy to best-practice usual breast cancer care to prevent breast cancer-related lymphoedema: The ACHIEVE trial protocol

Introduction: Breast cancer-related lymphoedema (BCRL) is a prevalent condition associated with lifelong physical, psychological and social burden, and lower quality of life. The primary aim of this trial is to determine if adding exercise therapy or compression therapy to usual care can prevent BCRL. Secondary aims evaluate effects on patient-reported outcomes and the cost-effectiveness of preventive strategies.

Methods: This multi-state, phase III, single-blind, parallel-group (1:1:1), randomised controlled trial will recruit adults with a first diagnosis of breast cancer who are at high risk of BCRL. Participants will be randomised to usual care, usual care plus exercise therapy, usual care plus compression therapy. 660 participants are needed to detect a 10% absolute difference in 12-month BCRL incidence between groups (α=0.05, β=0.2, 10% drop-out). BCRL incidence will be assessed using bioimpedance spectroscopy, circumferences, tissue dielectric constant and validated self-report measures, applying predetermined diagnostic thresholds. Secondary outcomes include patient-reported outcomes of symptoms, function, quality of life, mental health and physical activity as well as intervention cost-effectiveness. Usual care includes prospective surveillance (lymphoedema assessments of the upper-limb, postoperative lymphoedema education including risk reducing strategies and shoulder function rehabilitation). Exercise therapy (behaviour-change counselling and individualised prescription of aerobic and resistance training targeting 150 minutes per week) and compression therapy (provision of individually-fitted compression garments for daily wear) will be delivered through fortnightly calls over a 6-month period. Primary and secondary outcomes will be assessed at baseline, 3-, 6-, 12-, 24-months, and 5 years post-randomisation.

Results: Study ethics approval is under review. Study protocol will be registered on the Australian New Zealand Clinical Trial Registry (ANZCTR). Findings will be disseminated via peer-reviewed publications and national/international conferences.

Conclusion: This trial will determine the efficacy and cost-effectiveness of incorporating exercise therapy or compression therapy into best-practice usual breast cancer care for BCRL prevention.

Speaker: Ms Camila Sanchez Saez (School of Allied Health, Sport and Social Work Griffith University, Queensland, Australia)

13 A tailored exercise and nutritional intervention for improving early-stage NSCLC outcomes: the STARLighT study

Introduction. Observational evidence links exercise to longer survival, but to date, no causality has been demonstrated. The primary aim of the STARLighT trial is to evaluate the impact of a structured exercise and nutrition intervention on pathological complete response (pCR) in patients undergoing neoadjuvant treatment and on disease-free survival (DFS) in patients undergoing adjuvant treatment.
Methods. Two cohorts of patients with non-oncogene addicted with early-stage non-small cell lung cancer (NSCLC), stages IB to IIIA, will be enrolled. COHORT A will accrue 46 patients undergoing neoadjuvant chemo/immunotherapy and exploit a single-arm phase II design to detect an increase in the proportion of pCR from 20% to 40%; COHORT B will accrue 278 patients undergoing physician's choice of adjuvant treatment and exploit a 1:1 randomized controlled design to detect an increase in 2-year DFS rates from 55% to 70% in the control and experimental arms, respectively. All patients in COHORT A will receive a personalized exercise intervention thrice a week, tailored nutritional counseling, and immunonutrients, two bottles/day. The intervention in COHORT A will last for the entire neoadjuvant treatment period. In COHORT B, whereas patients randomized in the controls will receive the current standard of care and dedicated educational health material, those allocated in the experimental arm will undergo exercise twice a week, nutritional counseling, and whey protein, 20 gr/day. The intervention for the COHORT B will last 6 months. Translational studies will encompass baseline assessment of genomic and transcriptomic features and longitudinal assessment of circulating immuno-inflammatory profiles and tumor microenvironment composition, to be correlated with clinical and lifestyle data to build a comprehensive predictive model.

Conclusion. We expect that a tailored lifestyle intervention will result in a higher pCR rate and longer DFS in patients in the neoadjuvant or adjuvant setting, respectively, thereby potentially increasing cure rates in early NSCLC.

Speaker: Alice Avancini (University of Verona)

14 Design of a multicenter randomized controlled trial to assess the effects of exeRcise And Diet on quality of life in patients with Incurable Cancer of Esophagus and Stomach: the RADICES study

Background
Patients with incurable gastroesophageal adenocarcinoma (GAC) experience an impaired health-related quality of life (HRQoL), which might further deteriorate over time. These patients are often confronted with significant life-impacting symptoms, such as fatigue and reduced physical functioning. Exercise combined with nutritional support may improve these outcomes. However, careful evaluation of such an intervention is needed to avoid burdening patients at this vulnerable stage. Therefore, this study aims to evaluate the effects of a combined exercise and nutritional intervention on HRQoL in patients with incurable GAC.

Methods
The RADICES study is a multicenter randomized controlled trial and planning to enroll 196 patients with incurable GAC. Participants are randomly assigned (1:1) to either a patient-tailored intervention or a control group. Patients in the intervention group will receive two supervised training sessions per week and two-weekly nutritional consultations, delivered by trained physiotherapists and dietitians over a 12-week period. The control group will continue to receive standard care, supplemented with general physical activity advice. All patients will receive a Fitbit. As of Dec 12th, 76 patients have been included.

The primary outcome is the between-group difference in HRQoL at 12 weeks, adjusted for baseline HRQoL, measured by the EORTC QLQ-C30 summary score. HRQoL is assessed at baseline, 6, 12 weeks, and every 3 months thereafter up to 1 year. Key secondary outcomes include patient-reported outcomes (including physical functioning, role functioning and fatigue), cardiorespiratory fitness, dietary intake, disease progression, overall survival and cost-effectiveness. Adherence and safety are monitored throughout the intervention period.

Discussion
This study will generate evidence on the effectiveness of a patient-tailored combined exercise and nutritional intervention in patients with incurable GAC. If the intervention shows improvement in HRQoL, it could be integrated into standard care for patients with incurable GAC.

Speaker: Ms Linde Huis in 't Veld (Department of Medical Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands)

15 Effect of a 12-month multidisciplinary rehabilitation intervention on fatigue, work, and health-related quality of life among breast cancer survivors with chronic fatigue – A protocol abstract of the randomized ReCharge Trial.

Background: Persistent fatigue is a complex and highly distressing late effect after cancer, reported by more than one-third of women treated for breast cancer (BC). Randomized controlled trials (RCTs) investigating the effect of multidisciplinary interventions among cancer survivors with persistent fatigue are lacking. In a recently completed RCT in fatigued lymphoma survivors (the REFUEL-trial), we found that a 12-week multidisciplinary intervention including patient education, exercise, cognitive behavioral therapy (CBT) and nutrition counseling significantly improved level of fatigue, however, this effect did not sustain at 6- month follow-up. We believe that an intervention with longer duration focusing on behavioral change techniques might lead to more sustainable effects. We therefore aim to investigate the effects of a 12-month multidisciplinary rehabilitation program on fatigue BC survivors (BCSs) with persistent fatigue.

Patients and methods: A total of 200 BCSs with persistent fatigue, aged ≤70 years, diagnosed with stage II-III BC in 2019-2024 and > 2 years from curative treatment at Oslo University Hospital or St. Olavs Hospital will be randomized to standard care (n=100) or a 12-month multidisciplinary intervention (n=100). The intervention consists of one digital patient education session, a personalized aerobic exercise program, seven digital CBT-based group sessions and five group based nutritional counseling sessions. The primary outcome is total fatigue assessed by Chalder Fatigue Questionnaire (FQ). Secondary outcomes include other BC related late effects, work, health-related quality of life, cost-utility and cardiorespiratory fitness. Both groups will undergo assessments at baseline, and at 12-, 24- and 36-month post-randomization.

Expected results and clinical impact: We hypothesize that the 12-month multidisciplinary intervention will reduce fatigue in BCSs with persistent fatigue, as well as improve other health and functional outcomes. We expect that the results will be valuable for developing and improving healthcare services for cancer survivors with persistent fatigue.

Speaker: Dr Synne-Kristin Hoffart Bøhn (Department of Oncology, Oslo University Hospital)

16 EffectivenesS of a supervised multimodal exercise Intervention on persistent Cancer therapy Induced peripheraL neuropathY: protocol of the SICILY multicenter randomized controlled trial

Background Exercise has been suggested as a promising non-pharmaceutical intervention for cancer treatment induced peripheral neuropathy (CIPN). However, current evidence is limited to only a few, mostly small, studies with heterogeneous interventions and methodological limitations, and only a limited number of studies focus on chronic CIPN. In addition, data on the cost-effectiveness of exercise programs for CIPN are lacking, limiting the implementation of multimodal exercise programs in clinical practice.
Objective To investigate the (cost-)effectiveness of a supervised multimodal exercise program on CIPN burden in patients with persistent CIPN after neurotoxic cancer treatment in a full-scale randomized trial.
Methods This multicenter RCT will include 136 patients who completed curative neurotoxic systemic cancer treatment ≥6 months ago and experience CIPN-interference in daily life. Patients will be randomized (1:1) to an intervention group receiving a novel 12-week supervised multimodal CIPN-specific exercise program, or a wait-list control group receiving the program after a 12-week waiting period. The multimodal program consists of CIPN-specific exercises combining balance, aerobic and resistance exercises twice per week, supervised by a physiotherapist; goal-directed occupational therapy; home-based balance training supplemented with daily hand/feet exercises; and the recommendation to walk ≥30 minutes on days without scheduled exercise sessions. The primary outcome is patient-reported CIPN burden (EORTC QLQ-CIPN20). Secondary outcomes include CIPN symptoms, disability, mood, fatigue, fear of falling, fear of movement, patient-specific goals, quality of life, physical functioning, physical activity, cost-effectiveness (from a societal perspective) and patient satisfaction. Data will be collected at baseline, 12 weeks (i.e., primary endpoint), and 24 weeks.
Results Recruiting since September 2025.
Conclusion This trial will provide evidence on the (cost-)effectiveness of a CIPN-specific supervised multimodal exercise program for patients with persistent CIPN.

Speaker: Nida Huijben (Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands)

17 Efficacy of a group-based videoconference intervention to increase physical activity in cancer survivors: A study protocol

Background and Purpose: Moderate to vigorous intensity physical activity (MVPA; i.e., aerobic and resistance exercise) improves physical function and quality of life for cancer survivors and is associated with reductions in cancer-specific and all-cause mortality. Unfortunately, recent estimates suggest that only 14% of individuals with a cancer history are engaging in the amount of MVPA considered necessary to achieve these health benefits. Thus, there is a need for effective and wide-reaching interventions that can help cancer survivors increase MVPA. Supervised group-based interventions are successful in increasing MVPA among cancer survivors, however, delivering these interventions face-to-face can be resource intensive, and present a barrier in terms of access. Virtually supervised PA interventions (i.e., using videoconferencing) can offer the benefits of real-time supervision and social interaction, while retaining the scalability and reach advantages of other remote delivery modalities.
Methods: This study is a phase II randomized controlled trial to examine the effect of a group-based videoconference intervention to increase MVPA among N=300 post-treatment cancer survivors. Additional outcomes include physical function and quality of life, behavioral mediators and moderators of intervention effects, and loneliness. Participants will be randomized to the 12-week intervention or an asynchronous comparator group. The intervention will include twice-weekly instructor-led group-based aerobic and resistance exercise, and PA behavior change discussion sessions. Outcomes will be assessed at baseline, post-intervention and six-month follow-up. All study visits and intervention components will be delivered in real time using videoconferencing software. Potential Impact: Videoconferencing has the potential to vastly expand the reach and scalability of supervised exercise interventions, while retaining the key components of accountability and social support. Given the positive impact that aerobic and resistance exercise can have on multiple health outcomes and cancer-survival, if many cancer survivors can achieve and sustain recommended levels of MVPA, the public health impact would be substantial.

Speaker: Heather Leach (Colorado State University)

18 ENERGY study: Efficacy of a program combining exercise, nutritional management and psychological support in patients aged ≥ 70 years included in early clinical trials (phase I)

Older adults, who represent nearly half of new cancer diagnoses in France, remain largely underrepresented in phase I trials (<7%). Functional decline and frailty are key barriers to their participation. The primary purpose of the ENERGY study is to determine whether a multimodal intervention combining exercise, nutritional management, and psychological support can improve inclusion and retention rates of cancer patients aged ≥70 years in phase I clinical trials. The main hypothesis is that enhancing patients’ physical function, nutritional status, and psychological resilience will increase their eligibility for, and adherence to, experimental treatments. The ENERGY trial consists of two sequential phases. The first is a pilot study assessing the feasibility and implementation of the multimodal intervention in 10 patients. The second phase is an open-label, randomized (1:1), multicenter controlled trial comparing the intervention group with standard care across 10 French centers accredited for early-phase oncology trials. A total of 196 patients aged ≥70 years, treated for cancer and enrolled in a phase I clinical trial, will be included. Participants will undergo physical, nutritional, and psychological assessments at baseline and at 1, 2, and 3 months. The intervention group will receive a 3-month combined program of exercise, nutritional management, and psychological support, the specific modalities of which will be refined through patient and caregiver input during the pilot phase. The control group will receive standard care. Quantitative analyses will evaluate feasibility, adherence, and the program’s impact on functional outcomes and trial inclusion/retention rates. As recruitment has not yet started, no data are available at this stage. The presentation will therefore describe the study protocol and planned analyses. The study’s originality lies in its pragmatic, home-based multimodal design integrating exercise, nutrition, and psychological support within early-phase oncology trials for older adults.

Speaker: Baptiste Fournier (Centre Léon Bérard)

19 Exercise training in patients with malignant melanoma undergoing neoadjuvant checkpoint inhibitor therapy – NEO-MEL TRAIN

Background:
Since introduction of immune checkpoint inhibitors, the prognosis of melanoma has improved markedly in both adjuvant and metastatic settings. More recently, neoadjuvant therapy has emerged as an alternative to adjuvant treatment and has shown encouraging clinical and pathological outcomes for patients with melanoma, although long-term survival data are still maturing. Exercise training (ET), an emerging focus in oncology, enhances physical capacity, improves quality-of-life, reduces emotional distress, and modulates immune function in can-cer patients. However, prospective data—particularly on ET combined with immunotherapy—remain limited. This study aims to investigate the impact of structured ET in patients undergo-ing neoadjuvant immunotherapy for resectable stage III melanoma.

Objective:
The NEO-MEL TRAIN trial investigates whether supervised ET can improve cardiorespiratory fitness and patient-reported outcomes, and tumor- and immune-related biomarkers in mela-noma patients receiving neoadjuvant immunotherapy.

Methods:
This phase II randomized trial will include 60 patients with resectable stage III melanoma scheduled for neoadjuvant immunotherapy at Herlev Hospital or Odense University Hospital. Patients will be randomized 1:1 to receive standard-of-care neoadjuvant immunotherapy alone or in combination with an 8-week supervised, cycle-based interval training program performed three times weekly at moderate-to-high intensity. The intervention is delivered us-ing a decentralized, home-based model, with remote supervision.

The primary endpoint is change in cardiorespiratory fitness after 8 weeks, measured by VO₂max with an incremental cycling test. Secondary endpoints include patient-reported quali-ty of life and emotional distress (EORTC QLQ-C30, HADS). Exploratory endpoints include immune responses, tumor microenvironment features, circulating tumor DNA, gut microbi-ome, and treatment-related adverse events.

Conclusion:
This trial will provide prospective, randomized evidence on feasibility and potential benefits of structured ET during neoadjuvant immunotherapy for patients with melanoma and may help inform future integrative and supportive treatment strategies.

Research Plan
The trial is expected to initiate in the first quarter of 2026, subject to regulatory approvals

Speaker: Rasmus Døssing (MD, National Center for Cancer Immune Therapy)

poster_iseo_rd_pdf.pdf

20 EXERTION-mC: A protocol for EXERcise during chemoTherapy infusION to improve outcomes for people with metastatic Colon cancer

Background

Despite strong evidence supporting exercise in cancer care, uptake into routine practice remains low. Exercise during chemotherapy infusion (intra-infusion) offers a novel strategy to address this gap. Exercise could enhance treatment efficacy by acutely increasing tumour blood flow, potentially enhancing drug delivery when performed simultaneously with chemotherapy infusion. Intra-infusion exercise also leverages time when patients are otherwise sedentary and confined to the treatment suite, overcoming common barriers such as time and access. Supervised exercise during infusion could also reduce fear and build confidence for exercise beyond treatment.

Aim

The primary aim is to evaluate the effect of an intra-infusion exercise program on tumour depth of response (tumour shrinkage) in people with metastatic colorectal cancer. Secondary aims will explore progression-free survival, hospitalisations, adherence to chemotherapy, symptom burden, HRQoL, self-efficacy, physical activity, body composition and adverse events.

Methods

This multi-centre randomised controlled trial will recruit people (n=197) receiving chemotherapy for metastatic colorectal cancer. Adults planned to receive chemotherapy for 6 months will be randomised to exercise or usual care. During each chemotherapy session, the exercise group will complete moderate-intensity aerobic exercise for 20 minutes during infusion. All participants will receive one session with an Exercise Physiologist for general advice and information on available exercise services.

Significance

This study has the potential to redefine supportive care for people undergoing chemotherapy by improving both clinical outcomes and symptom management, reinforcing exercise as an adjuvant to medical treatment. By challenging traditional exercise models, it could lead to a fundamental shift in hospital-based exercise services and inform future care recommendations. Findings will have broad applicability to other cancer types and infusion-based treatments, laying the foundation for large-scale, multi-centre trials to further explore the efficacy of intra-infusion exercise and its potential impact on cancer treatment dosages.

fundamental shift in hospital-based exercise services and inform future care

Speakers: Kate Edwards (The University of Sydney), Catherine Seet-Lee (The University of Sydney)

21 Feasibility and implementation of digital cancer rehabilitation in South Baltic Countries - Study protocol and preliminary results from the AMBeR eRehab study

Introduction
Research in exercise oncology has consistently provided evidence supporting the integration of exercise into all phases of cancer care but less is known about how this can be implemented across patient groups, geographical borders and health care systems. This study, part of the Interreg South Baltic Program-funded project “AMBeR” (Advanced Modelling of Baltic E-cancer caRe), aims to evaluate the feasibility and implementation of digitally supported physical rehabilitation during and after systemic cancer treatment in five Baltic Sea countries (DK, SWE, GER, POL, LTU).
Methods
This international, multicenter, prospective study includes two single-arm feasibility trials (“early rehab” and “rehab@home”). Each participating site targets enrollment of 30 patients in each arm, in total 300 adult cancer patients. Feasibility assessment includes recruitment rate and acceptability (patients’ and physiotherapists’). Implementation assessment includes evaluation of Reach, Effectiveness, Adoption, and IMplementation (RE-AIM). Non-participant information will be analyzed regarding demographics and reason for refusal. Each site uses digital rehabilitation solution available in their country.
Results
Recruitment started for the first site in October 2024 and is expected to end in May 2026. Until now, 109 and 80 patients have been enrolled in the early rehab and rehab@home arms respectively. At the conference we will present preliminary results for feasibility and reach, including referral and recruitment patterns, e-health literacy, and the differences between participants and decliners in terms of anthropometrics, socio-demographics, clinical characteristics and reasons for declining.
Discussion
Personalized digitally supported physical rehabilitation has the potential to overcome barriers in integrating exercise in oncology. However, unbalanced implementation may increase inequity in cancer rehabilitation rather than reducing it, if improvements are unavailable for patients with fewer resources. In this report we present reach and feasibility of implementation across 5 South Baltic countries.

Speaker: Dr Gunn Ammitzbøll (Danish Research Center for Equality in Cancer, Zealand University Hospital, Department of Clinical Oncology and Palliative Care)

22 Home-Combo: an online home-based exercise intervention for women with breast cancer undergoing neoadjuvant chemotherapy: study protocol for a 2-arm pragmatic randomized controlled trial.

Background. Chemotherapy side effects often cause dose reductions or delays in women with breast cancer (BC), and relative dose intensities below 85% are linked to poorer prognosis and reduced treatment efficacy. Exercise may modulate treatment response by influencing the tumor microenvironment. Recent evidence suggests that exercise may contribute to tumor regression during neoadjuvant treatment. Therefore, studies investigating the effects of exercise interventions on chemotherapy completion rates are needed. Home-based exercise is a convenient strategy during treatment and has been proven to be effective and beneficial for women with BC. However, to date, no study has analyzed the effects of these interventions on tumor regression in women with BC.
Purpose. This study describes a 2-arm pragmatic randomized controlled trial protocol targeting women with BC undergoing neoadjuvant chemotherapy.
Methods. Implemented in a real-world setting, this study compares an online structured and supervised group exercise intervention with an active control group during neoadjuvant chemotherapy. Ninety-eight participants with stage I-III BC scheduled to receive neoadjuvant chemotherapy will be enrolled continuously over one year. Primary outcomes are chemotherapy completion rate and tumor regression. Secondary outcomes include body composition, functional performance, self-reported physical activity, and general and BC-specific quality of life. Assessments will be conducted at baseline, mid-treatment, post-intervention, and 3-month follow-up.
Discussion. Home-based exercise training programs are safe for women with BC during treatment. However, structured and supervised interventions remain scarce. This study, involving participants undergoing neoadjuvant chemotherapy, allows evaluation of the intervention in the context of prehabilitation and its impact on post-surgery during follow-up. More studies are needed to analyze the effects of exercise on chemotherapy completion rates and tumor regression in BC. The results may demonstrate a reduced treatment exposure time, faster return to daily activities, fewer side effects, and improved overall and disease-related quality of life.

Trial registration: NCT06429189 (June 6th, 2024)

Speaker: Pedro Ramos (Universidade Lusófona)

23 Impact of aerobic exercise on adipose tissue, muscle health and sarcopenia in people with colon cancer: a CCTG CO.21 sub-study protocol

The CCTG CO.21 Trial is a large randomized controlled trial that recently improved disease-free survival and overall survival in colon cancer patients after a 3-year structured exercise program. PURPOSE: This sub-study leverages data from the CO.21 Trial to test the effect of the first 12-months of physical activity behaviour change intervention (EG) compared to health-education group (HEG) on muscle health and body composition in adults with colon cancer using computed tomography (CT) images. METHODS: Canadian sites of the CO.21 were approached to participate. De-identified CT scans at the time of diagnosis and 12-month follow up will be collected using a secure on-line platform (https://www.globus.org/). Whole body tissue volumes were estimated based on CT images at the level of the third lumbar vertebra using DAFS Express (Voronoi Health Analytics Inc., Vancouver BC). Height-adjusted muscle quantity will be measured as skeletal muscle index (SMI), muscle quality will be measured as skeletal muscle density (SMD). Quantity of visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and intermuscular adipose tissue (IMAT) will also be measured. The presence of sarcopenia will be measured as the proportion of patients who are sarcopenic at 1-year follow-up, based on three different approaches to defining sarcopenia (CT derived only, physical performance derived only, and CT & performance derived). We will run multiple linear regression to assess the difference between the INT and CON groups in change over time. RESULTS: To date, 13 of 21 Canadian trial sites have agreed to participate and are in the process of completing data sharing agreements. The full data set will include baseline demographic data and CT images from 465 potential participants. Final results are expected in 2026. CONCLUSION: This work will provide insight into mechanisms linking physical activity to cancer outcomes and inform future studies of optimal lifestyle interventions to improve cancer outcomes.

Speaker: Dr Ignacio Catala Vilaplana (Department of Physical Therapy, University of British Columbia, Vancouver, Canada)

24 Improving Response to Chemotherapy by Adding Physical Exercise in the Neoadjuvant Setting of Breast Cancer Patients – Study Protocol for the KEYMOVE trial

Purpose: Improving the effectiveness of breast cancer (BC) treatment remains a major priority due to its high incidence and mortality. Neoadjuvant chemotherapy (NACT) is widely used in triple negative and HER2 positive disease, and in selected luminal HER2 negative cases. Evidence suggests that structured exercise may enhance treatment responses. This RCT aims to: (1) determine whether adding exercise training to NACT improves therapeutic efficacy; (2) explore biological mechanisms that may mediate exercise-related effects.
Methods: This 1:1 parallel group RCT includes 86 women with primary BC undergoing NACT. Participants are randomized, stratified by cancer subtype, to standard care or standard care plus a supervised exercise program. The intervention consists of three weekly sessions of combined moderate-to-vigorous aerobic and resistance training throughout NACT. The primary outcome is pathologic complete response (pCR), defined as the absence of invasive tumor in the breast and axillary nodes at surgery. Secondary outcomes include chemotherapy tolerance and compliance, systemic and tumor-specific immune responses, inflammatory biomarkers, maximal isometric strength (handgrip and quadriceps), exercise tolerance, physical activity, and quality of life. Assessments occur at baseline and post NACT. Relative dose intensity will be calculated at treatment completion, and patient reported outcomes will be collected weekly during chemotherapy. The sample size provides 80% power to detect differences in pCR, with analyses using a 95% confidence interval. The study is conducted at the Local Health Unit of Gaia/Espinho, Portugal, approved by the institutional ethics committee and registered under NCT05976815. Recruitment began on August 2023; by December 2025, 80 participants had been enrolled, with 60 having completed the trial.
Conclusion: This trial is among the first adequately powered RCTs to test whether structured exercise can enhance pCR in BC patients receiving NACT. Immune and treatment compliance analyses may clarify the mechanisms underlying exercise training impact on treatment efficacy.
Funding: UIDB/04045/2020; 2021.09879.BD;2023.15551.PEX

Speaker: Nuno Dias Rato (CIDESD - Research Center in Sports Sciences, Health Sciences and Human Development, Portugal ; ONCOMOVE® - Associação de Investigação de Cuidados de Suporte Em Oncologia (AICSO), Portugal)

25 Lymphedema Incidence and Intervention After Endometrial Cancer: Protocol for a Randomized Controlled Trial

Background: Our research shows that symptoms of lower-extremity lymphedema are commonly reported in women who have undergone surgery for endometrial cancer. Although previous trials have demonstrated beneficial effects of exercise training on lymphedema among women with breast cancer, the feasibility and efficacy to treat lower-extremity lymphedema in women with gynecological cancer remains unclear. Therefore, we aim to investigate the validity of self-reported lymphedema and the effects of exercise in women with endometrial cancer.
Patients and Methods: The current study is based on the cross-sectional SENSOR study, which comprises >1000 women who have undergone surgery for endometrial cancer:
First, we aim to validate the Lower Extremity Lymphedema Screening Questionnaire (LELSQ), by inviting women with self-reported lymphedema from the SENSOR study to undergo clinical and objective assessments of lymphedema. Objectively evaluation of lower-extremity lymphedema will be measured by circumferential measurements at predefined anatomical landmarks and perform bioelectric impedance analysis (BIS).
Second, we will invite 80 women with objectively confirmed lower-extremity lymphedema to participate in a randomized controlled trial comparing the effects of adding twice-weekly combined aerobic and resistance training and daily home-based exercises to promote lower-limb circulation to standard care (exercise group), with standard care alone (control group) for 20 weeks. The primary outcome will be the change in lymphedema volume, measured with BIS before and after the intervention. Secondary outcomes include lymphedema symptoms, quality of life, and physical fitness (cardiorespiratory fitness and muscle strength).
Implications for Exercise Oncology: Our research could identify LELSQ cutoff values that help detect women with early-onset lymphedema symptoms in clinical settings and guide future exercise recommendations for patients with lower-extremity lymphedema.

Speaker: Tormod Nilsen (The Norwegian School of Sport Sciences, Norway)

26 Men United: Evaluating the Feasibility and Acceptability of Translating the Danish FC Prostate Cancer Programme to Ireland, Protocol for a Mixed-Methods Study

Background
Exercise is vital in prostate cancer survivorship, yet many men face barriers to traditional programmes, particularly gym-based options that may not align with their preferences. The Danish FC Prostate Cancer initiative, a recreational football model, has shown strong feasibility and acceptability by offering a culturally familiar, male-friendly alternative that supports social connection and sustained engagement. Men United will translate this evidence-based programme into an Irish community setting to address gaps in accessible, appealing activity options for men and improve the reach of exercise oncology services.
Purpose
This study aims to evaluate the feasibility, acceptability, and implementation of delivering a 12-week FC Prostate football-based physical activity programme in Ireland.
Methods
A mixed-methods feasibility design will be employed. The programme will comprise twice-weekly recreational football sessions delivered over 12 weeks at SETU Arena. Quantitative feasibility metrics will include screening logs, recruitment and retention rates, session attendance, and adherence. Qualitative data will be collected through post-programme focus groups with participating men and semi-structured interviews with clinicians, coaches, and community stakeholders. Field notes and implementation checklists will document fidelity and contextual factors influencing delivery. All qualitative data will be audio-recorded, transcribed verbatim, anonymised, and analysed using a framework-based thematic approach. Participants will be ≥18 years, English-speaking, and have a non-metastatic prostate cancer diagnosis. Recruitment will occur through oncology services and community referral pathways. Ethical approval has been sought.
Expected Outcomes
As the study has not yet begun, results are not available. Findings will inform feasibility, acceptability, implementation considerations, and future replication or national scale-up.
Conclusions
Men United will generate essential evidence on translating an established football-based exercise oncology model into the Irish context, with potential to improve survivorship support for men with prostate cancer.
Funding
This project is funded by the Irish Cancer Society (ICS) through the ICS SEED Funding Award (Ref: SEED25_019).

Speaker: PATRICIA SHEEHAN (SOUTH EAST TECHNOLOGICAL UNIVERSITY)

27 Personalized exercise to prevent chemotherapy-induced peripheral neuropathy: protocol for a randomized controlled trial (CIPN-EX Trial)

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of neurotoxic cancer treatments, primarily affecting sensory and motor functions in hands and feet. CIPN can interfere with daily activities and cancer treatment. Exercise may represent a promising approach to CIPN prevention; however, it is not currently reflected in international guidelines because evidence remains limited.

Objective: This randomized controlled trial (RCT) aims to determine the effectiveness of a personalized exercise program combining sensorimotor, strength, and aerobic training to prevent CIPN during taxane- or platinum-based chemotherapy. A secondary aim is a process evaluation investigating program barriers and facilitators (NCT06962579).

Methods: Patients with breast or colon cancer (n=206) scheduled for taxane- or platinum-based chemotherapy are randomized to usual care (control) or exercise (intervention). All participants receive an educational session on physical activity during chemotherapy and an activity tracker for 24 weeks. The intervention group follows a 12-week personalized exercise program: supervised sensorimotor and strength training twice weekly plus home-based aerobic sessions. The program is based on oncology exercise guidelines and the PREFERABLE II LION RCT (NCT06270628).

Results: The first patient was enrolled on June 5th, 2025. CIPN sensory symptoms (EORTC QLQ-CIPN20, primary outcome), motor and autonomic CIPN symptoms, CIPN signs, chemotherapy dose intensity, and physical and psychosocial functioning are assessed at baseline (prior to chemotherapy) and at 12 (primary endpoint) and 24 weeks. The effects of the exercise intervention will be analyzed using a linear mixed model. In addition, qualitative interviews with patients and health care providers will be analyzed using inductive and deductive approaches to identify barriers and facilitators.

Conclusion: This trial will provide evidence on the effectiveness of exercise for CIPN prevention during chemotherapy and identify factors influencing adherence and implementation. Results may inform evidence-based exercise recommendations and support integration of exercise into supportive cancer care to reduce CIPN burden.

Speaker: Dr Lore Dams ((1) Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp Antwerp, Belgium (2) Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium. (3) Pain in Motion International Research Group, Belgium (4) Improving Care for Edema and Oncology Research Group, Belgium)

28 Physical Activity and physical function in men undergoing hormone therapy for Prostate Cancer - The PAPC study

Background: Lifestyle factors such as physical activity (PA) may help prevent and reduce adverse effects of androgen deprivation therapy (ADT) in men with prostate cancer. Most evidence on PA in this population comes from exercise-based interventions or self-reported measures that primarily capture structured exercise. While exercise can be beneficial, it is not always appealing or feasible for patients. Devices such as accelerometers provide detailed insights into overall PA and activity patterns, including sleep, sedentary time, light PA, and incidental movement. These behaviours may be more practical targets for intervention than structured exercise, yet remain understudied.

Purpose: To examine prospective associations between objectively measured PA, sedentary time, and sleep with physical function, health-related quality of life, and psychological outcomes in men undergoing ADT, and to describe changes in activity patterns during treatment.

Methods: This prospective observational study will recruit men with prostate cancer scheduled to start ADT at Oslo University Hospital, Norway. Eligible participants include those receiving primary ADT, ADT as adjuvant/neoadjuvant to radiotherapy, or combined ADT and androgen blockade. Assessments will occur at baseline, 6 and 12 months. PA, sedentary time, and sleep will be measured using a wrist-worn ActiGraph GT3X+ accelerometer for seven days. Physical function will be assessed by sit-to-stand, 6-minute walk, and grip strength tests; body composition by dual-energy X-ray absorptiometry. Psychological outcomes, lifestyle habits, and demographics will be collected via questionnaires; clinical data from medical records. We aim to enroll 214 participants over 1–2 years to detect associations between PA and changes in lower limb physical function (80% power, p<0.05). Data collection starts January 2026.

Potential impact: This study will generate novel insights into the role of PA, sedentary behavior, and sleep in maintaining physical function and health during ADT, and may inform clinical guidelines and support tailored interventions to improve care during and after treatment.

Speaker: Dr May Grydeland (Department of Physical Performance, Norwegian School of Sports Sciences)

29 Protocol for ADHERE: a randomised controlled trial evaluating a digital exercise intervention with virtual supervised group exercise sessions compared to standard of care for patients receiving androgen deprivation therapy for prostate cancer

In the UK, supervised exercise is recommended by NICE for prostate cancer patients receiving androgen deprivation therapy (ADT); however, engagement in physical activity remains limited. Although high adherence is observed during supervised exercise, it is unclear whether participants maintain activity after supervision. Barriers include treatment-related side-effects and low motivation. Digital exercise interventions that include education and behaviour change support may address these barriers and promote sustained engagement in physical activity.

The primary objective of ADHERE is to determine whether a digital exercise intervention incorporating group exercise sessions improves adherence to physical activity compared with standard of care (SOC). Secondary and exploratory objectives include assessment of health-related quality of life (HRQoL), fatigue, physical function, clinical biomarkers and participant experiences, and evaluation of cost-effectiveness.

ADHERE is a single-centre, phase III, two-arm randomised controlled trial. Prostate cancer patients within eight weeks of starting ADT and planned for radiotherapy will be recruited at The Royal Marsden NHS Foundation Trust. Participants will be randomised 1:1, stratified by ADT duration (≤6 months or >6 months), to SOC alone or SOC plus the intervention. The intervention includes virtual supervised group exercise sessions delivered weekly over 26 weeks, access to exercise videos, an individualised exercise programme, educational content and “patient buddy” support.

Assessments will be conducted at baseline and three, six, and 12-months post-radiotherapy. Primary endpoint is adherence to physical activity guidelines at six months post-radiotherapy, assessed using device-based activity monitor and self-reported exercise diary. Secondary endpoint is HRQoL and will be measured using FACT-P. 160 participants (80 per arm) will be recruited allowing for 20% dropout.

ADHERE has ethical and regulatory approval and will be conducted in accordance with Good Clinical Practice. An interim analysis will be conducted, with final analyses performed following completion of all participant follow-up. Results will be disseminated via peer-reviewed publications and conferences.

Speaker: Emily Curtis (The Royal Marsden NHS Foundation Trust/King's College London)

30 Randomized controlled trial of the Effects of combined resistance and AerobiC exercise on Health-related quality of life in patients undergoing first-line chemotherapy for metastatic colorectal cancer (REACH): A Trial Protocol

Background: Metastatic colorectal cancer is largely incurable. The primary goal of first-line treatment is to prolong survival while maintaining acceptable levels of health-related quality of life. However, chemotherapy is associated with substantial treatment-related toxicity, and 30–50% of patients with mCRC experience clinically relevant reductions in health-related quality of life during systemic treatment. Exercise training has been shown to improve HRQoL in patients with early-stage cancers; however, the effects of exercise training on health-related quality of life in patients with metastatic colorectal cancer receiving first-line chemotherapy remain insufficiently investigated.
Objectives: The primary objective of this trial is to evaluate the effects of an 18-week combined home-based resistance and aerobic exercise program on health-related quality of life in patients undergoing first-line chemotherapy for metastatic colorectal cancer. The secondary objectives are to evaluate the effects of exercise training on cancer-related fatigue, tolerability of first-line treatment, physical performance, maximal oxygen consumption, and body composition.
Methods: This trial is a national, multicenter, parallel-group, randomized controlled trial. Adult (≥ 18 years of age) patients with metastatic colorectal cancer scheduled for first-line systemic chemotherapy are eligible. Exclusion criteria include pregnancy, life expectancy <6 months, absolute contraindications to maximal exercise, ECOG performance status >2, inability to understand Danish or English, and engagement in structured moderate-to-high intensity aerobic exercise for >30 minutes more than once per week during the past 3 months. The patients are recruited from five oncological departments in Denmark. A total of n = 150 participants will be randomized 1:1 to standard care or standard care plus 18 weeks of supervised and unsupervised home-based combined moderate-to-high intensity aerobic and resistance training (three 35-minute session per week). The trial adopts a decentralized design, including in-home outcome assessment and intervention delivery. The primary outcome is health-related quality of life.

Speaker: Simon Nørskov Thomsen (Centre for Physical Acticity Research)

31 RISE-YA: A Novel Intervention for Young Adult Brain Tumor Survivors with Cancer Related Fatigue-Study Protocol for a Randomized Controlled Trial

Introduction: Cancer-related fatigue (CRF) disproportionally impacts survivors of adolescent and young adult (YA) brain tumors. CRF is understudied and poorly managed in this population. While exercise training has demonstrated efficacy at improving CRF in adult cancer survivors—potentially by improving cellular energy production and reducing inflammation— it has not been tested in fatigued YA brain tumor survivors. YAs’ life stage, where many are completing their education and seeking independence, limit their engagement in interventions designed for adults. CRF may further hinder intervention adherence. To address these challenges, we have developed the Remote Implementation of Supervised Exercise for YAs (RISE-YA) intervention. This trial will test the efficacy of RISE-YA to improve CRF, physical activity (PA), and physical function in fatigued YA brain tumor survivors. We will also determine associations of cellular energy production and inflammation with CRF and intervention effects on these potential biological indicators.
Methods: This 24-week, two-arm randomized controlled trial (NCT07186556) has Institutional Review Board approval. Up to 150 fatigued YA brain tumor survivors (diagnosed at 15-39 years; 6 months to <5 years post-treatment) will be recruited from MD Anderson Cancer Center and UTHealth Neurosciences in Houston, Texas, USA and randomized 1:1 to the RISE-YA intervention or attention control. The intervention group will receive 12-weeks of virtually delivered supervised strength and aerobic exercise, energy conservation counseling, and behavioral change coaching. The attention control group will discuss survivorship topics. Outcomes, measured at baseline, 12-weeks, and 24-weeks, include CRF (Multidimensional Fatigue Inventory), PA (accelerometer), physical function (timed up & go, single leg stand, 1-minute chair stand, 6-minute walk test, hand grip strength), oxidative phosphorylation in peripheral blood mononuclear cells, and circulating inflammatory mediators (systemic inflammation index, C-reactive protein, interleukin (IL)-6, tumor necrosis factor (TNF), TNF receptor 2, IL-1 receptor antagonist, IL-10). Results will be disseminated through peer-reviewed publications and presentations.

Speaker: Emily C. LaVoy (University of Houston)

Poster Session 1.2: Muscle (Mass), Strength, Function and Body Composition / Pediatric Oncology, Adolescents and Young Adults (Posterarea 2)

32 18 months of physical exercise effects in children and teenagers with cancer diagnosis

Childhood cancer (CCA) is a global and devastating disease. Although it is relatively rare compared to CA in adults, its incidence is still significant. The most common types of CCA include leukemia, central nervous system tumors, and lymphomas. The causes of CCA are not yet completely understood, but genetic, environmental, and immunological factors play important roles. Early diagnosis is essential for successful treatment, and despite advances in research, CCA continues to pose a significant challenge due to its complexity and emotional impact on families. Continued efforts are needed to improve survival rates and quality of life for children affected by CA. In this sense, physical exercise (PE) has been increasingly used as a safe and effective intervention to improve the health and well-being of patients with CA, but few studies have evaluated its effect on children/teenagers.
PURPOSE: Thus, the present study aimed to analyze the impact of 18 months of regular PE practice on children and teenagers. METHODS: 11 Maple Tree Cancer Alliance patients (12.4±3.4 years old) admitted or undergoing treatment at the GPACI Children's Cancer Hospital (GPACI), in Sorocaba/SP – Brazil, participated in this research. Each PE session, accomplished twice weekly, consisted of cardiorespiratory, coordination, balance, strength, and flexibility exercises. Assessments of functional capacity (TUG), strength (hand grip), resistance (elbow flexion), and flexibility (sitting and reaching) were carried out before and after the intervention. RESULTS: As a result, after regular PE practice, all the capacities evaluated obtained statistically significant improvements, with special attention to the reduction of fatigue and its correlation with muscular strength. CONCLUSION: Thus, we conclude that the regular practice of guided PE brought physical and functional improvement to children and teenagers affected by CA.

Speaker: Karen Wonders (Maple Tree Cancer Alliance)

33 A Qualitative Investigation of Family Experiences of ‘CHAMPs’: a 12-week Multi-component Physical Activity Behaviour Change Intervention for Childhood and Adolescent Survivors of Cancer

Purpose:
This qualitative study used focus groups (FGs) to explore family experiences of CHAMPs (The CHildhood and adolescent cancer survivors physical Activity and Movement Programme). CHAMPs is a 12-week multi-component physical activity (PA) behaviour change intervention for childhood and adolescent survivors of cancer (CASC) aged 10 to 19 years.
Methodology:
CHAMPs aimed to improve PA, quality of life (QoL) and physical functioning among CASC. It was evaluated as part of a single-arm repeated measures study. Online debrief FGs were conducted by an independent qualitatively-trained researcher with young people who had completed CHAMPs, and their parents. Participants were asked to share their experiences regarding i) their engagement with each component of the intervention (e.g. supervised home-based sessions, PA toolkit), ii) the impact of the intervention on their PA and well-being, and iii) recommendations for intervention improvement. Discussions were audio recorded, transcribed verbatim and analysed using reflective thematic analysis.
Results:
Three and two FGs were conducted with CASC (n=9) and parents (n=6), respectively. Fifty-six per cent of teenage participants (mean age 14.7yrs (± 1.9 SD); 67% male) had had a brain tumour and 100% had received chemotherapy. Sixty-seven percent of parents (88% female) were parents of a child who had had a brain tumour. Three themes, denoted by T, were identified. The young-person centred, home-based nature and personalization aspect of the intervention were reported as strengths, which contributed to an inclusive and supportive environment for PA (T1). Families credited CHAMPs with improving the young person’s physical function which in turn optimized QoL and social and emotional well-being (T2). Recommendations were provided to inform future CHAMPs delivery in research and service settings (T3).
Conclusion:
Families described the positive effect of CHAMPs on young people’s physical functioning, overall well-being and QoL, and deemed it acceptable to 10–19-year-old CASC.

Speaker: Mairéad Cantwell (SHE Research Centre, Department of Sport & Health Sciences, The Technological University of the Shannon)

34 Assessment Methods for Fascial Connective Tissue

BACKGROUND:
The role of fascia has gained significant attention, especially in the fields of sports medicine, but also recently in oncology. Understanding fascial pathology not only offers insights into the biomechanics and movement but also may reflect potential therapeutic targets for cancer patients. However, evaluation of fascial properties is not trivial.

RESEARCH QUESTION:
The objective is to evaluate different assessment methods for fascial connective tissue.

RESULTS:
Fascia operates as a continuum. Healthy fascia is flexible and hydrated, but factors like injury, poor biomechanics, and most notably cancer can cause rigidity, resulting in fascial adhesion and even microcalcifications. This leads to compromised movement and, over time, pain. Hence, assessment methods can focus on fascial appearance, stiffness, hydration, and functional aspects such as sensitivity and the gliding abilities.
The most often used assessment method is palpation. The advantage is, that there is a close interaction between examiner and patient. However, the palpation of different layers appears to be subjective and the reproducibility is poor. Imaging techniques comprise magnetic resonance tomography, ultrasound (B-scan and transmission), and elastography. Stiffness can be evaluated with customized force transducers. Finally, there is a method, which assesses the electrical impedance. Using alternating current, the method gives insight into hydration and electrolytes as well as the cellular components, because a phase shift is expected in cell-rich tissue types.

CONCLUSION
In a nutshell, changes of the fascial tissue occur in cancer patients and can effectively alter biomechanical tissue properties and mechanosensory thresholds. Fascial contractility is a key element of pathological tissue conditions and pain syndromes. Fascial alterations may be reversible, fixed or a combination of both. The different assessment methods may help to understand physiology and pathology of fascial tissue and may improve the individualized strategy in exercise oncology.

Speaker: Prof. Werner Klingler (Fascia Research Group, Department of Neurosurgery, Ulm University, Ulm, Germany)

35 Beyond Muscle: Neuro Fascial Health as a Missing Piece in Exercise Oncology

Background:
Emerging work in fascia biology and integrative oncology suggests that fascia is not a passive scaffold but a dynamic, innervated interface that shapes tumor mechanics, immune trafficking, and symptom burden. Fascial integrity, stiffness, and remodeling appear to influence local invasion, metastatic spread along tissue planes, and treatment-related fibrosis, with direct implications for imaging, surgery, and rehabilitation. This narrative review (peer review pending) explores the neuro fascial interface from an exercise oncology perspective.
Methods:
Clinical, translational, and preclinical evidence on fascial involvement in cancer was synthesized, focusing on fascia-tumor relationships, neuro immune interactions, and the impact of physical-based interventions (exercise, manual/myofascial techniques, and movement-based therapies) on fascial structure and function in oncology populations. Data were drawn from imaging studies of tumor-fascia interfaces, surgical and pathological descriptions of fascial planes, and clinical trials or pilot studies evaluating fascial or myofascial interventions in cancer survivors.
Results:
Across tumor entities, fascial planes and connective tissue interfaces can function both as barriers and as preferred routes for cancer cell invasion and metastatic spread, and tumor-fascia relationships on MRI are highly predictive of malignancy in superficial soft tissue masses. Physical-based fascial interventions, including myofascial and manual therapies as well as exercise-based approaches, demonstrate potential to modulate connective tissue stiffness, inflammation, and fibrosis, with early data supporting improvements in pain, range of motion, dysphagia, and other patient reported outcomes. Fascial assessment further refines preoperative planning and margin evaluation, potentially enhancing surgical precision and functional preservation.
Outlook/Conclusion:
Fascia, conceptualized as a neuro immuno mechanical interface, represents a pivotal yet underutilized target in oncology, spanning diagnosis, treatment planning, symptom control, and rehabilitation. Integrating fascia-focused assessment and neuro fascial interventions - particularly exercise and manual therapies - into exercise oncology frameworks may optimize both biological and patient-centered outcomes and supports a more holistic, systems-oriented approach to cancer care.

Speaker: Dr Stephanie Otto (Comprehensive Cancer Center Ulm (CCCU), University Hospital Ulm, Ulm, Germany, and Fascia Research Society (FRS), USA)

36 Bridging Care Settings: A Partially Standardized and Individualized Exercise Approach to Improve Adherence in Pediatric Oncology (BEPPO Study)

Background: Children undergoing cancer treatment exhibit significantly reduced physical activity, contributing to declines in physical function and quality of life during and after medical treatment. Despite guideline recommendations, exercise interventions are not sufficiently implemented into standard care, and consistent delivery is challenged by the varying inpatient and outpatient settings and wide referral areas; and health insurance companies generally do not cover the costs. The BEPPO study evaluates the effectiveness of a structured, individualized, and cross-sectoral exercise intervention program designed to guarantee continuous support and improve patient-related outcomes in pediatric oncology.
Methods: This multicenter RCT will include n=346 pediatric patients (aged 3-18 years) within 6 weeks after cancer diagnosis. Participants in the intervention group (n=173) receive a 6-month individualized exercise program delivered across inpatient, outpatient, and home settings, including telemedical supervision with the goal of 3–5 sessions per week. Adherence is promoted through proactive contact strategies, flexible delivery formats, and four structured movement counseling sessions. These counseling sessions aim to strengthen the therapeutic alliance, address individual barriers to participation, and foster intrinsic motivation for sustained engagement. A key innovation of the present approach is the integration of standardized training principles with individualized determinants. Each training session is structured around a specific goal and grounded in established principles of sports science. Concurrently, individual interests, current health status, as well as motivational and psychological factors are systematically considered to enhance participant adherence, practical feasibility, and consequently the overall effectiveness of the intervention.
Conclusion: This study introduces a novel model of targeted exercise intervention in pediatric oncology by integrating A) continuous care, B) structured training principles meeting individualized approaches, and C) counseling-based support to improve adherence. Improvements in physical performance, treatment-related side effects, and quality of life are anticipated. The findings may support the sustainable integration of exercise therapy into routine oncological care.

Speaker: Annika Tomanek (Institut for Movement and Exercise, West German Cancer Center, University Hospital Essen, Essen, Germany)

37 Chemotherapy-related cardiotoxicity can be prevented through exercise in childhood cancer survivors: a framework for exercise-induced cardioprotection

PURPOSES: Pediatric cancer patients exposed to anthracycline drugs are at high risk of cardiac dysfunction and early-stage of heart failure. Hence, chemotherapy-related cardiotoxicity is a long-term complication in childhood cancer survivors and is associated with mortality. Strategies to mitigate these effects are explored. Exercise has emerged as a promising intervention to address long-term cardiac complications. This study aims to provide an overview of the current literature and to develop a framework for exercise-induced cardioprotection in childhood cancer survivors.
METHODS: A comprehensive literature search was conducted to identify relevant studies. Our framework was developed using a structured six-step approach: (1) defining the scope of exercise-induced cardioprotection in childhood cancer survivors; (2) identifying key components of chemotherapy-related cardiotoxicity and exercise mechanisms; (3) synthesizing evidence from therapeutic trials; (4) establishing a conceptual model linking exercise to cardiovascular outcomes; (5) identifying critical knowledge gaps; and (6) refining the framework through expert input.
RESULTS: The framework for exercise-induced cardioprotection involves integrating both primary prevention (i.e., exercise initiated before or during treatment to reduce cardiotoxic impact) and secondary prevention (i.e., exercise used after treatment to manage or reverse subclinical or overt cardiac dysfunction). Five themes have been identified: (1) Risk Identification, (2) Assessment & Stratification, (3) Prevention Strategies, (4) Implementation & Monitoring, (5) Outcomes & Long-Term Follow-up. Exercise interventions can lead to cardioprotective mechanisms and improved cardiac outcomes. Therefore, exercise training can preserve cardiac function, while low activity levels and physical deconditioning increases mortality and cardiac dysfunction.
CONCLUSIONS: Our framework highlights the need for exercise-based strategies to mitigate chemotherapy-related cardiotoxicity, focusing on anthracycline-induced cardiac damage. In fact, exercise holds strong potential in mitigating chemotherapy-related cardiotoxicity in childhood cancer survivors. This framework guides future research and clinical applications while identifying the need for more therapeutic trials and long-term follow-ups in childhood cancer survivors.

Speaker: Dr Maximee Caru (PENN STATE COLLEGE OF MEDICINE)

38 Comprehensive Effects of Prolonged Structured Exercise on Fitness, Body Composition, and Quality of Life in Cancer Patients

Purpose: Cancer and its treatments frequently induce detrimental alterations in body composition, which adversely affect patients’ prognosis and quality of life (QoL). This study investigated the impact of exercise on body composition, physical fitness, and QoL in patients living with cancer.
Methods: Patients with solid cancers treated at the University Hospital of Verona enrolled in a 9-month structured program, held twice per week and organized into 3 macrocycles (M): M1 with progressive moderate-intensity aerobic exercise and resistance training; M2 with high-intensity interval training (HIIT) and circuit-based resistance training; and M3 with HIIT and machine-based resistance training. Safety and feasibility were monitored during the intervention. Body composition was assessed via bioelectrical impedance ; cardiorespiratory fitness using the 6-minute walk test (6MWT); muscle strength and endurance with handgrip strength and the 30-second chair stand, respectively. QoL was measured using the EORTC QLQ-C30 questionnaire. Assessments were performed at baseline, at 3, 6, and 9 months. Data were analyzed using descriptive statistics and repeated-measures ANOVA.
Results: Twenty-nine, and 16 patients completed 6 and 9 months of intervention, respectively. Breast and pancreatic cancer were the most common cancer types; 40% had a metastatic disease, and 64% were undergoing treatments. Body composition and strength did not change significantly over the months, whereas waist circumference decreased by 3% after 6 months (p = 0.018). Significant improvements in 6MWT at 6 (+10.5%, p < 0.001) and 9 months (+12.6%, p < 0.001) were observed, as well as in muscular endurance (+25%, p < 0.001; +22%, p < 0.001). About QoL, improvements in emotional functioning and reductions in insomnia were also detected.
Conclusions: Despite minimal changes in body composition, a prolonged supervised exercise program produced significant benefits for cardiorespiratory fitness, muscular endurance, and QoL among patients with cancer.

Speaker: andrea trevisan

39 Digital Physical Activity Surveillance and Personalized Counseling for Cardiovascular Prevention in Survivors of Childhood and Adolescent Hodgkin Lymphoma – Design of the Cardio-HOPE Randomized Controlled Trial

Background: Survivors of childhood and adolescent Hodgkin lymphoma (HL) exposed to cardiotoxic therapy face a substantially increased risk of long-term cardiovascular morbidity. Physical activity (PA) is a key modifiable risk factor for cardiovascular risk reduction; yet, sustainable PA promotion in survivorship care remains challenging. The Cardio-HOPE study evaluates whether digitally supported, personalized counseling can increase moderate-to-vigorous physical activity (MVPA) in HL survivors through a 6-month intervention combining graded PA promotion, individualized live counseling, and continuous monitoring.
Methods: This randomized, controlled, open, three-arm multicenter trial aims to enroll 200 HL survivors diagnosed before age 21, treated with anthracyclines and chest irradiation, ≥ 5 years post-treatment without manifest cardiovascular disease. Following exercise and cardiological assessment to determine physical performance and medical eligibility, participants will undergo a 4-week baseline assessment using wearable-based monitoring, medical, and daily-life parameters for stratification according to PA levels and are randomized (1:1:1) to: (1) control group receiving a wearable without feedback, (2) intervention group 1 receiving a wearable and monthly general PA information, or (3) intervention group 2 receiving a wearable plus personalized PA counseling over 6 months. Primary endpoint: Objectively measured MVPA increase at 6 months. Secondary endpoints: MVPA, sedentary time, adherence to international PA guidelines at 3, 6, and 9 months.
Perspective: This approach integrates exercise oncology expertise into a digital health application, enabling continuous monitoring of PA and functional performance in daily life. Personalized counseling is based on objectively assessed performance and digital activity data. The intervention combines structured feedback, behavioral support, and individualized PA recommendations to facilitate long-term adherence in cardio-oncology survivorship care. Cardio-HOPE will provide evidence on the effectiveness of personalized digital PA interventions to increase MVPA among HL survivors and support implementation of individualized exercise-based cardio-oncology survivorship care pathways.
Acknowledgments: Funded by the German Federal Ministry for Research, Technology, and Space (16SV9594).

Speaker: Dr Sabine Kesting (Technical University of Munich, Germany; TUM School of Medicine and Health, Department of Pediatrics. German Center for Child and Adolescent Health (DZKJ), partner site Munich, Germany)

40 Do Physical Impairments Shape Gait in Childhood Cancer? Evidence of Compensatory Strategies to Ensure Safe Walking: A Cross-Sectional Correlation Study

Background & Aims: Safe and unrestricted walking is essential for participation in everyday life. It depends on the balanced contribution of muscle strength and joint mobility, modulated by precise sensory feedback. In children with cancer, physical impairments like reduced strength, limited joint mobility, and balance deficits can disrupt this interplay, and lead to compensatory gait adaptations. However, the relationship between gait and physical performance has not yet been systematically investigated. Therefore, this study aims to examine this relationship in childhood cancer patients. The findings may help identify potential compensatory strategies and support the development of targeted interventions to improve walking ability and reduce fall risk.
Methods: Sixty-four childhood cancer patients and survivors aged 9.75 ± 4.01 years performed gait analysis and physical performance assessments (lower limb strength, joint range of motion, balance, and functional mobility). Performance data were compared with age- and sex-matched normative values using Wilcoxon signed-rank test. Associations between physical performance and gait were analyzed using partial Spearman’s rank correlation, adjusted for age, body height and weight. Significance was set at p < .05.
Results: Participants showed significant deficits in gait (step length, base of support, walking speed; p < .001) and physical performance parameters (lower limb strength, joint mobility, balance, functional mobility; p < .05) compared to normative values. Correlation analysis revealed significant associations between strength, joint mobility, balance, functional mobility, and gait parameters (p < .05).
Conclusions: Our findings highlight noticeable impairments in gait and physical performance in children and adolescents with cancer. Observed adaptations in gait patterns may reflect compensatory strategies in response to limitations in strength, joint mobility, or balance, but no causal relationships can be inferred. Regular assessments of gait and physical performance may help detect deficits early and guide personalized interventions to support safe ambulation and long-term functional outcomes.

Speaker: Ms Mareike Kühn (University Medical Center of the Johannes Gutenberg-University Mainz, Childhood Cancer Center Mainz, 55131 Mainz, Germany)

41 DOSE RESPONSE EFFECT OF EXERCISE ON FUNCTIONAL CAPACITY AND BODY COMPOSITION IN CANCER SURVIVORS.

Introduction
Exercise is recognized as a key component of supportive care in cancer. However, adherence to exercise programs varies considerably among cancer patients, which may influence their effectiveness in improving functional capacity and body composition. Therefore, we aimed to investigate the dose–response effects of exercise on functional capacity and body composition in cancer survivors.
Methods
This interventional study included 96 cancer patients, allocated to either a 24-week structured multicomponent EX program or a usual care control (CON). The EX group (n=82) was divided into tertiles according to the amount of weekly exercise performed, compared with CON (n=14): low-EX (38 ± 17 min/week), middle-EX (64 ± 14 min/week), and high-EX (99 ± 8 min/week). Outcomes included handgrip strength, sit-to-stand test (STS), gate speed (GS), 6-minute walk test (6MWT), appendicular skeletal muscle mass index (ASMMI), fat-free mass (FFM) and fat mass (FM).
Results
Both the middle-EX (Δ = +53.0 m; p < 0.001) and high-EX groups (Δ = +69.9 m; p < 0.001) showed greater improvements in 6MWT distance compared with CON (Δ = –16.3 m). The high-EX group also demonstrated significant reductions in STS time (Δ = –1.61 s; p = 0.016) and GS time (Δ = –0.64 s; p = 0.035) compared with CON. No significant differences were observed among groups for body composition outcomes.
Conclusion
A modest amount of structured exercise improves cardiorespiratory fitness in cancer survivors, whereas higher weekly exercise volumes are required to induce meaningful gains in functional capacity.

Speaker: Mr Mauricio Lopes (Physical Education, State University of Londrina, Londrina, Brazil)

42 Exercise training program during and after treatment in lymphoma pediatric cancer population (StaiBene3.0! Plus Project)

Pediatric oncology is an area in which pharmacological treatments can lead to significant reductions in physical capacity, muscle strength, and overall quality of life. In recent years, adapted physical exercise has emerged as a safe and effective complementary intervention for oncology patients, although the literature still offers limited evidence. For this reason, the present study aims to evaluate the feasibility, safety, and sustainability of a personalized exercise program specifically designed for pediatric and young adult patients diagnosed with Hodgkin and non-Hodgkin lymphoma, throughout the different phases of their therapeutic pathway. The sample consisted of nine participants, aged between 13 and 16 years, recruited at the Division of Pediatric Hematology-Oncology at the University Hospital of Padua. All subjects underwent a functional assessment at T0 and T1. The tests performed were the 30" Sit-to-Stand Test, 3' Step Test, Handgrip Test, Chair-Sit-and-Reach Test, and Flamingo Balance Test. Perceived fatigue was also recorded for each test using the Borg scale. Each participant followed an adapted training program including mobility exercises, muscle strengthening, and balance activities, all tailored to individual clinical conditions and the current phase of treatment. Despite the notable limitations encountered during the study, preliminary results suggest that the program is well tolerated, does not lead to significant adverse events, and shows good adherence among participants, indicating strong feasibility. Furthermore, the ability to modulate the training sessions allows for sustainable implementation even in the presence of clinical variability typical of the oncological pathway. In conclusion, adapted physical exercise is confirmed to be a safe and potentially effective intervention to support the physical and psychological well-being of pediatric patients with lymphoma. This study contributes to the development of operational protocols aimed at integrating motor activity into oncological care.

Speaker: Dr Elisabetta Baldo (Department of Biomedical Sciences, University of Padova, Italy)

43 Feasibility and Preliminary Efficacy of Heavy Lifting Strength Training versus Usual Care in Head and Neck Cancer Survivors: A Randomized Controlled Trial (the LIFTING 2 Trial)

Background: Head and neck cancer survivors (HNCS) endure side effects including loss of muscular strength and physical functioning, fatigue, and swallowing difficulties that impact quality of life (QoL). Our team previously conducted a single-group pilot study of heavy lifting strength training (HLST) in HNCS, that showed promising results. The proposed study will build on this work to further evaluate the safety, feasibility, and preliminary efficacy of HLST compared to Usual Care (UC).

Methods: This single-centre, two-armed, randomized controlled trial aims to recruit 38 evaluable adult HNCS from the Alberta Cancer Registry who are ≥1-year posttreatment with adequate shoulder ranges of motion. Participants are randomly assigned to the HLST group or UC group. The HLST group exercises twice weekly under supervision, for 12 weeks, and progresses to lifting low repetitions of heavy loads at 80-90% of perceived exertion. The UC group does not receive any exercise prescription. Physical assessments and questionnaires for both groups will occur at baseline and postintervention. The primary efficacy outcome is upper and lower body muscular strength assessed by 3-repetition maximum tests. Secondary efficacy outcomes include measures of physical function and quality of life.

Results: To date, we have mailed invitation letters to 750 HNCS through the Alberta Cancer Registry and have been contacted by 53 (7.1%) of which 36 (4.8%) were eligible and 22 (2.9%) were randomized. At baseline, mean age is 67.6 ± 6.4 years, 17 (77.3%) are males, and 17 (77.3%) were diagnosed with early stage (I-III) cancer. Mean BMI is 27.4 ± 3.4 kg/m2. Two (9.1%) participants were lost to follow-up. Adherence to the exercise intervention is 95.8%, excluding the one intervention drop out. Baseline data of the whole cohort by randomized group will be described at the ISEO conference presentation.

Speaker: Ms Stephanie M. Ntoukas (Faculty of Kinesiology, Sport, and Recreation, College of Health Sciences, University of Alberta, Edmonton, AB, Canada)

44 Four weeks of high-intensity interval training improves vascular endothelial function and cardiopulmonary exercise testing performance in both young cancer patients and healthy individuals

Introduction
Solid tumors are often characterized with abnormal vascular structures, reduced perfusion and endothelial dysfunction which collectively limits therapy delivery. Preclinical data suggest that aerobic exercise of high-intensity may create a tumor-suppressive environment, enhancing treatment efficacy. This study investigates the effects of high-intensity interval training (HIIT) on vascular endothelial function using dynamic retina-vessel analyzer (DRVA) in cancer patients under acute therapy and healthy participants of similar age.

Methods
This non-randomized controlled trial with two arms was registered with the German Clinical Trials Register (DRKS00035528). Following medical clearance, cancer patients (n=9; 2M/7F; age 33±5 y) and healthy individuals (n=9; 2M/7F; age 30±4 y) underwent a four-week HIIT intervention. The HIIT protocol consisted of three weekly sessions, each including seven 1-minute intervals at 90% peak power output (PPO), interspersed with 2-minute recovery periods at 30% PPO. Data on primary and secondary outcomes were collected both before and after the intervention. The primary outcome measure was DRVA (Imedos-Health, Jena, Germany) and its derived biomarkers of the dominant eye. Secondary outcomes included CPET-data.

Results
There were no significant differences between the groups at baseline in age, BMI, or intraocular pressure. The adherence to HIIT was 92% and 93%, for cancer patients and healthy participants, respectively. Healthy participants exercise at 229 W±60, while the PO was 177±77 for cancer patients. Both groups showed improvements in some primary outcomes: DRVA-derived artery constriction, while flicker light-induced dilation capacity was reduced in cancer patients. CPET performance improved, with higher PPO and sustained efforts exceeding one minute compared to baseline in both groups. Peak V̇O2 increased in healthy, while cancer patients maintained their peak V̇O2.

Conclusion
Our preliminary data analysis suggests that four weeks of HIIT improve vascular endothelial function to some extent, even during acute treatment. Future research should investigate how HIIT influences therapy delivery and treatment responses.

Speaker: Dr Damir Zubac (University Hospital Cologne, Center for Integrative Oncology,)

45 Gross Motor Coordination in Pediatric Oncology Patients Compared to Normative Motor Quotients

Introduction: Children undergoing cancer treatment frequently exhibit motor impairments; however, objective comparisons with normative motor development standard remain limited. Understanding the coordination deficits is essential to guide early and targeted rehabilitation strategies in pediatric oncology. Methods: This cross-sectional study evaluated gross motor coordination (GMC) using the standardized Körperkoordinationstest für Kinder (KTK) in children and adolescents aged 5 to 15 years undergoing oncology treatment at Joana de Gusmão Children’s Hospital, Florianópolis, Brazil. Performance in the four test tasks -balance beam, lateral jumps, hopping for height, and shifting platforms- was converted from raw scores into age- and sex- standardized Motor Quotients (MQ). According to reference values, MQ <85 indicates below-average coordination and MQ ≤70 reflects significantly impaired performance. Results: Twenty-two participants were evaluated (mean age of 8.57±2.70 years; 65.38% female), undergoing outpatient treatment for solid (54.5%) or non-solid tumors (45.5%). Clinical characteristics included a mean treatment duration of 21.9±24.09 months, a high prevalence of underweight, and reports of pain (45.5%) or peripheral neuropathy (9.1%). All participants exhibited motor coordination impairments relative to normative expectations. Every child scored MQ ≤70, placing the sample in the very poor coordination category. The mean raw KTK score (87.50±50.53) was lower than the normative expected value (199.77±44.51), representing an average deficit exceeding 110 points. Individual deviations ranged from −79 to −142 points, indicating underperformance across all motor tasks. Although age was positively associated with KTK components, even older participants remained significantly below normative classifications. Discussion: The reduction in GMC suggests that motor impairments are a pervasive consequence of pediatric cancer treatment. These deficits reflect combined effects of fatigue, muscle weakness, prolonged treatment duration, and limited physical activity. Conclusion: Children undergoing cancer treatment present severe GMC deficits compared with normative MQ values, underscoring the need for early, structured, and individualized motor rehabilitation strategies in pediatric oncology.

Speaker: Ricardo Artur Etchatz Bilac (Federal University of Santa Catarina)

46 Identification of Pediatric Sarcopenia in Oncology: A Comparative Analysis of Anthropometric, Functional, and Strength-Based Models

*Introduction:Pediatric sarcopenia is increasingly recognized in children and adolescents with cancer, as the disease and its treatments accelerate muscle mass and strength loss. Early detection is crucial to guide nutritional and functional care. Thus, the objective of this study was to compare two classification models of sarcopenia based on anthropometric indicators, muscle strength, and functional capacity in pediatric patients undergoing cancer treatment. Methods: A cross-sectional study was conducted at Joana de Gusmão Children’s Hospital, Florianópolis, Brazil. The following measures were assessed: Body Mass Index (BMI), Mid-Upper Arm Muscle Circumference (MUAC), handgrip strength, and functional capacity (Timed Up and Go – TUG). Two classification models were analyzed: Model 1 (uniform scoring for all variables) and Model 2 (double weight for handgrip strength). The presence of three altered outcomes indicated sarcopenia. Comparisons between models used paired Wilcoxon, Stuart–Maxwell, weighted and simple Kappa coefficients, and McNemar test (p < 0.05). Results: The sample consisted of 12 participants (11.8±2.1 years), with 58.3% male and 58.3% diagnosed with solid tumors. A significant difference was found between model medians (V = 0; p = 0.003), with Model 2 presenting higher scores. Agreement between models was good (Kappa = 0.71; p < 0.001), while dichotomous classification showed fair agreement (Kappa = 0.333; p = 0.121). Model 2 identified more cases of sarcopenia (n = 6) compared to Model 1 (n = 2), although no significant difference was observed in the McNemar test (χ² = 2.25; p = 0.134). Conclusion:* Both models demonstrated good agreement and are valid for pediatric sarcopenia screening. Model 2 showed greater sensitivity, especially due to the increased weight of handgrip strength, potentially favoring earlier detection of muscle deficits. Larger studies are needed to refine diagnostic criteria and support more accurate clinical decision-making.

Speaker: Ricardo Artur Etchatz Bilac (Federal University of Santa Catarina)

47 Life Satisfaction and Emotional Distress Among Family Members of Children Undergoing Cancer Treatment: A Pilot Study

Introduction: Childhood cancer treatment represents a highly challenging experience for the entire family. Changes in daily routines and uncertainty about the future can intensify emotional distress among family members. Objective: To examine the association between life satisfaction and emotional distress among family members of children undergoing cancer treatment. Method: This cross-sectional pilot study with a mixed-methods approach was conducted at the Joana de Gusmão Children’s Hospital in Florianópolis, Brazil. Standardized instruments were used to assess psychological outcomes, including the Subjective Well-Being Scale for life satisfaction, the Generalized Anxiety Disorder-7 (GAD-7) for anxiety symptoms, and the Patient Health Questionnaire-9 (PHQ-9) for depressive symptoms. Correlation analyses were performed using Pearson or Spearman coefficients, with a significance level set at p < 0.05. Results: Thirty-three family members participated, most of whom were female (78.8%), with a mean age of 38.2 ± 9.3 years. The children undergoing treatment had a mean age of 8.3 ± 3.7 years, and 60.7% were diagnosed with solid tumors. Mean life satisfaction score was 3.01 ± 0.32, while anxiety (14.69 ± 5.45) and depression (13.54 ± 7.06) scores indicated a high prevalence of moderate to severe emotional distress. Significant positive correlations were observed between emotional distress and anxiety (r = 0.54; p = 0.001) and depressive symptoms (r = 0.61; p < 0.001), indicating that greater emotional burden was associated with lower life satisfaction. Discussion: These findings highlight the psychological vulnerability of family members during pediatric cancer treatment and emphasize the interrelationship between emotional distress and perceived well-being. Conclusion: Family members of children undergoing cancer treatment with higher emotional distress levels show lower life satisfaction, highlighting psychological vulnerability and the need for multiprofessional mental health support strategies for this population.

Speaker: Ricardo Artur Etchatz Bilac (Federal University of Santa Catarina)

48 Long-Term Psychosocial Outcomes in Childhood Cancer Survivors

Objectives
Long-term effects of childhood cancer and its treatment can impair psychosocial functioning, which can influence engagement in physical activity. Identifying severity and affected domains is essential for designing effective interventions.

Methods
In this cross-sectional study, 84 Childhood Cancer Survivors (CCS) (41.6% male; 19.0 ± 3.4 years; 4.2 ± 3.3 years post-treatment; range 0.5–11.2 years) and 84 matched healthy controls completed measures of depression (BDI-II), distress (Distress Thermometer: social, physical, practical, religious) and positive/negative affect (PANAS).
Results are presented as median [IQR]. Group differences were assessed using Kruskal–Wallis and Mann–Whitney U tests, associations with Spearman correlations.

Results
CCS reported greater BDI scores (median 10[IQR 15] vs 6[11]; p =.0018), more physical distress (5.5[7] vs 3[4]; p <.001), and lower positive affect (31[8] vs 33[8]; p <.001) compared to healthy peers. Among CCS, 35.7% had BDI scores indicating at least mild depression vs 22.6% of controls; moderate to severe depression occurred in 19.0% versus 11.9%.
Social distress (ρ=-.228; p=.038) decreased with time since treatment completion, other outcomes remained stable relative to time since end of treatment.
Younger diagnostic age correlated significantly with greater social distress (ρ=.223; p=.043).
Female CCS displayed more depressive symptoms (12[14] vs 5[14]; p =.002), higher practical (1.00[2] vs 1.00[1]; p =.008) and emotional distress (5.00[6] vs 3.00[4]; p =.024), greater negative affect (23.00[11] vs 17.00[8]; p <.001), and a trend toward lower positive affect (29[8] vs 32[7]; p=.051).

Conclusion
CCS experience enduring psychosocial difficulties that are more pronounced than those of healthy peers. These difficulties were largely unrelated to time since treatment completion, even among survivors more than 10 years post-treatment. Only social distress improved over time. Female and younger survivors show the greatest vulnerability. These findings highlight the importance of sustained psychosocial monitoring and tailored support for CCS, particularly for female survivors.

Speaker: Anne Ceulemans (KU Leuven)

49 Loss of Skeletal Muscle Mass During Systemic Cancer Treatment: A Systematic Review and Meta-analysis

Background: Loss of skeletal muscle mass (SMM) is common during systemic cancer treatment, but the extent and variability across cancer and treatment types remain uncertain. This systematic review and meta-analysis aimed to describe changes in SMM during systemic cancer treatment.
Materials and methods: We systematically searched PubMed, Embase, and Web of Science until April 11, 2025, for longitudinal studies reporting SMM during chemotherapy and/or immunotherapy (± targeted therapy) in patients with cancer across diagnoses (PROSPERO CRD42022308388). The standardized mean change (SMC) relative to the baseline standard deviation was pooled using random-effects models with Hartung-Knapp adjustment. Risk of bias was assessed with the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.
Results: Seventy-eight studies (n=10,502; 52% male; median age 64 years, range: 34–77) were included. Meta-analysis across cancers showed a decline in SMM (59 studies; n=6,373; SMC = -0.24, 95%CI: –0.29 to –0.20), corresponding to an average loss of 5% over a mean follow-up of 107 (SD: 63) days. Declines were most pronounced during chemotherapy (+ targeted therapy), whereas changes were not statistically significant with immunotherapy or combined chemo- and immunotherapy. Decline in SMM was greatest among patients with pancreatic (SMC = –0.41, 95%CI: –0.63 to –0.19), urological (SMC = –0.30, 95%CI: –0.42 to –0.18) and lung cancer (SMC = –0.30, 95%CI: –0.54 to –0.06). In 26 (84%) of reporting studies, the prevalence of low SMM increased during treatment, with the mean percentage rising from 43% to 51%.
Conclusion: Across cancer types, SMM declines rapidly during systemic cancer treatment, most prominently in patients receiving chemotherapy. The average SMM decrease observed over 3.5 months is equivalent to roughly five years of age-related SMM loss, underscoring the potential importance of routine body composition monitoring to support treatment planning and targeted strategies to preserve SMM.

Speaker: Lukas Svendsen (Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Denmark)

50 Meeting muscle-strengthening guidelines and measures of muscle mass and strength in the German National Cohort (NAKO)

Background: The World Health Organization (WHO) recommends adults to perform muscle-strengthening activities on two or more days per week at moderate or greater intensity. Muscle-strengthening activities and having sufficient skeletal muscle mass and strength are increasingly recognized for their role in improving health outcomes in both primary and tertiary prevention settings, including in cancer patients. However, it remains unclear whether meeting the muscle-strengthening guideline is associated with greater muscle mass and strength at the population level – important information for refining physical activity recommendations for cancer prevention and survivorship.
Methods: We used data from the baseline examination of the population-based German National Cohort (NAKO). The frequency and intensity of muscle-strengthening activities were self-reported. Skeletal muscle mass index adjusted for body mass (SMI, in %) was calculated using data from bioelectrical impedance analysis. Maximal handgrip strength (in kg) was assessed using dynamometers. Sex-stratified linear regression estimated the associations between meeting the muscle-strengthening guideline (yes/no) and SMI and handgrip strength, adjusting for potential confounders including age.
Results: The analytical sample comprised 49,467 participants (50.7% female) with a mean age of 48.3±12.6 years. Females had a mean SMI of 27.5±4.1%; males had a mean SMI of 35.4±4.0%. Furthermore, females had a mean handgrip strength of 30.7±5.7kg, while males had a mean handgrip strength of 48.8±8.7kg. Meeting vs. not meeting the muscle-strengthening guideline was positively associated with SMI in both sexes (e.g., β=0.40, p<.001, in females). Conversely, guideline adherence was positively associated with handgrip strength in males (β=0.71, p<.001), but only approached statistical significance in females (β=0.28, p=.09).
Conclusions: Performing muscle-strengthening activities on two or more days a week and at moderate or greater intensity was associated with a higher SMI in both sexes and with greater handgrip strength in males. Although the associations were relatively small, these findings generally support current muscle-strengthening guidelines.

Speaker: Mr Julian Brummer (Division of Physical Activity, Cancer Prevention and Survivorship, German Cancer Research Center (DKFZ), Heidelberg, Germany & Medical Faculty, Heidelberg University, Heidelberg, Germany)

51 Psychosocial factors and their association with physical activity and exercise capacity in childhood cancer survivors compared to healthy controls: a cross-sectional study

Background: Childhood cancer survivors (CCS) often experience long-term adverse effects that may compromise physical activity (PA) and cardiorespiratory fitness (CRF), with potential implications for psychosocial outcomes including depression, affect and distress. This study explored associations between physical- and psychosocial outcomes in CCS.
Methods: 84 CCS (42% male, 0.5-10 years after chemo- and/or radiotherapy, median age at diagnosis: 14.1 years(IQR:5.1)) and 84 matched healthy controls were included. Participants performed a cardiopulmonary exercise test on a treadmill to assess peak oxygen uptake (VO2peak) and completed the Beck Depression Inventory (BDI-II), Distress Thermometer (practical-, social-, emotional-, religious- and physical subscales), and positive- and negative affect scales (PANAS). PA was measured through daily steps using a Fitbit Sense for 14 days. Subgroup analyses were performed for diagnosis type, treatment type, treatment duration and time since diagnosis.
Results: CCS had a lower VO2peak compared to controls (34.8±7.2 vs 44.0±7.0 ml/kg/min,p<.001) and fewer daily steps (8800±2994 vs 11441±4009,p<.001). There were no significant associations between physical and psychosocial variables in CCS or controls. However, in CCS with hematological malignancies (n=42), BDI-II scores correlated moderately with PA and VO2peak (r=-.346,p=.033;r=-.525,p=.002) and emotional problems correlated moderately with VO2peak (ρ=-.369,p=.027). Among CCS treated with only chemotherapy, PA correlated moderately with BDI-II scores and positive affect (n=54, r=-.336,p=.011;ρ=.308,p=.033). In this group, VO2peak correlated moderately with BDI-II scores and emotional problems (r=-.402,p=.009;ρ=-.345,p=.019). CCS with treatment duration above the median (n=44,>0.69 years) showed a moderate correlation between PA and positive affect (r=.404,p=.012). CCS with time since cancer diagnosis below the median (n=42,<4.97 years), VO2peak correlated moderately with emotional problems and physical problems (r=-.428,p =.012;r=-.379,p =.027).
Conclusions: CCS demonstrated lower CRF and PA than matched controls. Stronger associations between physical and psychosocial outcomes were present among CCS after hematological malignancies, treatment with only chemotherapy, longer treatment duration and shorter time since cancer diagnosis.

Speaker: Nel Van Ermengem (KU Leuven)

52 Quality of Life and Functional Capacity in Brazilian Pediatric Cancer Patients: A Correlational and Mediation Analyses

Introduction: Quality of life (QoL) is a central outcome in pediatric oncology, and both patient- and caregivers reported perspectives contribute to understanding overall well-being. However, it remains unclear whether children’s functional status influences the relationship between caregiver perceptions and self-reported QoL. This study examined the association between caregiver proxy-reports and children’s own QoL ratings and explored whether hand grip strength (HGS) and functional capacity (Timed Up and Go test - TUG) mediate this relationship. Methods: A cross-sectional study was conducted with pediatric patients (4-15 years old) undergoing outpatient cancer treatment Joana de Gusmão Children’s Hospital, Florianópolis, Brazil. Sociodemographic, clinical and anthropometric data were collected, followed by functional assessments (HGS and TUG). QoL was measured using the PedsQL 4.0 questionnaire completed independently by children and their caregivers. Pearson correlations and mediation analyses using linear regression (p<0.05) were performed to explore direct and indirect associations. Results: Thirty-seven children and adolescents participated in the study, representing a heterogeneous clinical profile regarding diagnosis, treatment status and physical condition. A moderate, statistically significant correlation was observed between caregiver-reported QoL and children’s self-reported QoL (r=0.48; p=0.002), indicating meaningful convergence between perspectives. Mediation models demonstrated a significant direct effect of caregiver-reported QoL on child QoL (β=0.35; p=0.0047). However, neither HGS nor TUG contributed to significant indirect effects, suggesting that functional capacity did not mediate the relationship. Discussion: The alignment between caregiver and child perceptions of QoL appears to be independent of functional capacity. These results suggest that caregivers may capture aspects of children’s lived experiences that are not necessarily reflected in objective functional measurements. Conclusion: Caregiver assessments are positively and directly associated with children’s QoL, with no evidence of mediation by functional performance. Incorporating both perspectives into routine clinical evaluation may strengthen patient-centered care in pediatric oncology.

Speaker: Ricardo Artur Etchatz Bilac (Federal University of Santa Catarina)

53 Resistance Exercise as a Therapeutic Strategy for Cancer-Related Sarcopenia: Molecular Insights from a Preclinical Model

Background. Cancer-related sarcopenia is a unique form of muscle atrophy. No other type (immobilization, aging, microgravity, etc.) results in such profound impairment of patient prognosis. Considering that and given the absence of a curative treatment, we aimed to investigate the molecular basis of cancer-related sarcopenia and the role of exercise in its management.
Methods. Two experiments were conducted. In the first, colon cancer–related sarcopenia was induced using the AOM/DSS preclinical model. A skeletal muscle panel was performed to identify differentially expressed genes (DEGs) associated with sarcopenia. In the second experiment, cancer-related sarcopenic mice were assigned to a 5-week resistance exercise (RE). Untrained sarcopenic mice served as controls. The RE protocol consisted of ladder climbing with progressive loads attached to the animals’ tails. Gene and protein expression were compared between sarcopenic and exercise-trained sarcopenic mice. In both experiments, sarcopenia was determined by the reductions in muscle strength and impaired locomotor capacity, along with myofiber atrophy, assessed by in vitro cross-sectional area.
Results. Volcano plot analysis identified 10 differentially expressed genes (DEGs) related to skeletal muscle fibrosis, protein degradation, and inflammation. Hierarchical clustering analysis revealed distinct expression patterns between sarcopenic and non-sarcopenic mice. Receiver operating characteristic (ROC) analysis demonstrated that Atrogin-1 and MuRF-1, two key components of the ubiquitin–proteasome system, have potential diagnostic value for sarcopenia. RE prevented skeletal muscle atrophy and impaired motor performance, which are hallmark features of sarcopenia. In addition to normalizing the expression of several inflammation- and fibrosis-related genes, RE also prevented the exercise-induced increases in muscle Atrogin-1 and MuRF-1 protein levels, key regulators of muscle atrophy.
Conclusion: RE prevents cancer-induced sarcopenia by downregulating Atrogin-1 and MuRF-1, key components of skeletal muscle proteolysis signaling. These findings demonstrate the potential of RE to treat cancer-related sarcopenia and detect key targets for sarcopenia-specific pharmacological development.

Speaker: Rafael Deminice (State University of Londrina)

54 Resistance Training Is Key to Maintain and Improve Muscle Mass and Whole Body Phase Angle During and After Treatments for a Hodgkin’s Lymphoma Patient

Introduction
Exercise interventions are feasible and safe for patients with malignant lymphomas, with no evidence of increased adverse events. Allogeneic hematopoietic stem cell transplantation is a demanding therapy that significantly affects quality of life (QOL) and is associated with reductions in respiratory function, muscle strength and exercise capacity. Resistance training (RT) has demonstrated safety and efficacy in attenuating cancer-related adverse effects such as fatigue, decreased physical functioning and reduced health-related QOL. Precise manipulation of training variables is essential to optimize clinically relevant outcomes.

Case Report
A 35-year-old female presented at The Strength Clinic in November 2019 with a history of Hodgkin’s Lymphoma diagnosed in 2016 treated with chemotherapy and radiotherapy. After relapse in 2019, she underwent an autologous bone marrow transplant in August. Functional evaluation identified multiple movement dysfunctions associated with muscle weakness. InBody770 analysis showed low muscle mass and low whole-body phase angle (WBPA), which is linked to decreased strength, poorer QOL and increased mortality in cancer patients. She initiated an RT program focused on strength development. A new relapse occurred in January 2020, requiring immunotherapy, followed by another relapse in October. Additional immunotherapy preceded an allo-transplant from a fully compatible donor in March 2022, resulting in seven months of detraining. In February 2023, she developed Graft-Versus-Host Disease, interrupting training for one month and necessitating high-dose cortisone. Upon resuming training, decreases in muscle mass, elevated Extracellular Water Ratio and persistently low WBPA were noted. In June 2025, she was diagnosed with Mucoepidermoid Carcinoma of the parotid gland and treated. Despite these challenges, she maintained twice-weekly training, achieving improvements in muscle mass, WBPA, inflammation markers and self-reported QOL.

Conclusion
In this patient, structured RT effectively improved muscle mass, phase angle, strength and physical performance during and after lymphoma-related treatments. RT conducted alongside medical therapy and peri-transplant was feasible and safe.

Speaker: Mr Pedro Correia (The Strength Clinic)

55 Toward targeted exercise and dietary interventions for adolescents and young adults with cancer

Background: Adolescents and young adult (AYA) cancer survivors (18-39 years at diagnosis) face unique long-term challenges following treatment. Fatigue is among the most persistent problems, impairing health-related quality of life (HRQoL) and reducing workability. Many AYAs also engage in unhealthy lifestyle behaviours. My recent analyses from the Dutch SURVAYA data (~4000 AYA cancer survivors >5 years after diagnosis) revealed that only 28% maintained a healthy body weight, 25% met the fruit and vegetable intake recommendations, and 35% achieved physical activity guidelines. Importantly, lower adherence to these lifestyle recommendations was associated with higher levels of fatigue and poorer HRQoL.

Problem: Existing trials confirm that exercise and diet reduce fatigue, but they focus on adults aged 40 years and older, and typically examine exercise and diet in isolation. Furthermore, current programs rarely address the unique psychosocial, developmental, and behavioural characteristics of AYAs. Integrated, age-specific lifestyle interventions remain scarce.

Solution: This project represents the first steps toward a targeted multimodal lifestyle intervention for AYAs, with three integrated aims:
1. Trajectory analysis: Map exercise and dietary behaviours from diagnosis to 2 years, identifying high-risk groups – using COMPRAYA, a large longitudinal AYA cohort in the Netherlands
2. Intervention evaluation: Assess the combined effects of exercise and dietary support on fatigue and HRQoL and explore variations by patient and clinical characteristics – using the POLARIS database, which includes data from 52 RCTs and 425 AYAs.
3. Needs assessment: Identify AYA’s preferences and requirements for lifestyle support to ensure interventions are relevant, acceptable, and sustainable. – via focus groups.
Results from all aims will be presented at ISEO.

Impact: By laying the groundwork for a dietary and exercise trial in AYAs, this project aims to deliver a targeted exercise and dietary intervention that reduces fatigue, enhances quality of life, and improves workability.

Speaker: Marlou Floor Kenkhuis (Radboudumc)

Poster Session 1.3: Symptommanagement and Quality of Life (Posterarea 3)

56 Beneficial effects of exercise on breast cancer patients undergoing aromatase inhibitors: Scoping Review

Background: Hormone receptor-positive breast cancer patients receiving aromatase inhibitor (AI) therapy commonly experience adverse effects such as joint pain, fatigue, and reduced quality of life. These symptoms can affect treatment adherence and survivorship. Given the growing number of breast cancer survivors, understanding supportive care strategies such as exercise is critical for improving long-term outcomes. Exercise is a promising non-pharmacological approach, but its effectiveness in managing AI-related side effects remains unclear.
Methods: This scoping review was conducted in accordance with the PRISMA-ScR guidelines. A systematic search of two electronic databases (PubMed and EMBASE) was performed using predefined keywords. Relevant data were extracted using EndNote and charted in a structured Excel spreadsheet. The findings were summarized narratively.
Results: Fifteen studies involving 596 breast cancer patients receiving aromatase inhibitor therapy were included. Aerobic and resistance training were the most commonly employed interventions, demonstrating benefits such as reduced arthralgia, improved physical function, enhanced quality of life, and better sleep. Some studies also reported favorable changes in body composition and cardiovascular fitness. Pelvic floor muscle training effectively reduced urinary incontinence. Overall, exercise interventions were safe, feasible, and showed good adherence.
Conclusion: Exercise appears to be a safe and effective strategy to reduce aromatase inhibitor related side effects and improve quality of life in breast cancer survivors. Individualized exercise programs are recommended to enhance feasibility and adherence.

Implications for Cancer Survivors: Future research should focus on diverse populations and long-term outcomes to inform the development of accessible and sustainable exercise interventions for breast cancer survivors experiencing aromatase inhibitor-related side effects.

Keywords: scoping review, breast cancer, aromatase inhibitors, exercise
Preferred type of presentation: Poster presentation
Declaration of interest: The authors declare no conflicts of interest.
Funding: None.
*Corresponding author: Justin Y. Jeon, E-mail: jjeon@yonsei.ac.kr

Speaker: Jinyoung Moon (Graduate Program in Sports Applied Industry, Yonsei University, Seoul, Republic of Korea)

57 Effects of the Multimodal Oncology Rehabilitation Exercise (MORE©️) program on cognitive performance, sleep quality, and psychological distress amongst head and neck cancer survivors undergoing chemoradiotherapy (CRT).

Background: Head and neck cancer (HNC) and its treatments have significant detrimental effects on multiple survivorship domains. Multimodal programs incorporating exercise-based interventions are frequently integrated as supportive care strategies in western cohorts, however evidence in resource constrained settings remains scarce. The purpose of this study was to evaluate the effects of the MORE©️ program, a structured exercise-based intervention incorporating physical exercises, cognitive exercises, and psychosocial strategies on subjective cognitive function, sleep quality and psychological distress among HNC survivors undergoing CRT.
Methods: 118 HNC survivors presenting with HNC stages III to IVb were recruited in the MORE©️ program, delivered thrice weekly across eight weeks. Outcomes were assessed at baseline, four, eight and twelve weeks. Subjective outcomes were assessed using validated patient reported outcome measures, translated into the Kannada language. Changes in outcomes over time were assessed using the linear mixed effects model.
Results: Median age of the survivors was 47 years (78.8% males), with a high prevalence of tobacco chewers. Oral cavity was the most common primary tumor site, and majority presented with stage IVa of the disease. Significant improvements were observed in perceived cognitive impairments (β: 3.45, p<0.001), sleep quality (β: 2.8, p<0.001), and psychological distress (β: -2.4, p <0.001) by the 12th week. However, none of the demographic or clinical covariates were associated with magnitude of improvements in the outcomes.
Conclusion: The MORE©️ program demonstrated significant improvements in subjective cognitive function, sleep quality and psychological distress among HNC survivors undergoing CRT. These findings highlight the potential of structured, multimodal exercise programs as adjuncts to cancer treatment for improving cancer related outcomes. To the best of our knowledge, this is the first study to evaluate the effects of such an intervention among HNC survivors, highlighting the need for large scale randomized controlled trails to strengthen the evidence supporting these findings.

Speaker: Ms Hritika Pai (Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, India)

58 Exercise effects on quality of life and fatigue in patients living with and beyond cancer with low or clinically elevated symptoms of anxiety or depression: A pooled analysis of individual patient data of 30 RCTs

Background: Psychological symptoms, including anxiety and depression are prevalent among patients living with and beyond cancer. Limited research suggests that exercise effects might differ between patients with low or elevated symptoms of anxiety or depression. However, single randomized controlled trials (RCTs) are often underpowered to detect moderation effects. Hence, drawing on individual patient data (IPD) across multiple exercise-oncology RCTs, we investigated whether the effects of exercise on quality of life (QoL) and fatigue in patients living with and beyond cancer differ between those with low or clinically elevated symptoms of anxiety or depression.

Methods: Data from 30 RCTs (N=4104), available via the POLARIS database, were pooled and analysed using a one-stage IPD meta-analytical approach. Linear mixed models, adjusted for baseline outcome values and random intercept, were used to assess exercise effects on standardized post-intervention outcomes (Z-scores) of QoL and fatigue in patients with low or clinically elevated symptoms of anxiety or depression (categorized based on evidence-based cut-off scores).

Results: At baseline, 22.2% and 32.4% of all participants reported clinically elevated symptoms of anxiety and depression, respectively. Participants with elevated symptoms of anxiety showed greater benefits of exercise on QoL (β=0.25, 95%CI=0.10;0.40) and fatigue (β=-0.27, 95%CI=-0.42;-0.13) compared to those with less symptoms (QoL: β =0.15, 95%CI=0.07;0.22; fatigue: β =-0.15, 95%CI=-0.22;0.07). Similarly, participants with elevated symptoms of depression showed greater improvements in QoL (β=0.18, 95%CI=0.09;0.28) and fatigue (β=-0.24, 95%CI=-0.34;-0.14), compared to those with less symptoms (QoL β=0.15, 95%CI=0.08;0.22, fatigue β=-0.13, 95%CI=-0.20;-0.06).

Conclusion: This pooled analysis of IPD data showed greater improvements in QoL and fatigue among patients living with and beyond cancer with clinically elevated symptoms of anxiety or depression. These findings may suggest that these patients could benefit more from exercise interventions than patients with low symptoms and that exercise may need to be given higher priority within their individual care.

Speaker: Aniek Bonhof (Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.)

59 Exercise for bone metastases: Effects on physical function, symptoms, and quality of life – A scoping review

Background: Although exercise therapy has the potential to address physical decline, symptoms, and reduced quality of life (QOL) in patients with bone metastases, its effectiveness has not been sufficiently examined. This scoping review aimed to identify, summarize and map the relevant literature that provides information on the effects of exercise on physical function, symptoms, and QOL in patients with bone metastases.
Methods: A systematic search of PubMed, the Cochrane Library, Web of Science, and CINAHL was conducted from inception to December 2024. Studies examined the effects of exercise on physical function, symptoms, and QOL were included.
Results: Following the eligibility assessment, 15 studies (eight randomized controlled trials [RCTs] and seven non-RCTs) were included from 1,060 records. Most of the primary tumors were mixed cancer types or prostate cancer. The outcomes included measures of physical function, such as muscle strength, physical performance, exercise tolerance, balance, and body composition; bone mineral density; and symptom measures, including pain, fatigue, psychological status, and bone metastasis-specific symptom scales. The outcomes also included comprehensive QOL measures. Five interventions were found to be effective for improving physical function, one for bone mineral density, four for pain, two for fatigue and psychological distress, and five for QOL.
Conclusion: While current evidence suggests that exercise may positively influence outcomes, it is insufficient to determine the full effects of exercise and the most effective exercise regimens. Future studies should clarify whether exercise improves these outcomes and identify optimal exercise regimens for patients with bone metastases.

Speakers: Dr Eisuke Ochi, Takuya Fukushima

60 Exercise Interventions for Cancer-Related Fatigue and Related Symptoms in Racialized Women with Cancer: A Systematic Review

Background: Cancer-related fatigue (CRF) is one of the most distressing symptoms experienced by individuals with cancer and significantly affects physical functioning and quality of life. Although exercise is recognized as an effective strategy for managing CRF, racialized women remain underrepresented in exercise oncology research. This systematic review synthesized evidence from randomized controlled trials evaluating exercise interventions for CRF and related symptoms—sleep disturbance, anxiety, and depression—in racialized women with cancer.

Methods: A comprehensive search of MEDLINE, Embase, CINAHL, PsycINFO, and SPORTDiscus (inception to March 2025) identified eligible randomized controlled trials. Studies included adult racialized women with cancer and evaluated aerobic, resistance, or mind–body exercise interventions versus no exercise, usual care, or waitlist controls. Two reviewers independently conducted screening, data extraction, and risk-of-bias assessment using ROB-2. Standardized mean differences (SMDs) were pooled using random-effects models. Certainty of evidence was assessed with GRADE.

Results: Five trials (N=312), all involving breast cancer survivors, met inclusion criteria. Interventions included aerobic training, resistance exercise, yoga, and Baduanjin, delivered during or after treatment. Low-certainty evidence suggested that exercise may reduce CRF (SMD −0.85, 95% CI −1.43 to −0.26), representing a large effect. Exercise also showed a small reduction in depressive symptoms (SMD −0.36, 95% CI −0.71 to −0.01). Evidence for anxiety (SMD −0.57, 95% CI −1.17 to 0.02) and sleep disturbance (SMD 0.09, 95% CI −0.44 to 0.61) was very uncertain due to small sample sizes and methodological limitations. All studies were at high risk of bias, and substantial heterogeneity was observed for CRF.

Conclusion: Exercise may reduce fatigue and depressive symptoms in racialized women with cancer; however, evidence remains limited and imprecise. Larger, culturally responsive trials are needed to strengthen the evidence base and ensure equitable access to exercise-based supportive care across diverse populations.

Speaker: Danielle Lawrence (McMaster University)

61 Exercise Training Before, During, and After TIL Therapy in Malignant Melanoma

Background
Tumor-infiltrating lymphocyte (TIL) therapy is an intensive adoptive T-cell treatment for meta-static malignant melanoma (MM) that can induce sustained clinical responses in patients with advanced disease, including after failure of immune checkpoint inhibitors. The treatment in-volves tumor excision, ex vivo TIL expansion (5–7 weeks), lymphodepleting chemotherapy, and high-dose interleukin-2. It typically requires a ~3-week inpatient stay and is associated with substantial toxicity and psychological and physiological burden. Exercise training (ET) improves quality of life, physical capacity, and immune function in cancer populations, but its role during TIL therapy is unknown. This study evaluates the feasibility and potential effects of ET before, during, and after TIL therapy on patient-reported outcomes and physiological and biological parameters.
Methods
Fifteen patients (performance status 0–1, Danish- or English-speaking, and no major comor-bidities) with advanced MM scheduled for TIL therapy at Herlev Hospital, Denmark, will be enrolled. This phase II study includes ET across three phases: (1) a ~6-week supervised pre-admission program; (2) individualized daily ET, including strength training, during ~3 weeks of hospital admission; and (3) a 4–5-week supervised post-discharge program. ET in phases 1 and 3 consists of supervised cycling three times weekly, including continuous and high-intensity interval training, delivered either center-based or in-home depending on patient pref-erence.
Outcomes
The primary outcome is feasibility, assessed as adherence (%) to the prescribed ET dose.
Secondary outcomes include health-related quality of life and emotional distress, VO₂peak, skeletal muscle and abdominal adipose tissue volumes, adverse events, immune cell pheno-typing, tumour-specific T cells, circulating cytokines, tumour microenvironment characteris-tics, and gut microbiome composition.
Assessments occur at baseline, during admission (selected outcomes), and six weeks post-discharge.
Perspectives
This study will determine whether ET can be feasibly integrated throughout the TIL treatment trajectory and inform supportive care strategies and future randomized trials. Expected initia-tion is autumn 2026, pending approvals.

Speaker: Louise Lehrskov (Herlev and Gentofte Hospital, Department of Oncology, Denmark)

62 Impact of Household Income on Physical Activity, Depression Symptoms, Fatigue, Pain and Sleep Quality among Latina/Hispanic Breast Cancer Survivors

Purpose-Latina/Hispanic breast cancer survivors (LHBCS) often experience worse outcomes due to late diagnosis, poor treatment adherence, and limited healthcare access. LHBCS also show insufficient physical activity levels, which may contribute to poorer treatment outcomes. Low income, limited education, and restricted healthcare access strongly influence cancer screening and survival. However, whether household income (HHI) affects physical activity of LHBCS remain unclear. The objective was to investigate the impact of HHI on moderate-vigorous physical activity (MVPA), depression symptoms, fatigue, pain and sleep quality in LHBCS. Methods-LHBCS residing in Massachusetts, US, and enrolled in a 16-week virtually supervised exercise intervention targeting metabolic dysregulation (NCT01140282) were eligible. Analyses used only baseline data. Participants were stratified above or below the state median HHI of $100.000,00. MVPA was assessed using ActiGraph (ModelwGT3X-BT®). Socioeconomic status data were self-reported, and validated questionnaires for depression symptoms (CES-D), fatigue (BFI), pain (BPI), and sleep quality (PSQI) were used. Differences in means were assessed using t-tests or Mann-Whitney; Chi-square assessed categorical associations; logistic regression evaluated the relationship of the HHI with other variables, with statistical significance set at p<0.05. Results-Participants with lower-HHI (n=23) were 45.78±10.0 years old with a BMI of 30.3±4.8 kg/m2, while those with higher-HHI (n=14) were 43.07±8.9 years old with a BMI of 30.2±5.7 kg/m2. Groups were similar in age and BMI (p>0.05). Higher-HHI women were more likely to meet MVPA recommendations of ≥150 minutes/week (OR=5.833; p<0.05; 95% CI: 1.298–26.223). Lower-HHI participants showed worse depressive symptoms (p=0.001), greater fatigue (p=0.0405), higher pain interference scores (p=0.0215), and poorer sleep quality (p=0.0286). Conclusion- LHBCS with higher-HHI met MVPA recommendations, while LHBCS with lower-HHI experienced poorer fatigue, depression, pain and sleep outcomes. Said findings underscore the need for lifestyle interventions that reduce socioeconomic inequalities, promote equitable care, and improve treatment outcomes for LHBCS.

Speaker: Anderson Vulczak (Dana-Farber Cancer Institute / Harvard Medical School / University of Sao Paulo)

63 Incorporating Remote Monitoring to Support Exercise Adherence in Cancer-Related Fatigue

Category: Survivorship or Remote/Digital Integration
Background:
Cancer-related fatigue (CRF) is one of the most prevalent and persistent symptoms among cancer survivors, significantly impacting quality of life and functional participation. Exercise is an evidence-based intervention for CRF; however, many survivors remain exercise-naïve and require structured support when initiating exercise in their routine or transitioning from supervised rehabilitation to independent exercise. We evaluated the feasibility of integrating a personalized exercise program with remote monitoring to support exercise adherence in patients with CRF.
Methods:
We conducted a 6-month retrospective review of referrals from a cancer rehabilitation physician to exercise physiologists at our institution for patients with fatigue who had a cancer diagnosis. Patients deemed medically appropriate for exercise participation were enrolled in individualized programming and introduced to the Connect MHealth remote monitoring platform. Outcomes included referral completion, attendance at exercise physiology visits, engagement with remote exercise logging, and adverse events.
Results: Twenty-five cancer patients were referred to exercise physiology in this time frame, and 18 (72%) completed at least one exercise physiology visit. Seven of the 18 patients had previously completed physical therapy for cancer-related impairments but had not received fatigue-focused interventions. Six (33%) patients completed multiple exercise physiology visits and actively utilized remote monitoring. Walking was the most commonly reported activity among all participants, with additional participation in cycling, rowing, hiking, and other aerobic and strengthening exercises. Exercise engagement ranged from 2 to 99 logged sessions per participant. No adverse events were reported.
Conclusions: A remotely monitored exercise physiology program for CRF was feasible and safe among appropriately screened cancer survivors. Digital health platforms such as Connected Mhealth can support the transition from rehabilitation to long-term exercise participation by facilitating exercise engagement and clinician oversight. Future work will evaluate patient-reported outcomes, user experience, and fatigue-related clinical outcomes.

Speaker: Nandita Keole (Mayo Clinic Arizona)

64 Influence of Physical Activity Level on the Development of Chemotherapy-Induced Peripheral Neuropathy: Preliminary Data

Background:
Chemotherapy-induced peripheral neuropathy (CIPN) is a side effect of the administration of oxaliplatin, a neurotoxic agent, which causes dysfunction of peripheral neurons and interferes with quality of life. Pharmacological therapies have shown limited efficacy in controlling symptoms, leading to the exploration of physical exercise as a therapeutic alternative. Additionally, patient's physical activity level has been identified as a factor important for treatment tolerance, quality of life, and potentially, mitigating CIPN symptoms. However, the relationship between pre-chemotherapy physical activity levels and incidence and progression of CIPN symptoms remains poorly understood, particularly in patients with advanced colorectal cancer receiving oxaliplatin-based chemotherapy.

Aim:
To assess whether physical activity levels prior to chemotherapy influences the progression of CIPN symptoms across three cycles of oxaliplatin-based chemotherapy.

Methods:
Ten patients diagnosed with advanced colorectal cancer (stages III and IV), with a mean age of 63.5 ± 9.5 years, were evaluated. Physical activity levels were assessed at baseline using the International Physical Activity Questionnaire - Short Version (IPAQ-SV), and CIPN symptoms were assessed using the Chemotherapy-Induced Peripheral Neuropathy Assessment Tool (CIPNAT) at baseline and throughout three subsequent chemotherapy cycles.

Results:
Of the 10 patients evaluated, 7 were classified as sedentary or insufficiently active, who presented a progression of CIPN symptoms throughout the cycles. A significant increase in CIPN symptoms between cycles 1 and 3 (p < 0.05) was observed in these 7 patients, suggesting neurotoxicity in this cohort. In contrast, the three patients classified as active did not experience a significant increase in symptoms over the same period (p > 0.05).

Conclusions:
Our preliminary data suggest that pre-chemotherapy physical activity levels may modulate the development of CIPN symptoms. These findings underscore the need for confirming this association and investigating the effects of structured exercise training as a potential non-pharmacological strategy to prevent and/or manage these symptoms.

Speakers: Guilherme Ramos (School of Physical Education and Sport, University of Sao Paulo), Vitor Hugo Rodrigues (School of Physical Education and Sport, University of Sao Paulo)

65 Interplay of strategies for surviving cancer: Physiotherapy, Massage, Walking, Ballet, Swimming, Breathing techniques and Psychotherapy

Diagnosed with breast cancer during the pandemic of COVD-19, professional ballet dancer and professor with 43 years old had a mastectomy with reconstruction, followed by hormonal treatment (Tamoxifen). Patient had family breast cancer history (mother twice-35y/75y; cousins, greatgrandmother and grandmother’s sister). Before diagnosis patient was a high performance athlete with professional ballet performances, swimming, walks and gym.
Between surgeries from February to December 2021 online physiotherapy followed a light protocol on movement recovery (stretches, mobility and strength), breathing exercises, meditation. Walks, ballet classes and teaching were allowed dependent on patient’s pain.
Patient performed sensory stimulation in the pectoral, shoulder, scapula, and left upper limb regions, active mobilization of the shoulder girdle, cervical spine, and relaxation of the temporomandibular joints, in addition to lung expansion exercises and stimulation of diaphragmatic breathing. Different textures and temperatures’ exercises brought sensorial awareness to the area. The second physiotherapeutic strategy was scapulothoracic gliding stimulation with gain in final ranges of shoulder flexion, dissociation of the scapular and pelvic girdles.
After the 2nd (May) and 3rd (July)surgeries in 2021 the patient returned to work in August with significant pain condition (VAS – 6 out of 10), restarting sensory stimuli, and myofascial self-release techniques in the pectorals, teres major, and glenohumeral joint exercises were added.
In October, patient began strength exercises in the rotator cuff, biceps, and triceps brachii, and in a closed kinetic chain, gradually unloading body weight onto the left upper limbs, but the persistent pain caused irritability and fatigue. Patient did laser treatment during 2022, and to in-person myofascial massages from 2021 until today.
Psychotherapy was crucial until today to face the emotional trauma of the cancer.
Limitations in strength, flexibility and pain continues. The patient’s ability to dance ballet resumed to 3x, swim 3x , teach ballet 2x and rehearse 3-5x a week.

Speaker: Adriana Canedo (Deutsches Krebsforschungszentrum)

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Updated Poster Exercise Oncology Doris Interplay of strategies ballet swim walk massage psychotherapy.PDF

66 Meeting Physical Activity Recommendations Attenuates Obesity-Related Functional and Quality of Life Impairments in Women with Breast Cancer

Introduction: Breast cancer and obesity have been independently associated with functional limitations and reduced quality of life (QoL). However, the extent to which physical activity modifies obesity-related impairments in breast cancer survivorship remains unclear. This study aimed to compare functional performance and QoL across groups defined by obesity status and physical activity level in breast cancer survivors.
Methods: This cross-sectional study included 133 breast cancer survivors classified according to PA level and obesity status. PA was assessed using the International Physical Activity Questionnaire, and participants were categorized as meeting or not meeting PA recommendations (≥150 min/week of moderate or ≥75 min/week of vigorous PA). Obesity was defined as body mass index (BMI) ≥30 kg/m². Functional performance was assessed using the sit-to-stand test and the 6-minute walk test (6MWT). QoL was evaluated using the EORTC QLQ-C30 questionnaire. Linear regression models were used, with active women with BMI <30 kg/m² as the reference group.
Results: Obesity was associated with impaired functional performance and poorer QoL. In the 6MWT, obese women meeting PA recommendations showed reduced walking capacity compared with the reference group (β = −0.273; p = 0.035;). Obesity was also associated with greater interference of fatigue in daily activities (β ≈ 0.31–0.34; p < 0.01). When obesity was combined with not meeting PA recommendations, impairments were exacerbated. Obese inactive women demonstrated poorer lower-limb muscle function in the sit-to-stand test (β = 0.264; p = 0.021;) and markedly lower walking capacity (β = −0.464; p < 0.001), representing a larger magnitude of association than that observed in obese active women.
Conclusion: Obesity is associated with worse functional performance, fatigue, and QoL in breast cancer survivors. Meeting PA recommendations partially attenuates obesity-related functional limitations, whereas physical inactivity amplifies these impairments, supporting physical activity promotion as a key component of survivorship care.

Speaker: Prof. Paola Sanches Cella (State University of Northern Panara and State University of Londrina)

67 Outcome measures to assess the effectiveness of exercise interventions on chemotherapy-induced peripheral neuropathy (CIPN): a scoping review

Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of neurotoxic chemotherapy that can affect functioning and quality of life. No effective pharmacological treatments exist, highlighting the need to understand non-pharmacological strategies such as exercise. Given significant heterogeneity in the CIPN outcome measures chosen across studies, this scoping review aimed to identify the outcome measures used to evaluate the effectiveness of exercise interventions as a potential countermeasure for CIPN. Following the Arksey and O’Malley framework refined by Levac and colleagues, and the PRISMA-ScR guidelines, four databases (CINAHL, EMBASE, Medline, Scopus) were searched. Exercise randomized controlled trials involving adults with or at risk of CIPN that implemented a CIPN outcome measure were eligible for inclusion. Of the 1858 citations retrieved, 16 articles were included in this review. Data were charted on study characteristics, cancer and chemotherapy factors, exercise prescription, outcome measures, and CIPN-related findings. The included studies spanned a range of cancer types, chemotherapy agents, and intervention timings, with most participants either undergoing or having recently completed chemotherapy. Exercise interventions varied widely in modality, duration, supervision, and delivery setting. Outcome measures varied widely across studies, encompassing various patient-reported, clinical, and functional measures. The most common patient-reported, clinical, and functional measures were the EORTC QLQ-CIPN20, vibration sensation, and both the 6-minute walk test and maximal isometric strength, respectively. Approximately half of the included studies reported significant improvements in CIPN symptoms with exercise, with some also demonstrating benefits in physical function or health-related quality of life. In contrast, others showed stable symptoms or no between-group differences. No study satisfied the components of the core outcome measure set proposed by Park and colleagues, limiting cross-study comparisons. These findings underscore the need for standardized CIPN outcome measures in future exercise studies to strengthen evidence synthesis and inform clinical practice.

Speaker: Trei Lindstrom (Faculty of Rehabilitation Medicine, College of Health Sciences, University of Alberta, Edmonton, AB, Canada)

68 Physical activity and quality of life five years after in-person Alberta Cancer Exercise (ACE) participation.

Background
Exercise oncology programs demonstrate short-term benefits for physical function and quality of life (QOL); however, evidence supporting long-term survivorship outcomes remains limited.
Purpose
To describe five-year survivorship health status, physical activity (PA), and QOL among participants who completed 12-week in-person exercise programming for the Alberta Cancer Exercise (ACE) study from 2017 to 2019 (pre-COVID).
Methods
Participants who enrolled in ACE and were eligible for follow-up (i.e., not withdrawn or lost to follow-up) were invited to complete an optional survey five years from baseline program entry (n = 1,194 eligible). Outcomes included self-reported PA, health, symptoms, and QOL; descriptive analyses summarized five-year outcomes. Multivariable general linear models examined associations between PA status at five years and EQ-5D-5L visual analogue scale (VAS) scores, adjusting for age, sex, baseline VAS score, cancer type, and five-year treatment status.
Results
A total of 563 of 1,194 eligible participants (47.1%) completed the five-year follow-up (mean age 63.0 years; 73.7% female). Similar to baseline, breast cancer accounted for 45.5% of the participants, followed by hematologic (13.2%) and genitourinary cancers (9.9%); 18.5% were receiving active cancer treatment at follow-up. At baseline, 146 of 522 (28.0%) were meeting PA guidelines compared to 226 of 522 (43.3%) at five years (p < 0.001). Baseline EQ5D-5L VAS scores based on five-year PA classification were 72.3 (+/- 15.3), 68.7 (+/-15.6), 66.5 (+/-18.0) across active, insufficiently active and completely inactive groups respectively. At five-year follow-up, participants meeting PA guidelines ("active") reported significantly better overall self-rated health scores than those insufficiently active or completely inactive (five-year adjusted means: 80.4 vs 74.8 vs 65.9; p < 0.001).
Conclusions
Despite some improvement in PA, long-term maintenance was inconsistent, suggesting a need for ongoing support. Achieving or maintaining guideline-level PA was strongly associated with better long-term QOL (additional symptom and physical function outcomes will be presented).

Speaker: Christopher Sellar (University of Alberta)

69 Prospective Associations Between Sleep Quality and Patient-Reported Outcomes During Neoadjuvant Treatment for Breast Cancer

Purpose
To examine the associations between baseline sleep quality and patient-reported outcomes (PROs) during neoadjuvant breast cancer (BC) treatment, and whether participation in an exercise program modified these associations.

Methods
Women undergoing neoadjuvant BC treatment participated in supervised exercise or usual care as part of the Neoadjuvant Exercise Oncology Program randomized trial. Participants were prospectively assessed at baseline, mid-, and end-treatment for sleep quality (PSQI), fatigue (FACIT-F), pain, physical functioning and global health (QLQ-C30), anxiety, and depression (HADS). Our first analysis examined changes in PROs from baseline to end-of-treatment using linear mixed-effects models. We then computed Pearson correlations to examine unadjusted and adjusted (for baseline PROs; i.e., partial correlations) associations between baseline sleep quality and PROs collected at end-of-treatment. In our last examinations we computed correlations for sleep quality-PROs stratified by exercise vs. usual care.

Results
Participants were 62 women, 51.8±9.1 years, who completed 16-20 weeks of neoadjuvant chemotherapy. The average PSQI score at baseline was 6.8±3.5 and approximately 42.6% of BC patients reported having poor sleep. Fatigue, pain, physical functioning, global health, anxiety, and depressive symptoms deteriorations ranged from 7 to 70% during treatment when compared to baseline (all p < 0.05). Sleep quality at baseline was associated with end-of-treatment fatigue (r = −0.30, p = 0.025), pain (r = 0.28, p = 0.038), and physical functioning (r = −0.28, p = 0.036), but not with global health, anxiety, or depressive symptoms. After adjusting for baseline PROs, sleep quality at baseline remained only associated with pain (partial r = 0.26, p = 0.046). Correlations remained similar across the exercise and usual care groups.

Conclusion
Neoadjuvant chemotherapy is associated with worsening patient-reported outcomes and pain, in particular seems to be aggravated by poor sleep quality at diagnosis. Interventions targeting sleep may potentially improve pain outcomes during BC treatment.

Speaker: Carla Malveiro (Breast Cancer Research Program, Champalimaud Foundation, Portugal)

70 Protective Neurocognitive Effects of High-intensity Interval Training (HIIT) among Women with Breast Cancer Receiving Chemotherapy: interim analysis results from the CLARITY Trial

Background: Cognitive impairment, including memory and attention problems (“chemo-brain”), following chemotherapy is present in as many as 70% of patients treated with chemotherapy. High-intensity Interval Training (HIIT) has shown to be more effective than moderate continuous intensity aerobic exercise for improving cognitive function among adults. Therefore, the CLARITY Trial sought to examine the preliminary efficacy of a supervised HIIT exercise intervention on cognitive function in breast cancer patients receiving chemotherapy.

Study Design and Methods: This ongoing pilot randomized controlled trial will randomize 50 breast cancer patients receiving chemotherapy to HIIT or attention control (AC). This analysis included 20 women (HIIT, n=12; AC, n=8) who completed the trial as of October 2025. The HIIT group performed a supervised 16-week, thrice-weekly intervention, with each session including 10 sets of alternating intervals: 1-minute high-intensity (90% maximal power output POmax) and 1-minute recovery (10% POmax). The AC group received a stretching program for 16 weeks. Cognitive function was assessed using NIH Toolbox tests: picture sequence memory, oral reading recognition, list sort working memory, pattern comparison processing speed, oral symbol digit, and auditory verbal learning, and the Montral Cognitive Assessment (MoCA). Within- and between-group mean differences were calculated using paired sample t-tests or Wilcoxon, or ANCOVA, adjusting for baseline cognitive performance, respectively.

Results: From baseline to post-intervention, the HIIT group improved performance on the pattern comparison processing speed test (within-group: 3.92 ± 3.60, p=0.003) and relative to the AC group (between-group: 5.69 ± 11.48, p=0.01). No significant effects were detected for remaining cognitive assessments (p>0.05).
Conclusions: This first-of-its-kind study incorporates a novel HIIT exercise intervention and comprehensive cognitive measures. Our preliminary evidence suggests a positive impact of HIIT on processing speed during chemotherapy. Trial completion and larger RCTs should assess neuroprotective effect of HIIT on cognitive health among adults receiving chemotherapy for cancer.

Speaker: Christina Dieli-Conwright (Dana-Farber Cancer Institute / Harvard Medical School)

71 Randomized comparison of supervised exercise for lymphedema and related arm symptoms: SAFE trial exploratory analyses

Background
Exercise is increasingly recognized as beneficial in addressing breast cancer treatment-related sequelae including lymphedema. However, uncertainty remains regarding the safety of low levels of supervision. Currently, only supervised exercise is recommended for those at risk of, or with, lymphedema, yet head-to-head trials directly comparing supervision levels are limited. These exploratory analyses from the SAFE trial compared low- versus high-supervision exercise on breast cancer-related lymphedema prevalence and associated up-per-extremity symptoms.
Methods
Sixty women undergoing, or within five years of treatment for stage ll+ breast cancer were randomized to a 12-week, individually prescribed aerobic and resistance exercise program (target 150 minutes/week, moderate-intensity) with LOW (five in-person sessions) or HIGH (twenty in-person sessions) supervision. Outcomes included lymphedema prevalence (self-reported diagnosis and objectively measured via bioimpedance spectroscopy) and severity of fifteen upper-extremity symptoms related to lymphedema including heaviness, tightness and range of movement) (self-report, five-point scale ranging from 0 (none) to 4 (extreme)). Tests of statistical significance were 2-sided. Analyses followed intention-to-treat principals. Regis-tered at: Australian and New Zealand Clinical Trials Registry, ACTRN12616000547448

Results
Twenty participants were identified with lymphedema at baseline based on objective and/or self-report of a clinical diagnosis. At follow-up, there was no evidence to suggest that change in prevalence differed according to supervision level, irrespective of assessment method. Both groups maintained or improved most lymphedema-related arm symptoms, though po-tential for additional benefit in range of movement was observed in HIGH, with 52% reporting improvement versus 12% in LOW (P<0.05).
Conclusion
Though future studies are warranted to confirm findings, the results of this study indicate that breast cancer survivors with or at risk for lymphedema can benefit from exercise participa-tion, irrespective of low or high supervision. Overall results support the value of exercise, even at lower supervision levels, which may enhance the feasibility of wide-spread, equitable implementation of exercise services.

Speaker: Kira Bloomquist (Center for Health Research UCSF), Copenhagen University Hospital, Rigshospitalet)

72 Reducing Symptom Burden Through Physical Exercise in Melanoma Patients Under Immunotherapy or Targeted Therapy: the RESPECT Trial – First Insights Into an Ongoing Trial

Background: Despite survival gains with immune checkpoint and targeted therapies, toxicities and adverse effects—particularly fatigue—impair quality of life in melanoma patients. Although exercise benefits are established in oncology, its integration in melanoma care is underexplored. RESPECT examines whether a supervised hybrid (online/in-person) exercise program reduces fatigue and improves quality of life, cognition, and physical function during adjuvant immunotherapy or targeted therapy.

Methods: The RESPECT trial is a single-center randomized controlled trial at the West German Cancer Center (N=104), allocating patients 1:1 to a 12-week supervised hybrid exercise program vs standard care. The intervention includes online group sessions (2/week), in-person visits (3 during intervention period), and app-guided home training (1/week); each 60-minute session combines aerobic, resistance, and coordination exercises with cognitive elements. Assessments at baseline, post-intervention, and 6-week follow-up include fatigue (FACIT-F), melanoma-specific quality of life (FACT-M), physical activity (BSA questionnaire), physical function (5RM; VO2peak), cognition (MoCA), body composition (BIA), and circulating metabolites/cytokines; EHRs capture treatment exposure and clinical events.

Discussion: To date, n=6 patients have been enrolled (median age 60 years; range 42–73). Based on evidence in other cancers, we hypothesize that regular exercise will reduce fatigue in melanoma. Integrating metabolite and cytokine profiling with patient-reported, cognitive, and performance outcomes will elucidate immunometabolic pathways by which exercise may influence treatment efficacy and toxicity. The patient-centered, digitally supported design addresses varying health, toxicities, digital literacy, and travel distance; individualized prescriptions, app-supported home sessions, and close team contact aim to optimize adherence and safety. Interim feasibility data of approximately 25 patients can be presented at the conference.

Conclusion: If efficacious, this pragmatic model could underpin routine implementation of structured exercise in adjuvant melanoma care.

Disclosure Statement: All authors declare no competing interests.

Speaker: Miriam Götte (University Hospital Essen, West German Cancer Center, 45122 Essen, Germany)

73 Resistance Training and Psychological Well-Being in People Diagnosed with Cancer: A Feasibility Study

Background: Cancer often brings psychological challenges such as distress, depression, and anxiety, which can negatively affect health outcomes. Exercise is known to improve these symptoms, yet the mechanisms underlying its psychological benefits remain unclear.

Aims: This feasibility study examined the effect of a six-week resistance training programme on exercise-self-efficacy, self-esteem, and the severity of depression and anxiety symptoms in adults diagnosed with cancer.

Methods: Twelve adults (mean age 62 years; mixed cancer types and stages) completed three resistance training session per week for six weeks. Psychological health outcomes of Exercise Self-Efficacy, Hospital Anxiety and Depression Scale, and The Rosenberg Self-Esteem Scale were assessed at baseline, mid-point, and post-intervention.

Results: Resistance training was associated with significant improvements in exercise self-efficacy and reductions in depressive symptoms, alongside clinically relevant decreases in anxiety. Higher self-efficacy was strongly related to lower depression and moderately related to lower anxiety across timepoints.

Conclusion: Resistance training appears to enhance psychological health in adults with cancer, with self-efficacy emerging as a key mechanism. These findings support the feasibility of incorporating resistance training into rehabilitation pathways and warrant larger, controlled trials to confirm effectiveness and refine mechanistic understanding.

Speaker: Jay Calder (University of Canberra)

74 Structured Respiratory Training Improves Clinical Eligibility for Deep Inspiration Breath Hold in Left-Sided Breast Cancer Radiotherapy

Purpose: Deep Inspiration Breath Hold (DIBH) is an established technique to reduce cardiac dose in left-sided breast radiotherapy. Successful implementation requires adequate thoracic expansion, stable plateaus, and sufficient apnea-time. This study evaluates the effect of structured respiratory training on breath-hold performance and DIBH eligibility, and whether breath-hold capacity mediates the relationship between training and DIBH approval.
Methods: A total of 166 patients with left-sided breast cancer were assessed for adjuvant radiotherapy using optical surface-guided system. Participants were allocated to a Control group (n= 91) or a Training group (n= 75). Patients in the Training group underwent supervised 30-minute respiratory training sessions at the Champalimaud Foundation Exercise Oncology Hub. Breath-hold duration was compared between groups using the Mann–Whitney U test. Associations between respiratory training and DIBH approval were examined using chi-square tests. Multivariable logistic regression analysis was performed to identify independent predictors of DIBH eligibility.
Results: Patients who underwent respiratory training sustained significantly longer breath-holds than the control group (median 40.56 s vs 30.20 s; U = 2030.5; p < 0.00001). The proportion of patients approved for DIBH was higher in the Training group compared with controls (74.7% vs 48.3%; p = 0.001). In logistic regression analysis, breath-hold duration was strongly associated with DIBH approval (β = 0.184; OR = 1.20, 95% CI 1.13–1.27; p < 0.001). After adjustment for breath-hold duration, participation in respiratory training was no longer associated with DIBH eligibility (p = 0.793), indicating that the effect of training on DIBH approval is mediated by improvements in breath-hold capacity.
Conclusion: Respiratory training increases the proportion of patients able to perform DIBH during breast radiotherapy by improving breath-hold capacity. Breath-hold duration is the main determinant of DIBH approval. Introducing supervised respiratory training supports patient selection and facilitate cardiac-sparing radiotherapy in routine clinical practice.

Speaker: Dr Javier Morales (Radiotherapy Department & Breast Cancer Research Program, Champalimaud Foundation, Lisbon, Portugal)

75 Taking back control’ through exercise: a qualitative exploration of treatment-related side effects and physical activity in women during treatment for ovarian cancer

Introduction: Physical activity during treatment for cancer has been shown to improve function, and reduce treatment-related side effects, but existing evidence is largely derived from early-stage and more common cancers and may not reflect the experiences of women with ovarian cancer. This qualitative study explored side effects associated with chemotherapy and experiences with physical activity across treatment stages among women with ovarian cancer enrolled in an exercise clinical trial.

Methods: Participants were drawn from the phase 3 ECHO trial, which was a 6-month telephone delivered exercise intervention during chemotherapy (exercise versus usual care). Eligible women were newly with diagnosed ovarian cancer, were aged ≥18 years, had ECOG score 0–2, and had completed the ECHO trial between June–December 2022. Guided by the socioecological framework, semi-structured interviews were conducted using a phenomenological approach. A pragmatic, inductive thematic analysis was undertaken to develop salient themes using the Braun & Clarke methodology.

Results: Seventy of 489 eligible ECHO participants were invited to participate; 26 returned consent forms, and 15 completed interviews (mean age 61.9 years). Most participants had stage III (53.3%) or stage IV (20%) disease; 53% were in the intervention group. Six themes were constructed: (1) side effects along the cancer continuum; (2) physical, mental, and emotional exhaustion; (3) fears related to uncertainty, long-term impacts, and recurrence; (4) “choosing what I can control”; (5) exercise to navigate side effects and daily living; and (6) participation in an exercise trial as “lifesaving.”

Conclusion: Women experienced significant symptom burden yet used exercise to manage side effects, maintain normality, and regain control, supporting the need for tailored exercise programs across the ovarian cancer treatment continuum.

Speaker: Melanie Plinsinga (Australian Centre for Precision Health and Technology (PRECISE), Griffith University, Australia)

76 The Effects of 12-Weeks of Exercise on Cancer-Related Fatigue Over Time in Cancer Patients

Current evidence suggests that exercise is safe and well-tolerated by cancer patients and has potential to mitigate cancer-related fatigue (CRF), a distressing and undermanaged adverse event. This study evaluated if supervised group exercise for 60 minutes (aerobic/strength), 2-3 times/week for 12 weeks, can impact CRF over time. FACIT-FS, a self-reported questionnaire, was used to assess CRF in Week 1, 4, 8, and 12. Subgroup analyses of FACIT-FS categorical baseline fatigue levels were also conducted. Participants (N = 35) consisted of adult women (n = 32) and men (n = 3) who were diagnosed with any type of cancer and were receiving treatment or had completed treatment within the last 5 years. All participants showed a significant difference in mean FACIT-FS from Week 1 (M = 37.37, SD = 8.92) to Week 12 (M = 42.89, SD = 8.10), p < .001, favoring an improvement in CRF. Participants with baseline moderate-to-severe CRF (n = 11) had the most significant improvement in CRF from Week 1 (M = 26.36, SD = 3.91) to Week 12 (M = 38.36, SD = 6.76), p = < .001. For participants with minimal baseline fatigue (n = 16), increases in mean FACIT-FS still occurred suggesting that exercise can be beneficial to health status in patients not experiencing CRF. Pairwise comparisons showed CRF levels significantly improved from Week 1 (M = 41.00) to Week 8 (M = 45.00, p = .021) and Week 12 (M = 46.23, p = .009) as well as Week 4 (M = 43.53) to Week 12 (M = 46.23, p = .023) suggesting eight weeks is key timepoint when benefits of exercise begin to occur and continue over time. This study provides strong evidence that supervised group exercise is beneficial in mitigating CRF and improving patient overall well-being.

Speaker: Dr Deborah Middleton, Ph.D. (Concordia University-St Paul, Minnesota; Senior Medical Education Director, Hematology/Oncology, Global WebMD/Medscape Education)

77 Toward Real-Time Understanding of Cancer-Related Fatigue and Physical Activity: A Scoping Review of Ambulatory Assessment Research

Context Cancer-related fatigue (CRF) is one of the most prevalent and debilitating symptoms among cancer survivors. Although physical activity is widely recommended to mitigate CRF, existing evidence largely relies on retrospective, between-person approaches that fail to capture intra-individual fluctuations and contextual influences in daily life. Ambulatory Assessment (AA) enables real-time monitoring and offers opportunities to examine the micro-temporal interplay between CRF and physical activity behavior in everyday life.
Objective This scoping review examined: (a) AA-based approaches for assessing CRF; (b) concurrent physical activity assessment; and (c) emerging evidence on bidirectional relationships. Key methodological challenges were identified to inform future precision-oncology research.
Design Scoping review conducted according to PRISMA-ScR guidelines.
Eligibility Criteria Studies using AA methods to assess CRF in adult cancer survivors, with or without concurrent physical activity measurement.
Study Selection PubMed, Web of Science, EMBASE, CINAHL, and Scopus were systematically searched through March 2026. Titles, abstracts, and full texts were independently screened, supplemented by forward and backward citation tracking.
Main Outcome Measures AA procedures, CRF operationalization, physical activity assessment, temporal alignment between measures, and reported associations.
Results Forty-three studies met inclusion criteria, of which 21 included concurrent physical activity assessment. Substantial methodological heterogeneity in CRF and physical activity assessment was identified, and precise temporal synchronization between measures was rare. Nevertheless, AA approaches revealed substantial intra-individual variability and diurnal CRF fluctuations. Emerging intensive longitudinal findings provide preliminary evidence for time-sensitive, potentially bidirectional associations, with higher physical activity and lower sedentary behavior generally linked to lower fatigue.
Conclusion AA is shifting CRF research toward a dynamic, within-person framework. However, limited temporal synchronization and lack of standardized assessment approaches constrain interpretability and translation. This review provides methodological recommendations for standardized CRF assessment, objective activity monitoring, temporally aligned measurements, and within-person analytical approaches to advance adaptive, context-sensitive interventions for cancer survivorship care.

Speaker: Dr Corinna Meyer-Schwickerath (Exercise Oncology Research Group, Division of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and Heidelberg University Hospital, Heidelberg, Germany)

78 Week-to-Week Acute Fatigue Response to Exercise During an Outpatient Cancer Rehabilitation Program

Background/Purpose: Cancer-related fatigue (CRF) is a common, debilitating symptom among cancer survivors. Exercise-based cancer rehabilitation improves CRF over time but less is known about acute effects. This study examined week-to-week changes in CRF from before to after exercise sessions during a 12-week outpatient rehabilitation program.

Methods: As part of an observational, longitudinal cohort study, CRF was measured before and immediately after one exercise session per week using a 0-10 visual analog scale. Sessions occurred on the same day/time each week. Multilevel models predicted CRF before, after, and change (ΔCRF) across intervention weeks, with treatment status included as an interaction term and covariate, and before exercise CRF as a covariate.

Results: Participants (N=25; 62±12 years; 84% female; diagnosed with breast (16%), colorectal (12%), pancreatic (12%) or other cancer; 68% currently on treatment) completed 187 exercise sessions (M=11.3±1.7 per participant). Treatment status predicted CRF before (M=5.54±2.30 on treatment; M=0.53±0.85 off treatment; Coeff.=3.00±1.05; 95% CI=0.92, 5.03) and after exercise (M=3.45±2.16 on treatment; M=1.00±0.88 off treatment; Coeff.=2.51±1.03; 95% CI=0.49, 4.52). Average ΔCRF was M=–0.06±1.65 (range –5 to 9). ΔCRF went from M=–0.40±1.57 in week 1 to M=0.10±0.85 in week 12. CRF before exercise significantly predicted ΔCRF (Coeff.=-0.53±0.04; 95%CI=-0.62, -0.44). There was no effect of week or treatment status on ΔCRF.

Conclusions: Participants receiving treatment reported higher CRF but there was no difference in ΔCRF by treatment status. There was no effect of week of program or treatment status on ΔCRF, but higher CRF before exercise was associated with a larger ΔCRF. These findings suggest that CRF before exercise may affect the acute CRF response to an exercise session.

Speaker: Hannah Parker (Colorado State University)

79 YOCAS©® Yoga, Symptom Burden, and Symptom Interference with Work and Activities of Daily Living (ADLs) in Cancer Survivors: A Nationwide Multicentered Randomized Controlled Trial (RCT) in the United States

Introduction: Cancer survivors experience many symptoms years after treatment. This overall symptom burden interferes significantly with the ability to work and perform activities of daily living (ADLs). Yoga, a form of exercise, is a promising therapy to mitigate these symptoms.
Methods: We conducted a nationwide, multicenter, phase III, RCT testing the effect of Yoga for Cancer Survivors (YOCAS©®) on overall symptom burden (OSB) and OSB interference (OSBi) with work and ADLs. Cancer survivors, 2-24 months posttreatment were recruited via the University of Rochester Cancer Center (URCC) National Cancer Institute Community Oncology Research Program (NCORP) Research Base across the United States. Survivors were randomized to the YOCAS©® yoga intervention (10-15 survivors/group; 75 minutes/session; 2x/week; 4 weeks; gentle Hatha and Restorative) or usual care. OSB and OSBi with work and ADLs were assessed at baseline and post intervention, using a Clinical Symptom Inventory.
Results: A total of 410 cancer survivors; 96% female, mean age 54 years, 75% breast cancer survivors were recruited. Mixed effects modeling demonstrated that YOCAS©® participants experienced a significant reduction in OSB compared to usual care participants (mean change difference [MCD]-5.64, SE=1.16, p<0.05) from pre- to post-intervention. YOCAS©® participants reported significant reductions in OSB from pre- to post-intervention (mean change [MC]-6.64, SE=0.93, p<0.05), while usual care participants did not (MC-0.96, SE=0.87, p>0.05). YOCAS©® participants also experienced significant reductions in OSBi with work (MCD-0.86, SE=0.23, p<0.05) and ADLs (MCD-1.01, SE=0.22, p<0.05) compared to usual care participants. YOCAS©® participants reported significant reductions in OSBi with work (MC-0.97, SE=0.19, p<0.05) and ADLs (MC-1.02, SE=0.19, p<0.05), pre- to post-intervention, while usual care participants did not (work MC-0.04, SE=0.18; and ADLs MC=0.21, SE=0.18, all p>0.05).
Conclusion: YOCAS©® yoga is effective for reducing OSB and OSBi with work and ADLs among cancer survivors. Further research is needed to confirm these results.
Funding: NCI UG1CA189961, T32CA102618

Speaker: Dr Alisha Chakrabarti (James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States of America; Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America.)

Poster Session 1.4: Behavioral Interventions & Physical Activity Behavior (Posterarea 4)

80 ACTIVATE: A pilot randomized Activity Coaching Trial to Increase Vitality and Energy during post-operative pelvic radiation therapy for endometrial cancer

Background: Women with endometrial cancer experience substantial symptom burden during adjuvant pelvic radiation therapy (PRT), with cancer-related fatigue among the most debilitating. Fatigue is exacerbated by recent surgery, older age, obesity, and treatment-related side effects, making exercise challenging. This trial evaluates the feasibility and preliminary efficacy of personalized exercise coaching delivered during post-surgical PRT versus initiating exercise 5-7 weeks post PRT, enabling assessment during treatment and early recovery.
Methods: Sixteen women with Stage I–IVA endometrial cancer scheduled to receive adjuvant PRT after total/modified radical hysterectomy are randomized to immediate or delayed coaching using an attention-control design. The intervention is a 10-week personalized exercise-coaching program with weekly sessions helping participants achieve ≥150 minutes/week of moderate activity. The immediate group begins coaching at PRT initiation; the delayed group 5-7 weeks post-PRT. Participants wear an activity monitor and complete patient-reported outcomes at baseline, post-PRT, 5-7w post-PRT, and 6-mo follow-up: fatigue (FACIT-Fatigue), bowel/urinary toxicity (EPIC), sexual function (PROMIS), and quality of life (PROMIS-29+2). Functional capacity is assessed via six-minute walk test (6MWT). Feasibility benchmarks: ≥50% provider acceptability; ≥50% patient acceptability; ≥50% appropriateness of screening criteria; ≥70% adherence to coaching and device wear. Enrollment began January 2025 and is expected to conclude January 2026, with follow-up completed by July 2026.
Preliminary Results: Thirteen participants have enrolled to date (54% non-Hispanic White, 15% non-Hispanic Black, 15% Hispanic, 8% Middle Eastern/North African). Baseline mean weight was 79.4 kg, height 63.6 inches, 6MWT distance 1168 meters. Six women were randomized to immediate start and 7 to delayed. Assessment completion is 100% at baseline, post-PRT, 6mo follow-up; 86% at 5-7w post-PRT. Three participants withdrew for unrelated reasons (PRT side-effects, medical issue, social hardship). Five have completed the study, all meeting feasibility benchmarks.
Conclusions: Early findings indicate good feasibility and acceptability, supporting the feasibility of delivering exercise coaching during PRT.

Speaker: Dr Melissa Miller (Inova Peterson Life with Cancer)

81 Adherence to physical activity recommendations and health-related quality of life in long-term survivors of breast, prostate or colorectal cancer

Background:The prospective association between physical activity (PA) and health-related quality of life (HRQoL) in long-term cancer survivors (LTCS, ≥ 5 years post-diagnosis) is understudied, particularly across different cancer diagnoses. We assessed these associations among long-term survivors of breast, prostate and colorectal cancer within a large prospective cohort in Germany.
Methods: A total of 6,057 LTCS from six German cancer registries were included between 2009 and 2011; 2,704 of them completed the follow-up assessment between 2018 and 2019. PA was assessed using self-reported weekly time spent on moderate- to vigorous PA and was categorized as fully adherent (≥150 min/week), partially adherent (75-149 min/week) and non-adherent (<75 min/week) according to the World Cancer Research Fund/American Institute for Cancer Research recommendations. HRQoL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30. Generalized linear models were conducted to examine associations between PA and HRQoL outcomes overall and by cancer type.
Results: In total, 42.8% survivors were fully adherent to PA guidelines and 48.5% were non-adherent. Non-adherence at baseline was associated with poorer HRQoL across all functioning and higher symptom burdens in the follow-up. Compared to fully adherent survivors, non-adherent survivors reported lower global health status/QoL (β: -4.79, 95% CI: -6.45, -3.13) and physical functioning (β: -5.44, 95% CI: -6.97, -3.91), as well as higher fatigue and pain scores, after full adjustment. Associations persisted in breast and prostate cancer survivors and in males with colorectal cancer, but not in females.
Conclusions: Non-adherence to PA recommendations was associated with poorer HRQoL among LTCS. The magnitude of associations differed by cancer types and sex, highlighting the need for tailored survivorship care and the importance of PA promotion in long-term survivorship.

Speaker: Chunsu Zhu (Deutsches Krebsforschungszentrum)

82 Advancing Communication on Physical Activity for Health: Creation of a Slogan and its Visualization

Introduction: Although physical activity (PA) is essential for overall health and well-being, existing PA guidelines are often complex and fail to effectively reach the general population. Further, adherence remains suboptimal, particularly for muscle-strengthening recommendations. To enhance public engagement, we aimed to distill key PA messages into a memorable slogan and design an accompanying infographic to support primary disease prevention.

Methods Our multidisciplinary team examined scientific literature on PA for health and identified core, actionable messages for adults. Through iterative discussions, the core messages were refined into candidate slogans, which were then supplemented with and contrasted against suggestions from multiple large language models. Prioritizing clarity, memorability, and support for long-term adherence, the team finalized a brief slogan and developed an infographic with the aim of presenting the advice in an inviting and visually accessible format.

Results: The final slogan, “Move – Mix it up – Make it fun,” encapsulates core PA guidance. “Move” encourages any PA, emphasizing the benefit of doing some PA over none, without focusing exclusively on structured exercise. “Mix it up” highlights the benefits of engaging in various activities, specifically including both, aerobic and muscle-strengthening components. “Make it fun” reminds individuals to choose enjoyable activities, supporting sustained engagement in PA.

Conclusion: Presenting PA advice in a concise, attractive format may help lower perceived complexity and make the information feel more approachable, potentially supporting public engagement with PA. The slogan and accompanying infographic are proposed as communication tools that might encourage the general population to integrate PA into daily life.

Speaker: Duc Truong Nguyen (Division of Physical Activity, Cancer Prevention and Survivorship, German Cancer Research Center (DKFZ), Heidelberg, Germany)

83 An Exploratory Analysis of 24-Hour Movement Behaviors in Individuals with Cancer Completing a 12-Week Resistance Exercise Intervention

Background/Purpose: Individuals with cancer often experience disrupted sleep, sedentary behavior, and reduced physical activity. This exploratory analysis examined the feasibility of continuous 24-hour monitoring using wrist-worn accelerometers and characterized movement behaviors during a 12-week supervised resistance training program in individuals with cancer. We additionally aimed to evaluate whether daily movement behaviors (moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), sedentary time, and sleep) differed between exercise and non-exercise days.

Methods: Thirty individuals with cancer wore Axivity accelerometers continuously while participating in supervised resistance training (2–3 sessions/week). Feasibility was assessed via wear-time compliance. Movement behaviors were analyzed descriptively across exercise and non-exercise days throughout the intervention. Multilevel models with person-mean centering were used to predict 24-hour movement behaviors on days with exercise sessions compared to days without exercise sessions.

Results: Participants demonstrated high adherence to continuous monitoring, with valid wear data on 70% of all days of the intervention. Within-person comparisons revealed significantly higher MVPA (+3.8 minutes) and LPA (+13 minutes) on exercise days. No significant changes were observed in sleep duration or sedentary time across the intervention or between exercise and non-exercise days.

Conclusions: Continuous wrist-worn accelerometry is a feasible method for long-term behavioral monitoring in individuals with cancer. Supervised resistance training produced modest acute increases in physical activity but did not impact sleep or sedentary time. Integrating wearable monitoring into survivorship care may support personalized exercise prescriptions and behavioral feedback. However, targeted strategies beyond exercise may be needed to produce broader changes in 24-hour movement behaviors.

Speaker: Hannah Parker (Colorado State University)

84 Barriers and Motivators for Physical Activity in Cancer Patients: A Cross-Sectional Study at the university hospital of Freiburg

Background
Physical activity is a key component of cancer care, improving quality of life and reducing treatment-related side effects. However, many patients remain insufficiently active. This study aimed to identify determinants of physical activity and of participation in structured exercise programs among cancer patients.
Methods
A quantitative cross-sectional study was conducted in the oncology department of the university hospital of Freiburg. Adult patients with a confirmed cancer diagnosis already affiliated with the Department of Exercise Oncology (ExOnc) and patients in the oncology outpatient clinic who were not currently receiving sports oncology care (non-ExOnc) were recruited. Data were collected via questionnaires and clinical records. Multivariable logistic regression was used to identify factors associated with regular physical activity (≥1×/week) and program participation, applying a hierarchical model including functional, medical, psychosocial, and structural variables.
Results
A total of 223 patients were included (106 ExOnc, mean age 64±11 years, 69.8% female; 117 non-ExOnc, mean age 62±11 years, 37.1% female). In the non-ExOnc group, more patients were currently undergoing cancer treatment (93.2% vs. 63.4%), and the treatment approach was more often palliative (76.9% vs. 43.4%). Functional impairment and reduced psychological well-being were significantly associated with less physical activity (OR ≈ 0.39 and OR ≈ 0.42, respectively). Differences in awareness and access to exercise programs were observed between groups, particularly among the non-ExOnc patients. Physician´s recommendation and prior information about exercise programs were the strongest predictors of participation in structured exercise oncology services.
Conclusion
Systematic patient education and the clinicians´ engagement are critical to promote physical activity in cancer care. Early identification of functional and psychosocial limitations may support tailored interventions. Our findings highlight the need for structured information strategies and integrated exercise support within clinical routine, especially in patients with advanced cancer and during ongoing anticancer therapy.

Speaker: Cécile Weiß

85 Baseline Physical Activity in the Canada-wide EXercise for Cancer to Enhance Living Well (EXCEL) study: Understanding Rural/Urban Differences

Introduction: Rural–urban differences in physical activity (PA) among individuals living with and beyond cancer (ILWC) are poorly understood. Using baseline data from the Canada-wide EXercise for Cancer to Enhance Living Well (EXCEL) study, we compared PA levels between rural and urban participants and with national benchmarks.

Methods: Baseline data from 1,485 participants (73% rural, 27% urban) were analyzed. Self-reported PA (m-GLTEQ) was quantified via MET-hours/week (mild, moderate, strenuous, and summed for total) and compared to national guidelines (8.3-16.6 MET-hours/week, approximately 150-300 min moderate PA). Rural-urban classifications were defined by postal codes linked to population sizes <>100,000, respectively. Rural–urban differences were assessed using nonparametric group comparisons of self-reported MET-hours/week after exclusion of extreme high values using an IQR-based approach. National adherence metrics were from the accelerometry-measured 2025 Canadian Health Measures Survey (StatsCan).

Results: ILWBC in EXCEL exhibited high baseline PA, with rural participants reporting significantly higher moderate-intensity PA (median 10.0 vs 8.3 MET-hours/week, p = 0.01) and higher total weekly MET-hours (median 36.0 rural vs 35.8 urban, p = 0.02). Both rural (88.4%) and urban participants (80.3%) reported levels greater than the WHO-recommended 16.6 MET-hour/week needed for added health benefits (p = 0.02). PA levels for the recommended ≥ 8.3 MET-hours/week threshold were also high (>98%) in both groups compared to national norms (46.2%). Strenuous and mild PA did not significantly differ between groups.

Conclusions: PA levels in the EXCEL baseline cohort exceeded those of the general population, possibly reflecting selection bias common in exercise oncology research. While 46% of Canadian adults meet accelerometry-based national PA guidelines (≥8.3 MET-hours/week), the EXCEL study's self-reported 98% adherence may reflect overestimation, warranting cautious interpretation. Observed rural–urban differences in PA levels have implications for our future work, including interpreting EXCEL effectiveness and designing sustainable programs that reach less active individuals.

Speaker: S. Nicole Culos-Reed (University of Calgary)

86 Demographic, lifestyle, and clinical factors associated with accelerometer-based physical activity in patients with head and neck cancer: a prospective cohort study

Abstract
Background
Patients with head and neck cancer (HNC) typically show low levels of physical activity (PA) due to disease- and treatment-related effects.
Objective
To objectively assess changes in PA and moderate-to-vigorous physical activity (MVPA) from HNC diagnosis up to two years post-treatment, and to identify demographic, lifestyle, and clinical factors associated with PA and MVPA levels and their trajectories.
Methods
This study used data from the prospective NET-QUBIC cohort. PA was measured using a waist-worn accelerometer (ActiGraph-wGT3X) before treatment and at 6-, 12-, and 24-months post-treatment. Linear mixed models were used to examine changes in PA (counts/minute) and MVPA (minutes/day) over time, and to assess associated patient characteristics.
Results
Of the 737 included patients, 517 completed at least one PA measurement. Multivariable analyses showed no independent overall time effect. However, alcohol use and sex showed time-dependent associations with PA and MVPA. Alcohol users were more active at baseline, but their activity declined to levels comparable to non-users at later time points. Females had higher levels of PA at baseline, but males consistently had higher levels of PA and MVPA after treatment. Comorbidities, smoking, and older age were significantly associated with lower PA and MVPA. A WHO performance score of one or two was associated with lower PA.
Conclusion
PA and MVPA did not significantly change over time, but trajectories differed by alcohol use and sex. Smoking, comorbidities, older age, and a WHO performance score of one or two were consistently associated with lower activity levels. Our findings suggest that patients with HNC engage in less PA and MVPA compared to other populations with cancer.
Clinical impact
These findings highlight the urgent need for early and sustained rehabilitation programs and may inform risk profiles which could help clinicians determine the focus and intensity of these programs.

Speaker: Dr Caroline Speksnijder (UMC Utrecht)

87 Dose-response association of accelerometry-measured physical activity and sedentary time with non-communicable diseases: a systematic review and meta-analysis

Background: Non-communicable diseases (NCDs) are leading causes of global mortality, with physical inactivity being a key modifiable risk factor. While previous studies relied on self-reported activity measures, meta-analyses incorporating objective accelerometer measurements remain limited. This study investigated dose-response associations between accelerometer-measured movement behaviors and NCD outcomes.
Methods: This systematic review and meta-analysis analyzed 28 prospective studies (17 unique cohorts) that used accelerometers to measure physical activity (PA) and sedentary behavior (SB). We examined associations with mortality (all-cause, cardiovascular disease (CVD), and cancer) and incident disease (CVD, cancer, and diabetes). Dose-response relationships were assessed using restricted cubic splines.
Results: For SB, risks substantially increased beyond 7-8 hours/day, with each additional hour associated with increased mortality risks (all-cause: HR: 1.04, 95% CI: 1.02-1.06, CVD: HR: 1.09, 95% CI: 0.95-1.25). Light physical activity (LPA) demonstrated inverse association, with each additional hour reducing all-cause mortality (HR: 0.93, 95% CI: 0.89-0.97) and cancer mortality (HR: 0.86, 95% CI: 0.77-0.95). For CVD mortality, LPA showed optimal benefits at 2.2 hours/day (40% risk reduction). Moderate-to-vigorous physical activity (MVPA) showed the strongest protective associations for mortality and demonstrated early benefits for disease incidence, with significant risk reductions within the first hour/day for CVD and first 20 minutes/day for diabetes.
Conclusions: SB exceeding 7-8 hours/day increased mortality and disease risks, while even modest increases in LPA or MVPA conferred meaningful health benefits. These findings support public health recommendations emphasizing reduced SB and increased PA across all intensity levels.

Speaker: Dong Hoon Lee (Department of Sport Industry Studies, Yonsei University, Seoul, Republic of Korea)

88 Early Intervention Exercise and Nutritional Education Shows Promising Results in Cancer Survivorship in the Life Insurance Industry.

Abstract:

Best practice guidelines recommend that people living with cancer be referred for exercise and nutritional support early in their diagnosis. Yet only 15% access structured exercise programs, and within the Life Insurance industry the average delay is 15 months. To address this gap, we partnered with two leading Australian Life Insurers to deliver a collaborative cancer care program, providing earlier intervention and improved outcomes for those undergoing active treatment.
Method: Customers were screened within 0–60 days of claim lodgement to enable rapid access. Approval was sought from each participant’s GP or Oncologist, with exclusion criteria applied and consents obtained. The program comprised of six supervised exercise sessions and three telehealth nutrition consultations over 12 weeks. Participants also received individualised Survivorship Care Plans and tailored educational resources. Outcomes were measured using FACT COG, Fatigue Severity Scale, Distress Thermometer, and SF 36.
Results: Twenty nine customers commenced the program, with a 79% completion rate. At baseline, 91% demonstrated no capacity for work, reduced to 41% at completion. Overall capacity increased from 9% to 59%, with weekly work hours rising from 1.2 to 9.5. Participants reported a 10% improvement in cognitive functioning (FACT COG), distress scores decreased from 4.1/10 to 2.5/10, and fatigue severity reduced by 8 points. SF 36 outcomes showed gains in physical functioning (54% → 76%), social functioning (58% → 77%), general health (43% → 55%), and emotional health (63% → 83%).
Discussion: These findings highlight the impact of early, multidisciplinary intervention combining exercise and nutrition. The program enhanced recovery, functional capacity, and readiness for return to work, underscoring the vital role of integrated survivorship care in cancer treatment pathways.

Speaker: Ms Megan Scott (Guardian Exercise Rehabilitation, ESSAM)

89 Effects of exercise on psychological caseness and psychosocial predictors of responses in people with cancer

Background: Exercise is a potent non-pharmacological treatment to reduce anxiety, depression, and overall psychological distress. However, evidence in oncology remains less clear, with inconsistent findings across cancer types, treatment status, and psychological disorders, partly attributable to a floor effect.
Purpose: To investigate the effects of exercise on anxiety, depression, and overall psychological distress in people with clinically relevant distress (“cases”) and to identify psychosocial predictors of responses.
Methods: The analysis included participants in a community exercise oncology program (Life Now Exercise) across Western Australia, who met the criteria for psychological caseness, defined as a Global Severity Index ≥48 on the Brief Symptom Inventory-18. Individually tailored resistance, aerobic, and flexibility exercises were delivered twice weekly in a group format for 3 months, supervised by accredited exercise physiologists. All participants were followed up for 6 months, with continuation of the program optional during this period. Anxiety, depression, and overall psychological distress were assessed at baseline, post-program, and 6 months post-program using the Brief Symptom Inventory-18.
Results: A total of 397 cases were included, of which 61% were aged under 65 years, 42% had breast cancer, 87% had non-metastatic disease, and 66% were undergoing cancer treatment. Adjusted mixed-model analyses demonstrated improvements at post-program in anxiety (-3.1 [95% CI, -4.1 to -2.1]), depression (-2.9 [95% CI, -3.9 to -1.9]), and overall psychological distress (-3.6 [95% CI, -4.4 to -2.7]). The improvements were preserved at 6 months post-program. Further, the effects did not differ by treatment status or staging. Marital status (partnered vs. non-partnered: -2.5 [95% CI, -4.85 to -0.15]) and baseline core self-evaluation score (P ≤0.05) predicted the program effects on anxiety.
Conclusion: Exercise is effective in reducing psychological burden in patients with psychological caseness. Partnered patients and those with lower baseline core self-evaluations tend to have a greater magnitude of improvement.

Speaker: Dr Hao Luo (Edith Cowan University)

90 Exercise Activity Patterns Among Patients with Breast Cancer During and After Chemotherapy: A URCC NCORP Nationwide Prospective Longitudinal Cohort Study

Introduction: Exercise improves both quality and quantity of life for patients with cancer. We previously reported overall physical activity (PA) patterns in a cohort of patients with breast cancer, yet limited data exists on how patients’ structure exercise behavior from pre- to post-chemotherapy.

Methods: 580 female patients with stage I-IIIC breast cancer were recruited from community oncology clinics across the USA, affiliated with the URCC NCI Community Oncology Research Program (NCORP) Research Base. Participants reported their PA (Aerobic Center Longitudinal Survey), including structured exercise (e.g., weightlifting, treadmill use, aerobic dance/calisthenics, jogging, bicycling, swimming, and moderate- to vigorous-intensity sports) over the past three months at pre-chemotherapy, post-chemotherapy (reflecting the final three months during chemotherapy), and six months post-chemotherapy.

Results: Participants (mean age = 53.4 years; 76% stage I/II) reported walking, a non-structured exercise, as the most common exercise activity. Average walking time was 81.8 ± 111.0 minutes/week pre-chemotherapy, declined to 59.9 ± 93.3 during chemotherapy, and rose to 80.8 ± 111.0 post-chemotherapy. The proportion reporting any walking participation dropped during chemotherapy (57% to 48%) and increased to 60% post-chemotherapy. Structured exercise showed a similar pattern, decreasing from 68.0 ± 141.8 to 45.1 ± 99.7 minutes/week during chemotherapy, rising to 84.8 ± 144.6 afterward; participation shifted from 65% to 56% and then to 73%. The most frequently reported structured activities were weightlifting (11% pre-chemotherapy, 7% during chemotherapy, 16% post-chemotherapy), treadmill use (11%, 9%, 14%), and aerobic dance/calisthenics (12%, 7%, 14%). Vigorous-intensity sports were rare (<1% at all time points).

Conclusion: Patients engaged in some exercise, mainly walking, during and after chemotherapy. However exercise levels, particularly in resistance training, fell far short of evidence-based recommendations for reducing side effects and toxicities. These findings underscore the need to identify effective strategies for referring patients with trained exercise-oncology professionals who can deliver evidence-based exercise prescriptions.

Speaker: Lindsey Mattick (James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States of America; Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America.)

91 Exercise preferences and barriers in cancer survivors: A cross-sectional study

INTRODUCTION: Limited number of cancer survivors meet the recommended physical activity guidelines, regardless of the clear benefits, due to mental and physical constraints of a cancer diagnosis and treatment. Further, research is required to better understand the preferences and perceived barriers of cancer survivors and how different factors influence their participation in exercise prorgammes.
METHODS: This cross-sectional survey used an anonymous online questionnaire (Qualtrics) consisting of 35 questions concerning 5 domains on: participants background, physical activity levels, exercise preferences, cancer site and treatments and exercise barriers. Participants were recruited through charitable and exercise organizations in the UK. Data analysed using SPSS 29.0 (IBM SPSS).
RESULTS: Sixty-four cancer survivors (56 females; 8 males) participated in the study, most patients affected by colorectal (n=40, 62.5%) and breast (n=13, 20.3%) cancers, while 28% were on active treatment. Participation in activities with strenuous, moderate and mild intensities all reported reduced after a cancer diagnosis. Low confidence was the most frequent exercise barrier reported (32.8%), followed by time constrains (31.3%), low motivation (29.7%), lack of knowledge (23.4%), while access to facilities (6.3%) was the least reported factor. Most patients (57.8%) were willing to partake in an exercise programme that involved supervision (45.3%), in group (30.8%) or at home (30.8%), three sessions/week (35.9%) and at moderate intensities (67.2%). The preferred mode of exercise instruction was face-to-face (50%).
CONCLUSION: Factors such as low confidence and lack of cancer specific exercise education may have a negative influence on cancer survivors’ exercise participation and adherence. Decreased physical activity post diagnosis may have significant impact on quality of life and cancer recurrence. Further research is required to better understand cancer survivors’ physical activity preferences/constrains to better inform contemporary multimodal and individualized interventions.

Speaker: Dr Konstantinos Kaliarntas (1. School of Health Rehabilitation Sciences, University of Patras, Greece; 2. School of Applied Sciences, Edinburgh Napier University, UK)

92 Exploring the Sense of Coherence (SOC) Across Treatment Stages in Breast Cancer Survivors: A Qualitative Study

Background: Breast cancer is the most common malignancy among women worldwide, and the number of survivors continues to increase as five-year relative survival rates improve (93.6% in Korea). Beyond medical survival, contemporary cancer care emphasizes supporting patients in recognizing and mobilizing health-promoting resources throughout the entire treatment trajectory and into survivorship. Within this resource-oriented approach, Sense of Coherence (SOC) is conceptualized as a core concept of salutogenesis, referring to a key psychological resource that enables individuals to understand life challenges and stress experiences, perceive them as manageable, and construct meaning through those experiences. Although SOC is recognized as an important predictor of treatment-related behaviors and long-term quality of life, existing breast cancer research has largely relied on cross-sectional designs using global SOC scores, thereby limiting qualitative understanding of stage-specific changes in SOC components and patients’ lived experiences.
Purpose: Guided by Antonovsky’s Salutogenic Model, this study aims to explore how women newly diagnosed with breast cancer experience changes in the three components of the SOC—comprehensibility, manageability, and meaningfulness—across key treatment stages.
Methods: This qualitative longitudinal study will involve four repeat interviews with the same participants at distinct treatment stages: within one week of diagnosis, immediately before surgery, within four weeks after surgery, and three months post-surgery. Grounded in descriptive phenomenology, in-depth interviews will explore participants’ lived experiences. Data will be analyzed using reflexive thematic analysis, supplemented by matrix-based longitudinal comparison. Within- and cross-case analyses will trace temporal shifts in meaning and SOC. Analytical rigor will be ensured through an audit trail and reflexive memoing.
Expected Implications: This qualitative longitudinal study delineates stage-specific changes in SOC across early breast cancer treatment and survivorship, thereby deepening understanding of patients’ meaning-making processes over time. The findings may inform the design of tailored supportive care, rehabilitation, and exercise-based survivorship interventions aligned with stage-specific psychosocial resources.

Speaker: Kim Minji (Department of Sport Industry Studies, Yonsei University, Seoul, Republic of Korea)

93 Integrating Attitudes, Capability, Self-Regulation, and Habit to Identify Behavioral Profiles in Prostate Cancer Survivors: A Latent Profile Analysis

Background: Prostate cancer survivors (PCS) often experience challenges engaging in physical activity (PA) and reducing sedentary time (SED) after treatment. The Multi-Process Action Control framework (M-PAC) posits that attitudes, self-regulation, and habit predict behavior. This study identified M-PAC-based profiles and examined how they relate to SED and quality of life (QoL).
Methods: A cross-sectional analysis was conducted using baseline data from a randomized controlled trial of sedentary PCS. Eligible participants were aged ≥18 years and reported ≥8 h/day of SED. Six M-PAC indicators (affective attitudes, instrumental attitudes, perceived capability, perceived opportunity, behavioral regulation, and habit) were assessed using self-report. SED (Longitudinal Aging Study Amsterdam SED Questionnaire), PA (Godin Leisure-Time Exercise Questionnaire), QoL (FACT-G), Health & Disability (WHO Disability Assessment Schedule) and Fitbit-derived daily steps were also collected. Latent profile analysis identified psychosocial classes, followed by multinomial regression.
Results: Participants (N=115, Mage=69.4±9.9 years) had localized disease (80.9%) and treated with surgery (65.2%), radiation (40.9%), and/or androgen deprivation therapy (ADT) (29.6%). A 3-class model showed optimal interpretability. Class 1 (37.96%) demonstrated strong attitudes but weak regulation and habit. Class 2 (19.22%) showed low attitudes, capability opportunity, with modest regulation. Class 3 (42.81%) reflected highest capability, regulation, and habit. Class 3 also reported the highest PA, QoL, and lowest disability scores while Class 2 had the highest SED and lowest QoL. Compared with Class 3, PCS with higher PA were less likely in Class 1 (RRR = 0.97, CI: 0.95–0.99, p = .036), higher QoL was associated with lower odds of Class 2 (RRR = 0.94, CI: 0.90–0.98, p = .003), and ADT exposure observed in Class 1 (p = .08).
Conclusion: Distinct psychosocial profiles exist and show meaningful behavioral and QoL differences. Supportive care interventions that enhance capability, self-regulation, and habit may help PCS adopt and sustain healthier movement patterns.

Speaker: Hui Xiao (University of Toronto)

94 Mental Health Constructs and Tools in Exercise Oncology: A Systematic Review and Meta-Analysis

Purpose
Psychological constructs have been shown to independently effect health outcomes and overall quality of life in the psycho-oncology literature. Whilst exercise can positively influence psychological constructs, studies in oncology populations often limit their measurement to negative psychological constructs (e.g. depression), with limited evidence exploring positive psychological constructs (e.g. optimism). This systematic review aims to evaluate which psychological constructs have been utilised, and which have been found to effectively respond to exercise, within the exercise oncology literature.

Methods
A systematic search of PubMed, EMBASE, CINAHL, and Cochrane was performed following the PRISMA guidelines for all publications up until February 2024. Randomised controlled trials (RCTs) that analysed the effects of exercise on any psychological constructs in any oncological population and only full-text articles published in English in peer-reviewed journals were included. All results were exported to Covidence and screened by two independent reviewers. Study quality was assessed using the Delphi list tool.

Results
A total of 6166 articles were retrieved, with 186 RCTs subsequently included in the review. The vast majority of studies included measurements of negative psychological constructs, predominantly anxiety and depression. A paucity of studies assessed positive psychological constructs such as motivation, hope and self-efficacy.

Conclusions
The current exercise oncology literature places an overemphasis on the influence of exercise on negative psychological constructs compared to positive psychological constructs. Future research should include measures of positive psychological constructs to confirm whether exercise can influence these findings.

Speaker: Prof. Tina Skinner (University of New South Wales, The University of Queensland, University of Technology Sydney, University of the Sunshine Coast)

95 Perceptions of Patients on Lifestyle Habits and Quality of Life During Cancer Treatment

Background:
Lifestyle habits, including physical activity, nutrition, and emotional health, play a crucial role for individuals undergoing cancer treatment. Understanding how patients perceive these habits during their oncologic journey can help guide more effective and patient-centered supportive care strategies.
Methods:
This cross-sectional observational study analyzed responses from an online questionnaire completed by patients undergoing or having completed cancer treatment. The survey included questions on demographics, cancer history, treatment modalities, lifestyle behaviors, physical activity frequency, and perceptions of the importance of discussing lifestyle habits in oncology care. Descriptive statistics were used to summarize the data.
Results:
A total of 433 participants responded to the survey. Most respondents were female and between 40–65 years of age. Physical activity levels varied: many reported engaging in exercise 1–2 times per week or 3–5 times per week, while a significant subgroup reported no regular exercise. Despite this variability, the vast majority of patients rated discussions about physical activity as “very important” or “important” during oncology care. Barriers commonly included were fatigue, pain, and emotional distress. Patients who maintained some level of physical activity reported improved well-being, sense of control, and perceived quality of life. Similar patterns were observed regarding the perceived importance of discussing nutrition and weight management during treatment.
Conclusions:
Patients highly value the integration of lifestyle counseling—particularly regarding physical activity—into their oncologic care. Many of them faced challenges in maintaining healthy habits due to treatment-related symptoms, suggesting a need for structured, individualized exercise and lifestyle-support programs. Enhancing professional guidance in these areas may positively impact quality of life throughout the cancer continuum.

Speaker: Karen Wonders (Maple Tree Cancer Alliance)

96 Perspectives and needs of cancer survivors and stakeholders on the development of a combined lifestyle intervention for cancer survivors: a qualitative study

Purpose: To explore the perspectives and needs of cancer survivors and stakeholders on the development of a Combined Lifestyle Intervention (CLI) for cancer survivors, e.g., goals, target population, form, and content. In a CLI, various lifestyle components are included, such as physical activity, nutrition, energy balance, and sleep.
Methods: This qualitative study comprised ten focus groups, including four with cancer survivors (n=16. persons) and six with stakeholders working in oncology (after) care, e.g., founders of lifestyle interventions/organizations, dietitians, physical therapists, lifestyle coaches, oncologists, and oncology nurses (n=31). Reflexive thematic analysis was performed on the transcripts of the focus groups. This study was part of GLINK research project, which has the aim of developing and evaluating a combined lifestyle intervention for cancer survivors.
Results: Five overarching themes were generated: 1. All cancer survivors should be offered lifestyle support, 2. Personalization is essential due to various needs, 3. Communication and collaboration in cancer care needs to improve, 4. Lifestyle support should be offered as soon as possible and ideally never stop, and 5. Lifestyle support for cancer survivors should be organized nationally.
Conclusion: These findings highlight key considerations for the development of a CLI for cancer survivors; balancing accessibility with personalized support, all within the constraints of the current healthcare system and financial sustainability. These insights guided the design of a CLI for cancer survivors, which effectiveness is currently under evaluation in the GLINK trial.

Speaker: Nadine Florisson

97 Physical activity before and after radiotherapy. Reports from older patients with cancer

Introduction: Applying targeted measures to maintain physical activity and thereby function in older patients with cancer requires knowledge about activity level and influencing factors.
Study aim: To describe patient-reported physical activity in older patients with cancer before and after radiotherapy (RT) and explore potential associated factors.
Methods: A cluster-randomised pilot study (Clinicaltrials.gov ID NCT03881137) tested effectiveness of geriatric assessment with management versus conventional care in patients ˃65 years, receiving palliative or curative RT. Since no impact on physical function or quality of life was found, the two arms were analysed jointly. Physical activity, defined as last month’s weekly frequency of light (not sweaty/out-of-breath) and heavy (sweaty/out-of-breath) activity, as in a Norwegian population survey, was reported at start and 8, 16 and 52 weeks after RT.
Results: Overall, 178 patients participated, mean age 74.1 years, 38.2% women, and 30.9% received palliative RT. Compliance in activity reports dropped from 97.8% to 69.1% (light) and 64.0% (heavy) at week 52. At baseline, nine patients reported no physical activity, 165 (93%) and 86 (48.3%) patients reported light and heavy activity of any duration, respectively, and 27 (15.2%) reported >2 hours of heavy activity. Among respondents at week 8, 16 and 52, the proportions reporting light and heavy activity remained stable, except for decrease in light activity for >2 hours per week from 57.5% [baseline] to 42.3% [52 weeks] and a slight increase in heavy activity for >2 hours from baseline to 24.2, 23.7 and 21.1% at subsequent assessments. Curative RT was associated with higher activity than palliative RT.
Conclusion: About half of patients reported activity consistent with physical exercise (heavy activity), and this proportion was maintained after RT. To further explore trajectories of activity and influencing factors (age, gender, cancer type, treatment intent, frailty status) regression models will be estimated.
NO COI TO DECLARE

Speaker: Dr Marit Slaaen (The Research Centre for Age-Related Functional Decline and Disease (AFS), Innlandet Hospital Trust, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo)

98 The effectiveness of theory-based, multiple movement behaviour interventions in adults living with and beyond cancer: a systematic review

Background: Adults living with and beyond cancer (LWBC) commonly engage in low physical activity (PA), high sedentary behaviour (SED), and insufficient sleep, contributing to increased symptom burden. Although these movement behaviours interact within the 24-hour continuum, most survivorship interventions target them individually. The effectiveness of theory-based interventions designed to modify multiple movement behaviours remains unclear. Therefore, this review evaluates the effectiveness of such interventions on multiple movement behaviours, health-related outcomes, and adherence. As this is an ongoing review, preliminary results are presented below.
Methods: This registered review follows PRISMA-P guidelines. Comprehensive searches will be conducted in CENTRAL, CINAHL, Embase, MEDLINE, PsycINFO, and Scopus. Eligible studies include randomized controlled trials, quasi-experimental designs, pilot/feasibility studies, and pre-post interventions involving adults LWBC of any type or treatment phase. Interventions must target at least two movement behaviours and explicitly incorporate a behavioural theory or framework. Outcomes include changes in movement behaviours, health outcomes, and intervention adherence. Two reviewers will independently screen records, extract data using a piloted form, and assess risk of bias using RoB-2 or ROBINS-I, with additional evaluation of selective reporting and publication bias (Egger’s test, contour-enhanced funnel plots). Narrative synthesis guided by Popay et al.’s (2006) framework will examine patterns in intervention components and outcomes.
Results: Preliminary screening between November-December 2025 identified 1,004 records from Embase, 455 from MEDLINE, and 320 from PsycINFO. Among eligible trials, interventions targeting PA and SED were most common. Considerable heterogeneity was observed in theoretical foundations, intervention modalities, and measured outcomes. The full synthesis will provide a clearer understanding of current evidence and remaining gaps.
Conclusion/Anticipated Implications: This review will provide the first synthesis of theory-based, multiple movement behaviour interventions in adults LWBC. Findings will inform the development of integrated, theory-driven survivorship intervention strategies that reflect the interconnected nature of movement behaviours.

No conflicts of interest.

Speaker: Mr Jian Kun Zhan (Faculty of Kinesiology and Physical Education, University of Toronto)

99 The feasibility of a multi-phasic, exercise-based intervention utilising behavioural change, dyadic coping and wearable technology in women before and after surgery for early-to-locally advanced breast cancer

Background: Women undergoing breast cancer surgery often experience declines in physical function and quality of life. Preoperative exercise may mitigate these effects, but implementation is complicated by the short time frames between diagnosis and surgery. The feasibility of a remotely supervised, multi-phasic program in this context is uncertain.

Methods: We conducted a feasibility study of a remotely supervised, multi-modal exercise intervention incorporating behavioural change, dyadic coping, and wearable technology. Thirty-four women with early-to-locally advanced breast cancer scheduled for surgery participated in supervised and unsupervised sessions before and after surgery. The primary objective was feasibility and safety with secondary, exploratory outcomes in physical function and quality of life.

Results: Recruitment targets were achieved after a modest, 12-week, extension. Retention and adherence exceeded predefined thresholds: 85% of participants completed post-intervention assessments, 76% completed three-month follow-up, and adherence to supervised sessions was 86% preoperatively and 88% postoperatively. The intervention was well tolerated, with 59% of participants reporting no adverse events; most reported events were mild, transient, and consistent with postoperative recovery and exercise. Exploratory analyses demonstrated clinically meaningful improvements from baseline to post-intervention in six-minute walk distance (+48 m), estimated VO₂max (+3 ml·kg⁻¹·min⁻¹), and sit-to-stand (+2 repetitions), with gains maintained at three-month follow-up. Shoulder RoM in the surgical arm improved post intervention by +31° from its postoperative nadir, and by a further +50° at three-month follow-up. Patient-reported outcomes recovered post-intervention in physical (+14 points), role (+33 points), and social functioning (+26 points), with reductions in pain (−16.7 points) and fatigue (−6.3 points). Emotional and cognitive functioning also improved, while body image and sexual wellbeing remained impaired.

Conclusions: A multi-phase exercise program is broadly feasible and safe for women undergoing breast cancer surgery, and its high retention and adherence, along with encouraging functional and psychosocial trends, support progression to a larger multicenter trial.

Speakers: Mr Edward Stanhope (University of Wolverhampton), Dr Ian Lahart (University of Wolverhampton)

100 “I know it will make me feel better”: A qualitative study on physical activity in people with melanoma receiving immunotherapy

Purpose: The benefits of physical activity for patients undergoing cancer treatment are well established. However, experiences of physical activity and desired supports among those with melanoma receiving immunotherapy are not well understood. This study explored: a) the types and levels of physical activity engaged in during immunotherapy; b) the factors influencing physical activity behaviour; and, c) preferences and desires for physical activity support.

Methods: Participants were recruited from a 12-month longitudinal study capturing physical activity and patient-reported outcomes during immunotherapy. Following four planned immunotherapy cycles, patients receiving immunotherapy as either an adjuvant therapy or in the treatment of unresectable tumours or metastatic melanoma participated in a semi-structured interview exploring physical activity guidance, behaviours, perceptions, and desired supports. Interviews were transcribed and analysed thematically. The derived themes were mapped to the COM-B model (Capability, Opportunity, Motivation – Behaviour).

Results: Fifteen participants were interviewed (median age 61-years, 60% male). Four major themes were identified: physical activity knowledge, physical activity guidance and support, physical activity trajectory across treatment, and physical activity drivers and discouragers. Engagement in physical activity and changes made due to immunotherapy were varied among participants. Whilst most remained active throughout immunotherapy, participation was often hindered by limitations in knowledge and opportunities for support with physical activity.

Conclusions: Interventions focused on enhanced education, integrated support pathways, and behaviourally informed strategies may effectively promote physical activity engagement.

Implications for Cancer Survivors: Due to the complexities of both treatment and behaviour change, patients receiving immunotherapy for melanoma may benefit from individualised physical activity guidance.

Speakers: Kate Edwards (Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia. Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia), Sarah Marvin (Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia. Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia.)

Thematic Poster Session 1: Implementation (Hall 2)

Chairs: Paolo Bergerot & Sabine Kesting

101 Evaluating Re-Triage Patterns in an Exercise Oncology Triage and Referral System

Exercise is a well-established supportive care intervention that reduces treatment-related side effects and improves quality of life, yet many individuals’ receiving chemotherapy do not achieve sufficient activity levels. Despite endorsement by numerous medical and health organizations, only about 15% of patients report receiving an oncologist referral to exercise services, largely due to limited time and uncertainty in assessing suitability. The Moving Through Cancer program at UPMC Hillman Cancer Center uses a validated adapted version of the EXCEEDS triage tool to guide referrals; however, there may be value in additional components to strengthen implementation.
Purpose: To identify and examine factors that influence re-triage decisions during implementation to inform adaptations that strengthen the triage and referral system.
Methods: During infusion visits, medical assistants administer the adapted EXCEEDS triage questions embedded in the electronic medical record, generating an initial triage to community-based exercise oncology resources (COM), personalized home-based exercise prescription (HEP), or physical therapy (PT). Exercise professionals review triage results and assess patients for behavioral and safety factors to provide the final referral. Data collected during 2025 was extracted to quantify initial triage categories, re-triage frequencies, and final referrals. Descriptive statistics summarized patient characteristics, triage outcomes, re-triage patterns, and referral distributions.
Results: A total of 600 patients were triaged: COM (52%), HEP (40%), and PT (9%). Overall, 35% were re-triaged and assigned a different referral category. The most common reasons for re-triage were exercise safety concerns (21%), patients already engaging in regular physical activity (17%), and adjusting for readiness/motivation to exercise (15%). Final referral distributions were COM (12%), HEP (75%), and PT (13%).
Conclusion: Shifts between initial and final referrals show that there is value to adding components to EXCEEDS. The largest re-triage shift occurred from COM to HEP referrals. Incorporating safety and behavioral factors into the triage process may improve referral accuracy.

Speaker: Erica Schleicher (University of Pittsburgh)

Schleicher_Thematic_ISEO.pptx

102 Predictors of attendance to a referral-based exercise oncology program at a comprehensive cancer center

PURPOSE: Even when exercise oncology programs are integrated into clinical care, impact is limited when referrals do not translate into attendance. We sought to identify predictors of attendance to a referral-based exercise oncology program to develop targeted interventions for improving engagement.

METHODS: Patients referred to a clinical exercise oncology program (2023-2025) were retrospectively reviewed via clinical documentation, program database, and patient-reported outcomes (PROs). Upon referral, an exercise physiologist contacted patients to discuss the program and schedule a consultation. Attenders (≥1 visit) were compared to nonattenders using chi-square or t-tests, examining demographics, disease characteristics, ECOG performance status, baseline exercise habits, and PROMIS-29 v2.1.

RESULTS: Of 809 referred patients, 351 (43.4%) attended and 458 (56.6%) did not. The primary barrier was inability to contact patients despite multiple attempts. Attenders were more likely to have been self-referred or referred by a physician than a nurse, have better ECOG PS (p=0.0008) and to be Black (17.4% vs. 12.9%, p=0.04), likely reflecting the program’s community partnerships. Among the subset completing baseline PROs (n=234 attenders, n=154 nonattenders), attenders reported significantly lower symptom burden across PROMIS domains: higher physical function (45.3 vs 43.3, p=0.034), lower depression (49.6 vs 51.9, p=0.009), lower fatigue (55.0 vs 57.1, p=0.029), better social participation (48.5 vs 46.1, p=0.013), and less pain interference (53.6 vs 55.6, p=0.049). No significant differences were observed in age, BMI, gender, marital status, insurance type, treatment stage, or baseline physical activity levels.

CONCLUSIONS: Nonattenders demonstrated greater symptom burden and worse functional status, suggesting these as barriers to engagement rather than disease phase or baseline MVPA. The primary obstacle was inability to establish contact, highlighting the need for enhanced outreach strategies. Based on these findings, the program is implementing center-wide electronic PROs with proactive outreach by supportive care navigators to high symptom burden patients, targeting those most in need.

Speaker: Danielle Halsey (Indiana University School of Medicine)

ISEO Slides DH.pptx

103 Assessing the Reach of Exercise Therapy Care Pathways in German Comprehensive Cancer Centers

Background: The MOVE-ONKO Project aims to design and evaluate a comprehensive care pathway for cancer patients in need of exercise therapy. The goal is to develop, implement, and sustain a structured care pathway to gain cancer patient access into exercise therapy options.
Methods: This two-phase exploratory study used a mixed-methods design. Evaluation of the comprehensive exercise therapy care pathways was guided by the Consolidated Framework for Implementation Research and the RE-AIM framework. Reach was defined as the number of patients accessing cancer centres, enrolling in the exercise therapy pathway, and receiving referrals to exercise programmes. Semi-structured interviews with healthcare professionals contextualised care settings, while surveys of key informants collected organisational data on patient flow relevant to the reach dimension.
Results: In 2022, the average patient flow was 5,315 (± 2,721.9) cancer patients receiving medical care. Of these, 118.4 (± 91.8) received exercise counselling, and 88.3 (± 79.5) were referred to oncology exercise interventions. In 2023, the average patient flow increased to 6,836.4 (± 2,971.0) patients, with 168.3 (± 136.6) receiving exercise counselling and 111.4 (± 76.2) referred to exercise interventions. Breast cancer was the most common diagnosis in both years. In 2024, MOVE-ONKO was implemented. At baseline, 353 patients were enrolled, of whom 36.3% had breast cancer and 8.1% lung cancer; other diagnoses each accounted for less than 5%. Overall, an increase in average patient flow was observed over the two years. Qualitative findings indicate that younger and female patients show greater openness towards supportive care and well-being and are therefore more likely to seek exercise counselling independently.
Conclusion: With considerable individual effort, a small number of motivated patients can currently be reached. Without adequate funding and governmental support, equitable and comprehensive patient access to exercise therapy will remain uncertain. Thus, the uptake of a structured care path is needed.

Speaker: Saskia Blütgen (Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Chair of Medical Sociology, University of Cologne, Cologne, Germany)

MOVE-ONKO_ISEO_Blütgen.pptx

104 SweCanMove – The Swedish Network for Exercise and Cancer

Tagline:
Connecting Research, Practice, and People in Exercise Oncology
Background:
Exercise is increasingly recognised as a powerful intervention in cancer prevention, treatment, and survivorship. In Sweden, SweCanMove has been established as an independent network to connect research, clinical practice, and community engagement, aiming to enhance the integration of exercise across cancer care.
Objectives:
As a national Swedish initiative, SweCanMove aims to coordinate and strengthen research and clinical practice, disseminate evidence-based knowledge, and promote patient engagement in exercise as an integral component of cancer care and rehabilitation.
Approach:
The network is open to all stakeholders and focuses on four strategic areas: (1) building a national network; (2) promoting knowledge across healthcare and society; (3) integrating exercise into clinical cancer care; and (4) fostering collaborative research.
Key activities include national workshops and seminars, digital communication platforms, guideline implementation, and facilitating partnerships among patients and their families, clinicians, and researchers, recognising the vital role of loved ones in supporting cancer rehabilitation.
Anticipated Impact:
Within two years, SweCanMove expects to engage over 50 members across various regions and professions, establish thematic and reference groups, and conduct workshops and seminars for patients and their families. The network will support clinical exercise programmes, foster collaborative research, and strengthen partnerships among patients, families, clinicians, and researchers, thereby enhancing the integration of exercise across cancer care and rehabilitation.
Conclusion:
SweCanMove offers a dynamic, national platform to advance exercise oncology in Sweden, bridging research, practice, patient and family engagement, while aligning with international initiatives such as ISEO.

Speaker: Annika Grynne (Jönköping University, Jönköping, Sweden)

105 Barriers and Facilitators to Implementing Exercise Therapy in Pediatric Oncology in Germany: A Mixed-Methods Study of Patient and Healthcare Professional Perspectives

Introduction: Quality-assured oncological exercise therapy (qOET) is increasingly recognized as a safe and effective supportive intervention to improve physical functioning, reduce treatment-related adverse effects, and enhance quality of life in pediatric cancer patients. However, its integration into routine care remains inconsistent, highlighting the need to identify key barriers and facilitators for implementation.
Methods: As part of the nationwide IMPLEMENT project on the implementation of qOET, funded by the German Cancer Aid, pediatric cancer patients and their legal guardians from 12 German pediatric oncology centers completed baseline online or paper-pencil surveys (n=69; median age 11 [IQR 8-15] years; 46% female). Additionally, semi-structured interviews (n=15) were conducted to capture experiences with qOET as well as perceived motivators and barriers to physical activity. Follow-up surveys and interviews are currently ongoing.
In parallel, healthcare professionals from 15 participating centers completed baseline online questionnaires (n=52; median age 34 [IQR 29-44] years; 75% female) and semi-structured interviews (n=15). The interview guide was developed drawing on the updated Consolidated Framework for Implementation Research (CFIR), and was informed by a prior CFIR-based survey among key stakeholders at the participating clinics. A follow-up survey with the same stakeholders is ongoing.
All interview recordings are pseudonymized, externally transcribed, and examined using framework analysis, supported by MAXQDA software. Qualitative findings will be triangulated with quantitative data using an explanatory sequential mixed-methods approach.
Results/Perspective: Data collection is ongoing, with final assessments scheduled for March 2026. The analyses aim to identify key facilitators and context-specific determinants for implementing qOET by comparatively examining perspectives of pediatric cancer patients, their families, and healthcare professionals. The findings are expected to provide practice-oriented insights to support the sustainable integration of qOET into pediatric oncology care and will be incorporated into guidelines and implementation strategies, e.g. through the Network ActiveOncoKids. Final results will be presented at the conference.

Speaker: Rebecca Zimmer (Universitätsklinikum Essen (AöR), Zentrum für Kinder- und Jugendmedizin, Kinderheilkunde III)

Presentation_ISEO2026_RebeccaZimmer.pdf

106 Developing an international consensus to evaluate the practical inclusion of autoregulation in exercise oncology practice

Exercise is essential for managing side effects, maintaining fitness, and improving quality of life across the cancer continuum. However, current guidelines lack practical recommendations for adjusting exercise based on daily fluctuations. Autoregulation—the ability to adjust exercise variables based on individual readiness to train—offers a pragmatic strategy to address daily fluctuations and improve long-term adherence. Though Exercise and Sports Science Australia guidelines mention autoregulation, evidence-based guidance and consensus for its application in exercise oncology practice remains limited.

To obtain consensus on autoregulation definition(s), practical applications, and implementation strategies for exercise oncology prescription.

Exercise professionals with ≥2 years' experience in cancer exercise prescription will be invited to complete three online Delphi rounds (20 minutes per round). Thirty participants completed round one (conducted July 2025). Round 1 comprised open-ended questions exploring current understanding and practice; responses were content-analysed to generate consensus statements. Respondents were predominantly exercise physiologists (n=60%) and physiotherapists (n=13%);73% were clinical practitioners with an average of 8 years’ experience (range 2–20), and most were from Australia (n=57%), followed by USA (23%). Round 2 is in progress, and panellists will rate statements on a 5-point Likert scale. Round 3 will address borderline consensus items and confirm final agreement. A-priori consensus is defined as ≥80% agreement/disagreement among respondents.

Round 1 (n=30) revealed autoregulation is universally applied across all cancer types and exercise modes, with intensity and volume as primary variables modified. Key themes included: clinicians rely on real-time assessment to guide decisions; significant evidence gaps remain despite the widespread use of autoregulation; and clinicians typically develop expertise through experience rather than formal training. Round 2–3 is in progress and will establish consensus on autoregulation definitions, practical application methods, and implementation strategies. The final consensus statements will provide expert recommendations to strengthen future exercise oncology guidelines and support more personalised cancer exercise prescription.

Speaker: Brent Cunningham (University of the Sunshine Coast)

Thematic Poster Session 2: Mechanism (Forum 1)

Chairs: Eva Zopf & Scher Mama

107 Exercise training reshapes the systemic immune environment in patients with metastatic breast cancer: results from the PREFERABLE-EFFECT multi-centre randomised-controlled trial

Background:
The multinational PREFERABLE-EFFECT RCT (NCT04120298) demonstrated beneficial effects of a 9-month supervised exercise program on fatigue and quality of life among patients with metastatic breast cancer (mBC). As a secondary outcome of the study, we investigated the impact of the exercise program (2x/week resistance, aerobic and balance training) on systemic inflammation and lymphocyte subsets, and explored their association with fatigue in patients with mBC.

Methods:
Blood samples were collected at baseline (T0) and at 3 (T1) and 6 months (T2) into the intervention. PBMCs were analysed with multicolour flow cytometry and 92 plasma proteins were measured with the Olink immuno-oncology platform. Between-group differences were identified with linear-mixed-models. Associations of physiological and proteomic markers with clinically relevant baseline fatigue (EORTC QLQ-C30) were explored using Ridge logistic regression.

Results:
Consistent trends toward a higher proportion of CD8+T and CD56dim and a lower proportion of CD4+T cells were found in the exercise group(EX). FlowSOM cluster analyses revealed increases of circulating CCR7+CD45RA+KLRGlowCD8+T, CD56-gammadeltaT cell populations and 3 subsets of CD56dim cells compared to controls. Significantly lower levels of inflammatory mediators, including IL-6(T1:-0.28NPX, p=0.01), CSF-1(T1:-0.06NPX, p=0.008), CCL3(T1:-0.15NPX, p=0.008 ; T2:-0.13NPX, p=0.02) and CD8A(T1:-0.15NPX, p=0.01; T2:-0.13NPX, p=0.03) were measured in EX compared to controls. PTN, associated with worse BC survival was lower (T1: -0.19NPX, p=0.04) and two markers involved in cell death TWEAK(T2:+0.08NPX, p =0.04) and CASP-8(T2:+0.24NPX, p=0.007) were increased in EX. At baseline, the exercise-responsive proteins CSF-1, IL-6, TWEAK and PTN were associated with clinically relevant fatigue.

Conclusion:
Our results demonstrate that the PREFERABLE-EFFECT exercise intervention led to a proportional enrichment of specific immune cell subsets, most of which have a cytotoxic potential, and attenuated chronic inflammation. Multiple exercise responsive proteins were also linked to lower clinically relevant fatigue at baseline, thereby advancing mechanistic understanding of exercise effects in patients with mBC.

Speaker: Elisa Heyrman (Division of Clinical Physiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden & Unit of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden)

2026_ISEO_poster_presentation_EH.pptx

108 Acute HIIT preferentially mobilizes virus-reactive CD8+ T cells and enhances leukocyte migratory capacity

Physical activity induces rapid, selective leukocyte mobilization, thereby modulating immune surveillance. Among the most responsive cell types to high-intensity exercise are NK and CD8+ T cells, key effectors of immune defense against infected and malignant cells. However, comprehensive characterization of acute high-intensity interval training (HIIT)-induced effects on leukocyte populations is limited. We collected peripheral blood from 23 healthy participants undergoing a supervised, group-based HIIT session at baseline, immediately post-exercise (ex02), and 1h post-exercise (ex60). Cell counts were quantified using clinical-grade flow cytometry. CD8+ T cells were analyzed for memory and differentiation status and virus peptide reactivity using DNA-barcoded peptide-MHC multimer staining targeting 250 peptides. Chemokine receptor expression (CX3CR1, CXCR2, CXCR4, CCR2, CCR5) and ligand regulation were evaluated via flow cytometry and Olink proteomics. Associations between individual characteristics – fitness, sex, body composition, and age – and CD8+ T cell mobilization were analyzed. Chemokine receptor expression on CD4⁺, γδ T cells, NK cells, and monocytes was profiled using flow cytometry and FlowSOM clustering. A single HIIT bout induced robust cell type-specific mobilization followed by substantial egress, consistent across fitness levels, body composition and age. NK, γδ and CD8+ T cells were the most HIIT-responsive cell types. Catecholamines NE and EPI peaked post-exercise, and NE was selectively associated with CD8+ T cell mobilization. Memory subsets were reorganized, reducing terminally differentiated and CD57⁺, PD-1⁺, and CD28neg cells at ex60 post exercise. Circulating virus-reactive T cells increased across 12 virus types. HIIT modulated chemokine receptor profiles in a cell type-specific manner – CD56dim CX3CR1⁺ CXCR2⁺ NK cells and two populations of CD8+ T cells with distinct chemokine receptor patterns were preferentially mobilized. Acute HIIT mobilizes functional, virus-reactive CD8+ T cells with features indicative of enhanced migratory and activation potential, supporting translational use from tumor immunology to infectious diseases.The study is registered at clinicaltrials.gov (NCT05826496).

Speaker: Katharina Leuchte (National Center for Cancer Immune Therapy (CCIT-DK), Department of Oncology, Copenhagen University Hospital Herlev)

20260722_INHALE_ISEO_v3_clean.pptx

109 Does Training Status Influence Myokine Levels and Cancer Cell Suppression In Vitro? Effects of a Single Bout of Exercise in Breast Cancer Survivors

Purpose. We investigated the impact of training status (untrained versus trained) on acute myokines with anti-cancer properties and cancer cell suppression before (untrained) and after (trained) a 12-week resistance training (RT) vs high-intensity interval training (HIIT) program.
Methods. Twenty-eight breast cancer survivors completed a single bout (defined as one complete exercise session) of RT or HIIT before and after a 12-week structured RT or HIIT program. Blood was collected before, immediately and 30 minutes after each acute RT or HIIT session to measure serum levels of myokines (decorin, interleukin 6 [IL-6], secreted protein acidic and rich in cysteine [SPARC], and oncostatin M [OSM]) and MDA-MB-231 cell growth in vitro.
Results. The acute session after a 12-week RT or HIIT significantly increased myokine levels compared to the acute session pre-training (p < 0.05), with elevations observed for IL-6 and OSM in RT (generalized eta squared [ges] = 0.029 to 0.131) and decorin and OSM in HIIT (ges = 0.016 to 0.031). The acute exercise session performed after 12 weeks of RT or HIIT induced significantly greater cancer-suppressive effects on MDA-MB-231 cells in vitro compared to the pre-training session (p < 0.05), with inhibitory effects observed in RT (ges = 0.156) and HIIT (ges = 0.052).
Conclusion. A single exercise bout, whether RT or HIIT, elevates myokines and suppresses breast cancer cell growth in vitro, with greater effects after 12 weeks of training (trained individuals). RT and HIIT showed comparable outcomes, highlighting that regular exercise enhances myokines with anti-cancer properties and reduces in vitro cell growth. Thus, higher levels of physical fitness (i.e., training status) may create a systemic environment less supportive of tumour growth, potentially contributing to a lower risk of cancer progression and recurrence.

Speaker: Francesco Bettariga (University of Technology Sydney)

110 High-Intensity Exercise Serum Alters Glycolytic Metabolism and Proliferation Rate of A549 Lung Cancer Cells

Introduction:
Numerous studies have reported exercise-induced changes in circulating factors that may partly explain the association between physical activity and reduced cancer risk (1, 2). Acute exercise-conditioned serum from both healthy individuals and patients has been shown to reduce the viability of several cancer cell lines, suggesting that transient changes in soluble factors such as cytokines/myokines may target key cancer hallmarks. However, the mechanistic pathways responsible for these effects remain poorly understood. This study aimed to investigate the effects of lifelong and high-intensity exercise–conditioned serum on cancer cells bioenergetics and proliferation.
Methods:
Cardiorespiratory fitness (VO₂max), body composition, and serological profiles were assessed in 13 master athletes and in 13 healthy age-matched non-exercisers. Using in vitro assays, human lung carcinoma cell cultures (A549) were exposed to serum collected at rest and following a progressive maximal aerobic test, from both cohorts. Cellular bioenergetic phenotype and proliferation rate were evaluated across three independent experiments.
Results:
Master athletes had a higher relative VO2max, increased muscle mass, and reduced fat mass compared to non-exercisers. While serum L-lactate concentrations at rest and post-exercise were similar between cohorts, cytokine and growth factor profiles differed in a cohort-dependent manner. Acute exercise-conditioned serum from both master athletes and non-exercisers significantly reduced L-lactate production by A549 cells, which was associated with reduced proliferation rate. Moreover, L-lactate concentration in culture medium supplemented with participant’s serum showed a statistically significant moderate negative correlation with A549 cells proliferation rate.
Conclusion:
These findings suggest that reductions in cancer cell proliferation may be mediated by exercise-induced modulation of the serological profile. Acute exercise-conditioned serum from both athletes and non-exercisers reduced cancer cell proliferation, supporting the concept that each exercise bout may cumulatively contribute to cancer prevention. Furthermore, the effects of exercise on cancer cells appear to be linked to exercise intensity and bioenergetic pathways.

Speakers: Carlos Soares (CIPER, University of Coimbra, Portugal), Prof. Ana Teixeira (CIPER, University of Coimbra, Portugal)

111 Ultrastructural Skeletal Muscle Adaptations to Resistance Exercise With or Without Creatine Supplementation in Individuals Treated for Colorectal Cancer

Background: Colorectal cancer and its treatments accelerate declines in skeletal muscle health, decreasing physical function and increasing vulnerability to morbidity and mortality. While resistance exercise training (RET) is recommended to counter these declines, individuals with cancer may experience a blunted adaptive response. Further, to date RET’s impact on skeletal muscle ultrastructure in cancer survivors has yet to be explored. This trial examined the effects of a 10-week RET program with or without creatine supplementation on body composition, physical function, and skeletal muscle ultrastructural changes in individuals treated for colorectal cancer. Methods. Twenty-seven participants were randomized to RET plus creatine (CRE; n=13) or RET plus placebo (PLA; n=14). RET was performed three times per week using a hybrid delivery model. Body composition and physical function [grip strength, chest press, leg extension, Short Physical Performance Battery (sPPB)] were assessed pre- and post-intervention. Vastus lateralis muscle biopsies were analyzed using transmission electron microscopy (TEM) to assess ultrastructural alterations (intramyocellular lipid droplet morphology, mitochondrial organization, and extracellular matrix remodeling). Results: Preliminary analyses revealed no statistically significant between-group differences; however, both CRE and PLA groups demonstrated improvements in lean body mass (1.22 kg ± 2.50; p=0.023), chest press (7.70 kg ± 4.73; p<0.001), leg extension (12.4 kg ± 7.94; p<0.001). TEM analyses showed decreases in intramyocellular lipid droplet number (-38%; p=0.031) and increases in mitochondrial area (+66%; p=0.006), accompanied by reduced mitochondrial swelling and fragmentation, and no detectable changes in mitochondrial number, indicating improved mitochondrial integrity following RET. Conclusion. Preliminary findings suggest that RET may improve body composition and functional outcomes while eliciting favorable changes in skeletal muscle ultrastructure among individuals treated for colorectal cancer. Although creatine supplementation did not confer additive benefits in this initial analysis, ongoing quantitative TEM analyses will further clarify the extent and significance of exercise-induced muscle remodeling in this population.

Speaker: Thomas Cardaci (Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA)

112 Tumor blood flow at rest and during exercise in breast cancer patients

INTRODUCTION
It has been suggested that exercise during chemotherapy drug infusions might be beneficial for cancer patients. The rationale is that pre-clinical studies have shown increased tumor blood flow during exercise, which could enhance drug delivery into the tumor. However, this phenomenon remains sparsely investigated in the clinical setting in cancer patients and was therefore the topic of the present investigation.

METHODS
Tumor blood flow (BF) was quantified in twenty breast cancer patients with [15O]-H2O positron emission tomography imaging at rest and during supine cycling in the scanner (individually chosen intensity by Borg scale, RPE 11-16). BF was also measured in non-cancerous, contralateral breast tissue.

RESULTS
Tumor BF was at rest 12.7±8.5 ml/(dl/min) and during exercise 8.7±8.1 ml/(dl/min), p=0.004. Thus, tumor BF was significantly reduced from rest to during exercise condition. BF in the contralateral healthy breast tissue was much lower and was not significantly changed from rest to exercise (2.0±1.9 ml/(dl/min at rest and 1.6±1.7 ml/(dl/min) during exercise, p=ns).

CONCLUSION
Tumor blood flow is reduced during exercise from the resting baseline in breast cancer patients. These results do not support the reasoning that at least breast cancer patients should exercise during their chemotherapy infusions. Whether the responses differ between different cancer patient groups/tumors remains to be investigated.

Speaker: Ilkka Heinonen (Turku PET Centre, University of Turku)

Keynote: Laurien Buffart - The impact of exercise on biopsychosocial health and symptom management in cancer patients (Hall 2)

Convener: Laurien M. Buffart (Department of Medical BioSciences, Radboud University Medical Centre, Nijmegen, the Netherlands)

113 Laurien Buffart - The impact of exercise on biopsychosocial health and symptom management in cancer patients

Speaker: Laurien Buffart (Radboud University)

ISEO: Founders Talk (Hall 2)

Chairs: Tina Skinner & Ulrike Dapund

Convener: Kathryn Schmitz (UPMC Hillman Cancer Center)

114 ISEO - Founders Talk

Speaker: Kathryn Schmitz (UPMC Hillman Cancer Center)

14:45 Coffee Break

Oral Session 3: Exercise and cancer treatment (Hall 2)

Chairs: Karen Steindorf & Lene Thorsen

115 Patterns of physical activity and fatigue in patients receiving immunotherapy for melanoma

Background: The efficacy of physical activity (PA) in managing fatigue has been well-established for a range of cancers and treatment types. However, whilst patients with melanoma commonly report fatigue as a side-effect of immunotherapy treatment, the relationship with physical activity is not well-understood in this population. This ongoing study aims to examine the relationship between PA and fatigue in adults receiving immunotherapy as adjuvant therapy or treatment of metastatic melanoma.

Methods: Adults (ECOG 0-2) commencing immunotherapy as adjuvant therapy or treatment of metastatic melanoma were followed across four planned cycles of immunotherapy (C1-C4). Minutes of moderate-to-vigorous physical activity (MVPA) were measured using a Fitbit activity monitor. Meeting PA guidelines of 150-minutes of moderate or 75-minutes of vigorous activity was determined for each cycle. Fatigue was measured at each infusion and 1-week following using the Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F). Clinically significant fatigue was defined as FACIT-F <34.

Results: Forty-four participants (mean age 62-years, 61% male, 44% metastatic) have completed this ongoing study. Average weekly minutes of MVPA was 112-minutes (±124-minutes), with 34% meeting PA guidelines in ≥1 cycle. However, only 14% met guidelines every cycle. Whilst there was no significant effect of cycle number on MVPA (p=0.697), average MVPA depicted an upwards trend increasing by 36-minutes from C1-C4. Clinically significant fatigue was reported by 36% at ≥1 cycle. Notably, there was no significant effect of cycle number on fatigue (p=0.199), however individuals who met PA guidelines reported significantly lower fatigue levels (p=0.026). Eleven participants discontinued treatment between C1-C4, though reasons for discontinuation require further investigation.

Conclusions: Levels of PA observed in this population are often below recommended guidelines, with many reporting clinically significant levels of fatigue. Preliminary findings suggest a positive relationship between PA and fatigue. Further analyses will be conducted in a larger sample.

Speakers: Sarah Marvin (Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia. Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia), Kate Edwards (Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia. Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia)

Sarah Marvin_ISEO Session 3.pptx

116 Daily In-Hospital Exercise During Neoadjuvant Chemoradiotherapy Counteracts Immune Suppression in Patients With Esophageal Cancer

Background: In our previous study, exercise during neoadjuvant chemoradiotherapy (NCRT) showed potential to enhance tumor regression in patients with esophageal cancer, but underlying mechanisms are unclear. As preclinical evidence suggests that exercise decreases tumor growth through mobilization, activation, and tumor infiltration of natural killer (NK) and CD8+ T cells, we explored these pathways in our trial participants.
Methods: Blood samples and tumor tissue were collected from 31 patients with esophageal cancer, randomized to: 1) 30-minute in-hospital moderate-intensity aerobic exercise within one hour before each radiotherapy fraction, five times per week (ExPR); 2) two 60-minute supervised aerobic and resistance exercise sessions per week (AE+RE); or 3) usual care (UC) during NCRT. Blood samples were collected before randomization (T0), after NCRT (T1), and before surgery (T2), as well as before and directly after one ExPR session. Exercise-induced immune mobilization, and exercise training effects on immune profile and peripheral NK and T cell function were examined by flow cytometry. Tumor material is currently analyzed for vascularization, hypoxia, and immune infiltration using multiplex immunofluorescence.
Results: 30-minute aerobic exercise mobilized immune cells into circulation. We observed shifts in peripheral immune profile, particularly trends towards an increase in dendritic cells in ExPR compared to UC and AE+RE at T1 (p=0.07, p=0.06), and in eosinophils compared to UC at T2 (p=0.10). Additionally, NK cell degranulation was preserved in ExPR, but declined in UC and AE+RE resulting in significant between-group differences at T1 (p=0.05, p=0.02). Furthermore, the %IFN-γ+CD8+ T cells was maintained in ExPR compared to a decline in UC, causing a significant between-group difference at T2 (p=0.005).
Conclusion: Aerobic exercise before each radiotherapy fraction resulted in a stable NK and CD8+ T cell function, contrasting the deterioration observed with UC. These findings suggest that exercise may counteract treatment-related immune suppression, which could contribute to improved clinical outcomes.

Speaker: Anna Ubink (Department of Laboratory Medicine, Laboratory Medical Immunology, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Medical BioSciences, Radboud University Medical Centre, Nijmegen, the Netherlands)

117 Functional Reserve and Sarcopenia Shape Treatment Outcomes After CAR-T Cell Treatment: Results of a Real-World Pilot Study

Objective
Assessment of patient fitness before CAR-T cell therapy relies on the subjective ECOG performance status (PS), offering limited granularity for clinical decision-making. To establish a more objective reproducible evaluation, we implemented two standardized bedside physical performance tests. In this prospective pilot study, we investigated whether quantitative measures of functional capacity provide discriminatory value for improved risk stratification of CAR-T outcomes.
Methods
90 patients were screened and 66 enrolled for standard-of-care CD19- or BCMA-directed CAR-T cell therapy for LBCL, MCL, B-ALL, or MM between 04/2024–11/2025. In addition to ECOG PS, patients completed a 10-meter walk test and a 30-second sit-to-stand test. Individuals meeting reference values for both tests were classified as fit; failure of one or both tests defined the unfit group. Clinical endpoints included CRS, ICANS, ICAHT, overall survival (OS), progression-free survival (PFS), and non-relapse mortality (NRM). Body composition was quantified on pre-treatment PET/CT scans using an AI-based segmentation tool (Ship-AI), capturing adipose tissue compartments (TAT, VAT, IMAT) and skeletal muscle measures (SMI, SI). Kaplan–Meier analyses assessed survival outcomes.
Results
The cohort comprised 32 fit (48%) and 34 unfit (52%) patients (median age 63, ECOG 0: 23% ECOG 1: 70%, ECOG ≥2: 6%). ECOG PS was similarly distributed between groups (p=0.55) and did not discriminate survival outcomes, whereas the fitness assessment demonstrated a trend toward improved OS (p=0.068). When integrated with sarcopenia metrics, the model provided significantly greater survival discrimination (p=0.037). CRS and ICANS rates did not differ between groups. Fit patients showed higher SMI and SI, indicating better muscle reserves. Gait speed correlated inversely with adipose tissue (IMAT p=0.003; TAT p=0.041; VAT p=0.048).
Conclusions
This study demonstrated feasibility and clinical relevance of standardized fitness metrics before CAR-T therapy. The combination of impaired physical performance and low muscle mass identifies a high-risk phenotype associated with inferior survival.

Speaker: Alessandra Holzem (Department of Medicine III, LMU Hospital Munich)

118 Effect of adding exercise therapy to first-Line chemotherapy on progression-free survival and wellbeing in ovarian cancer: Results from the phase 3 ECHO trial

Introduction:
ECHO is a phase 3 randomised controlled trial designed to determine whether adding exercise therapy into first-line chemotherapy effects progression-free survival (PFS) and physical wellbeing in women newly diagnosed with ovarian, primary peritoneal, or fallopian tube cancer (ANZCTRN12614001311640).
Methods:
Participants were allocated to either standard chemotherapy plus exercise therapy or standard chemotherapy alone. The exercise intervention aimed for 150 minutes per week of moderate-intensity, mixed-mode exercise. Primary outcomes were PFS and physical wellbeing (FACT-O physical wellbeing subscale), while secondary outcomes included overall survival, physical function, body composition, quality of life, fatigue, sleep, lymphoedema, anxiety, depression, chemotherapy completion rate, chemotherapy-related adverse events, and physical activity (assessed via self-report or objectively measured). Assessments occurred at baseline (pre-cycle 2 of chemotherapy), and again at 6 and 12 months. Analyses followed the intention-to-treat principle; time-to-event survival outcomes were evaluated using Kaplan–Meier estimates and Cox proportional hazards models, and changes in physical wellbeing and relevant secondary outcomes were examined using Generalised Estimating Equations (GEE).
Results:
489 eligible women were randomised (exercise: n=243; control: n=246); 74% with stage III–IV disease and mean age of 61 years. The exercise program proved safe (no grade ≥3 exercise-related adverse events), and feasible (median 135 minutes of weekly exercise completed). After a median follow-up of 4.5 years, PFS events occurred in 159 (65%) individuals in the exercise arm and 148 (60%) in the control arm, corresponding to median PFS of 24 and 23 months, respectively (HR 1.09; 95% CI 0.87–1.36; p=0.45). Physical wellbeing at 6 and 12 months did not differ between groups (GEE-estimated difference 0.11; 95% CI –0.66 to 0.87; p=0.78). No difference for any secondary outcome was observed between groups.
Conclusion:
Adding exercise therapy to first-line chemotherapy did not yield improvements in PFS or physical wellbeing for women with ovarian cancer.

Speaker: Sandra Hayes (Cancer Council Queenslnd)

119 The influence of exercise on the relationship between neuropathic pain and its interference with daily activities among cancer patients receiving chemotherapy

Introduction. Chemotherapy-related neuropathic pain (i.e., hot/burning or sharp/shooting sensations) substantially interferes with cancer patients’ ability to perform daily activities. Exercise is a promising therapy that may reduce neuropathic pain and its interference with daily activities during chemotherapy.

Methods. We conducted a nationwide phase II randomized controlled trial through the University of Rochester Cancer Center NCI Community Oncology Research Program Research Base. Patients receiving neurotoxic chemotherapy were randomized to Exercise for Cancer Patients (EXCAP©®) or usual care (UC). EXCAP©® is a 6-week individually tailored exercise prescription including daily walking and resistance band exercises. Participants rated neuropathic pain severity and its interference with daily activities on 0-10 numerical rating scales daily for six weeks. Linear mixed models adjusted for baseline values assessed changes in neuropathic pain, interference with daily activities, and their association across six weeks.

Results. We recruited 114 participants from 37 community oncology practices across the US (mean age 59±10; 75% female; 36% breast cancer; 37% gastrointestinal cancer). During the intervention, EXCAP©® participants significantly increased daily steps by 1664±242 (p<0.01) and performed 99±9 minutes/week of resistance band exercises at low intensity (perceived exertion 4.5/10). UC participants showed no significant change in daily steps (399±210, p=0.07) and performed minimal resistance exercise (8±3 minutes/week). From baseline to post-intervention, EXCAP©® participants reported significant reductions in neuropathic pain (-0.6±0.01, p<0.01) and interference with daily activities (-0.9±0.02, p<0.01), while UC participants reported no changes (both p>0.05). Neuropathic pain was positively associated with interference with daily activities (0.3±0.02, p<0.01). However, EXCAP©® participants reported less interference with daily activities than UC participants at comparable neuropathic pain severity levels (difference in slope: -0.2±0.04, p<0.01).

Conclusions. Exercise reduces neuropathic pain and its interference with daily activities among patients receiving chemotherapy. Moreover, exercisers experience less interference with daily activities than non-exercisers, even when experiencing the same severity of neuropathic pain.

Speaker: Po-Ju Lin (Wilmot Cancer Institute, University of Rochester Medical Center)

2026 ISEO_Lin.pptx

Oral Session 4: Pediatrics, Adolescents and Young Adults (Forum 1)

Chairs: Fiona Streckmann & Nicole Culos
Reed

120 Exercise for survivorship: effectiveness of a community-based group exercise program for adolescent and young adult cancer survivors.

Background: Adolescent and young adult (AYA) cancer survivors experience persistent physical and psychosocial effects after treatment. Despite evidence supporting exercise in adult cohorts, research specific to AYAs remains limited. This study examined the effectiveness of a community-based, group exercise program in improving physical and psychosocial outcomes among AYA cancer survivors.
Methods: A pragmatic, single-arm, pre-post study design was used. AYAs aged 15–27 years within two years post-treatment completed a 12-week group exercise program in a community setting. Biweekly, individualised sessions incorporated aerobic, resistance, and flexibility training under Accredited Exercise Physiologist supervision. The primary outcome was VO₂peak, with secondary outcomes including 1RM strength, physical function, body composition, and quality of life (EORTC QLQ-C30, SF-36). Pre–post changes were analysed using mixed-effects models adjusted for diagnosis.
Results: Of 127 participants (mean age 21.4 ± 3.0 years; 51% male), 93 (73%) completed the program and final assessments. A significant improvement was observed in VO₂peak (3.1 mL·kg⁻¹·min⁻¹, p < 0.001), all 1RM strength measures (Leg press: p<0.001; Chest press: p<0.001; Seated Row: p<0.001), physical function (Push Ups: p<0.001; Sit Ups: p<0.001; 5-rep Sit-to-Stand p<0.001; Grip Strength: p=0.028), lean mass (p<0.001) and quality of life across physical, role and social domains (p<0.001). Fat mass percentage (p=0.002) and fatigue (p<0.001) decreased. No adverse events occurred.
Conclusion:
Community-based, group exercise is safe and effective for AYA cancer survivors, improving fitness, strength, and quality of life. Findings support scalable, real-world exercise models to enhance long-term survivorship outcomes.

Speaker: Claire Munsie (1. Western Australian Youth Cancer Service 2. Sir Charles Gairdner Hospital, North Metropolitan Health Service. 3. School of Human Sciences (Exercise and Sport Science), University of Western Australia 4. School of Allied Health, Curtin University)

Jade cycle video.mp4

Munsie_ Exercise for Survivorship: Effectiveness of a community-based group exercise program for Adolescent and Young Adult cancer survivors.

121 Effects of a structured exercise intervention in childhood cancer patients during intensive treatment: Results of the multicenter randomized controlled FORTEe trial

Background: Despite substantial advances in treatment, children and adolescents with cancer continue to face high morbidity and health issues, including cancer-related fatigue, treatment-related complications, and physical inactivity. Integrating exercise into pediatric oncology care has emerged as a promising approach to mitigate these burdens during cancer treatment. While preliminary data support its potential to reduce treatment-related side effects and enhance quality of life, robust evidence -especially from large, multicenter trials- remains limited. The aim of the randomized, controlled, multicenter FORTEe trial was to evaluate a personalized and standardized exercise intervention in children, adolescents, and young adults undergoing cancer treatment across ten centers in Europe.
Methods: Participants were randomly assigned to either the exercise intervention group, receiving a tailored, supervised 8–10 weeks lasting exercise program, or the control group, which received usual care. The exercise program includes endurance, strength, flexibility, and balance training, adapted to each patient’s age, fitness, and cancer treatment phase. Exercise sessions were intended to take place 3–5 times a week with moderate intensity, with both frequency and intensity adapted to the clinical condition of the individual. Digital tools and telehealth solutions supported the intervention, allowing for both in-person and remote training.
Results: A total of 478 childhood cancer patients (mean age: 11.6 ± 4.4 years; 43 % female) were enrolled in the trial. The formal evaluation is ongoing, and the corresponding data will be available for presentation at the ISEO Inaugural Conference in July 2026.
Conclusion: As a progress beyond the current state-of-the-art, FORTEe has the ambition to implement pediatric exercise oncology as an evidence-based treatment option for all childhood cancer patients, ultimately integrating it as a standard into clinical practice worldwide.

Speaker: Lena Wypyrsczyk (University Medical Center of the Johannes Gutenberg-University Mainz, Childhood Cancer Center Mainz, 55131 Mainz, Germany)

122 IMPLEMENTATION OF PHYSICAL ACTIVITY IN PEDIATRIC ONCOLOGY

Introduction: Pediatric cancer patients are living longer at the expense of adverse health outcomes. Physical activity (PA) is a promising strategy to support physical and mental health, yet optimal approaches for implementing PA remain unclear. This abstract integrates findings from a RCT focusing on a 12-week behavioral PA intervention, and the results of a qualitative study examining how clinical conversations influence PA engagement in childhood cancer survivors (CCS).
Methods: In the RCT, 40 CCS (mean age 13.6 years) were allocated 1:1 to a behavioral PA intervention or control group. The intervention was based on pediatric oncology PA guidelines and the COM-B framework, with weekly support calls to refined PA prescriptions ((frequency, intensity, time and type). In the qualitative study, 20 CCS (mean age 14.1 years) participated in audio-recorded clinical conversations with their healthcare provider (HCP). HCPs received a 20-minute educational session on PA benefits. The conversations promoting PA were incorporated into routine clinical visits. Conversations were transcribed and independently reviewed using content analysis. CCS reported PA levels at baseline, 1 week and 3 months using the GSLTPAQ.
Results: The acceptability rate of the behavioral PA intervention was 90.9% and the feasibility exceeded 85%. CCS improved PA frequency (85%), intensity (80%), duration (100%), with 50% meeting PA guidelines. Six-minute walk distances were greater in the intervention group than controls (465.8±74.5m vs. 398.7±92.9m; p=0.016). No adverse events occurred, and PROs were within normal ranges. The qualitative study yielded six themes: #1 introducing PA, #2 explaining benefits, #3 providing recommendations, #4 goal setting, progression and assessment, #5 identifying opportunities, and #6 assessing receptiveness. CCS increased PA levels following these conversations.
Conclusion: Structured behavioral PA interventions and PA-focused clinical conversations are effective strategies to enact behavior changes in CCS. These findings are an important step to make exercise standard practice in pediatric oncology.

Speaker: Maxime Caru (PENN STATE COLLEGE OF MEDICINE)

123 Promotion of Physical Activity in the Pediatric Oncology Outpatient Clinic: Experience of the ATIVAONCO Project

Introduction: Children and adolescents undergoing cancer treatment often experience physical deconditioning, emotional distress, and reduced engagement in physical activity. Integrating movement-based interventions into outpatient oncology care may help mitigate these effects while promoting a more humanized healthcare environment. The ATIVAONCO Project was created to promote adapted physical activity for children and adolescents undergoing outpatient cancer treatment, aiming to reduce physical and emotional effects and transform the hospital environment into a more welcoming and active space. Method: This qualitative, observational study is based on professional records, systematic observations, and reports from children, adolescents, and family members describing the experience of the ATIVAONCO Project implemented in the pediatric oncology outpatient clinic of the Joana de Gusmão Children’s Hospital, Brazil. Interventions take place twice a week in the family room and integrate playful activities, motor exercises, and health education actions directed at parents and caregivers. Activities include motor circuits, cooperative games, light exercises, and themed proposals adapted to individual needs. Results: Between 2023 and 2024, more than 200 children participated in the sessions; in 2025, the program reached 320 children, with an average of 8 to 12 participants per session. Improvements were observed in socialization, increased physical disposition, reduced anxiety related to the hospital environment, and strengthened bonds between the multidisciplinary team, patients, and families. The presence of Physical Education professionals proved essential for integrating physical, emotional, and educational dimensions into care, allowing safe interventions tailored to participants’ clinical conditions. Conclusion: The project demonstrates that systematic implementation of adapted physical activity in hospital environments is feasible, safe, and effective, contributing to a more humanized pediatric oncology experience. Continuation and expansion of the project are recommended, as well as longitudinal studies to support public policies incorporating physical activity into pediatric oncology care.

Speaker: Ricardo Artur Etchatz Bilac (Federal University of Santa Catarina)

https://drive.google.com/file/d/142l-_AWBFMZWLozl0H2GmIv38JSD9RS3/view?pli=1

124 Core Areas of Exercise Implementation in Pediatric Oncology: The Three-Stage Network ActiveOncoKids Wheel Model

Background
The Network ActiveOncoKids (NAOK) is a working group of the German Society for Pediatric Oncology and Hematology. The NAOK’s core work involves implementing safe and effective exercise interventions and increasing physical activity in children and adolescents with and beyond cancer. The NAOK wheel model was developed as a suitable instrument for implementing exercise interventions in clinical settings and concept-guided counseling regarding long-term integration into sports structures for follow-up care.
Methods
The model is based on three interconnected, synergistically acting components. (1. Component) Free, nationwide counseling of patients in cooperation with partners from rehabilitation clinics, oncological centers, and organized (para-)sports, (2. Component) institutional implementation of sustainable care structures in oncological centers and clinics, and (3. Component) professional qualification and networking via working groups and multicenter studies.
Results
Individual counseling includes measures to increase sports participation and physical activity (current cohort: N=263; 43% female; largest age group 11-15 years, 35% brain tumors, 24% leukemias/lymphomas, 17% bone tumors; 69% in follow-up care). The structural, needs-oriented support for implementation of exercise at pediatric oncology centers considers personnel, organizational, and financial resources, quality-assuring measures and certification (total: N=40 clinics; since 06/2019: N=27 newly implemented; currently: N=20 certified NAOK sites). A guideline-based training concept (blended learning) has qualified therapists specifically in the field of pediatric exercise oncology (currently N=21). Additionally, a study registry for adverse events occurring during supervised exercise interventions aims at developing evidence-based recommendations to minimize potential risks during such programs.
Conclusion
The NAOK wheel model represents a centrally coordinated, quality-assured framework model for sustainable implementation of exercise interventions in pediatric oncology. Through multidimensional approaches, both access to extraclinical movement offers (school/club/leisure) and guideline-conform implementation of supervised exercise interventions are ensured. Central coordination is a crucial success factor for promoting synergies, bundling successful care models, and developing evidence-based concepts for peripheral care.

Speaker: Miriam Götte (West German Cancer Center Essen, University Hospital Essen, Germany)

Keynote: Robert Newton - Exercise is Medicine in Prostate Cancer (Hall 2)

Convener: Robert Newton (Edith Cowan University)

125 Robert Newton - Exercise is Medicine in Prostate Cancer

Speaker: Robert Newton (Edith Cowan University)

Thursday 23 July

08:00 Registration

Remarks: Opening (Hall 2)

Keynote: Marlies Meisel - Exercise, Microbiome and the Immune System - New perspectives in Exercise Oncology (Hall 2)

Convener: Marlies Meisel (University of Pittsburgh)

126 Marlies Meisel - Exercise, Microbiome and the Immune System - New perspectives in Exercise Oncology

Speaker: Dr Marlies Meisel (University of Pittsburgh)

10:00 Networking Break

Oral Session 5: Breast Cancer (Hall 2)

Chairs: Sandi Hayes & Andreas Schneeweiß

127 The randomized controlled BENEFIT trial investigating the effects of aerobic or resistance exercise concomitant to neoadjuvant chemotherapy on clinical outcomes in women with breast cancer

Rationale: Preclinical and observational evidence suggests that exercise may enhance primary tumor treatment, but evidence from clinical trials is scarce. We therefore conducted a randomized controlled trial to examine the effects of adding exercise to neoadjuvant chemotherapy (NACT) on clinical outcomes.

Methods: In the BENEFIT trial, breast cancer patients scheduled for NACT were randomized 1:1:1 to supervised resistance training (RT, n=60), supervised aerobic training (AT, n=60), each performed twice weekly during NACT, or a waitlist control group (WCG, n=60). Clinical records were used to obtain data on change in tumor size (primary endpoint, categorized) as well as pathologic complete response (pCR), need for axillary lymph node dissection (ALND), premature chemotherapy discontinuation, and relative chemotherapy dose intensity (RDI). Analyses were conducted using multiple (ordinal) logistic regression models.

Result: While there was no overall significant difference in post-intervention tumor size between RT or AT and WCG, there was a significant effect modification by hormone receptor (HR) status (p-interaction=0.030). Among patients with HR-positive tumors, results suggest a beneficial effect of AT on tumor shrinkage (odds ratio (OR) = 2.37; 95%CI: 0.97‒5.78), on pCR (OR=3.21; 0.97‒10.61); and on ALND (OR=3.76; 0.78‒18.06) compared to WCG. Effects of RT were slightly less pronounced. For HR-negative tumors, beneficial effects on RDI were found for AT (OR=3.71; 1.20‒11.50) and similarly for RT (OR=2.58; 0.88‒7.59). Both AT and RT reduced premature discontinuation of chemotherapy (OR (no vs. yes) = 2.34; 1.10‒5.06), irrespective of tumor receptor status.

Discussion: The findings suggest that incorporating aerobic and resistance exercise during NACT may beneficially influence tumor shrinkage and pCR rates, lower the need for ALND in patients with HR-positive breast cancer, and help prevent low RDI in those with HR-negative disease. Together, these results highlight the importance of offering supervised exercise already during NACT to support treatment effectiveness and tolerance.

Speaker: Martina Schmidt (Division of Physical Activity, Cancer Prevention and Survivorship, German Cancer Research Center (DKFZ), and National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and University Medical Center Heidelberg, Germany)

128 Improving sleep quality of patients with metastatic breast cancer through supervised exercise: results from the PREFERABLE-EFFECT trial

Background: Impaired sleep quality is a common burden in patients with breast cancer, yet the effects of exercise on sleep quality, particularly in patients with metastatic disease (mBC), remain understudied. Therefore, the effects of supervised exercise on sleep quality in patients with mBC were investigated in the multinational randomized controlled PREFERABLE-EFFECT study.

Methods: Patients with mBC (ECOG ≤2, survival prognosis >6 months) were 1:1 randomized to a 9-month supervised resistance, aerobic, and balance training intervention (2x/week) or usual care. Sleep quality (secondary outcome) was assessed at baseline, 3, 6 (primary timepoint) and 9 months using the Pittsburgh Sleep Quality Index (PSQI). To quantify cancer-related sleep impairments at baseline, individual PSQI scores (global score and seven component scores) were compared to sex-specific reference values from the general population [1]. Linear mixed models for repeated measures were calculated to assess potential intervention effects.

Results: Among the 357 included patients (355 female; mean age 55.4±11.1 years), 74.2% reported worse overall sleep quality (global score) at baseline compared to the general population. With respect to the component scores, impairments were observed for the majority of patients for sleep disturbance (98.9%), sleep efficiency (73.9%) and daytime dysfunction (70.6%). Compared to usual care, exercise significantly improved sleep disturbances (6-month between-group difference (BGD6) = -0.13, 95% CI [-0.24, -0.01], effect size (ES) = 0.23; 9-month BGD9=-0.14 [-0.26, -0.03], ES=0.26), reduced sleep medication use (BGD6=-0.16 [-0.32, -0.00], ES=0.14), and improved daytime dysfunction (BGD6=-0.16 [-0.30, -0.01], ES=0.21). Small and non-significant effects were observed on PSQI global score (BGD6=-0.59 [-1.20, 0.01], ES=0.17).

Discussion: Poor sleep quality is highly prevalent among patients with mBC. Health-care professionals should encourage patients to engage in supervised exercise, as it has a variety of well-established beneficial effects and may also contribute to improved sleep quality.

[1] Hinz et al. (2017) Sleep Med 30 DOI: 10.1016/j.sleep.2016.03.008

Speaker: Jana Müller (Exercise Oncology Research Group, Department of Medical Oncology, Heidelberg University Hospital, Medical Faculty Heidelberg, Heidelberg University, National Center for Tumor Diseases Heidelberg, a partnership between DKFZ and Heidelberg University Hospital, Heidelberg, Germany)

129 Exploring the feasibility of exercise training during (neo)adjuvant chemotherapy in women with early-stage breast cancer: a pilot study examining immune and metabolic outcomes

Background:
Immune function critically influences chemotherapy efficacy. Preclinical evidence is that exercise mobilizes NK and CD8+ T cells, enhances immunosurveillance, and improves treatment response. However, its immunological effects during chemotherapy for breast cancer remain poorly defined.
Methods:
This non-randomized pilot study examined a 12-week supervised combined aerobic- and resistance-exercise program during (neo)adjuvant chemotherapy (± immunotherapy) in women with early-stage breast cancer. The program consisted of 2-3 sessions per week at a moderate to vigorous intensity. Eleven patients completed the intervention and six served as a convenience control group for blood markers. Outcomes included feasibility, peripheral immune cells, cytokines, metabolic biomarkers, body composition, quality of life and fatigue.
Results:
Uptake was 35% (13/37 enrolled). Compared with controls, exercisers showed a greater increase in CD8+ EMRA cells (p = 0.019) and reduction in CD8+ naïve T cells (p = 0.029). Within-group analyses showed increases in CD8+, CD8+ EMRA, CD8+ CD57+, CD8+ HLA-DR+, CD4+ PD-1 and CD4+ CD57+ cells, with reductions in CD4+ and CD8+ naïve T cells (all p < 0.05). NK-cell profiles indicated a greater increase in CD56bright CD16+ NK cells in controls, while exercisers showed signals of increased total NK and NKT cells. In addition, there was a signal toward a reduction in IL-15 in the exercise group (p = 0.066). Exercise preserved metabolic stability, preventing the insulin rise seen in controls (p = 0.034). Patients maintained body weight and fat mass with a signal toward increased lean mass (0.8 kg, p = 0.093). Finally, exercise improved global quality of life (p = 0.031) and showed a signal toward reduced fatigue (p = 0.063).
Conclusions:
Supervised exercise was feasible during chemotherapy, promoted an activated, cytotoxic immune profile, and mitigated metabolic dysregulation. Exercisers maintained body composition and improved quality of life. Larger, adequately powered trials are warranted.

Speaker: Cristina Crespo García (Exercise Medicine Research Institute. Edith Cowan University)

FASTEX_ISEO 2026_Cristina Crespo.pptx

130 Exercise during chemotherapy for breast cancer: Not just improving patients’ functional ability

Background: Exercise during chemotherapy for breast cancer (BCa) offers significant health benefits and could influence disease progression. Evidence suggests that exercise-induced circulating factors mediate such anticarcinogenic effects, although the implicated cellular processes remain uncharacterized.

Method: Twenty-nine BCa patients (40.0±0.9 yrs, 25.0±0.8 kg/m2) were randomized with a 2:1 ratio either to exercise (EX) or usual care (UC) group. The EX participated in a 12-week exercise program during chemotherapy, consisting of both aerobic (25min; 40-59% Heart Rate Reserve) and resistance training (30min; elastic bands), 3 times per week, with monthly assessments of their functional ability. On the 12th week, human serum was collected from the EX immediately before (PRE-EX) and after (POST-EX) an exercise session and used to treat BCa cells (MCF-7) in vitro, to examine the effect of the exercise-conditioned serum on their metabolic activity, cytotoxicity, DNA damage and levels of apoptosis.

Results: Compared to baseline, in EX the cardiorespiratory endurance (Rockport 1-mile walk test) was improved by 10.78±4.59% (p<0.05) after the 12th week, as were also the handgrip strength on the mastectomy side (-21.00±4.79%) and the “Sit to Stand-60sec” (10.78±4.59%) and “Sit Ups-60sec” performances (p<0.001). In UC, the cardiorespiratory endurance exhibited a decreasing trend (-12.63±7.0%) and the handgrip strength on the mastectomy side deteriorated (-19.43±7.10%; p<0.001), along with the “Sit to Stand-60sec” (-8.80±3.44%; p<0.01) and “Sit Ups-60sec” (-21.90±9.98%; p<0.05) performances. Furthermore, the treatment of BCa cells with the POST-EX serum decreased their metabolic activity (32±6.4%; p<0.001), while induced cytotoxicity (1.5±0.04 fold-change; p<0.001) and DNA damage (1.8±0.2 fold-change; p<0.05), when compared to the PRE-EX condition. Also, the number of apoptotic cells raised to 14.6±0.4% (p<0.05) in the POST-EX serum-treated cells.

Conclusion: Exercise during chemotherapy not only counterbalanced functional ability deteriorations that were experienced by UC but also appeared to enrich patients’ blood with anticarcinogenic exerkines, which could act additively to chemotherapy.

Speaker: Argyro Papadopetraki (Physiology Laboratory, Medical School, National and Kapodistrian University of Athens)

131 Habitual physical activity patterns and longitudinal changes in insulin resistance following breast cancer diagnosis and treatment

PURPOSE: Insulin resistance (IR) and hyperglycemia are common side effects of cancer therapy, and IR that persists despite treatment cessation is likely much more common than previously estimated. It is unclear if habitual physical activity (PA) alters cancer-induced IR in the year after diagnosis. METHODS: Fasting glucose, insulin, and self-reported PA were measured at diagnosis, 6-, and 12-months post-diagnosis in n=73 stage I-III breast cancer patients who received chemotherapy. IR was assessed via Homeostasis Model Assessment-Insulin Resistance (HOMA-IR). Differences in HOMA-IR, hormones and metabolites by PA were quantified via ANOVA, and associations between variables over time were determined via logistic regression. Participants were then placed into quartiles based on individual percent change in HOMA-IR from diagnosis-6M and 6M-12M to determine any contribution of PA to the attenuation and/or reversal of IR. RESULTS: Compared to active patients (n=37), inactive patients (n=36) had significantly elevated HOMA-IR (3.1±2.8 vs. 2.0±1.6, p<0.01) and glucose (5.3±0.7 vs. 4.8±0.7 mmol, p<0.001) at diagnosis. Among patients who were active at diagnosis, those who temporarily reduced or halted PA at 6M had higher HOMA-IR at 12M compared to those who consistently maintained (or increased) PA levels (1.8±1.2 vs. 1.2±0.7, p<0.05). Glucose concentrations at 12M were lower in patients who initiated PA at 6- and/or 12M compared to patients who remained inactive (5.0±0.5 vs. 5.6±1.1 mmol, p<0.04) despite no difference in HOMA-IR. PA did not significantly contribute to the attenuation or reversal of cancer-induced IR, however over 60% of those patients with the greatest percent reduction in IR also increased PA intensity from 6- to 12M. CONCLUSION: PA is beneficial for glycemic control regardless of activity levels at diagnosis, but high levels of PA alone may not prevent cancer-induced IR. Increasing PA intensity may contribute to reversal of IR, but more precise assessments of PA and IR is required.

Speaker: Richard Viskochil (Department of Exercise and Health Science, University of Massachusetts Boston)

Oral Session 6: Implementation (Forum 1)

Chairs: Martjin Stuiver & Freerk Baumann

132 Exercise Oncology Implementation for Underserved Populations: The EXCEL Study

Background: Exercise oncology research is limited for individuals living with and beyond cancer (ILWBC) in rural/remote and underserved communities, who face barriers to participation and lack of resources post-research to support exercise maintenance. The EXercise for Cancer to Enhance Living Well (EXCEL) study is in phase 2, transitioning from a focus on trial delivery to an implementation-ready program model.
Methods: EXCEL is a 5-year hybrid effectiveness–implementation study guided by RE-AIM [1-3]. To support sustainable program delivery, implementation includes clinical exercise physiologists at regional hubs supporting healthcare-provider referral, conducting intake, and training qualified exercise professionals (QEP) to deliver the 8–12-week, primarily online, group exercise+behaviour change intervention. Effectiveness is measured with fitness, PA self and objective reporting, and a series of validated patient-reported outcomes (PROs). Ongoing transition to program implementation is guided by the Implementation Research Logic Model.
Results: To Spring 2025, EXCEL has n=1,485 participants (1,085 rural; 400 urban) with mean age 59.7 years (rural 60.7; urban 57.2), 79.4% female, 54.8% on treatment, and 22.3% reporting metastatic/advanced disease. Implementation metrics include over 200 clinical contacts and 50+ trained QEPs, with 22 QEPs involved in exercise class delivery. Barriers and facilitators to implementation gathered via quality improvement cycles have supported changes to program recruitment, referral, and assessment. Measures within the program model are ongoing (anticipated n=500) and include visual analogue scale PROs to capture symptoms, PA levels, and quality of life. Individual results reports are shared with participants to facilitate behaviour change, and educational resources are included in handouts.
Discussion: To support delivery that increases access for ILWBC, EXCEL program implementation is ongoing (2025-26). Program model development includes strengthening HCP referral pathways, supporting QEP training in our ‘exercise and educate’ model for behaviour change, integrating outcome reporting into clinical workflows, and formalizing community partnerships to expand equitable reach while preserving fidelity.

Speaker: Prof. S. Nicole Culos-Reed (Faculty of Kinesiology, University of Calgary, Calgary, Canada)

133 Characterising exercise support needs and triage barriers in cancer care: findings from a regional centre evaluation

Background:
Exercise benefits people undergoing cancer treatment; yet most do not receive this evidence-based care. Research is required to determine effective care pathways that overcome barriers to routine integration of exercise recommendations into cancer care pathways.

Methods:
An exercise referral process was co-designed with healthcare partners and consumers from a regional radiation therapy clinic in Western Australia. The process integrated an exercise discussion for all people receiving treatment into the initial nursing appointment. Referrals were generated to an oncology-trained exercise physiologist (EP) with consultant access to medical record systems. They completed a phone consult consisting of tailored exercise recommendations and triage to appropriate community programs. Audit-and-feedback was used to monitor reach, fidelity, and acceptability from February to November 2025.

Results:
From 688 patients treated, 158 (23%) were not referred due to system gaps. Of the 530 referred patients, 186 (27%) declined participation, 157 (23%) had medical contraindications, 20 were unable to be contacted. EP consultations were completed for 156 patients (23%). Physical activity guideline adherence was assessed for 418 patients, with 267 (64%) not meeting recommendations. Among the 151 (36%) meeting some guidelines, 61 met aerobic only, 54 met both aerobic and strength, and 8 met strength recommendations only. Exercise support requirements were determined for 619 patients. Moderate-intensity support requiring exercise oncology expertise, but not ongoing supervision was most common (296, 48%). Program preferences (n=31) showed 71% preferred independent home-based programs, 16% group-based sessions, and 13% one-on-one support. Average EP consultation time was 29.5 minutes per patient.

Conclusions:
Clinical integration of exercise support is possible but requires implementation monitoring to manage system-level barriers as one-half of patients were prevented from accessing exercise services. Most patients do not meet exercise guidelines and require moderate-intensity exercise support, highlighting the ongoing need to continue work to systematically integrate exercise into cancer treatment pathways.

Speaker: Mary Kennedy (Edith Cowan University)

134 Improving access to exercise services after a cancer diagnosis: patient and health professional perspectives

Background:
Exercise is a critical component of best practice cancer survivorship care, but availability and uptake of services is highly variable. Group exercise may be an effective and affordable service option for many patients but is not routinely accessible. The primary objective was to capture and evaluate the experiences of people living with and beyond cancer (PLWBC), oncology medical providers (OMPs) and exercise professionals (EPs), regarding exercise engagement and service provision in cancer care. Secondary objective: Explore participants' perspectives on how to make community-based group exercise programs accessible, engaging, and inclusive of diverse needs and preferences.
Methods:
PLWBC were recruited from the community and OMPs/EPs recruited from public hospitals and community in NSW, Australia.
PLWBC participated in online focus groups. OMPs and EPs completed one-on-one interviews. Discussions centred on exercise engagement post-diagnosis, the quality of exercise advice received, personal and system-level barriers affecting referral and adherence, and suggestions for improving service delivery. Qualitative data was coded using NVivo and thematic analysis was used to identify key themes from the data.
Results:
Fifteen PLWBC, 7 OMPs and 5 EPs participated between May 2024 and October 2025. Four themes emerged: Challenges integrating exercise into cancer care pathways; Designing flexible and inclusive service models; Enhancing exercise readiness, self-efficacy, and ongoing motivation; Building organisational capacity and workforce confidence. Both PLWBC and OMPs highlighted the importance of timely and consistent guidance, including accurate and available resources. Tailored support and adaptability within group settings were viewed as essential for meeting diverse needs effectively. Participants expressed a preference for a hybrid delivery model combining in-person and online group exercise sessions.
Conclusion:
The findings provide rich data and actionable insights which can be implemented into existing practice. Future work will focus on upskilling EPs in the workforce to enhance availability of suitable services and optimising referral pathways.

Speaker: Briana Clifford (School of Health Sciences, Faculty of Medicine and Health, UNSW, Sydney, Australia.)

ISEO_2026_CLIFFORD.pptx

135 “Let’s talk exercise and cancer”: Understanding barriers and facilitators of exercise communication between healthcare professionals and individuals with cancer – An International focus group study

Purpose

To effectively integrate exercise into cancer rehabilitation for survivors, families, and caregivers, it is essential to understand barriers and facilitators influencing patient-centered communication and shared decision-making about exercise. Both survivor and health-care professional (HCP) perspectives matter and may differ in how they view the role of exercise, the challenges in discussing it, and the support needed. Understanding these barriers and facilitators will support development of evidence-based exercise-oncology communication standards that fit existing healthcare systems.

Methods

As part of the LION-COM sub-study within the multinational, EU funded PREFERABLE 2 study, totally ten focus groups were conducted in Germany, the Netherlands, Portugal, Spain, and Sweden from April – December 2024. In each country, one focus group was conducted with survivors who had completed primary curative cancer treatment and one with HCPs working within cancer care. The transcripts of the semi-structured discussions were transcribed verbatim, translated to English, and analyzed inductively using reflexive thematic analysis.

Results

We developed four main themes from the focus groups with survivors: Bringing up the topic, The silent gaps behind the conversation, Opening the door to more effective communication, Need for more than just advice. Parallely, four main themes were developed from HCP focus groups: Exercise conversations compete with the realities of cancer care, Unclear ownership and professional boundaries create a communication gap, Trust and quality shapes meaningful conversations, Cultural and personal norms impact deeper communication.

Conclusions and Implications

While survivors seek proactive, personalized conversations, HCPs report systemic constraints, unclear roles, and cultural factors that hinder dialogue. Overcoming these major communication gaps might facilitate integrating exercise into routine care. Addressing these gaps requires clear guidelines, structured communication strategies, and role clarification to empower HCPs and foster shared decision-making. These insights can inform evidence-based communication standards for exercise oncology, aligning with healthcare systems and improving rehabilitation outcomes.

Speaker: Dr Poorna Anandavadivelan (Division of Nursing, Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, and Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden)

136 Influence of a multi-professional care pathway and network on physical activity and physical activity-related health competence

The multi-professional care pathway Move-Onko aims at providing cancer patients with evidence-based physical activity (PA) interventions. The pathway includes structured counselling to raise patients’ awareness of the benefits of PA and recommendations for exercise programs and therapy based on individual risk factors, needs and preferences. The evaluation of Move-Onko comprises views of patients and healthcare providers. Results from a first evaluation phase in 7 Comprehensive Cancer Centers focus on the impact of Move-Onko on PA.
In a longitudinal uncontrolled intervention study, patients were asked to report their PA (Godin-Shephard Leisure Time Physical Activity Questionnaire) and their physical activity-related health competence (PAHCO) at inclusion (before counselling; t0), after 4 (t1), 12 (t2) and 24 weeks (t3).
In the first evaluation phase, 353 patients (66,9% female, 32,6% male; age 54,4±13,0 years) were included. Mild/light PA at t0 was reported by 301 (85,3%) patients with a median of 3 hours/week; moderate PA was reported by 206 (58,4%) patients with a median of 2 hours/week; and 95 (26,9%) patients reported strenuous PA with a median of 2 hours/week. This level of activity had been kept up for 6,6 months (median); 152 (43,1%) patients stated they had been remarkably more active before that. At t2, of 236 responding patients, 202 (85,6%) reported mild/light PA, 166 (70,3%) moderate and 95 (40,3%) strenuous PA. There were significantly (McNemar tests) more patients pursuing a moderate or strenuous PA 12 weeks after inclusion in Move-Onko; there was no difference for mild/light activity. PAHCO was differentiatedly assessed: while competence for physical training and motivational abilities improved, PA-specific mood regulation declined.
Participation in the Move-Onko pathway did support patients in becoming or remaining physically active. The ongoing study with >1.000 patients included will allow further and refined analyses, i.e. of influencing and moderating factors on activity and activity-related health competence.

Speaker: Katja Krug

11:30 Lunch Break

Poster Session 2.1: Mechanism (Posterarea 1)

137 Acute Exercise Preferentially Increases B-Cell-Derived Cell-Free DNA In Adults with Chronic Lymphocytic Leukaemia

Background. Elevated and impaired cell-free DNA (cfDNA) clearance are associated with increased tumour burden in chronic lymphocytic leukaemia (CLL). Although exercise has anti-tumour effects, the mechanisms underlying these effects are unclear. In healthy adults, acute exercise induces biphasic increases in cfDNA, followed by reductions upon completion. We aimed to understand the cfDNA response to acute exercise in patients with CLL.
Methods. Five treatment-naïve CLL (CLL: 65±11 years), five age- and sex-matched (OLD: 60±2 years) and seven young (YOUNG: 21±1 years) healthy adults completed a 30-minute high-intensity interval exercise session with blood taken before (PRE), immediately after (POST) and 30 minutes after (P30) exercise. We assessed complete blood counts (WBC, lymphocytes, monocytes, and neutrophils), while cfDNA in serum was assessed using RT-PCR for DNA fragments from neutrophils, lymphocytes, monocytes, and B-cells.
Results. As expected, immune cell Group x Time interactions were observed for counts of WBC (F=9.8, p<0.001, η²=.620), lymphocytes (F=6.6, p<0.001, η²=.524) and monocytes (F=3.6, p=0.020, η²=.373). These were characterised by all groups increasing immune cell counts from PRE to POST and returning to PRE levels at P30. CLL had ~8-10 times more monocytes and lymphocytes at each timepoint (all p<0.05). Lymphocyte cfDNA increases were characterised by CLL having 38.2±12% higher B-cell specific cfDNA at POST compared to YOUNG (p<0.001) and OLD (p<0.001). A group x time interaction was observed for neutrophil cfDNA (F=8.28, p<0.001, ŋ²=0.580) with similar increases PRE-to-POST in CLL and OLD (mean group diff.=12±14%, p=0.072) but higher expression at POST in the YOUNG compared to CLL (mean group diff.=38±14%, p=0.004).
Conclusion. Exercise elicits an exaggerated transient B-cell-derived cfDNA response in CLL, suggesting that exercise damages CLL cells. These cfDNA dynamics could support immune modulation and disease management in CLL. Further investigation is warranted.

Speaker: David Bartlett

138 Aerobic exercise leads to a greater mobilization of CD8+ T cells and NK cells compared to resistance exercise

Exercise leads to reduced symptoms, enhanced physical functioning, improved quality of life, enhanced treatment efficacy, and better overall survival in patients with solid tumors. One of the suggested mechanisms is the modulation of the immune function. During acute exercise, immune cells, and especially CD8+ T cells and NK-cells, are mobilized into the circulatory system. The redistribution of these immune cells after exercise has not been characterized in depth. It has however been hypothesized that the mobilized immune cells migrate to tumor sites and become tumor infiltrating lymphoid cells (TILs), contributing to a more favorable prognosis. Here we compare the effect of aerobic exercise (AE) and resistance exercise (RE) on this mobilization and markers of homing and function.

Blood samples were obtained from healthy volunteers pre, post and 30 minutes after acute endurance and resistance exercise in a cross over design. PBMCs were isolated and analyzed with multicolor flow cytometry. Immune cell function was analyzed using viral peptides.

Our preliminary data illustrates that both exercise types lead to an increased frequency of cytotoxic subsets of CD8+ T cells and NK cells. However, aerobic exercise (AE) lead to a greater mobilization compared to resistance exercise (RE), potentially due to the difference in intensity. Characterization of markers of homing and function are ongoing. Current experiments focus on whether the enhanced mobilization is reflected also in the expression of homing markers and cytotoxic function.

The proposed research will provide novel information the effect of different exercise modalities on immune cell recruitment, homing and function, informing exercise intervention designs.

Speaker: Linda Ericsson (Division of Clinical Physiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden & Unit of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden)

139 Aerobic Exercise Training and β2-Adrenergic Signaling in the Regulation of Immunosuppression in Cancer

Sympathetic nervous system (SNS) hyperactivation contributes to tumor progression and cancer-associated immunosuppression. Aerobic exercise training (AET) is known to reduce sympathetic overactivity; however, its role in modulating tumor-induced immunosuppression via β2-adrenergic receptor (β2-AR) signaling remains poorly understood.
Objective:
To investigate how β2-AR signaling regulates tumor-associated immunosuppression and whether AET modulates immune function in preclinical tumor models.
Methods:
In vitro experiments were performed using the murine colon carcinoma CT26 cell line and primary splenocytes treated with propranolol (β-adrenergic antagonist, 5–20 µM) or clenbuterol (β2-AR agonist, 1–10 µM). Cell growth and gene expression of immune checkpoint molecules (PD-L1, Galectin-9, and VISTA) were assessed. In vivo, BALB/c mice underwent six weeks of AET on a treadmill prior to CT26 tumor inoculation. Animals were allocated to sedentary or trained groups, with or without propranolol treatment (5 mg/kg/day). Tumor growth, tissue mass, and immune cell populations in the spleen, lymph nodes, and tumors were analyzed by flow cytometry.
Results:
In CT26 cells, β2-AR activation increased VISTA expression, suggesting enhanced tumor-associated immunosuppression, whereas propranolol had no significant effect on checkpoint expression. In primary splenocytes, β-adrenergic blockade increased cell proliferation, indicating improved immune function. In vivo, AET induced a trend toward reduced tumor mass and significantly increased CD8⁺ T cell proportions in the spleen. However, these effects were not observed when AET was combined with propranolol treatment. Notably, AET prevented the reduction of CD8⁺ T cells in lymph nodes observed in sedentary tumor-bearing mice.
Conclusion:
AET partially counteracts tumor-associated immunosuppression and modulates systemic immune profiles. However, the contribution of SNS signaling requires further investigation, as β-adrenergic blockade appears to improve immune function in vitro but attenuates some AET-induced immune benefits in vivo. These findings support AET as a relevant adjuvant strategy to enhance anti-tumor immunity.

Speaker: Janaina da Silva Vieira (School of Physical Education and Sport and Dept of Physiology and Biophysics, Institute of Biomedical Sciences University of Sao Paulo)

140 Characterizing Glucose Homeostasis and Metabolic Response to Exercise in Patients with Metastatic Colorectal Cancer: Two Embedded Sub-Studies within the REACH Trial

Background: A systematic review and meta-analysis found that patients with cancer are insulin resistant, which has been associated with poorer treatment tolerance and survival. Exercise may counteract these abnormalities, but mechanistic evidence in metastatic colorectal cancer (mCRC) during first-line chemotherapy is limited.

Objectives: To characterize glucose homeostasis at baseline and to examine (1) whether patients with newly diagnosed, unresectable mCRC exhibit impaired glucose homeostasis compared with matched non-cancer controls, and (2) metabolic adaptations to an 18-week structured exercise intervention during systemic therapy.

Methods: Two exploratory sub-studies are embedded within the ongoing REACH trial (Randomized controlled trial of the Effects of combined resistance and AerobiC exercise on Health-related quality of life in patients undergoing first-line chemotherapy for metastatic colorectal cancer), a randomized controlled trial with health-related quality of life as the primary outcome.
- In Sub-study I, baseline glucose homeostasis is assessed using 2-hour oral glucose tolerance test (OGTT), and continuous glucose monitoring (CGM; Dexcom G6) for 10 days in patients with mCRC (n=24) and age-, sex-, ethnicity- and BMI-matched non-cancer controls (n=24).
- In Sub-study II, n=60 participants (~30 per randomized arm) undergo the same assessments pre- and post-intervention to evaluate changes in insulin sensitivity, glucose tolerance, and incretin responses (GLP-1, GIP). Blood samples collected during OGTT are analyzed for glucose, insulin, C-peptide, and related metabolic markers. The primary endpoint is a composite combining 2-hour glucose from OGTT and time-in-rage (TIR) from CGM for both sub-studies.

Results: Recruitment and assessments are ongoing. We anticipate presenting initial baseline characteristics and feasibility indicators (including participation and adherence to CGM/OGTT procedures), alongside preliminary baseline glucose profiles in mCRC.

Perspectives: These embedded sub-studies will provide clinically relevant insight into real-life glycemic patterns and glucose tolerance in advanced colorectal cancer and may inform future precision exercise strategies targeting metabolic health during oncology treatment.

Speaker: Laura Amira Kassem

141 Dietary Antioxidant Quality and Cognitive Function Among Cancer Survivors: NHANES 2011–2014

Background: Cancer survivors are at increased risk of cognitive impairment that may persist after treatment and adversely affect quality of life. Oxidative stress is a proposed mechanism underlying cancer-related cognitive dysfunction. Dietary antioxidant quality has been linked to cognitive performance in the general population, but evidence among cancer survivors remains limited. This study aimed to examine the association between dietary antioxidant quality and cognitive function among cancer survivors and to evaluate whether sleep influences this relationship.
Methods: We conducted a cross-sectional analysis of adult cancer survivors using data from the U.S. National Health and Nutrition Examination Survey from 2011 to 2014. Dietary antioxidant quality was assessed using the Dietary Antioxidant Quality Score (DAQS). Cognitive function was measured using the Digit Symbol Substitution Test (DSST) and the Animal Fluency Test (AFT). Survey-weighted linear regression models accounting for the complex sampling design were adjusted for demographic, socioeconomic, and clinical factors, with sleep included as a covariate based on prior evidence.
Results: For DSST, DAQS estimates were positive but not statistically significant in models adjusted for age, sex, and race (β = 1.05, 95% CI −0.47 to 2.57) and were attenuated after further adjustment for socioeconomic and clinical factors, including sleep (β = 0.39, 95% CI −0.95 to 1.73). For AFT, DAQS estimates were small and non-significant across all models, including the fully adjusted model with sleep (β = 0.07, 95% CI −0.02 to 0.17). Inclusion of sleep did not materially change the magnitude or direction of DAQS estimates for either cognitive outcome.
Conclusions: Across sequentially adjusted models, dietary antioxidant quality showed consistently positive but non-significant estimates for cognitive function among cancer survivors. The use of DSST and AFT allowed broader cognitive domain coverage and maximized sample size. Sleep did not explain or influence the association between dietary antioxidant quality and cognitive function.

Speaker: HyungRok Lee (Exercise Medicine & Rehabilitation Laboratory, Yonsei University)

142 Eccentric Exercise in Rodents: Modeling Resistance Training for Translational Oncology Applications.

Introduction: Exercise is a key factor in reducing cancer risk and improving care, with structured physical activity linked to reduced treatment-related toxicities, enhanced physical function, and better quality of life. Resistance training is specifically recommended to preserve or restore muscle mass and strength during chemotherapy-induced sarcopenia and functional decline; however, its influence on tumor biology and systemic treatment responses is not fully understood. While most preclinical research has focused on endurance modalities, there is a lack of studies investigating resistance training’s underlying impacts. We implemented a model of eccentric (lengthening) muscle contractions in female rats to develop an effective preclinical paradigm for resistance exercise. Eccentric exercise offers high mechanical stimulus at a low metabolic cost, making it promising for oncology patients with limited capacity.

Methods: Obese, female Wistar Rats were randomized to eccentric exercise (Ex) or sedentary controls (Sed). The 8-week Ex protocol consisted of treadmill exercise at a 16° decline, simulating downhill hiking at a brisk walking pace. Rats trained three times per week, each session comprising six 5-minute bouts separated by 2-minute rest intervals.

Results: Exercise did not impact body weight, but significantly increased lean mass (qMR) and tended to increase quadriceps mass vs sedentary controls. Further molecular analyses of muscle hypertrophy and damage are ongoing.

Conclusion: These findings demonstrate that eccentric treadmill exercise is a feasible and effective resistance training model in rodents, resulting in increased lean muscle mass. Resistance training may offer distinct advantages in future translational oncology studies, providing beneficial effects with lower cardiorespiratory demand relative to endurance training. This preclinical framework provides the basis for further investigation into the role of resistance exercise in cancer care.

Speaker: Erin Giles (University of Michigan)

143 Effects of exercise on gut microbiota in patients with cancer: A Scoping Review

Background: Cancer and its treatments, such as chemotherapy, radiotherapy, endocrine, and targeted therapies, often cause systemic effects including chronic inflammation, immune suppression, metabolic alterations, and gastrointestinal toxicity. These complications are increasingly linked to gut microbiota dysbiosis, which plays a central role in maintaining host homeostasis. Although exercise can modulate gut microbiota in healthy populations, its specific effects in cancer patients remain unclear.
Objective: To synthesize observational evidence on the association between exercise and gut microbiota outcomes in cancer patients, focusing on microbial diversity, taxonomic changes, and clinical implications.
Methods: This scoping review followed the PRISMA-ScR framework. Prospectively registered on OSF (Registration ID: hn92y). Peer-reviewed English-language studies examining exercise and gut microbiota in cancer populations were searched in PubMed, CINAHL, Cochrane, and Web of Science up to January 4, 2025. Reviews, case reports, and conference abstracts were excluded.
Results: Six observational studies (three cross-sectional and three prospective cohorts) were included from 2,814 records. Studies covered breast, colorectal, gynecological, and hematologic cancers. Exercise interventions—such as aerobic walking, inpatient physical therapy, and resistance training—were generally associated with favorable modulation of the gut microbiota. Exercise appeared to preserve microbial diversity, enrich beneficial taxa (Faecalibacterium, Roseburia, Akkermansia), and reduce potentially pathogenic taxa (Enterococcus) and pro-inflammatory markers. However, heterogeneity in cancer types, exercise modalities, timing, and microbiome analysis methods, along with small sample sizes and absence of standardized protocols or long-term follow-up, limited comparability.
Conclusion: Preliminary evidence suggests that exercise may help mitigate gut microbiota dysbiosis and inflammation in cancer patients. However, all available studies are observational, and no randomized controlled trials (RCTs) have been conducted to confirm causal relationships. Future research should employ standardized methodologies, incorporate the FITT framework (Frequency, Intensity, Time, Type) for exercise prescription, and include RCTs to clarify mechanisms and evaluate long-term clinical impacts on gut health across diverse cancer populations.

Speaker: Eisuke Ochi (Hosei University)

144 Exercise intensity in modulating immune responses and clinical outcomes in cancer survivors: A scoping review

BACKGROUND: Exercise has emerged as a potent, non-pharmacological intervention to enhance immune function in patients with cancer. However, the effects of exercise are likely influenced by patients’ oncologic characteristics, such as cancer treatment, and intervention variables, such as exercise intensity, which can lead to heterogeneous outcomes. This scoping review aimed to identify patterns, trends, and gaps in the literature regarding the relationship between exercise intensity and immune cell parameters in the context of treatment status.

METHODS: Reports were retrieved from PubMed, Medline, and Scopus. Eligible reports were controlled clinical trials that implemented an exercise training intervention with an objectively defined exercise intensity that reported a cellular immune outcome.

RESULTS: Twenty-one articles were included, comprising 15 randomized and 6 non-randomized controlled trials. Results suggest a potential effect of intensity, where vigorous-intensity exercise training more consistently elicited beneficial immunomodulation, specifically enhanced natural killer cell cytotoxicity and tumor infiltration. In contrast, light-to-moderate intensity exercise often resulted in no immunological changes, particularly for patients undergoing active treatment. Comparisons across studies were complicated by high heterogeneity in patient characteristics and intervention details. Furthermore, few studies reported oncologic outcomes, and none directly examined relationships between immune and clinical endpoints.

CONCLUSIONS: Current evidence suggests that vigorous exercise may be a promising strategy to bolster anti-tumor immunity. However, rigorously designed comparative trials with both clinical and immunological endpoints are required to definitively establish the role of exercise intensity in oncologic care.

Speaker: Dong-Woo Kang (Fred Hutch Cancer Center)

145 Exercise-Driven miRNA Seed Sequence Therapy for Colorectal Cancer Control

BACKGROUND:
Colorectal cancer (CRC) remains a major global health burden. Exercise suppresses tumor progression through mediators such as myokines, metabolites, and miRNAs, and several miRNAs are known to be upregulated in skeletal muscle following physiological stimuli. Although these exercise-responsive miRNAs can enter circulation and exert tumor-regulatory effects, the therapeutic potential of miRNAs sharing an identical seed sequence has not been well characterized. While the seed region determines target specificity, a seed-sequence based approach could simultaneously repress multiple tumor-promoting genes with high biological precision. This study aimed to evaluate a synthetic siRNA designed to mimic the conserved seed sequence found in exercise-driven miRNAs (Ex siR) as a strategy to reproduce anti-cancer effects in CRC.
METHODS:
CT26 murine CRC cells were cultured and transfected with each vehicle, Scrambled siRNA and Ex siR according to their groups. Cell viability (CCK-8) and migration (wound healing assay) were assessed. RNA-sequencing was performed to characterize transcriptomic changes following seed-sequence–based silencing, followed by differential gene expression and pathway enrichment analyses.
RESULTS:
FAM-labeled siRNA imaging confirmed efficient intracellular uptake. Ex siR significantly reduced cell viability at 72 hours compared with both untreated and scrambled siRNA controls (p < 0.001). Migration was markedly impaired, with delayed wound closure relative to scrambled siRNA (p = 0.007). RNA-sequencing revealed broad transcriptional repression, including 412 downregulated genes such as Crhr1, Tgfbi, and Actg2. Pathway analyses indicated enhanced apoptosis and p53 signaling, alongside suppression of EMT-related, migration-associated, and extracellular matrix remodeling pathways.
CONCLUSION:
Seed-sequence–based siRNA intervention effectively attenuates CRC cell viability and migration while repressing multiple oncogenic networks. These findings suggest that exercise-derived seed-sequence mimetics may represent a promising therapeutic strategy for leveraging exercise-associated tumor-suppressive mechanisms. Further in vivo studies will be important to establish this approach as a feasible therapeutic strategy to extend the exercise-driven tumor-suppressive benefits.

Speaker: Mr Jeremy J. Kim (Seoul National University, South Korea)

146 Exploring Exercise Oncology Through 3D In Vitro Models: Impact of Exercise-Conditioned Serum on Breast Cancer Cell Tumorigenicity

Purpose: Cell culture models in exercise oncology enable the assessment of exercise effects on cancer cell tumorigenicity and the identification of physiological predictors. Our research group pioneered the application of 3D translational in vitro approaches to evaluate exercise effects in breast cancer survivors and to explore potential predictors of exercise-conditioned serum activity.
Methods: Thirty breast cancer survivors completed a 12-week lifestyle intervention (LI) including aerobic exercise training and educational counseling. A subset performed two acute exercise sessions at 40% heart rate reserve (HRR; Moderate EX) and 70% HRR (Vigorous EX). Sera collected before and after LI, and post-exercise, were used to stimulate triple-negative breast cancer (TNBC) cells and patient-derived organoids (PDOs) to assess 3D spheroid formation in semi-solid matrices.
Results: Compared to pre-intervention sera, LI-conditioned sera significantly reduced TNBC spheroid formation, indicating decreased tumorigenic potential. IGF-1 emerged as a significant predictor of these effects. Exercise-conditioned sera also showed less capacity to form TNBC cell spheroids, compared to those collected at rest. Particularly, the strongest effects were observed 3h post-Moderate EX (-14.3 ± 6.7%). Similar trends were partially confirmed in PDOs, supporting the translational relevance of these findings.
Conclusions: These results reinforce the potential of aerobic exercise interventions to control tumor progression and recurrence risk in breast cancer survivors. Translational in vitro models represent a promising tool to predict the role of exercise-induced metabolic and physiological changes, advancing knowledge in exercise oncology and supporting personalized exercise prescriptions.

Speaker: Prof. Mauro De Santi (Department of Biomolecular Sciences, University of Urbino Carlo Bo, Urbino, Italy)

147 Integrating Physical Activity and Diet into Mechanisms of Metabolic Dysregulation and Cancer Risk: Insights from the MeDOC Consortium

Obesity and associated metabolic dysfunction are increasingly recognized as major contributors to cancer risk across diverse populations. The National Cancer Institute’s Metabolic Dysregulation and Cancer Risk (MeDOC) Consortium brings together six transdisciplinary research teams to identify mechanisms linking metabolic perturbations to cancer development and to identify actionable strategies for prevention. Given the importance of lifestyle factors, MeDOC is integrating harmonized measures of physical activity and diet to characterize behavioral contributors to metabolic health. The International Physical Activity Questionnaire (IPAQ) was implemented for studies enrolling participants prospectively and MeDOC harmonized physical activity assessed via questionnaire in historical cohorts. With dietary intake captured by food frequency questionnaires (FFQs), MeDOC is jointly assessing the roles of diet and physical activity in relation to metabolic dysregulation and cancer risk. Data harmonization enables evaluation of dietary patterns, while also positioning physical activity as a primary determinant, mediator, or effect modifier of metabolically driven cancer risk. MeDOC’s scientific aims are advanced through five synergistic projects. A-FABP focuses on fatty acid–binding protein–mediated lipid dysregulation’s impact on breast cancer biology and tumor-associated macrophages. CerMet examines the role of ceramides in colorectal cancer risk and tests ceramide-lowering interventions. iDOC leverages well-characterized large cohorts and deep inflammatory proteomics profiling to identify pathways most representative of the metabolically unhealthy obese state associated with colorectal and liver cancers. REMEDY investigates metabolic and inflammatory drivers of early-onset colorectal cancer, with particular attention to populations experiencing metabolic obesity at lower BMI levels. WELCOM evaluates obesity-altered gut microbiome–immune interactions that may influence breast cancer initiation. The George Washington University-based Coordinating Center provides oversight of harmonization efforts, data infrastructure, and cross-project collaboration. MeDOC’s integrated behavioral, metabolic, and mechanistic approaches offer new opportunities to understand how physical activity and diet may counteract metabolic dysregulation to reduce obesity-associated cancer risk.

Speaker: Dr E. Angela Murphy (Department of Pathology, Microbiology, and Immunology, School of Medicine, University of South Carolina, Columbia, SC, USA)

148 On the Neuro-Fascial Interface: An Empirical Synthesis of Experimental and Clinical Evidence regarding the Role of Vagal Tone in Exercise Oncology

Background: Modern oncology excels in targeting tumor biology yet often struggles to quantify the "non-molecular" impact of psychological states on disease progression and recovery. While George Engel’s biopsychosocial model challenges this reductionism since 50 years, the precise physiological mechanisms linking socio-emotional distress for example to the tumor microenvironment - and conversely, tissue states to behavioral patterns - still remain underexplored in standard oncological care. This presentation addresses this gap by examining the neuro-fascial interface and exercise oncology as an effective mediator between socio-emotional states and somatic oncology.
Theoretical Framework: Building on the theoretical framework of the Neurovisceral Integration Model (NIM), we outline the physiological cascade whereby socio-emotional states can modulate peripheral homeostasis, fascial tissue, and organ functioning. Central to this framework is the vagus nerve, which mediates "top-down" regulation of organ function; vagal withdrawal impairs the Cholinergic Anti-inflammatory Pathway (CAIP), promoting a pro-inflammatory fascial microenvironment. Crucially, this axis is bidirectional: afferent signaling from inflamed, stiffened fascial tissue ("bottom-up") is implicated in perpetuating sickness behavior and Cancer-Related Fatigue (CRF).
Crucially, the NIM provides a unified framework for both pathogenic and salutogenic trajectories. Vagal tone, therefore, serves as a measurable proxy for the organism's regulatory capacity. Consequently, 'pro-vagal interventions' enhance this competence on a systemic level. Hence, the NIM framework and its described mechanism supports a multimodal approach, integrating movement, respiratory modulation, and metabolic control across the entire cancer continuum (prehabilitation through survivorship).
Outlook: This contribution serves as a theoretical synthesis, integrating robust evidence from animal models, human studies, clinical trials and meta-analyses. It establishes a mechanistic foundation for future research in exercise oncology by elucidating the reciprocal causality between physiology, immunology and disease progression. We propose that both, exercise and fascia can act as a critical regulator within this framework, offering a physiological lever to improve cancer-related outcomes.

Speaker: Dr Marc N. Jarczok (Clinic for Psychosomatic Medicine and Psychotherapy Ulm University Medical Center, Ulm, Germany)

149 Physical activity and the microbiota in cancer- what do we already know?

Background: Higher physical activity (PA) levels are associated with improved upper gastrointestinal (UGI) cancer outcomes. One possible mechanism that may enable better optimisation of PA is its effects on the gut microbiota (GM), and tumour/oral microbiomes. We aimed to identify gaps in evidence on the relationships between PA and 1) microbiota in cancer, and 2) UGI cancer and related microbiomes.

Methods: We identified keywords that enabled the finalised search strategy of English manuscripts using electronic databases (EMBASE, Pubmed, Web of Science, CINAHL) published up to 11/4/2025. The scoping review followed the PRISMA-ScR Checklist.

Results: Reviewing references and citations resulted in a total of 1,475 eligible studies. Initial screening and exclusion criteria revealed 44 full-text papers. Most studies were randomized controlled trials (n=26 of which 22 are protocols), followed by cohort prospective observational interventions (n=10 of which 1 is a protocol) and quasi experimental (n= 5 of which 2 are protocols). Finally, there was one literature review, one bibliometric analysis and one Mendelian randomization analysis. Within intervention/observation studies, tumours included: mixed solid tumours (n=6) including 2 studies with UGI, breast (n=13), colorectal (n=7), lung (n=2), melanoma (n=3), prostate/testicular (n=6), preclinical (n=3) and preclinical/human breast (n=1).

Conclusions: Although evidence is emerging describing the relationship between PA and GM in cancer, other key microbiomes in cancer patients have not been widely explored. Until this gap in the knowledge is addressed, improvements in cancer outcomes from PA will not progress. Future research should consider different tumour types, microbiomes, PA interventions, diet and other potential influencing factors.

Speaker: Isla Veal (Guy’s and St Thomas’ Foundation Trust, Department of Physiotherapy, London, UK.)

150 Prehabilitation as a biologically active intervention reprograms pancreatic tumor-immune microenvironment to enhance anti-tumor immunity

Background: Pancreatic ductal adenocarcinoma (PDAC) is a highly lethal malignancy, and many patients are unable to undergo curative surgery due to frailty. Multimodal prehabilitation programs, incorporating exercise, nutritional support, and psychological optimization, improve functional readiness, but their biological impact on the PDAC tumor microenvironment (TME) remains largely unknown.
Methods: In this exploratory pilot analysis, we profiled resected PDAC tissues from prehabilitation-treated patients and matched controls using NanoString GeoMx Digital Spatial Profiling across immune (CD45⁺), tumor (PanCK⁺), and stromal cellular compartments. Transcriptomic signatures were evaluated through differential expression, GO/KEGG pathway enrichment, and MCP-counter deconvolution. Protein-level assessment was performed by multiplex immunofluorescence in an independent cohort (n = 8). Cell–cell communication dynamics were examined using ligand–receptor modeling. Prognostic relevance of key signatures was assessed using TCGA-PDAC (n = 178).
Results: Prehabilitation was associated with increased NK-cell cytotoxicity, interferon response, and chemokine recruitment in immune regions. MCP-counter analysis indicated higher neutrophil signatures (p < 0.01) and reduced fibroblast signatures (p < 0.05). Tumor compartments exhibited lower MAPK, PI3K/AKT, and Ras pathway activity, while stromal regions showed decreased TGF-β and Wnt/Hippo signaling and transcriptional patterns consistent with enhanced immune interaction. Multiplex immunofluorescence supported increased neutrophil infiltration and reduced fibroblast density. Ligand–receptor modeling suggested strengthened NK–tumor and stromal–immune communication. In TCGA, patients with neutrophil-high/fibroblast-low profiles had significantly longer survival (1,044.6 vs. 458.7 days, p = 0.016).
Conclusion: This exploratory pilot study suggests that multimodal prehabilitation may be associated with a more immune-active and less fibrotic TME in PDAC. These profiles resemble transcriptional states linked to improved survival, highlighting the need for prospective studies integrating biological and clinical endpoints to further evaluate prehabilitation as a biologically active adjunct to PDAC management.
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Speakers: Renee Stubbins (Houston Methodist Neal Cancer Center), Dr Atiya Dhala, Dr Hong Zhao

151 Preliminary pharmacokinetic findings of integrating body composition & physical activity to predict paclitaxel induced dose-limiting toxicities in women with breast cancer: the PABTOX trial.

Background:
Paclitaxel (PTX) frequently causes dose-limiting toxicities (DLTs), notably chemotherapy-induced peripheral neuropathy and neutropenia, leading to reduced relative dose intensity (RDI). Body-surface-area dosing overlooks inter-individual variation in pharmacokinetics (PK), body composition, and physical activity (PA), potentially resulting in under- or overdosing, increased DLT risk, and reduced RDI, impacting the prognostic outcome.
Objective:
To explore whether favorable body composition and higher PA are associated with reduced PTX-related toxicities, and whether these associations are mediated by individual differences in PTX-PK, using data from the 20 participants of the PABTOX observational cohort.
Methods:
Women with stage I–IV breast cancer receiving weekly PTX (80 mg/m²; 12 cycles) are assessed at baseline (T0), cycle 3 (T1), cycle 6 (T2), cycle 9 (T3), and cycle 12 (T4). PK sampling occurs at T0, T1, T2, T3 and T4 at two timepoints (post-infusion ~10 min; 16–26 h) to determine PTX blood concentrations and half-life (Cmax and time > 0.05 µmol/L). Body composition is analyzed using dual-energy X-ray absorptiometry and bioelectrical impedance analysis at T0, T2, T3, and T4. PA is assessed by 7-day accelerometry and a validated questionnaire at T0, T2, T3 and T4. DLTs are graded each cycle (using the CTCAE v5.0).
Results:
Ongoing analyses will report PTX exposure distributions, and associations between skeletal muscle mass and adipose tissue, PA, PK parameters, and DLT occurence.
Conclusion:
Preliminary findings suggest that integrating PK with body composition and PA may help explain variations in PTX toxicities. The PABTOX study will further evaluate these associations, aiming for personalized supportive oncologic care.
Clinical impact:
If confirmed, incorporating body composition and PA into risk assessment could improve toxicity prediction and allow physiotherapists to identify high-risk patients, supporting timely interventions.

This trial is funded by Kom op tegen Kanker (Stand up to Cancer), a project of the Flemish Cancer Society (project ID: 13163).

Speaker: Prof. Nele ADRIAENSSENS (Rehabilitation Research (RERE) group of Vrije Universiteit Brussel (VUB) - Laarbeeklaan 121, 1090 Brussels, Belgium; Medical Oncology Department of Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium)

152 Preoperative Metabolic Inflexibility Predicts Impaired Plasma Metabolite Clearance Following Radical Cystectomy

Introduction:
Metabolic flexibility is a key determinant of physiological resilience and predictor of complications following radical cystectomy. We hypothesize that the change in the metabolomic profile of cystectomy patients throughout the perioperative period is associated with metabolic flexibility, as determined by preoperative carbohydrate oxidation (CHOox) (g/min).

Methods:
We retrospectively analysed changes in 538 plasma metabolites pre-to-post cystectomy (three-month interval) in N = 17 adult patients from an IRB-approved study (Duke IRB Pro00103570) who underwent preoperative CPET. Metabolites were measured using the MxP Quant 500 kit (Biocrates, Innsbruck, AUT). CHOox was derived from CPET measurements using standardised nonprotein respiratory exchange ratios, with AUC calculated to anaerobic threshold. Patients were stratified by median split into high and low CHOox AUC groups (n = 8, n = 9). Differential metabolite changes were assessed using Mann-Whitney U tests with exploratory FDR correction (q < 0.2).

Results:
For all ten significant metabolites (q < 0.2), low CHOox capacity was associated with longitudinal metabolite differences, and increases in concentrations. Median lactate (+0.63-fold vs -0.78-fold, q = 0.1402, low vs high CHOox) and glutamate (+0.25-fold vs -0.29-fold, q = 0.1992) reflect changes in carbohydrate oxidation. Long-chain acylcarnitines C16 (+0.23-fold vs -0.15-fold), C18:1 (+0.23-fold vs -0.13-fold), C18:2 (+0.17-fold vs -0.09-fold) (q = 0.1402) indicate changes in fatty acid oxidation and mitochondrial fat transport. Lysophosphatidylcholines C16:0 (+0.73-fold vs -0.71-fold, q = 0.1475), C17:0 (+0.38-fold vs -0.49-fold, q = 0.1475), C18:0 (+0.66-fold vs -0.78-fold, q = 0.1402) and glycosylceramides Hex2Cer d18:1/24:1 (+0.06-fold vs -0.09-fold, q = 0.1402), d18:1/24:0 (+0.02-fold vs -0.08-fold, q = 0.1475) reflect alterations in lipid processing and tissue uptake.

Conclusion:
Low preoperative CHOox predicts persistent metabolite accumulation across multiple pathways, indicating sustained and worsened substrate processing deficits following cystectomy. This identifies metabolic inflexibility as a mechanistic driver of perioperative dysfunction and a specific prehabilitation target.

Speaker: Mr Thomas Boucher ((1) Hawkes Institute, UCL, London, UK, (2) Department of Medical Physics and Biomedical Engineering, UCL, London, UK, (3) Human Physiology and Performance Laboratory (HPPL), Division of Surgery and Interventional Science, Department of Targeted Intervention, Centre for Peri-operative Medicine, UCL, London, UK)

153 Risk reduction of cancers from a high physical activity level is associated with predicted tumour neoantigen count

Background: The magnitude of cancer risk reduction from physical activity is highly heterogeneous across different cancer types. Preclinical studies indicate that regular exercise enhances anti-tumour immunity, leading to the elimination of immune-susceptible tumour cell clones. Whether this mechanism explains variable risk reduction across clinical cancer types in physically active humans remains uncertain. Purpose: To determine whether variance in cancer risk reduction associated with physical activity relates to the immunogenomic landscape of tumour types, by integrating findings from large prospective cohort studies of lifestyle and cancer incidence with tumour multi-omics atlases. Methods: We performed a mixed effects meta-regression of published pooled clinical cancer incidence hazard ratios (HR) of 20 different cancers comparing high-vs-low (90th vs 10th percentile) leisure time physical activity levels from 12 prospective lifestyle cohort studies (Moore et al., 2016), against the immunogenomic profiles of >10,000 tumours across 20 corresponding cancer types in The Cancer Genome Atlas (TCGA). Immunogenomic variables included predicted tumour mutational burden, predicted neoantigen count, and tumour infiltration scores for immune cells. Results: A greater cancer incidence risk reduction from high-vs-low physical activity was associated with a higher median neoantigen count of corresponding cancers in TCGA ($\beta $=−0.0018, P<0.0001), accounting for 61.27% of the between-cancer variance in risk reduction, with each increase of 25 neoantigens associated with 4.5% greater cancer risk reduction. Similar, though weaker, associations were observed for TMB (R2=42.43%, $\beta$=−0.0417, P=0.0034). Conversely, key intra-tumoural immune measures including CD8+ T-cells and other immune effectors, showed weak or no relationships with physical activity HRs, perhaps reflecting immune dysfunction/failure within clinically manifested tumours in the TCGA cohort itself. Conclusion: Risk reduction of cancers from high-vs-low physical activity is linked to the predicted neoantigen burden of corresponding clinically detected cancers. These findings support the hypothesis that adaptive immunity contributes to the anti-cancer effects of physical activity in humans.

Speaker: John Campbell (University of Bath)

154 Running session-conditioned human serum reduces cancer cell spheroid formation

INTRODUCTION: Cancer remains a significant burden. Despite advances in diagnosis and treatment improving survival, recurrences are common. Observational studies suggest that physical activity (PA) is associated with lower cancer recurrence, but the linking biological mechanisms remain poorly understood. This study evaluated the effects of two acute running sessions (5 km and 10 km) on the modulation of spheroid formation capacity of triple-negative breast cancer (TNBC) cells.
METHODS: 14 healthy women (mean age 46.1±8.6 years; body mass index 22.4±2.2 kg/cm2) performed a 5 km- and a 10 km-long running session, interspersed by 2 weeks of wash-out time. The spheroid formation capacity of TNBC was evaluated in vitro using a 3D assay technique, stimulating cells with human sera collected before (PRE), after (POST), and 3 hours after exercise (POST-3h). After a 3-week incubation, spheroid formation was quantified through an automated imaging and analysis system for spheroid count.
RESULTS: In both running sessions, stimulation with POST and POST-3h sera resulted in a significant reduction in TNBC spheroid formation, compared with PRE sera, with the greatest effect observed with POST-3h sera. The latter collected after the 5 km run induced a >5% reduction in spheroid number in all participants (mean reduction 14.5±6.2%), compared with PRE sera. Comparable effects were observed after the 10 km run (>5% reduction in 13/14 sera; mean reduction 18.8±8.9%). No significant differences were found between the two runs.
CONCLUSIONS: These results align with our previous studies on prostate cancer cells exposed to running-conditioned sera, suggesting that acute exercise may reduce cancer tumorigenic potential, helping explain the link between PA and lower recurrence. Ongoing studies are expanding the cohort by enrolling additional female runners, and the collected sera are currently being tested on lung cancer cell models. These additional data will further clarify the systemic anticancer effects of acute exercise.

Speaker: Asja Conti (University of Urbino)

Poster_ISEO_Definitivo_Conti.pptx

155 Short-term metabolic and physical adaptations to low-carbohydrate time-restricted feeding with and without exercise

Background: Carbohydrate restriction and time-restricted feeding (TRF) have independently shown beneficial effects on metabolic health, including improvements in insulin sensitivity, body composition, and lipid metabolism. However, the combined effects of these dietary interventions with structured exercise on metabolic parameters and lipid profiles remain uncertain. This study investigated whether exercise participation enhances metabolic adaptations during a combined low-carbohydrate TRF intervention in healthy adults.
Methods: Twenty-seven healthy adults were randomly assigned to an exercise group (n=13) or control group (n=14). All participants followed a 2-week 16:8 TRF protocol with a low-carbohydrate diet. The exercise group performed six supervised sessions consisting of 30-minute bodyweight resistance exercises followed by 30-minute Zone 2 running, three times weekly. Comprehensive assessments included body composition, muscular strength, cardiorespiratory fitness, glucose metabolism markers, and lipid profiles at baseline, day 7, and day 14.
Results: Twenty-five participants completed the protocol. Both groups showed significant improvements in body weight (-1.47±1.06 kg), fat mass (-0.99±0.86 kg), blood pressure, fasting glucose, and insulin sensitivity (all p<0.001). Notably, the exercise group demonstrated preserved muscle mass and greater fat mass reduction compared to the diet-only group. Furthermore, leg press strength significantly improved only in the exercise group (p=0.016), with a trend toward improved VO2max (p=0.053). The proportion of larger LDL particles increased significantly in both groups. No significant group×time interactions were observed for metabolic parameters.
Discussion: The combined low-carbohydrate TRF intervention rapidly improved metabolic parameters and favorably shifted LDL particle distribution toward larger, less atherogenic subfractions. Exercise provided additional benefits in preserving lean mass and improving muscular strength and cardiorespiratory fitness. These findings suggest that timing and composition of food intake may offer targeted strategies to improve cardiometabolic health beyond conventional approaches.

Speaker: Mr Eun Chan Kim (Yonsei university)

156 Subtype-Specific Molecular Responses of Breast Cancer Cells to High-Intensity Interval Exercise-Conditioned Human Serum

Background: Exercise exerts antitumor effects through acute systemic responses that modulate tumor biology. In particular, high-intensity interval exercise (HIIE) induces transient changes in circulating factors that may influence cancer cell behavior. However, the underlying molecular mechanisms, subtype specificity, and temporal dependence remain incompletely understood.
Methods: Physically inactive women completed a single HIIE session. Blood lactate and circulating 17β-estradiol were measured before and after exercise. Pre- and post-HIIE serum was used to culture MCF-7 and MDA-MB-231 breast cancer cells under two paradigms: continuous exposure and repeated short daily pulses (3 h). Cell viability, apoptosis, and necrosis were assessed by biochemical assays, Western blotting, and flow cytometry. Estrogen receptor α signaling, inflammatory pathways, and growth-related signaling were analyzed by Western blot. Transcriptomic profiling was performed by RNA sequencing followed by GSEA using Hallmark and MitoCarta 3.0 collections.
Results: HIIE increased blood lactate and reduced circulating 17β-estradiol. In MCF-7 cells, continuous exposure to post-HIIE serum decreased ERα phosphorylation at Ser167 while increasing phosphorylation at Ser118. Continuous exposure did not affect viability or apoptosis, despite reduced 4E-BP1 phosphorylation in MDA-MB-231 cells and decreased MyD88 and p-NF-κB levels in both subtypes. MCF-7 cells showed enrichment of estrogen response, oxidative phosphorylation, DNA repair, and mitochondrial pathways, accompanied by downregulation of inflammatory and apoptosis-related programs. In contrast, MDA-MB-231 cells exhibited enrichment of cell-cycle programs with negative enrichment of oxidative phosphorylation, mitochondrial, and interferon-α–related signaling. Repeated short daily pulses of post-HIIE serum reduced viability at 48 h and 72 h in both cell lines, more markedly in MCF-7 cells.
Conclusions: HIIE-conditioned human serum induces subtype- and time-dependent modulation of tumor cell signaling. Continuous exposure alters estrogen, inflammatory, and mitochondrial pathways without overt cell death, whereas transient repeated exposure elicits antiproliferative effects, underscoring the importance of temporal dynamics when modeling exercise-induced systemic influences.

Speakers: Dr Mayalen Valero Breton (Institute of Health and Sport Sciences, Faculty of Health Science, Universidad Francisco de Vitoria. Madrid, Spain), Mr Pablo Ledesma Roncero (Faculty of Experimental Sciences, Universidad Francisco de Vitoria. Madrid, Spain)

157 Tissue blood flow at rest and during exercise in lymphoma and breast cancer patients

INTRODUCTION:
Blood flow (BF) during exercise in non-cancerous tissues in patients may among other things play a role in the development of metastasis, but remains poorly understood. Therefore, the main aim of the present investigation was to determine tissue BF responses in multiple organs during exercise.
METHODS:
Tissue blood flow responses during exercise were analyzed in patients with Hodgkin or non-Hodkin lymphoma (n=8) and breast cancer (n=20) with [15O]-H2O positron emission tomography (PET). PET/CT scans were performed at rest, and during supine cycling for 10 minutes at the individuals chosen intensity by Borg (RPE 11-16). BF was analyzed from vertebra, spinal cord, subcutaneous fat, lungs, sternum, bone and non-exercising muscle. Furthermore, spleen, liver and kidney BF were measured if they were located in the imaging area.
RESULTS: In patients with lymphoma, BF responses in all the analyzed tissues were largely unchanged during cycling. However, in patients with breast cancer the BF in the following tissues was decreased during exercise (mean ± standard deviation at rest and during exercise, respectively): 0.083 ± 0.060 ml/(ml/min) and 0.053 ± 0.059 ml/(ml/min), p < 0.01: spinal cord, spleen 0.783 ± 0.368 ml/(ml/min) and 0.466 ± 0.197 ml/(ml/min), p = 0.01 and liver 0.41 ± 0.15 ml/(ml/min) and 0.30 ± 0.15 ml/(ml/min), p < 0.01. In contrast, BF in the following tissues was increased during exercise: intercostal muscle 0.037 ± 0.024 ml/(ml/min) and 0.055 ± 0.026 ml/(ml/min), p = 0.010 and costal bone 0.047 ml/(ml/min) ± 0.026 ml/(ml/min) and 0.061 ml/(ml/min) ± 0.026 ml/(ml/min), p = 0.046. Other measured tissue BF remained unchanged during exercise in breast cancer patients.
CONCLUSION:
According to our results, tissue blood flow is reduced in spinal cord, spleen and liver, but increased in breathing-associated thorax tissues, intercostal muscle and costal bone, during exercise in breast cancer patients.

Speaker: Ms Venny Laitinen (Turku PET Centre)

158 Understanding the Mechanisms underlying the effects of Exercise on Cancer-Related Fatigue: A Systematic Review of Randomized Controlled Trials

Cancer-related fatigue (CRF) affects the majority of patients during or after cancer treatment and can persist long after treatment completion. Although exercise is the most effective non-pharmacological strategy to reduce CRF, its underlying mechanisms remain unclear. This review synthesizes evidence from randomized controlled trials (RCTs) on biological, behavioural,psychological, social, and physiological mechanisms through which exercise may reduce CRF.

A systematic review was conducted following PRISMA guidelines and a PROSPERO-registered protocol. PubMed, Cochrane Library, and Embase were searched (March 27, 2025) for RCTs in adults with cancer comparing structured aerobic and/or resistance exercise with usual care, stretching, or waitlist controls. Two reviewers independently screened studies and extracted data on CRF outcomes and mechanisms. The mechanisms were categorized through a narrative synthesis.

Sixteen RCTs were included (N= 22-277), eight during cancer treatment and eight post-treatment. Most interventions involved supervised, 12-week resistance and/or aerobic exercise. Biological mediators were assessed in eleven studies (6 during and 5 post-treatment), of which three reported significant mediation effects for IL-6, IL-10, and inflammatory ratios (e.g., IL-6/IL-10, TNF-α/IL-10). Behavioural mechanisms, particularly physical activity outside the intervention, significantly mediated fatigue reductions in two post-treatment studies. Psychological mechanisms including general self-efficacy and sleep dysfunction were significant mediators in two studies post-treatment. One study examined social mechanisms (perceived exercise support and physical activity enjoyment) that reported mediation effects. Physiological mechanisms were examined in four post-treatment studies; two reported that increases in muscle strength mediated the effects of exercise on CRF, while two others reported mediating effects for improvements in cardiorespiratory fitness.

Exercise appears to reduce CRF through multiple mechanisms, including inflammatory ratios, behavioural changes, psychological improvements, and enhanced physical fitness. Findings were limited by small samples, heterogeneous measures, and temporal-order and confounding biases. Future trials should be prospectively designed for mediation testing with repeated measurements to clarify how these pathways interact.

Speaker: Janine Krans (UMC Utrecht - Julius Centre)

Poster Session 2.2: Gastrointestinal / Lung / Hematalogy / Advanced Cancer (Posterarea 2)

159 A cross sectional study evaluating physical activity its relationship with functional status and quality of life in newly diagnosed patients with thoracic cancer

Introduction: In lung cancer, physical activity may help to manage treatment-related side effect thus improving treatment tolerance. However, a cancer diagnosis often triggers behavioral shifts that may contribute to increase the sedentary habits and reduce physical activity. This study esplored physical activity levels, nutritional and sarcopenia risk, and cardiorespiratory fitness (CRF) in patients recently diagnosed with thoracic cancer, and to analyze their relationship with quality of life (QoL).
Methods: This cross-sectional study was conducted at the Oncology Unit of the University of Verona. Patients with a recent thoracic cancer diagnosis were invited to complete a questionnaire evaluating physical activity, using the Godin-Shephard Questionnaire, CRF (FitMáx tool), nutritional risk (Nutrition Risk Screening - NRS-2002), sarcopenia risk (SARC-F), body mass index (BMI) and QoL through the Functional Assessment of Cancer Therapy – Lung (FACT-L). Descriptive statistics, absolute frequencies, and Pearson correlation analyses were performed.
Results: A total of 96 patients (52 males and 44 females; mean age: 68.8 years). The most common subtype was non small-cell lung cancer (90%), and 65% with an advanced stage of disease. At the time of diagnosis, 91% of patients were physically inactive, 42% were at nutritional risk, and 67% exhibited low CRF. An inverse correlation was observed between BMI with nutritional risk (rs = –0.313, p = 0.003) and CRF (rs = –0.402, p = 0.001). CRF showed a moderate correlation with FACT-TOI (rs = 0.267, p = 0.029), FACT-L (rs = 0.273, p = 0.025), BMI (rs = –0.402, p = 0.001), and sarcopenia risk. Sarcopenia, was also negatively related to FACT-TOI (rs = –0.369, p = 0.002), FACT-G (rs = –0.292, p = 0.013), FACT-L (rs = –0.333, p = 0.005).
Conclusion: In newly diagnosed patients with thoracic cancer, low physical activity, CRF, and high nutritional risk were common, and are associated with QoL.

Speaker: Christian Ciurnelli (University of Verona)

160 A prospective investigation of early-onset colorectal cancer risk factors–pooled analysis of three large-scale European cohorts

Background
Colorectal cancer (CRC) incidence is rising among adults under 55 years, but its causes remain unclear. Large-scale prospective studies are needed to identify risk factors for early-onset CRC (EOCRC).
Methods
We pooled three large European prospective cohort studies, examining 14 known or suspected risk factors with EOCRC (diagnosed <55 years, N = 1369) and later-onset CRCs (LOCRC) (diagnosed ≥55 years, N = 13,490). Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs).
Results
Higher body mass index (BMI, per 5 kg/m2 increase), was strongly associated with EOCRC in men (HR 1.33, 95% CI: 1.18–1.51), particularly for early-onset colon cancer (HR 1.55, 95% CI: 1.32-1.82), compared to later-onset disease (HR 1.25, 95% CI: 1.19–1.31) (Phet = 0.01). Weaker associations with BMI were observed for women and rectal cancers. Similar sex and subsite specific trends were observed for waist circumference and waist-to-hip ratio. Current smoking (HR 1.24, 95% CI: 1.07–1.44) and alcohol use (HR 1.15, 95% CI: 1.06–1.25) increased EOCRC risk, and physical activity (HR 0.71, 95% CI: 0.54–0.95) was protective.
Discussion
Adiposity, physical inactivity, smoking, and alcohol consumption are risk factors for EOCRC. Risk factors were largely similar between EOCRC and LOCRC, except for adiposity, with stronger EOCRC association in men.

Speaker: Kristin Benjaminsen Borch (UiT The Arctic University of Norway)

161 Baseline Physical Function Predicts Toxicity Outcomes After Chimeric Antigen Receptor T-Cell Therapy in Non-Hodgkin Lymphoma

Background
Baseline physical function may predict the toxicity of chimeric antigen receptor (CAR) T-cell therapy. The MD Anderson Cancer Center (MDACC) prehabilitation program evaluates older adults prior to CAR T-cell therapy to assess baseline physical function and optimize physical activity.
Objective
To evaluate the association of baseline physical function with the risk of CAR T-cell toxicity outcomes in non-Hodgkin lymphoma (NHL) patients.
Methods
This is a retrospective single-center study of NHL patients at MDACC evaluated in the prehabilitation program before CAR T-cell therapy. Baseline physical function measures included 6-minute walk test, five times sit to stand, 10-meter walk test, timed up and go test, activity measure for post-acute care (AM-PAC), and Edmonton Symptom Assessment Scale. Associations with cytokine release syndrome, immune effector cell-associated neurotoxicity syndrome, hospital length of stay, ICU admission, discharge disposition, and 90-day readmission were assessed with multivariable logistic regression models.
Results
A total of 131 patients with median age of 73 years (range 52-86) were included. The majority had large B-cell lymphoma, followed by mantle cell lymphoma, and follicular lymphoma. In the multivariable model, shorter 6MWT, slower 10MWT and longer TUG were associated with increased risk of ICANS. Shorter 6MWT and slower 10MWT were associated with longer LOS. Patients with TUG ≥12 seconds had higher risk of ICU admission and non-home discharge disposition. In contrast, 5XSTS, AM-PAC score, and ESAS showed no significant association to outcomes.
Conclusion
Baseline physical function by 6MWT, 10MWT and TUG independently predicted risk of ICANS and LOS in patients receiving CAR T-cell therapy for NHL. TUG was associated with increased risk of ICU admission and non-home discharge. Prospective studies are needed to determine whether interventions aimed at improving physical function can improve outcomes with CAR T-cell therapy.

Conflict of Interest: None

Speaker: Rhodora Fontillas (MD Anderson Cancer Center)

162 Cardiopulmonary Fitness, Postoperative Complications, and Length of Stay Following Robotic-Assisted Colorectal Cancer Surgery

Background
Robotic-assisted colorectal cancer (CRC) surgery is increasingly adopted due to improved surgical precision and recovery profiles, yet postoperative complications remain common. Cardiopulmonary exercise testing (CPET) provides objective measures of physiological reserve, but it is unclear which CPET-derived parameters are most clinically informative for risk stratification in robotic CRC surgery.

Methods
This pilot analysis examined associations between CPET-derived fitness measures and postoperative outcomes following robotic-assisted CRC surgery. Anaerobic threshold (AT) and peak oxygen uptake (peak VO₂) were expressed relative to body mass. Complications were classified as present or absent and as minor or major (Clavien Dindo classification). Length of stay (LOS) was recorded in days. Associations were examined using age and sex adjusted logistic regression, with non-parametric analyses for LOS.

Results
Fifty-seven patients (mean age 70 ± 8 years) underwent robotic-assisted CRC surgery; 23 (40%) developed postoperative complications. Median AT and peak VO₂ were 12.0 (IQR 3.4) and 17.1 (IQR 3.9) ml·kg⁻¹·min⁻¹, respectively.
In adjusted models, AT was associated with postoperative complication status (likelihood ratio test p = 0.045), whereas peak VO₂ was not. Female sex independently predicted reduced complication risk (p = 0.003). Neither AT nor sex was associated with complication severity.
Median LOS was longer in patients with complications (6.0 [IQR 8.5] vs 3.0 [IQR 3.0] days; p = 0.050). AT showed a weak inverse association with LOS (ρ = −0.22, p = 0.095).

Conclusions
In robotic-assisted CRC surgery, lower submaximal cardiopulmonary fitness assessed by AT is associated with postoperative complication risk, whereas lower peak VO₂ is not. These findings support the relevance of AT for perioperative risk stratification and exercise-based prehabilitation in robotic surgical pathways.

Speakers: Dr Mia Burleigh (University of the West of Scotland), Mr James Saldanha (University Hospital Hairmyres)

163 Cardiorespiratory fitness and muscle strength responses to exercise in advanced lung cancer: a systematic review and meta-analysis

Background: Exercise is increasingly integrated into supportive care for lung cancer, but objective evidence for patients with advanced disease remains limited. We synthesized randomized trials to quantify the effects of exercise on cardiorespiratory fitness and muscle strength in advanced lung cancer.
Methods: PubMed, the Cochrane Library, Web of Science, and CINAHL were searched up to June 28, 2024. Randomized controlled trials enrolling patients with advanced lung cancer and testing an exercise intervention were included. This analysis focused on cardiorespiratory fitness and muscle strength. Effect sizes were pooled as standardized mean differences with 95% confidence intervals using a random effects approach. Subgroup analyses were conducted by fitness assessment (VO2peak vs 6-minute walk test) and strength assessment site (lower limb, upper limb, trunk).
Results: Nine trials met the eligibility criteria. Exercise improved VO2peak compared with control (3 studies, n = 171; SMD 0.38; 95% CI 0.08 to 0.68; I2 = 0%). In contrast, no clear effect was observed for 6-minute walk distance (6 studies, n = 268; SMD 0.24; 95% CI −0.37 to 0.86; I2 = 77%). In an exploratory comparison, trials prescribing higher overall training volumes tended to show clearer gains in VO2peak. For muscle strength, exercise increased lower limb strength (4 studies, 6 datasets, n = 360; SMD 0.91; 95% CI 0.25 to 1.56; I2 = 84%), upper limb strength (3 studies, 4 datasets, n = 221; SMD 1.13; 95% CI 0.52 to 1.75; I2 = 68%), and trunk strength (2 studies, 3 datasets, n = 191; SMD 0.71; 95% CI 0.28 to 1.14; I2 = 34%).
Conclusion: In advanced lung cancer, exercise improves VO2peak and muscle strength, supporting incorporation of exercise into routine cancer care. Future trials should compare exercise modalities and doses, standardize outcome assessment, and determine how gains in VO2peak and strength translate into clinically meaningful endpoints.

Speakers: Prof. Eisuke Ochi (Hosei University), Dr Takuya Fukushima

164 Clinical Concerns and Functional Changes In Adults With Hematologic Malignancies Undergoing CAR T-cell Therapy

Chimeric antigen receptor T-cell therapy (CART), used to treat hematologic malignancies, including multiple myeloma (MM) and diffuse large cell B lymphoma (DLBCL), offers a chance of lasting remission for relapsed and refractory disease. Unfortunately, symptom burden can be high and impact clinical outcomes and functionality, leading to impaired patient quality of life. PURPOSE: Assess longitudinal clinical concerns and functional changes in adults diagnosed with DLBCL or MM scheduled for CART. Addressing these issues will help determine appropriate supportive care modalities. METHODS: Participants were recruited from UPMC Hillman Cancer Center in Pittsburgh, PA and were assessed before infusion, post-infusion discharge, +30 days after CART, and +90 days after CART. RESULTS: Twenty-five patients enrolled– 75% male, 71% DLBCL, and an average age of 67 years. CART candidates had an average of 12.8 days (6-48 days) from enrollment to CART admission and spent approximately 12.21 days inpatient following infusion (6-27 days). “Improving Physical Strength” was a top three concern amongst 76% of patients; yet only 36% of patients reported discussions on exercise with their healthcare team and 27% were referred to exercise services prior to CART. For the six-minute walk test, 94% of participants failed to walk 400 meters, a prognostic marker for non-relapse mortality and overall survival. For the 30-second chair stand test, 71% of men and 29% of women were categorized as a fall risk based on age- and sex-matched scores for adults 65 – 69 years. For the SPPB, participants averaged a score of 9.23 – 9.60 from baseline to 90-days post-CART, below the risk score of 10, indicating an increased risk of all-cause mortality. CONCLUSION: Although patients demonstrated natural functional recovery, there are numerous outstanding clinical, functional, and patient-centered concerns that remain to be explored. More research is needed to determine the role of exercise throughout the CART journey.

Speaker: Adeline Farrington (University of Pittsburgh)

165 Effect of postoperative exercise on bowel function in patients with stage 1-3 colorectal cancer: a randomized controlled trial

Background: Postoperative bowel dysfunction—including increased bloating, fecal incontinence, and embarrassment—is highly prevalent among colorectal cancer survivors and substantially impairs quality of life. Although exercise has shown promise for improving bowel motility, pelvic floor function, and overall physical recovery, little is known about which types of exercise are effective during the period when bowel dysfunction is most severe—specifically, from immediately after surgery to before adjuvant therapy. This study examined the effects of a structured postoperative exercise intervention on bowel function in patients with stage I–III colorectal cancer.
Methods: Thirty-two patients who underwent curative colorectal cancer surgery were recruited, and 28 participants were included in the final analysis. Participants were randomly allocated (1:1) to an exercise or usual-care control group using simple randomization. The intervention consisted of in-hospital bed-based exercises performed twice daily for 5–6 days, followed by supervised home-based core exercises delivered twice weekly for three weeks via video calls. The primary outcome was a composite bowel dysfunction score derived from core items of the EORTC QLQ-CR29, integrating bowel frequency, gas, bloating, fecal incontinence, and embarrassment.
Results: The exercise group demonstrated substantial improvements in bowel function, with composite scores decreasing from 70.0±102 at baseline to 18.9±23.5 post-intervention. In contrast, the control group exhibited worsening symptoms, with composite scores increasing from 98.7±75.9 to 182.1±167.3. Among composite components, embarrassment showed a particularly distinct between-group difference (exercise: 6.7±18.7 → 0.0±0.0; control: 2.6±9.2 → 43.6±43.9).
Conclusion: This randomized controlled trial indicates that a postoperative exercise program can significantly improve bowel function and prevent symptom deterioration in colorectal cancer patients. However, most participants presented with relatively mild baseline symptoms, and the small sample size and short follow-up restrict the generalizability of these findings. Larger and longer-term trials are warranted to validate the role of exercise-based interventions during early postoperative recovery.

Speaker: Bo Yeon Kim (Department of Sport Industry Studies, Yonsei University, Seoul, Korea)

166 Effectiveness of implementing a supervised physical exercise program in the clinical care of patients with lung cancer

INTRODUCTION:Patients with lung cancer often experience treatment-related physical deterioration, including reduced cardiorespiratory capacity, muscle strength, and functional performance, as well as unfavorable changes in body composition, negatively affecting quality of life.

OBJECTIVE:To analyze the effects of a supervised exercise program implemented in a community setting for patients with lung cancer, and to examine differences in response between patients with and without metastatic disease.

METHODS: A pre–post study without a control group was conducted at the AECC Exercise Unit (Madrid, 2021–2025). Participants underwent an individualized, supervised, moderate-to-vigorous concurrent training program. Functional capacity was assessed using the 30-Second Sit-to-Stand Test; maximal strength through bench press and leg press; cardiorespiratory fitness via estimated VO₂max from a submaximal treadmill test; and body composition using bioelectrical impedance analysis. Physical activity levels and quality of life were evaluated with validated questionnaires (IPAQ, FACT-G, FACT-F, EQ-5D-5L). Data normality was assessed, and pre–post differences were analyzed using paired t-tests or non-parametric equivalents. Comparisons between metastatic and non-metastatic patients were performed using independent t-tests. Statistical significance was set at p < 0.05.

RESULTS: Thirty-nine patients participated, with a mean attendance rate of 79.8%. Mean age was 59.5 ± 8.9 years, and 65% had metastatic disease. Significant improvements were observed post-intervention in VO₂max (+8.1 ± 4.8 ml/kg/min), upper-body strength (+11.9 ± 6.9 kg), lower-body strength (+29.9 ± 20.2 kg), and functional performance (+5.9 ± 3.5 repetitions) (all p < 0.001). Fat mass and visceral fat area decreased significantly, while phase angle increased, with no significant changes in body weight or muscle mass. No differences were found between metastatic and non-metastatic patients.

DISCUSSION AND CONCLUSIONS:An eight-week supervised community-based exercise program was feasible and effective in improving physical fitness, functional capacity, and body composition in patients with lung cancer, regardless of disease stage, supporting its integration as a complementary therapeutic strategy.

Speaker: Ángel Carrasco Carretero (Oncology Physical Activity Unit (Spanish Association Against Cancer) (AECC).)

167 Effects of Early Postoperative Exercise on Body Composition After Gastrectomy: Secondary Analysis of a Randomized Clinical Trial

Background: Patients with gastric cancer experience progressive muscle loss after surgery. Postoperative sarcopenia has been associated with increased mortality and complications; however, the effects of exercise on body composition after gastrectomy remain unclear.

Objective: To evaluate the effects of an early postoperative exercise program on CT-measured skeletal muscle area in patients following gastrectomy.

Methods: This secondary analysis of a randomized clinical trial was conducted from January 2023 to July 2024 at a tertiary center in Seoul, Korea. Fifty-two patients with stage I–III gastric cancer undergoing minimally invasive gastrectomy were randomized to exercise or usual care (1:1). The exercise group received supervised inpatient sessions on postoperative days 1–2, followed by a 4-week home-based program. Body composition was assessed via CT at the L3 level at baseline and 6 months postoperatively. Outcomes included skeletal muscle area, visceral fat area, and subcutaneous fat area (cm²).

Results: Of 52 randomized participants, 38 (exercise, n=20; usual care, n=18) with available CT data were analyzed; 14 were excluded due to unavailable follow-up CT. Skeletal muscle area decreased in both groups from baseline to 6 months (exercise: 123.3±35.28 to 120.3±34.47 cm²; usual care: 129.2±29.57 to 120.7±26.78 cm²), with no significant between-group difference (interaction P=.220). Visceral and subcutaneous fat areas also showed no significant differences (P=.323 and P=.978, respectively). In subgroup analyses, muscle mass tended to be better maintained in the exercise group among males (P=.078) and patients aged ≤60 years (P=.054).

Conclusion: Early postoperative exercise did not significantly preserve skeletal muscle area at 6 months after gastrectomy. However, hypothesis-generating subgroup findings suggest potential benefits in males and younger patients, which may inform tailored exercise strategies in future trials.

Speaker: Taeho Lee (Yonsei University, Seoul, Republic of Korea)

168 Expert consensus on physical activity promotion in survivors of locally advanced head and neck cancer in Switzerland: Preliminary results of a Delphi study

ABSTRACT
Background: Higher levels of physical activity (PA) are associated with better quality of life in survivors of head and neck cancer (sHNC). Nevertheless, many sHNC exhibit sedentary behaviour or engage in very low activity levels. Particularly those with advanced disease are challenged by the sequelae of their extensive treatment regimens. Switzerland lacks guidelines on implementing PA in this patient population. Therefore, this Delphi study aims to generate expert consensus on the delivery of PA promotion within the Swiss hospital-based care pathway from diagnosis to survivorship.

Methods: A multiprofessional panel of clinicians is invited to a three-round online Delphi survey. In the first round participants rated and commented statements on optimal strategies for PA promotion in sHNC diagnosed with advanced-stage cancer. Additionally open-ended questions explored missing items. New items from comments and open questions are added to the second round of this ongoing study. Consensus was defined as ≥80% or ≤20% agreement. Statements not reaching consensus in the second round will undergo forced decision in the third round to derive the final set of recommendations.

Preliminary results: Fifty experts in treating sHNC participated in the first round of the Delphi study. The panel answered twelve open questions and rated 85 statements on screening, assessing, and coordinating necessary PA support. Consensus was reached on 55 statements. Topics that did not reach consensus or were frequently stated in the comments included prehabilitation, the frequency and format of screening, as well as concerns regarding limited time resources and additional burden on patients and professionals.

Clinical implications: The study will generate expert-informed recommendations on delivering PA promotion to sHNC. These recommendations will provide practical guidance for integrating PA into routine care pathways in Switzerland.

Speaker: Martina Schmocker (University of Zurich, Faculty of Medicine, Zurich, Switzerland Cantonal Hospital Winterthur, Institute for Therapies & Rehabilitation, Winterthur, Switzerland)

169 Functional Performance Differences Between Patients With Advanced Colorectal Cancer Before Chemotherapy and Age-Matched Older Adults: A Comparative Cross-Sectional Analysis Using Handgrip Strength, Timed Up and Go, and Sit-to-Stand Tests

Background
Aging is associated with progressive declines in muscle strength and mobility, which may be exacerbated in individuals with cancer due to disease-related systemic inflammation, metabolic dysregulation, and accelerated muscle catabolism. In colorectal cancer, tumor-driven cytokine activity, decreased nutritional intake, and reduced habitual physical activity may further compromise muscle strength and mobility even before treatment begins. Evaluating baseline physical function is clinically relevant, as diminished neuromuscular capacity prior to chemotherapy is associated with higher risk of treatment toxicity, delayed recovery, hospitalization, and reduced overall survival.
Aim
To compare baseline functional performance between older adults with advanced colorectal cancer awaiting chemotherapy and age-matched older adults without cancer.
Methods
In this cross-sectional study, older adults were allocated into two groups: colorectal cancer group (CRC – stages III and IV; n=10; 62.8 + 10.9 years) and non-cancer control group (NCG; n=8; 67.125 + 4.35 years). Maximal handgrip strength was assessed using a standardized dynamometry protocol. Functional mobility was measured with the Timed Up and Go (TUG) test, and lower-limb function with the 30-second Sit-to-Stand (STS) test. Group comparisons were performed using appropriate parametric or non-parametric tests (p<0.05).
Results
Significant differences were observed in handgrip strength (p=0.0266) and TUG (p<0.0003) performance. The CRC group exhibited lower handgrip values (CRC = 27.93 + 6.915; NCG = 21.43 + 3.234) and longer TUG times (CRC = 11.91 + 2.558; NCG = 7.218 + 1.418) compared to the NCG, indicating impairments in muscle force and mobility. No significant differences were found for STS performance (CRC = 11.20 + 3.011; NCG = 10.02 + 1.727; p=0.3904).
Conclusion
Older adults with colorectal cancer demonstrate reduced baseline functional capacity, particularly in strength and mobility, reinforcing the importance of objective functional screening before chemotherapy. Early identification of deficits may support individualized exercise-based interventions aimed at enhancing treatment tolerance and clinical outcomes.

Speaker: Mr Fabricio Teixeira Garramona (School of Physical Education and Sport/ University of Sao Paulo; University of Sorocaba, Sao Paulo, Brazil)

170 Histology-specific meta-analysis of physical activity and lung cancer: the modifying role of gender across subtypes

Backgrounds
Physical activity is an established protective factor for several cancers, but whether its association with lung cancer differs by histological subtype and sex remains unclear. Clarifying these differences is essential for precision prevention.

Objective
To examine associations between physical activity and lung cancer risk across major histological subtypes—adenocarcinoma (LUAD), squamous cell carcinoma (LUSC), and small-cell lung cancer (SCLC)—and to assess sex-specific patterns.

Methods
PubMed and Embase were searched from January 1990 through September 4, 2025. Observational cohort or case-control studies evaluating prediagnostic physical activity and reporting subtype-specific lung cancer risk estimates were included. Eight studies met eligibility criteria. Two reviewers independently extracted study characteristics and maximally adjusted risk estimates. Random-effects models pooled relative risks (RRs) comparing the highest versus lowest physical activity categories. Sex-stratified analyses were performed.

Results
Eight studies were included (five cohorts: 1,094,095 participants; three case-control studies: 3,951 cases and 7,423 controls). Higher physical activity was associated with lower risk across all subtypes: LUAD (RR, 0.80; 95% CI, 0.73–0.88), LUSC (RR, 0.83; 95% CI, 0.73–0.94), and SCLC (RR, 0.78; 95% CI, 0.68–0.91). Sex-stratified analyses revealed subtype-specific heterogeneity. For SCLC, men showed a strong inverse association (RR, 0.66; 95% CI, 0.49–0.88), whereas the association in women was weaker and non-significant (RR, 0.82; 95% CI, 0.58–1.16). In contrast, for LUSC, women demonstrated the strongest protective association (RR, 0.73; 95% CI, 0.56–0.96), while associations in men were minimal (RR, 0.92; 95% CI, 0.74–1.15). Associations for LUAD were similar between sexes.

Conclusions
Physical activity was associated with reduced risk across major lung cancer subtypes, with effect magnitude varying by histology and sex. These findings suggest multiple, subtype-specific preventive pathways and support incorporating physical activity into precision lung cancer prevention strategies.

Funding
This research was supported by Korea Research Foundation (2024S1A5C3A0204344912) and funded by the National Research Foundation of Korea (NRF- 20241A5C3A02043449).

Speaker: Sungwoo Lee (Exercise Medicine and Rehabilitation Laboratory, Yonsei Uiversity)

171 MyeEx-Impact: a randomised controlled trial of bone-targeted exercise for people with multiple myeloma – an overview of study performance

Objective:
Preclinical models using osteogenic exercise have demonstrated mechanical load-induced changes delay osteolytic activity and rescue bone loss. Our recent work in multiple myeloma (MM) identified individualised targeted exercise can reduce bone pain; however, research is yet to explore the potential effect of exercise on bone health. The MyeEx-Impact multi-site randomised controlled trial aims to examine whether bone-targeted exercise can improve bone health in people with MM.
Methods:
Following baseline testing, people with MM (n=78), residing in Queensland and New South Wales in Australia, are randomised to exercise (EX) or control (CON). The EX group performs two supervised and one unsupervised sessions of individualised bone-targeted exercise each week over 9 months. The CON group receives usual care and maintains current physical activity levels. Primary outcomes (bone density and microarchitecture measured via dual-energy x-ray absorptiometry and peripheral quantitative computed tomography) and secondary outcomes (bone pain, quality of life, fatigue, physical function, psychological constructs, gut microbiome, bone biomarkers, immune function, disease response and progression) are assessed at baseline, 3-, and 9-months. Adverse events and adherence to the exercise program are monitored.
Results:
The MyeEx-Impact trial is on track to reach its a priori recruitment target. Participants have had high adherence to the resistance and impact loading exercises. Seven low-grade (Grade 1 and 2) adverse events have been reported, none of which have impacted subsequent exercise or study participation.
Conclusion:
The findings of this study will identify whether bone-targeted exercise is safe, feasible, and can improve bone health in people with MM. This study will provide evidence of the effects of bone-targeted exercise on common MM- and treatment-related side-effects, as well as the potential mechanisms underpinning these effects. Collectively, this novel study will identify the potential role of exercise as an adjuvant therapy for the management of bone health for people with MM.

Speaker: Tina Skinner (University of New South Wales, The University of Queensland, University of Technology Sydney, University of the Sunshine Coast)

172 Physical assessment outcomes in patients with pancreatic cancer: Baseline data from a European multicenter RCT

INTRODUCTION
Patients with pancreatic cancer often experience fatigue, sarcopenia, and reduced physical function, which can impair daily activities and quality of life. Targeted physical activity interventions, including both aerobic and resistance exercises, are essential to maintain muscle mass, improve functional capacity, and support treatment outcomes. The EU-Project RELEVIUM integrates personalized app-based training recommendations into standard care to improve multimodal supportive care for patients with pancreatic cancer.
METHODS
RELEVIUM is a multicenter randomized clinical trial (n = 132) incorporating an 8-week intervention and 16-week follow-up. At study entry, patients undergo standardized physical assessments (6-Minute Walk Test (6MWT), 5 Times sit to stand Test (FTSST), Handgrip-strength test (HGST), Brief-BESTest), which serve as the basis for tailoring an exercise program according to the ACSM guidelines. Training takes place unsupervised at home and is adjusted weekly based on patient-reported feedback and data captured by digital monitoring tools, including smartwatch-collected information on physical activity, heart rate, exercise type, duration, and perceived exertion. Daily fatigue ratings collected through the mobile app further guide session modifications. Exercise recommendations (aerobic and strength) are adapted as needed by an exercise therapist, and engaging an activity partner is intended to support adherence.
RESULTS
At this stage, only baseline data from the clinical center in Mainz are available. To date, 9 patients (90% male) with a mean age of 64 ± 4.6 years have been enrolled. Baseline characteristics are shown as mean ± standard deviation: 6MWT: 431.8 ± 68.4 m; FTSST: 11.8 ± 2.7 s; HGST dominant arm: 39.7 ±11.5 kg; Brief-BESTest Score: 20.6 ±3.6.
DISCUSSION
The study is still ongoing and aims to provide information on whether an individually tailored telemedicine approach is accepted and adopted by this patient group.

Speaker: Lisa Schwab (Institute of Sport Science, Dpt. Sports Medicine, Disease Prevention & Rehabilitation, Johannes Gutenberg University Mainz)

173 Physical performance decline during exercise therapy as a potential early indicator of glioblastoma recurrence: Preliminary observations from a prospective exercise trial

Background:
Early detection of glioblastoma (GBM) recurrence remains challenging. In clinical practice, distiguishing true tumor progression from treatment-related changes such as radiation necrosis (pseudoprogression) is difficult. Therefore, complementary markers of early disease activity are of interest. Based on own experiences, we investigated systematically whether documented changes in physical performance during exercise therapy could serve as early indicators of GBM recurrence within a prospective oligocentric intervention trial (ClinicalTrials.gov: NCT05015543) in high-grade glioma (HGG) patients.

Methods:
Patients with HGG undergoing adjuvant chemotherapy participated in a 16-week exercise program. During each endurance training session, workload (W) and heart rate were documented at 2-minute intervals, and exercise intensity was adjusted and recorded accordingly. A preliminary analysis of the first 36 GBM participants assessed whether changes in physical performance patterns were associated with premature study termination due to recurrence.

Results:
7/36 (19%) discontinued the intervention early due to confirmed recurrence (MRI and/or neurosurgery). In 6/7 cases, deterioration in general condition and increasing fatigue preceded radiological relapse. Worsening of preexisting neurological symptoms was observed in 5/7 cases, while new neurological deficits occurred only once. Training documentation showed reduced exercise tolerance requiring downregulation of intensity (4/7 cases), or absence of expected performance improvements despite protocol adherence (2/7 cases). Only one case showed stable performance without symptomatic change prior to MRI-confirmed recurrence.

Conclusion:
Declining physical performance and subtle symptom deterioration during supervised exercise therapy may serve as early indicators of GBM recurrence und could support the challenging distinction between true progression and pseudoprogression. Systematic documentation by trained exercise professionals may facilitate timely clinical evaluation. Upon completion of data analyses, it will be examined thoroughly whether in recurrent GBM patients certain patterns of altered physical performance and symptomatology while exercising are distinct from stable GBM patients.

Speaker: Dr Johanna Engl (Department of Neurosurgery, Pulmonary Research Division, and Department of Therapeutic Health Professions, Münster University Hospital)

174 Postoperative Aerobic and Resistance Exercise Training in Patients with Colorectal Liver Metastases – A Randomized Controlled Trial

Approximately 50-75% of the patients with colorectal cancer and liver metastases (mCRC) who undergo surgery with curative intent, experience disease recurrence within two years1. Repeated rounds of surgery and chemotherapy result in severe physical deconditioning. Exercise has been shown to improve disease-free survival in colorectal cancer, and early post-operative aerobic exercise is associated with fewer adverse events, earlier initiation of chemotherapy, and increases in cardiorespiratory fitness and physical function. However, the effects of a combined aerobic and resistance exercise program, applied in a dose-response manner during the early postoperative period and throughout adjuvant chemotherapy in mCRC patients remains unknown.

This randomized controlled trial investigates the effects of supervised exercise training on peak oxygen consumption (VO₂peak), skeletal muscle strength and function, and quality of life in patients with mCRC.Fifty-seven mCRC patients were randomized 1:1:1 to either 150 or 300 min/week of supervised exercise, or standard care. The intervention consisted of 24 weeks of supervised combined aerobic and resistance training, initiated two weeks following hospital discharge after surgical treatment of liver metastases.
VO₂peak was the primary outcome. Secondary outcomes included skeletal muscle strength, physical function, and quality of life. Assessments were conducted preoperatively and at 12 and 24 weeks after initiation of the exercise intervention. The final participant completed the 24-week follow-up assessment in December 2025, and data analyses are currently ongoing. Results will be available for presentation at the ISEO Conference in July 2025.

Speaker: Christina Yfanti (Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen)

175 Predictors of Adherence in a Personalized Lung Cancer Exercise Trial: Results from the PEP Study

Background: Exercise programs benefit lung cancer patients undergoing surgery but are rarely incorporated into clinical practice. Predictors of adherence to a perioperative remotely delivered, pragmatic, and personalized exercise intervention in lung cancer patients were assessed.
Methods: Patients randomized to the exercise group in the Precision Exercise Prescription (PEP) Study were included in the analyses. The exercise intervention was tailored to patients’ mobility starting in the pre-surgery period. Weekly Motivation And Problem-Solving (MAPS) calls were conducted for motivational purposes and to discuss barriers, exercise modifications, and self-reported exercise adherence with participants. Median scores derived from MAPS call notes were used to classify patients as non- (1: no activity) or partially (2: <3 days/week) vs. fully adherent (3: 3 or more days/week) from pre-surgery to 2 months and 2–6 months post-surgery. We investigated baseline predictors, clinicodemographic characteristics, 6-minute walk test (6MWT) distance, fatigue (FACIT-F), and quality of life (FACT-L), using forward stepwise logistic regression models.
Results: From baseline to 2-months, 41% of participants were fully adherent (N=34), 50% were partially-adherent (N=41) and 9% of participants were non-adherent (N=7). During the 2-to-6-month timeframe, 33% of participants were fully adherent (N=23), 61% were partially-adherent (N=42), and 6% of participants were non-adherent (N=4). From 2-6 months, fully adherent patients were older (69±9 years vs. 62±15 years) and had primary vs. secondary lung cancer diagnoses (96% vs. 70%) relative to non/partially-adherent patients. Baseline fatigue (OR:0.93, 95%CI:0.86–0.99, p=0.04) and secondary lung cancer (OR:0.11, 95%CI:0.01–0.63, p=0.04) were significant predictors of adherence for 2-6-month timeframe. Fatigue remained a significant predictor after adjusting for age, cancer type, and body mass index (OR: 0.92, 95%CI: 0.85–0.99, p=0.03). No significant predictors emerged for baseline to 2 months post-surgery.
Conclusions: Adherence to the PEP Study intervention was greater among older, primary lung cancer patients with lower fatigue at baseline.

Speaker: Victoria Bandera (University of Utah Huntsman Cancer Institute)

176 Resistance training is a safe, feasible and highly beneficial exercise intervention in a breast cancer survivor with liver metastasis, osteopenia and subjected to unilateral mastectomy

Introduction
Exercise-induced benefits in cancer patients have been consistently observed in exercise oncology research but precise manipulation of training variables (e.g., volume, intensity, frequency) is key to optimize clinically relevant patient-reported outcomes among breast cancer survivors (BCS). Evidence indicates that resistance training (RT) is safe, feasible, ameliorates lymphedema symptoms, improves muscle strength, bone health and body composition.
Case Report
A 51-year-old overweight BCS presented at The Strength Clinic in September 2023 for an exercise consultation. Walking and dancing were her main exercise activities. She had been diagnosed with breast cancer (left breast, G3, RE 85%, RP 5-10%, HER 2+ (3+) and Ki67 30%) and liver metastasis in May 2023. She was treated with neoadjuvant chemotherapy, hormone therapy, radiotherapy, ovarian removal surgery for hormonal control, an aromatase inhibitor (letrozole), unilateral mastectomy with axillary clearance and right hepatectomy surgery. Osteopenia was detected after her treatments. A TSC functional evaluation revealed good body awareness but with low levels of stability, general strength and occasional low back pain. An InBody770 analysis revealed high body fat, high visceral fat and above average systemic inflammation. The patient started progressive RT of two weekly private sessions and progressive integration into our small group training system. After two years, despite all challenges, improvements were made in: body fat and visceral fat; muscle mass; overall strength; bone mineral content and whole-body phase angle (an indicator of cellular integrity and longevity in cancer patients). No signs or symptoms of lymphedema were observed. She also reported improvements in quality of life and overall wellbeing.
Conclusion
A progressive RT intervention is safe, feasible and highly beneficial in a BCS with liver metastasis and osteopenia subjected to several medical interventions. Improvements were made in body fat, visceral fat, muscle mass, strength, bone health, phase angle, quality of life and overall wellbeing.

Speaker: Ms Catarina Oliveira (The Strength Clinic)

177 RETOS: Personalized Community-Based Physical Activity and Behavior Change Intervention in Lung Cancer Survivors Receiving Immunotherapy: A Pilot Study

Background: Patients with non-small cell lung cancer (NSCLC) receiving immunotherapy typically present low levels of physical activity and high sedentary behavior, negatively affecting health outcomes and quality of life. Conventional exercise programs often show poor long-term adherence, highlighting the need for community-based and patient-centered models that align with individual preferences and capacities.

Objective: To compare the effects of a personalized community-based exercise intervention versus usual care on physical activity levels and sedentary behavior in NSCLC survivors undergoing long-term immunotherapy.

Methods: A randomized controlled pilot trial (1:1; NCT06234735) was conducted in adults with metastatic NSCLC receiving immunotherapy. Thirty participants were included (control group [CG]: n=17; intervention group [IG]: n=13). Inclusion criteria comprised age 18–75 years, at least 12 months since initiation of immunotherapy, and active treatment or follow-up. The CG received general lifestyle advice, while the IG participated in a 6-month therapeutic exercise program combining face-to-face and online supervised sessions via the RehBody™ platform. The intervention included personalized goals, weekly challenges delivered through a private WhatsApp group, and exercise intensity monitoring using a heart rate sensor (POLAR Verity Sense™). Outcomes were assessed pre- and post-intervention using the IPAQ, SBQ, 6-minute walk test (6MWT), 1-minute sit-to-stand test (STS-1min), FACIT-F, EORTC QLQ-C30 and LC13, and PSQI. Statistical analyses included ANCOVA models and between-group comparisons of change scores.

Results: The community-based exercise intervention led to significant improvements in physical activity levels and reductions in sedentary behavior compared to usual care. The IG also demonstrated increased walking distance (6MWT) and a higher number of repetitions in the STS-1min test. Adherence to the program was high, with excellent compliance.

Conclusions: A combined face-to-face and online community-based therapeutic exercise program is feasible and effective in improving physical activity, reducing sedentary behavior, and enhancing functional capacity in NSCLC patients , with high adherence over time.

Speaker: Paula Jakszyn (Catalan Institute of Oncology)

178 Sedentary Behavior Is Associated with Impaired Cardiac Parasympathetic Modulation in Patients with Stage III–IV Colorectal Cancer: A Pilot Study

Colorectal cancer (CRC) and its treatment are frequently associated with autonomic nervous system (ANS) dysregulation, characterized by alterations in heart rate variability (HRV) and insufficient levels of physical activity (PA). This cross-sectional, single-center observational study (Phase 1) evaluated patients with Stage III–IV CRC from the Abdominal Surgery Service of Erasto Gaertner Hospital over a 9-month follow-up period. We investigated the association between objectively measured PA, assessed via accelerometry (ActiGraph GT9X), and HRV temporal-domain parameters derived from RR interval analysis (Polar V800). Eight patients of both sexes were included, with a mean age of 51 ± 7.7 years. Accelerometry provided data on Sedentary Time (ST) and Moderate-to-Vigorous Physical Activity (MVPA). ST ≤ 99 counts/min and MVPA ≥ 1952 counts/min were considered, with analyses conducted for total time, weekdays, and weekends. The median ST was 387 (217–468) minutes per day, representing 67.2% ± 9.9% of wear time. Median MVPA was 74 (28–195) minutes per day, corresponding to only 1.7% ± 2.1%, indicating a low overall PA level. The mean resting heart rate (HR) was 77 ± 11.2 bpm. A strong negative correlation was found between ST and RMSSD (root mean square of successive differences), a marker of parasympathetic activity (r = –0.74; p = 0.005), suggesting that higher sedentary time is associated with poorer parasympathetic autonomic modulation. No significant associations were observed between MVPA and HRV parameters.In conclusion, the high sedentary time observed in patients with CRC is strongly associated with reduced cardiac parasympathetic modulation. These findings underscore the importance of interventions aimed at reducing sedentary behavior to improve autonomic regulation and potentially enhance prognosis and quality of life in this population.

Speaker: Lilian Messias Sampaio Brito (School of Physical Education and Sport, University of Sao Paulo)

179 TEAM Me (Totally Excited about Moving, Mobility & Exercise), An Inpatient Hematopoietic Stem Cell Transplant Mobility Incentive Study

Background: Hospitalization for hematopoietic stem cell transplantation (HSCT) is associated with inactivity, and deconditioning in children, adolescent and young adults (CAYAs). Interventions promoting mobility during HSCT are limited. TEAM Me (Totally Excited About Moving, Mobility and Exercise) is a program utilizing a token economy system to encourage physical activity during hospitalization. During admission, tiered prizes are earned by completing walking laps, participating in physical/occupational therapy sessions, and group fitness activities.

Objectives: This pilot study evaluated feasibility of TEAM Me among hospitalized CAYAs undergoing HSCT. Primary outcomes included enrollment and measurement completion rate.

Methods: A non-random, matched-cohort, cluster-design was utilized to assign participants by site to the TEAM Me intervention, or standard-care control arm. Functional outcomes were assessed at admission, HSCT days: 0, +21, and discharge. Assessments included: Six-Minute Walk (6MWT), Timed Up-and-Go (TUG), 30-Second Sit-to-Stand (30STS), Functional Independence Measure (FIM) and Grip Strength (GS).

Results: Of 41 patients approached at the intervention site, 30 (73.2%) enrolled. Patients are median age 15 years (range 6-24 yrs), with 20 males. Most common diagnosis was leukemia. Baseline Lansky/Karnofsky scores ranged 80-100%.

At admission, completion rates were 100% for 6MWT, TUG, 30STS, FIM, and 93.3% for GS. Day 0 completion was 93.1% for 6MWT and GS, 89.7% for 30STS, and 86.2% for TUG and FIM. Day 21 was 95.2% for 6MWT, TUG, and 30STS, 90.5% for GS and FIM. At discharge, rates were 100% completion for TUG and 30STS, 96.4% for 6MWT, 92.9% for GS and 78.5% for FIM. Patients were discharged at median of Day +28 (range Day+13-Day+109) Control-site accrual remains ongoing.

Conclusions: TEAM Me is a feasible intervention promoting activity among CAYA HSCT patients. Final comparative analyses will occur following completion of control-site enrollment. Preliminary observations suggest high participant engagement with the TEAM Me program encouraging integration of mobility promotion during HSCT.

Speaker: Dr Priti Tewari (UT MD Anderson Cancer Center)

180 The CanBenefit programme: developing, evaluating and implementing tailored physical activity and nutrition support as standard care for people with lung cancer

BACKGROUND
Lung cancer is the leading cause of cancer death in the UK. Patients are often older, frail, and nutritionally compromised, and routinely excluded from research. Activity and nutrition interventions improve quality of life (QoL) and may enhance treatment outcomes, yet evidence in this population remains limited. The CanBenefit programme addresses this gap through a programme of research culminating in an implementation feasibility study.

METHODS & FINDINGS
Our systematic review among older adults with cancer found predominantly activity-focused research, very little tailored nutrition, and mixed QoL outcomes CanBenefit 1 qualitative interviews established strong acceptability for proactive, personalised wellbeing interventions among patients (≥70 years), carers, and clinicians; patients favoured clear, instructive “can do / can have” guidance. CanBenefit 2 tested a tailored physical activity and nutrition programme for older adults (≥60 years) with advanced lung cancer undergoing systemic treatment; despite recruitment challenges, participants reported feeling stronger, more confident, and valued the programme’s adaptability.

These findings informed CanBenefit 3: a multisite implementation feasibility study (in set-up), embedding exercise physiologist (EP) referral directly into routine lung cancer care across two NHS trusts in Yorkshire. The programme is delivered digitally-first via RehabGuru, a remote rehabilitation platform, with paper-based alternatives for those less digitally engaged. Clinicians identify and refer eligible patients; the EP conducts initial assessments and delivers personalised programmes with pre-defined criteria for stepped-up support. Outcomes, including treatment completion, one-year survival, physical function, patient-reported QoL, and lifestyle behaviours, are collected within health records and RehabGuru. The study aims to engage ≥300 patients over 12 months, with follow-up at 3, 6, and 12 months.

IMPLICATIONS
Embedding referral within standard care, delivered remotely, removes barriers of trial enrolment and geography, enabling equitable access across deprivation groups. CanBenefit 3 represents the culmination of iterative learning and will offer a model for scalable, digitally-delivered rehabilitation in lung cancer.

Speakers: Cindy Forbes (University of Hull), on behalf of the CanBenefit team

181 Using co-production and the person-based approach to design an inclusive prehabilitation intervention for colorectal cancer patients undergoing surgery

Background
Exercise prehabilitation can mitigate the risks of cancer surgery, however low recruitment and adherence are commonly described in trials. Patients with low baseline physical activity (PA) levels are likely to benefit the most from prehabilitation but have the lowest uptake. The person-based approach (PBA) is a set of methods for developing effective complex behavioural interventions and comprises three phases; planning and co-production, optimisation and implementation and evaluation. By co-producing, with patients and staff, an intervention grounded in behaviour change theory, low acceptance and adherence may be overcome. The aim of this study was to produce an inclusive, low-cost intervention to increase PA in inactive colorectal cancer (CRC) patients in the perioperative, recovery and survivorship phases.
Methods
In phase 1, literature reviews, semi-structured qualitative interviews with less active CRC patients (n=6) and expert opinion informed the creation of guiding principles and a logic model for the intervention. An expert panel, comprising health care professionals, a person with lived experience, researchers and an exercise specialist oversaw intervention development. In phase 2, the intervention was optimised through interviews with CRC patients (n=2) and focus groups with under-served adults (older and lower socioeconomic status).
Results
The intervention is underpinned by self-determination theory and the Capability, Opportunity, Motivation, Behaviour Model (COM-B). Guiding principles cover the need to provide a rationale and safety reassurance and to support flexible, independent and sustainable PA. The logic model provides mechanisms to aid motivation, self-monitoring, engagement and adherence to the intervention. The intervention is delivered by cancer support workers using a toolkit (electronic or paper-based), with activity goals based on patient preferences, abilities and circumstances.
Conclusion
My Active Plan is an inclusive PA intervention which is now ready for implementation and evaluation. An RCT to test the benefits of PA in under-served populations is planned.

Speaker: Dr Luke Hodgson (University Hospitals Sussex NHS Foundation Trust)

182 Yoga for Patients Undergoing Thoracic Radiotherapy and their Family Caregivers: Results of a Randomized Controlled Trial

BACKGROUND: Patients with advanced thoracic cancers undergoing standard radiotherapy (RT) have a high risk of experiencing performance declines and poor quality of life (QOL). Exercise programs may improve objective and subjective performance; yet adherence remains poor. Including family caregivers as active intervention participants may improve adherence and thus efficacy. Thus, this clinical trial seeks to examine the efficacy of a patient-caregiver dyadic yoga intervention relative to a dose-matched education/support intervention.
METHODS: Patients with lung or esophageal cancer undergoing at least 5 weeks of RT and their family caregivers were randomized to either a 15-session yoga or education/support (ES)comparison intervention. Patients and caregivers were assessed at baseline (T1), the last day of RT (T2) and 1 (T3), 2 (T4) and 3 (T5) months later. Patients completed the 6-minute walk test (6MWT; primary outcome) and both patients and caregivers completed a validated QOL measure (secondary outcomes).
RESULTS: A total of 222 participants were randomized. For the 6MWT, patients in the yoga group performed significantly better than those in the ES group across T2-T5 (least squared means (LSMs) in meters: yoga=469 vs. ES=441, P=.03). Patients in the yoga group also reported improved physical (LSMs: yoga=44.7 vs. ES=41.6, P=.03) but not mental QOL scores across T2-T5 compared with those in the ES group. As exploratory outcomes, patients in the yoga group also reported improved sleep (P=.01) and coping efficacy (P=.02).
CONCLUSIONS: Yoga significantly improves functional capacity and subjective physical QOL in patients undergoing thoracic RT. Involving a family caregiver may improve intervention adherence.

Speaker: Dr Kathrin Milbury (The University of Texas MD Anderson Cancer Center)

Poster Session 2.3: Implementation (Posterarea 3)

183 A Community-Based Exercise Oncology Model Delivering No-Cost Programming Across the Cancer Continuum

Background: Inova’s Peterson Life with Cancer (PLWC) is a nationally recognized supportive care program providing free psychosocial, integrative medicine, and educational services to individuals with cancer and their families across Northern Virginia, USA. Embedded within this model is an exercise oncology program delivering no-cost, community-based movement and fitness classes. The program addresses persistent gaps in access to safe, tailored exercise, particularly for individuals facing financial, geographic, treatment-related, or functional barriers to commercial fitness services.
Program Description: In 2025, PLWC delivered 680 exercise classes across diverse modalities, e.g., functional training, chair-based exercise, cardio drumming, strength and conditioning, men’s fitness workshops, Barre/Pilates fusion, tai chi, restorative yoga, Yin yoga for patients in treatment, and dance-based programming, complemented by one-on-one exercise consultations. Classes are intentionally designed to foster social connection through peer support, accountability, and approachability, supporting sustained engagement during and after cancer treatment. Programming is delivered through a hybrid telehealth and in-person model, dedicated on-site space, a centralized registration system, and minimal exercise equipment. The program is staffed by full-time exercise oncology professionals and contracted instructors and supported through institutional infrastructure and philanthropic funding, enabling universal access regardless of insurance status, diagnosis, or socioeconomic factors. This model also serves as a pragmatic platform for clinical trial collaboration to evaluate exercise-based interventions and supportive care delivery models across the cancer continuum.
Results: In 2025, the program averaged 817 exercise encounters per month, totaling 9,806 encounters annually and representing participation by approximately 700 unique patients. Nearly one-quarter of participants (23%) attended 12 or more classes annually, indicating sustained engagement.
Conclusions: Backed by institutional support and philanthropic investment, this community-based exercise program demonstrates that delivering large-scale exercise programming without financial burden to patients and families is feasible and sustainable. The PLWC model offers a scalable approach embedding accessible, socially-supportive exercise programming within comprehensive cancer care.

Speaker: Dr Melissa Miller (Inova Peterson Life with Cancer)

184 A nominal group technique to achieve consensus regarding the integration of a physical activity pathway in Irish cancer care

Introduction:
STEPs (Supporting cancer Treatment with Exercise Pathways) is a physical activity (PA) support programme for people who have, or have had, cancer. The aim of this study was to conduct a nominal group technique (NGT) to achieve consensus among key stakeholders regarding i) barriers to the integration of STEPs within usual cancer care in two Irish hospitals, and ii) solutions to overcome barriers identified.

Methods:
The NGT was conducted online via Zoom in February 2025 with 11 oncology experts, including people with a lived experience of cancer, medical professionals and academics. After reviewing the pathway, experts silently generated ideas regarding barriers and solutions, and shared their ideas sequentially in the subsequent phase. Responses were clarified and experts confirmed which items should feature for ranking. Experts ranked the challenges and solutions in order of importance in the final stage. A final group discussion occurred to review ranked items.

Results:
Challenges to integrating STEPs in clinical cancer care included: i) defining which patient cohort(s) STEPs could best support as influenced by people’s readiness to engage in PA and the extent of treatment burden experienced, ii) determining who is best placed within the multidisciplinary team to initiate conversations about PA, iii) limited clinical time and space for supporting and administering the programme, and iv) the completion of follow-up re-assessments in-person. Solutions to support the effective integration of the programme included: i) clearly defining cohorts who would be eligible to engage with STEPs, ii) identifying and supporting key healthcare professionals to initiate PA discussions, iii) securing clinical team buy-in to STEPs integration, and iv) incorporating flexible delivery and assessment options (e.g. remote support) within STEPs.

Conclusion:
The NGT process generated consensus-based, actionable recommendations for implementing STEPs. These findings will guide STEPs implementation as part of a two-arm non-randomised trial in 2026.

Speaker: Michael O Brien (Technological University of the Shannon)

185 A pragmatic evaluation of community-based lymphoedema services for individuals at risk of, or living with, cancer-related lymphoedema

Purpose: This study examined the long-term effects of standard care lymphoedema treatment, delivered by cancer support centres in community-based settings, on quality of life and self-reported symptom severity among individuals with cancer-related lymphoedema.

Methods: A single-group, pre-post pragmatic study design was adopted. Survivors of cancer referred to community-based cancer support centres were recruited. Participants received a minimum of 3 standard care lymphoedema treatment sessions at the centres with a certified lymphoedema clinician at baseline (T1), 1 month (T2) and 6 months (T3), where core treatment strategies may have included lymphoedema education to enable self-management, skin care, weight management, strength training and physical activity. Where applicable, lymphoedema clinicians emphasised the benefits of exercise to participants, encouraged attainment of the recommended physical activity guidelines and included regular exercise as an integral part of the person’s lymphoedema treatment plan, where exercise commenced at a low level and progressed slowly, as tolerated by the person. Assessments of quality of life and symptom severity were conducted at each visit using the Lymphoedema Quality of Life (LYMQoL) questionnaire and a researcher-developed tool of self-reported symptom severity.

Results: One-hundred and twenty survivors of cancer were recruited (mean age (±SD) 59 (±12y); 90% female). Forty participants (33%) completed the T3 assessment. Linear mixed-model analyses demonstrated significant improvements in arm cancer-related lymphoedema quality of life (n=78) from T1 to T3 (p<0.05), with a small effect size (Cohen’s d = 0.24). Leg-CRL QoL (n=18) improved significantly from T1 to T3 (p<0.001) with a medium effect size (Cohen’s d = 0.68). All 7 self-reported symptom ratings, including pain, swelling and functional restriction, improved from T1-T3.

Conclusion: Standard care lymphoedema treatment, when delivered in community-based cancer support centres, was associated with improvements in quality of life and self-reported symptoms among survivors of cancer at 6 months.

Speaker: Dr Mairéad Cantwell (SHE Research Centre, Department of Sport & Health Sciences, The Technological University of the Shannon)

186 Acceptability, Appropriateness, and Utility of an Online Decision Tool (The Exercise in Cancer Evaluation and Decision Support algorithm; EXCEEDS) to Support Adults Moving Through Cancer

Introduction
Cancer survivors experience physical and psychological effects from cancer treatments contributing to disability. These effects can be improved by exercise and/or cancer rehabilitation(CR). Guidelines recommend providers discuss exercise with patients and refer to appropriate programs; however, clinicians report barriers to referral and survivors are not connected to the required interventions. The Exercise in Cancer Evaluation and Decision Support (EXCEEDS) algorithm is a decision-support triage tool designed to connect survivors to the right exercise program at the right time.

Objectives
Primary: To assess the acceptability, appropriateness, and perceived usefulness of the EXCEEDS tool among individuals with a recent cancer diagnosis treated with curative intent.
Secondary: To assess EXCEEDS’ effectiveness (impact on behavior).

Methods
This cross-sectional, pragmatic, mixed-methods study includes quantitative evaluations at two timepoints and qualitative semi-structured interviews At time-point one, participants work through the EXCEEDS algorithm and are provided with their level of exercise category recommendation (cancer rehabilitation; clinically-supervised exercise; supervised cancer-specific exercise; unsupervised exercise) and a list of recommended programs for their exercise category. This is followed by a quantitative evaluation to assess the acceptability and appropriateness of the EXCEEDS tool. At time-point two (~4-6 weeks later), participants are asked about patterns of use related to the program recommendations. Semi-structured qualitative interviews will be conducted with a sample of participants (n=10-15) with the aim of gaining a deeper understanding of EXCEEDS’ acceptability, appropriateness, and use/effectiveness.

Results
Recruitment began December 2025 and is ongoing. A small sample (n=7) has completed time-point one and was triaged as follows: three patients to Medical Pre-Clearance, one to Cancer Rehabilitation, one to Clinically Supervised Exercise, and one to Independent Exercise. Updated results and acceptability will be presented at the ISEO meeting.

Conclusion
If acceptable and effective, the impact is a publicly available, online, patient-facing referral system connecting patients with appropriate exercise/CR programs.

Speakers: Karine E Ronan (Princess Margaret Cancer Centre), Dr Michelle B Nadler (Princess Margaret Cancer Centre)

187 Advancing Training in Oncological Exercise Therapy: Physiotherapists’ and Exercise Therapists’ Perspectives on an Online-Education Program

Introduction: Oncological Exercise therapy (OET) benefits oncology patients, highlighting the need for locally available programs delivered by qualified staff. In Germany, such training is mainly provided on-site, involving time and travel costs. The German Cancer Aid-funded IMPLEMENT project developed and evaluated an online training for exercise- and physiotherapists in oncology. This abstract reports participants’ perceptions about the digital format.
Methods: The online training (60 units in total) combined video-based self-study with two live online days focused on practical case work. Participants were introduced to the platform four weeks before the examination phase. Written exams were conducted online under videoconference supervision, and oral exams involved small-group case presentations. Post-course evaluations were collected via standardized questionnaire after each training.
Results: Three online trainings were held in November 2024, April 2025 and November 2025. Exams of the last training are ongoing, hence final results will be presented at the congress. To date, 74 participants have been certified via this format (registered: n=80; failed: n=6). Forty-two participants completed the survey. Most rated the course positively (overall 78.6% agree; lectures 64.3% agree). Organizational aspects, including the digital learning environment, were viewed positively by 52.4% and teaching materials by 85.7%. The majority (83.3%) felt that the training met their informational needs and prepared them to deliver OET (71.4%; none disagreed). The digital format and platform access were well received (92.9% agree), though a considerable part of respondents would still prefer in-person training (28.6% agree; 38.1% neutral).
Conclusions: Results indicate that online training in OET is well accepted and represents a potentially resource-efficient format to qualify exercise oncology experts. By reducing spatial barriers and travel costs, the digital format facilitates the concurrent training of a larger number of participants.

The authors declare no conflict of interest.

This abstract will be previously presented at the Deutsche Krebskongress 2026

Speaker: Melanie Reitz (Department I of Internal Medicine, Center of Integrated Oncology Aachen Bonn Cologne Düsseldorf, University Hospital of Cologne, Germany)

188 Challenges in Exercise Promotion for Bone Metastases: A Cross-Sectional Study of Healthcare Providers

Introduction: Although exercise is increasingly recognized as safe and beneficial for patients with bone metastases, clinicians often remain hesitant to recommend it. However, the reasons behind this reluctance are not fully understood. This study explored healthcare professionals’ attitudes, knowledge, and perceived barriers regarding exercise in patients with bone metastases.
Methods: An online survey was distributed across Italy through a professional mailing list. The questionnaire, developed with oncologists, radiotherapists, and exercise professionals, collected information on: (i) demographics and professional background; (ii) current practices in assessing, advising, and referring patients to exercise; (iii) clinical factors influencing recommendation; and (iv) barriers and facilitators. Descriptive statistics were used.
Results: Eighty-nine participants completed the survey, mostly oncologists (72%), primarily treating thoracic and breast cancers. Assessment of patients’ exercise was limited, performed sometimes (29%) or rarely (25%). Although 65% reported advising patients to increase activity levels and 57% reinforced its importance, only 24% referred patients to structured exercise services. Clinicians generally agreed that exercise improves psychological well-being and bone health, yet 47% were unsure whether exercise could worsen bone pain, compromise safety (46%), or increase the risk of skeletal-related events (43%). Several clinical factors discouraged recommendation, including osteolytic lesions, cervical or thoracic vertebral involvement, complicated bone disease, previous SREs, and pain at metastatic sites. The most frequently reported barrier in recommendations was the lack of dedicated exercise programs (70%), followed by insufficient training in assessing suitability. Conversely, educational sessions for healthcare teams (74%) and the integration of exercise specialists into clinical pathways (71%) were viewed as key facilitators.
Conclusions: Clinicians recognize the value of exercise but remain uncertain about its safety in complex metastatic scenarios. Expanding dedicated exercise programs, enhancing multidisciplinary collaboration, and providing targeted education may represent crucial steps to increase patients' exercise levels.

Speaker: Anita Borsati (University of Verona)

189 Demand for Dance Based Exercise Program: Lessons From a Cancer Charity

The incidence of cancer in Kenya has risen significantly in the recent years to more than 44000 new cancer cases annually. [Globocan 2022]. However, there has been no corresponding improvement in infrastructure, human resources, diagnostics and treatments. The focus of current investments is on enabling access to surgery, chemo and radiotherapy with little attention to other interventions like exercise and complementary therapies that have been shown to improve quality of life, mitigate anxiety, fatigue and related distress associated with a cancer diagnosis.
Objective: Evaluate the demand for complementary therapies including counselling and exercise.
Materials & Methods: A retrospective desk review was carried out with analysis of attendance records, patients and instructor logs as well as program reports of cancer patients accessing complementary therapies from a cancer charity from May 2024 to April 2025.
Findings: During this review period, 1628 patients and caregivers accessed different complementary therapies from a cancer charity. This was a 70% increase on the 1144 patients who sought similar services in the previous year. This translates to an average of 136 attendees for complementary therapies monthly. Psychological Counselling had the highest attendance at 19%, followed closely by Zumba at 16.5%. Half the patients utilizing Zumba were more likely to have completed treatment. None of the public cancer centres in the country offers a structured exercise program for cancer patients.
Conclusion: The growth in demand for psychological counselling to address mental health and Zumba to address the physical wellbeing cardiorespiratory and muscle strengthening present an opportunity to address gaps in patient care that are often overlooked in conventional oncology. Exercise programs combined with other psychosocial interventions are feasible safe and culturally acceptable interventions that can be delivered in settings outside of formal clinical environment to complete the care continuum as demonstrated by Faraja cancer support trust

Speaker: Mr DAVID MAKUMI- KINYANJUI (FARAJA CANCER SUPPORT TRUST)

190 Design and implementation of a personalized exercise program for improving physical function in cancer survivors (CanReAct Project)

Cancer survivors often experience long-term treatment side effects that substantially diminish their functional capacity and quality of life (QoL). Among the wide range of symptoms reported, chronic fatigue and loss of physical function—particularly reduced cardiorespiratory fitness, flexibility, and muscle strength—emerged as the most debilitating. These symptoms vary widely across individuals, highlighting the need for tailored, multi-modal rehabilitation approaches. Building on previous research and preliminary patient feedback, this study aimed to design, implement, and evaluate a personalized, exercise-based program targeting the physical and fatigue-related challenges faced by cancer survivors.
Eligible participants included individuals diagnosed with cancer at any treatment stage who had no contraindications to exercise. After completing informed consent and a PAR-Q+ form, participants underwent baseline assessments of fatigue, health-related QoL, and physical function, including cardiorespiratory fitness, muscular endurance, flexibility, balance, and body composition. Using these results and patient-reported symptoms, researchers developed individualized 12-week exercise programs incorporating aerobic, resistance, and flexibility training. Each program was supervised by an exercise physiologist or physiotherapist, who provided weekly guidance through online sessions, phone calls, and email check-ins. Programs were adjusted every four weeks based on participant progress.
Upon completing the 12-week intervention, participants repeated the physical assessments and questionnaires. Results demonstrated significant improvements in aerobic capacity and muscular endurance, alongside meaningful reductions in cancer-related fatigue. Additionally, a strong positive correlation was observed between post-intervention muscular endurance and reduced fatigue, indicating that gains in strength and endurance may play a key role in managing persistent fatigue.
Overall, this study concludes that personalized, multi-component exercise programs can effectively improve physical function and lessen cancer-related fatigue among survivors. Future research should refine assessment and exercise-prescription processes to further optimize recovery and long-term health outcomes for this population.

Speaker: Dr ANANYA GUPTA (UNIVERSITY OF GALWAY)

191 Developing a Sustainable Cancer Rehabilitation Program: An 18-Year Program Translating Evidence into Practice

Background: Cancer-related fatigue (CRF) is among the most prevalent and debilitating symptoms across the cancer continuum. Exercise-based rehabilitation is an effective evidence-based intervention to reduce CRF and improve functional outcomes. However, translating this evidence into sustainable clinical programs remains a challenge.
Purpose: To describe a cancer rehabilitation model that addresses this implementation gap.
Approach: Using a rehabilitation approach, this program emphasizes functional recovery through supervised exercise. It was launched in 2007 using existing staffing and equipment in a shared hospital pulmonary gym. Initial evaluations and individualized exercise prescriptions were completed by oncology-trained physical therapists (PTs) and billed to insurance, while ongoing sessions were provided by oncology-trained exercise physiologists (EPs) on a self-pay, drop-in basis. In 2015, the program transitioned to a wellness clinic embedded within a cancer center.
Findings: Program adjustments have improved efficiency and created a more sustainable model. Moving from drop-in to scheduled supervised CRF classes optimized staffing and the use of a smaller cancer center gym. Co-location within the cancer center increased CRF program volumes, narrowing the financial gap and positioning the program for profitability next year. The nominal self-pay model ($7 per session) minimized additional cancer-related financial toxicity and preserved insurance-covered rehabilitation visits for skilled services such as cognitive, pelvic floor, or lymphedema therapy. Over the past decade, annual program metrics grew from 206 referrals, 171 PT CRF evaluations and 2,428 class visits to 436 referrals, 309 PT CRF evaluation and 4,954 attended class visits in 2025. Financial performance has made incremental gains, and modeling projects a small loss in 2025 followed by profitability in 2026.
Conclusion: A hybrid model combining insurance-based and self-pay services within a hospital outpatient setting can be sustainable. This approach offers a scalable framework for integrating exercise into oncology care.

Speaker: Joanne Beasley (UCHealth- University of Colorado Health Authority)

192 Developing Agency in Cancer Patients by Bridging Theory and Practice: a 7-Week Outdoor Group-Based 4×4 Training: A Pilot Study

Background:
Exercise is a key component of supportive cancer care; however, access to community-based structured exercise remains limited. This pilot study examined the feasibility and psycho-emotional effects of a supervised 7-week outdoor group-based exercise on cancer patients.
Methods:
Twenty adult cancer patients (95% female; mean age 51.3 ± 9.5 years; BMI 23.9 ± 2.7 kg/m²; breast, ovarian, cervical, and other cancers) were recruited from existing outdoor exercise sessions specifically designed for cancer patients and were eligible if they had completed or were undergoing cancer treatment and had obtained appropriate medical clearance. Participants attended weekly 60-minute sessions following the 4×4 Training structure: 15-minute warm-up, 4-minute higher-intensity interval at ~85% HRmax, separated by 3-minute active recovery repeated 4 times, and a 10-minute cool-down. Psycho-emotional outcomes were assessed at baseline and week 7 using the Depression Anxiety Stress Scale (DASS-21), Swedish Core Affect Scale, and a time-perspective measure. Pre–post session affective responses were recorded using the Feeling Scale and Felt Arousal Scale.
Results:
After completion, significant reductions in psycho-emotional symptoms were observed. Median DASS-21 depression scores decreased from 0.93 to 0.29 post-intervention (p < 0.001). Stress scores declined from 1.79 to 1.29 (p < 0.01), and anxiety scores from 0.86 to 0.57 (p < 0.01). No significant changes were observed for core affect or time perspective. Across all sessions, participants reported significantly more positive feeling (mean increase: +1.2, p < 0.01) and increased arousal (mean increase: +0.9, p < 0.01) post-exercise. Increases in acute arousal were significantly associated with greater reductions in depression over 7 weeks (R² = 0.39, p < 0.01). No adverse events were reported.
Conclusions:
The outdoor 4×4 Training structure was feasible, safe, and associated with meaningful improvements in psycho-emotional health. Larger studies are warranted to evaluate scalability, enhance accessibility, and further advance natural-environment exercise as a supportive care strategy.

Speaker: Rūdolfs Cešeiko (Outdoor Against Cancer, Munich, Germany. Faculty of Health and Sports Sciences, Riga Stradins University, Riga, Latvia)

193 Exercise in Oncology: Variations in Clinical Practice and Barriers by Professional Role and Years of Experience in Latin America

Background: Exercise is an important component of cancer care, yet physicians’ engagement in assessment, referral, and prescription varies widely. Understanding how physician characteristics influence these practices, and the barriers they report, is essential to improving exercise implementation in oncology.
Methods: A cross-sectional survey was conducted among physicians from 21 Latin American countries. Exercise-related practices and perceived barriers (classified as low, moderate, or high impact) were compared by professional role and years of experience using chi-square tests.
Results: Among 454 respondents, oncologists reported higher engagement in exercise assessment (69.2% vs. 35.4%), referral (51.1% vs. 27.5%), and prescription (72.9% vs. 36.5%) compared with other specialties. Years of experience showed a graded effect: physicians with >10 years of experience reported the highest rates of assessment (64.8%), referral (45.2%), and prescription (74.1%), while those with <5 years reported the lowest. Significant differences in perceived barriers were observed by both experience and professional role. Physicians with >10 years of experience were more likely to report high impact barriers related to fatigue (p=0.018), emotional symptoms (p=0.040), social limitations (p=0.003), lack of motivation (p=0.010), and lack of evidence (p=0.001). Less experienced physicians (<5 years) reported higher rates of “not knowing how to prescribe exercise” (p=0.034). By specialty, oncologists were significantly more likely to report high-impact barriers related to patients’ lack of motivation (p=0.003), lack of qualified professionals (p=0.003), and lack of information about exercise resources (p=0.001).
Conclusions: For our knowledge, this is the first effort to understand Latin American physicians' practice on exercise oncology. Physician characteristics, both professional role and years of experience, shape not only how exercise is integrated into care but also which barriers they perceive as most limiting. Tailored strategies are needed: early-career clinicians may benefit from training on exercise prescription, while more experienced oncologists may require support addressing patient-level barriers and resource limitations.

Speaker: Paulo Bergerot (Hospital Santa Lucia, Brasilia, Brazil)

194 Exercise Oncology Starts Here: Innovative Undergraduate Training for Tomorrow’s Professionals

Best practice cancer care supports exercise referrals for all cancer survivors, both during and after treatment. However, with the rapid rise in the number of cancer survivors, the current exercise workforce cannot provide this level of care. Further, although the American Society of Clinical Oncology (ASCO) calls for clinicians to include exercise referrals as standard practice in oncology care, oncologist referral rates remain low (< 20%), in large part due to the lack of evidence-based exercise programs. The Exercise Is Medicine (EIM) Moving Through Cancer initiative has identified “exercise oncology workforce enhancement” as a focus area to ensure evidence-based exercise programs can feasibly be provided as a standard part of cancer care. To meet this need, specialized training is essential to develop the skills required for exercise professionals to work with people navigating a cancer diagnosis and its associated treatment. Training beyond traditional undergraduate degree programs is typically required to develop this workforce, yet few opportunities exist during undergraduate education to both drive interest in this profession while also helping students to develop these necessary skills. Interestingly, undergraduate programs may offer an ideal opportunity to simultaneously develop the workforce while driving occupational interest in exercise oncology; however, very few programs include cancer-specific training. As such, understanding novel approaches to undergraduate training is critical to develop an exercise oncology workforce able to meet the call of both ASCO and the EIM Moving Through Cancer initiative. The CARESLab (Cancer Research in Exercise Science Laboratory) has developed an innovative approach to integrating oncology training into the undergraduate student experience. This presentation will examine the development and implementation of the CARESLab model, identify fresh approaches in the training process of burgeoning exercise oncology professionals, all while exploring the feasibility of the model, lessons learned, and considerations for future exercise oncology workforce development.

Speaker: Dr Keith Thraen-Borowski (Loras College)

195 Global Dissemination of a Community-Integrated Clinical Exercise Oncology Model: The Maple Tree Cancer Alliance Approach

Background: As evidence supporting exercise as a standard component of cancer care continues to strengthen, scalable and sustainable implementation models are urgently needed. Maple Tree Cancer Alliance (MTCA) has developed a comprehensive clinical-to-community exercise oncology framework with global reach, serving more than 20,000 patients across 100+ locations in the United States and 34 countries. The MTCA model is designed to improve access, quality, and consistency of evidence-based exercise programming for individuals affected by cancer.

Methods: The MTCA clinical program is embedded within healthcare systems and initiated through formal referral pathways from oncology providers. Following referral, patients complete a standardized fitness assessment including patient-reported outcomes, functional capacity, strength, balance, and cardiovascular measures. Individualized exercise prescriptions are developed according to cancer type, treatment status, comorbidities, and symptom burden, and delivered through supervised, one-on-one exercise programming both in person and virtually. Reassessments occur every 12 weeks to evaluate progress and support long-term engagement. Program data—including referral-to-participation conversion rates, attendance, functional outcomes, safety indicators, and symptom changes—are systematically collected and reported to clinical and administrative stakeholders.

Beyond clinical care, MTCA extends its model into community-based fitness centers by supporting the implementation of structured survivorship programs that maintain clinical fidelity while improving accessibility and sustainability. Workforce development is a foundational component, delivered through standardized Exercise Oncology Instructor (EOI) and Cancer Fit certifications. EOIs are prepared to deliver individualized, evidence-based exercise within clinical oncology settings, while Cancer Fit professionals implement safe, structured survivorship programming in community environments. Internationally, MTCA partners with hospitals, universities, and cancer organizations to deliver these certifications and co-develop context-specific implementation plans, enabling consistent, culturally adapted program delivery across diverse healthcare systems.

Conclusions: MTCA represents a scalable, partnership- and workforce-driven approach to integrating exercise oncology across clinical, community, and international settings, advancing exercise as a standard component of cancer care worldwide.

Speaker: Karen Wonders (Maple Tree Cancer Alliance)

196 IMPACT OF A COMMUNITY-BASED EXERCISE PROGRAM ON PHYSICAL FITNESS IN CANCER PATIENTS

INTRODUCTION:Physical exercise has been shown to attenuate cancer treatment–related side effects and improve quality of life in people with cancer. Based on this evidence, the Exercise Oncology Unit (EOU) of the Spanish Cancer Association (AECC) was created to facilitate the integration of structured exercise programs into routine cancer care.
PURPOSE: To evaluate the feasibility and effectiveness of an 8-week clinical exercise program on physical fitness outcomes in cancer patients within a community-based setting.
METHODS:A pre–post intervention study without a control group was conducted at the AECC EOU in Madrid between 2020 and 2025. Participants completed an 8-week individualized, supervised, moderate-to-vigorous concurrent training program. Outcomes assessed at baseline and post-intervention included functional capacity (30-second sit-to-stand test), maximal strength (bench press and leg press), cardiorespiratory fitness (VO₂max estimated from a submaximal treadmill test), body composition (bioelectrical impedance), and patient-reported outcomes (IPAQ, FACT-G, FACT-F, EQ-5D-5L). Normality was verified prior to analysis. Pre–post changes were analyzed using paired t-tests, with statistical significance set at p < 0.05.
RESULTS:A total of 300 cancer patients completed the program and post-intervention assessments (mean age: 51.8 ± 10.0 years; 88% women). The most prevalent diagnoses were breast cancer (57.7%), lung (8.3%), ovarian (6%), colorectal (4.3%), and other cancers (23.7%). At enrollment,49.6% were undergoing active treatment, 15.7% had metastatic disease, and 34.7% had completed treatment within the previous two years; 78% had undergone surgery. Significant improvements were observed in VO₂max (+8.86 ml·kg⁻¹·min⁻¹),upper-body strength (+10.38 kg), lower-body strength (+28.10 kg), lower-body functional performance (+5.27 repetitions), lean body mass (+0.61 kg), skeletal muscle mass (+0.39 kg),skeletal muscle index (+0.07), phase angle (+0.06°), body fat percentage (−0.51%), and waist-to-hip ratio (−0.006) (all p ≤ 0.016)
CONCLUSIONS:An 8-week supervised, moderate-to-vigorous, multicomponent exercise program is feasible and effective for improving physical fitness and body composition in cancer patients within a community oncology care model.

Speaker: Mr Jaime Pérez Vélez (Oncology Physical Activity Unit (Spanish Association Against Cancer) (AECC).)

197 Implementation of a multi‑professional care pathway and network for the promotion of needs‑oriented exercise therapy for cancer patients – The MOVE-ONKO care approach

Although substantial evidence underlines the benefits of physical activity (PA) and tailored exercise as a supportive strategy for cancer patients, exercise therapy is not yet part of standard oncology care. MOVE-ONKO aims to bridge this gap by implementing a multi-professional care pathway to promote needs-oriented exercise therapy for cancer patients in different oncological care settings.

Following the preparation phase, a specific evidence-based care pathway was implemented in 7 comprehensive cancer centers (CCCs) (year 2) and is currently being rolled out across 49 oncological care facilities (year 3-4). The pathway includes the following sequential steps: 1) symptom/side-effect screening, 2) brief consultations to raise patients’ exercise awareness, 3) anamnesis and risk stratification based on exercise-relevant symptoms/comorbidities, 4) comprehensive exercise counselling, and 5) referral to needs-/preference-oriented exercise therapy.

Specifically trained oncological professionals in all care facilities conduct screenings and brief consultations with patients. For patients with no, mild or moderate symptoms/comorbidities, they may also provide comprehensive counselling and exercise-program referrals. Exercise oncology specialists based at the CCCs support the roll-out and manage complex patients with significant side effects/comorbidities. All steps are supported by an internally-developed telemedicine platform that guides users through the pathway, manages digital patient records, provides educational modules, and facilitates communication between patients and professionals.

The associated study evaluates implementation, reach, and patient outcomes [1]. Primary (patients’ health-related quality of life) and secondary (PA behavior and motivation, patient activation) outcomes are assessed at inclusion and at 4,12 and 24 weeks. A total of 2.240 cancer patients will be recruited. Care structures/processes are evaluated through questionnaires and interviews from both healthcare providers’ and patients' perspectives.

The MOVE-ONKO pathway is currently implemented in 7 CCCs and 33 oncological facilities. Of the 1.857 patients screened, 1.375 are participating. Beyond the pathway, initial results of the ongoing study regarding reach and outcomes will be presented.

Speaker: Dr Katharina Graf (Department of Oncology and Haematology, Krankenhaus Nordwest and University Cancer Centre (UCT) Frankfurt, Frankfurt am Main, Germany)

198 Integrating Exercise Oncology in the Community Through a Nonprofit Model

Background: Access to integrative oncology support including exercise and complementary medicine is limited despite strong evidence supporting their benefits for cancer-related symptoms and survivorship outcomes. This case report describes the work of Moving Beyond Cancer Collaborative (MBCC), a community-based nonprofit in Central Texas, that provides exercise and other integrative oncology services for both survivors and caregivers.
Methods: MBCC delivers 11 weekly in-person and virtual group exercise classes (yoga, Pilates, dance, low-impact cardio) and integrative oncology services including acupuncture, massage therapy, and mind-body classes. Program offerings were selected based on evidence that these modalities may reduce cancer-related side effects and improve physical function. Caregivers can participate to promote dyadic health and reduce barriers to engagement. Practitioners are paid independent contractors with advanced oncology training and experience. A donation- and grant-supported funding structure supports sliding-scale or no-cost access to services. Implementation outcomes were evaluated using descriptive data.
Results: From January 1 to December 10, 2025, MBCC had 1,227 exercise class attendances and delivered 1,385 integrative oncology treatment sessions. In-person yoga was the most frequently attended exercise class, and chair Pilates delivered virtually was the least attended class. Financial support from a local cancer center supported delivery of acupressure in the infusion clinic, demonstrating the feasibility of a collaborative model that embeds nonprofit-led services within clinical care settings. Facilitators for expanding reach and programming included collaboration with cancer centers and other non-profits, sliding scale payment options, virtual classes, and inclusion of caregivers. To improve adherence to and the potential therapeutic benefits of exercise programming, MBCC will transition from drop-in style exercise classes to structured in-person programs delivered by a physical therapist.
Conclusion: MBCC provides an example of a nonprofit model for delivering integrative oncology services, including exercise oncology, within community and clinical settings.

Speaker: Krystle Zuniga (University of Texas at Austin, Moving Beyond Cancer Collaborative)

199 International Network for exercise oncology: Guidelines, Training, and Implementation – International OncoExGuide

Background: Despite robust evidence of exercise oncology safety and efficacy, patients widely struggle to adopt and maintain an active lifestyle. Current implementation of exercise interventions is often not systematic, sustainable, accessible, or supported organizationally or legislatively. Crucially, the most vulnerable patients, facing the greatest access barriers, receive few offers. The International OncoExGuide study aims to build an international network to expand patients access to safe, effective, and evidence-based exercise interventions during and beyond cancer treatment by addressing meso- and macro-environmental health determinants.
Methods: The international network comprises patient partners, researchers, and professionals with expertise in implementing sustainable exercise oncology interventions. Participants were identified by the research team. A broader call for contributions will be disseminated through key associations. They will participate in two sequential Delphi techniques to reach consensus.
First, the network will define the essential knowledge and skills professionals require to design and deliver accessible, safe, evidence-based, sustainable exercise programs for individuals during and beyond cancer treatments, including those with vulnerabilities. Preliminary studies on existing training curricula and on professionals’ needs will inform this stage. Resulting training module(s) will be tailored to country contexts, translated, and tested across Europe.
Second, the network will reach consensus on the “core components” (essential intervention elements) and the “adaptable periphery” (elements modifiable without compromising the exercise intervention integrity). This formalization of the International OncoExGuide guidelines will facilitate iterative training updates.
Anticipated results: Eleven network members initially agreed to participate (Canada n=7, France n=3, USA n=1), and 20 additional experts have been identified across 9 countries. Ten learned and professional societies have agreed to support the project.
Conclusion: Leveraging the expertise of eminent researchers in exercise oncology and implementation science, alongside patient partners, this study will develop strategic recommendations for exercise oncology implementation. This approach supports the current paradigm shift in the cancer continuum.

Speaker: Mrs Mélina Ardjoune-Billi (Sorbonne Paris North University, Health Educations and Promotion Laboratory, LEPS, UR 3412, F-93430, Villetaneuse, France)

Call for participation to join the International OncoExGuide network

Poster_International OncoExGuide_ISEO2026_LEPS UR3412.pdf

200 OnkoMoveNurse - FIT by nurses: Physical activity in people with cancer during systemic antitumor therapy in an oncology day clinic initiated by nurses - Proof-of-concept study on the implementation of a person-centered physical activity concept

Physical activity (PA) is one of the most evidence-based supportive interventions in oncology, improving symptoms and in certain tumour entities even overall survival. Yet oncology day clinics lack a systematic approach to promoting it. Patients should be supported before, during and after therapy to integrate more PA into their daily lives. The "OnkoMoveNurse" concept offers oncology nurses a framework to encourage PA in routine care and foster a PA-friendly-culture. It includes three components: an activity compendium, a safety-concept and a communication-concept. Implementation is guided by person-centeredness and a team approach, supported by materials and interactive workshops. The aim is to evaluate feasibility and acceptance of OnkoMoveNurse in an oncology day clinic among patients and staff and to assess changes in patients’ PA, self-efficacy, well-being, and depressive symptoms.
Methods:
This proof-of-concept study uses a Hybrid Type 1 implementation design. The evaluation combines quantitative Patient-Reported-Outcome Measures (activity behaviour [BSA 3.0], quality of life [EORTC-QLQ-C30 3.0], sports-related self-efficacy [SSA], depressive symptoms [PHQ-2]) in a pre–post design (n=50) with qualitative methods, including digital storytelling, interviews (n=4), focus groups (n=2) and feedback questionnaires, to capture perspectives of patients and healthcare professionals. Quantitative analyses will follow an intention-to-treat approach (e.g., paired t-tests,α=0.05). Qualitative content analysis will follow Kuckartz and Rädiker.
Expected Results:
The evaluation will (1) examine how patients integrate PA on treatment days and throughout therapy, and (2) assess feasibility, acceptance, and resource requirements from the perspective of nurses and interprofessional staff. We expect changes in patients’ activity levels, self-efficacy, well-being, and depressive symptoms over the course of therapy.
Discussion:
In our presentation, we will share initial study results. We expect OnkoMoveNurse to positively influence the PA of patients by embedding activity promotion into daily routines. We anticipate these changes to be sustainable, as the intervention is integrated into everyday practice and the care environment.

Speaker: Ms Ramona Engst (OST Eastern Switzerland University of Applied Sciences, Department of Health, Institute for Health Sciences, St. Gallen, Switzerland)

201 Perceptions and practices of healthcare professionals regarding exercise for people receiving immune checkpoint inhibitor immunotherapy for cancer.

Background:There are calls for exercise to be integrated into routine cancer care. Healthcare professionals (HCPs) play a key role in promoting exercise. However, data on exercise during immune checkpoint inhibitor (ICI) immunotherapy is lacking, and HCP’s views on exercise within this setting are unknown. This study investigated the perceptions and practices of HCPs regarding exercise for people receiving ICIs for cancer.
Methods:An online survey was distributed internationally via professional associations, professional networks, and clinicians. Eligible participants were HCPs involved in the management of people receiving ICIs for cancer. The survey included questions regarding safety and efficacy of exercise during ICI treatment (using agree/disagree scale questions), as well as practices, confidence, and barriers with regard to exercise recommendations and referrals.
Results:A total of 110 HCPs completed the survey, including 28 exercise professionals and 82 non-exercise professionals (predominantly medical oncologists (n=40) and nurses (n=19)). Over 90% of HCPs totally or somewhat agreed that exercise is safe, important, and beneficial for people receiving ICIs, including to reduce treatment-related side-effects and maintain or improve physical and mental wellbeing. Further, 67% of HCPs totally or somewhat agreed that exercise can enhance ICI effectiveness. While 55% of HCPs totally or somewhat disagreed that exercise can increase the frequency or severity of immune-related adverse events (irAEs), 35% were undecided or did not know. On average, non-exercise HCPs reported recommending exercise to 62% of their patients and referring 36% of their patients to an exercise specialist.
Conclusion:Although evidence from human trials is scarce, our data suggests that HCPs believe exercise is beneficial for people receiving ICIs for cancer, with two-thirds believing it may also enhance treatment efficacy. HCPs also believe exercise is safe, although some were uncertain about the effects on irAEs. Additional insights into practices, barriers and confidence regarding exercise promotion will be presented at the conference.

Speaker: Dr Eva Zopf (Australian Catholic University)

202 Qualitative study on physiotherapy in advanced cancer care: barriers, facilitators, and pathways to excellence

Background
With advances in cancer treatments, more patients live longer with advanced stages of the disease, often facing complex symptom burdens and functional decline. Physiotherapy has emerged as a critical component of oncology care, supporting symptom relief, autonomy, and quality of life. Yet, its role in advanced cancer care remains under-recognised and inconsistently integrated.

Objective
PHYSPECTIVE is a multiperspective qualitative study aiming to explore the barriers and facilitators for embedding physiotherapy into advanced oncology pathways, viewed through the experiences of physiotherapists, physicians, and patients. By doing so, it seeks to identify strategies that can help promote excellence and inclusivity in oncology physiotherapy in the modern era.

Methods
Thirty individual semi-structured interviews were conducted with physiotherapists (n=10), physicians (n=10), and patients with advanced cancer (n=10). Interview guides were co-developed with experts in oncology, physiotherapy, and palliative/supportive care. Data were analyzed thematically, using iterative coding and constant comparison to identify cross-cutting themes.

Results
Key behavioural determinants influenced physiotherapy integration: limited awareness and knowledge led to late referrals; attitudes and beliefs shaped perceived relevance; while professional identity, confidence, and team dynamics shaped actual uptake. Facilitators included patient trust, adaptive person-centred care, and positive teamwork, whereas fragmented pathways, inadequate training, and lack of systemic recognition remained substantial barriers.

Conclusions
PHYSPECTIVE shows that physiotherapy is pivotal in advanced oncology care, where function and dignity are at stake. Earlier referral, stronger collaboration, policy support, and tailored training are key to implementation.

Clinical impact
In advanced cancer, physiotherapy can directly improve day‑to‑day clinical outcomes by sustaining mobility, preventing deconditioning, and relieving pain, dyspnoea, and fatigue. Yet many patients miss this support due to misconceptions and late or absent referrals. Embedding physiotherapy earlier and more systematically is essential to preserve independence, participation, and dignity in progressive disease.

Speaker: Luna Gauchez (Rehabilitation Research & End-of-Life Care research group, Vrije Universiteit Brussel (VUB), Brussels, Belgium)

Poster 1 - ISEO.pdf

203 Using a community-engaged approach to evaluate implementation of a physical activity intervention with rural breast cancer survivors

Background: Rural cancer survivors are less likely to meet physical activity (PA) recommendations than urban CS, contributing to differences in cancer survivorship. We used a community-engaged approach to adapt and evaluate an evidence-based intervention to increase PA and reduce psychosocial distress in rural breast cancer survivors (BCS).
Methods: Rural BCS (N=38) were interviewed to inform pre-implementation adaptations. Questions were guided by the socioecological model and assessed multilevel barriers/facilitators to engaging in PA. BCS ≥18 years who were ≥3 months post-treatment (N=43) were randomized to participate in the adapted intervention or usual care for 12 weeks and completed assessments at week 0, 12, and 24. Following week 24, a subsample of participants (n=20) completed an interview to evaluate acceptability and implementation of the study, guided by the Consolidated Framework for Implementation Research.
Results: Pre-intervention, rural BCS described multilevel barriers to participating in PA interventions/programs, including cancer treatment-related side effects, cost, lack of support and feeling socially isolated, and lack of resources. Knowledge of the benefits of PA post-diagnosis and access to resources were noted as facilitators. Additionally, participants described how characteristics of their rural community helped and hindered them from being active. Rural cancer survivors’ preferences included programming that supported even small amounts of PA to meet people where they are and programs that were flexible, offered at multiple times, held somewhere central that feels safe, and addressed psychological wellbeing. Post-intervention, participants described the program as convenient (timing, familiar location, easy parking), reported overall satisfaction (enjoyed exercises, health education, yoga/stretching), and reported benefits (behavior changes, support, increased motivation).
Conclusions: Input from rural BCS guided adaptations and implementation of an evidence-based PA intervention, contributing to high satisfaction. Future studies will evaluate effectiveness and implementation of the adapted intervention in a cluster randomized trial with additional rural community settings.

Speaker: Scherezade Mama (The University of Texas MD Anderson Cancer Center)

204 Using Mixed Methods to Develop a Theory-driven Narrative Intervention Strategy to Promote Resistance Exercise Among Black Breast Cancer Survivors

Purpose: Resistance exercise provides independent health benefits for breast cancer survivors, yet just 10.3% of Black survivors meet recommended guidelines (≥2 sessions/week). Theory-driven and culturally adapted narratives may enhance intervention uptake. This study aimed to refine six narratives featuring a Black breast cancer main character navigating cultural and cancer-related barriers and facilitators to resistance exercise for a future intervention. Methods: Utilizing a mixed methods design, a virtual community engagement studio was conducted with Black breast cancer survivors or patient advocates (N=8; Mage=45.5, SD=13.1), providing feedback on cultural relevancy and sensitivity. The session was audio recorded, transcribed, and analyzed with directed content analysis, reaching thematic saturation at n≈8. Narratives were revised based on this input, then evaluated by a new sample of Black breast cancer survivors (N=16; Mage=56.3, SD=8.5; 50.0% graduate degree; 68.6% employed; 42.8% Stage I diagnosis) using questionnaires to assess representativeness, interest, and usefulness. Results: Virtual community engagement studio participants rated the narratives as culturally relevant and sensitive, suggesting details (character names, geographic location) to enhance authenticity. Questionnaire participants (n=15, 93.8% response rate) rated all narratives as representative (Mscore=3.5 out of 5, SD=1.4), interesting (Mscore=4.1 out of 5, SD=0.9), and useful (Mscore=4.2 out of 5, SD=0.9) with additional suggestions for preferred character name spellings. Discussion: Findings demonstrate the importance of collaborating with the priority population and a systematic approach to narrative refinement. The refined narratives will be integrated into group discussions, with future research evaluating their effectiveness for facilitating resistance exercise adherence among Black breast cancer survivors.

Speaker: Angela Fong (University of Michigan)

205 “It all comes down to relationships and money, which it shouldn’t, but that’s healthcare”: Exploring funding models and funding-related barriers and facilitators to exercise oncology

Category: Behavioral Science/Implementation

Background: Despite strong evidence for exercise in cancer care, routine implementation remains a challenge. Closing the research-to-practice gap requires a multifaceted approach across all levels of the healthcare system. One key priority is to ensure exercise services are affordable and sustainable, which need to be supported by appropriate funding models and policies. However, little is known about how existing funding models support exercise oncology or the barriers and facilitators that affect them within Australia.

Methods: Semi-structured interviews were conducted with people living with or beyond cancer and providers delivering exercise oncology services (i.e. exercise physiologists) in Queensland, Australia. Interviews explored financial aspects of accessing and delivering exercise oncology services. For people living with or beyond cancer, topics included costs paid for exercise oncology services, use of funding supports, and cost-related factors influencing service uptake. For exercise physiologists, topics included billing practices, balancing affordability with service sustainability, and financial facilitators and barriers to provide exercise oncology services. Interviews were analysed using template thematic analysis.

Results: Fourteen participants completed interviews (n=9 people living with or beyond cancer, n=5 exercise physiologists). Coding and theme generation are ongoing until January 2026; complete results of the study will be presented.

Conclusions: Calls to action are valuable, but they are only meaningful if people living with or beyond cancer can afford exercise services and exercise oncology providers can sustainably deliver them. These outcomes are only possible when health funders and systems routinely and adequately support the cost of exercise oncology. This study will highlight how exercise services are funded and the financial and practical factors that influence both financial access to and delivery of exercise services. Findings can inform policy, guide resource allocation, and support sustainable, equitable models of care that integrate exercise into routine cancer care.

Speaker: Georgia White (University of the Sunshine Coast)

Poster Session 2.4: Breast Cancer / Gynacological Cancer (Posterarea 4)

206 Anthropometry and body composition outcomes from the PREDICOP trial – a randomized weight control trial among breast cancer survivors

Background: Evidence shows that obesity and physical inactivity increase breast cancer (BC) risk among postmenopausal women and may also influence prognosis. Evidence from well-designed clinical trials remain insufficient. This study helps fill this gap by evaluating an intervention combining diet and exercise.
Objectives: The primary aim is to assess the effect of the intervention on cancer recurrence in BC survivors. Secondary objectives include evaluating changes in weight and body composition.
Design: A multicentre randomized controlled trial was conducted in seven hospitals. Eligible participants were women aged 18-75 years with non-metastatic BC who have completed standard treatment. Participants were randomly assigned to intervention or control group. The control group received usual care, while the intervention group participated in a 1-year lifestyle program including a calorie reduction diet and moderate-intensity exercise sessions.
Outcomes: The primary outcome for this analysis was weight control at one year, defined as achieving >5% weight loss for women with BMI>25 or maintaining normal weight for women with BMI<25. Secondary outcomes included weight change, BMI and fat mass%.
Results: Of 699 women initially enrolled, 644 were included: 321 assigned to the intervention group and 323 to the control group. At baseline, the mean age of participants was 53.3(sd9.1), 51.3% were postmenopausal and mean BMI was 27(sd4.8). Weight control was achieved by 60.2% of patients in the intervention group versus 45.5% in the control group (p<0.0001). Among women with BMI>25, 70.5% in the intervention group and 43.1% in the control group lost weight. At 12 months, the intervention group had significant lower weight, BMI and fat mass% than the control group. Mean weight loss in the intervention group was 2.2%(95%CI:1.5,2.9), while the control group gained 0.8%(0.0,1.6).
Discussion: In this clinical trial, a combined diet and physical activity intervention induced significant weight control, weight loss and reduction in fat mass.

Speakers: Ms Catalina Bonet (Unit of Nutrition and Cancer, Catalan Institute of Oncology (ICO). L'Hospitalet de Llobregat, Barcelona, Spain. Programa de doctorat Medicina i Recerca Translacional, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain. Bellvitge Biomedical Research Institute (IDIBELL). L'Hospitalet de Llobregat, Barcelona, Spain.), Dr Marta Crous-Bou (Unit of Nutrition and Cancer, Catalan Institute of Oncology (ICO). L'Hospitalet de Llobregat, Barcelona, Spain.Bellvitge Biomedical Research Institute (IDIBELL). L'Hospitalet de Llobregat, Barcelona, Spain.)

207 Associations of Phase Angle with Sleep Quality, Fatigue, and Global Health in Women Newly Diagnosed with Breast Cancer

Purpose: To present a cross-sectional investigation analyzing the associations of whole-body phase angle (PhA) with sleep quality, fatigue, and global health in women newly diagnosed with breast cancer.
Methods: Sixty-four newly diagnosed breast cancer patients waiting for their first chemotherapy cycle were enrolled in this investigation [mean age, 52.0±9.5 years; body mass index (BMI), 26.2±4.9 kg/m2; PhA, 5.5±0.5º]. PhA was measured using a phase sensitive bioelectrical impedance analysis (BIA) device at 50kHz. Sleep quality, fatigue, and global health were assessed using validated questionnaires, including the Pittsburgh Sleep Quality Index, Functional Assessment of Chronic Illness Therapy - Fatigue, and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire, respectively. Associations were examined using multiple linear regression analysis models, including age and BMI as covariates (Model 1: unadjusted; Model 2: adjusted for age; Model 3: age and BMI).
Results: Higher whole-body PhA was associated with improved sleep quality, lower fatigue levels, and better global health. These associations were observed in unadjusted models (β=-0.337, p=0.007; β=0.262, p=0.036; and β=0.281, p=0.024, respectively), and remained associated after adjustment for age (β=-0.273, p=0.040; β=0.293, p=0.033; and β=0.283, p=0.039, respectively) and BMI (β=-0.303, p=0.027; β=0.338, p=0.016; and β=0.326, p=0.018, respectively).
Conclusion: Whole-body phase angle was independently associated with sleep quality, fatigue, and global health in women newly diagnosed with breast cancer, underscoring its clinical relevance as a simple, non-invasive marker of health status. Further research should examine whether PhA can be used to monitor changes throughout the disease trajectory.

Speaker: Ana Bernardino (Faculdade de Motricidade Humana, Universidade de Lisboa)

208 Delivering a physical activity intervention during breast cancer chemotherapy: recruitment, adherence, and attrition

Background: Increasing physical activity levels during chemotherapy is crucial for health maintenance; however, adherence is difficult. We piloted a randomized controlled exercise intervention during chemotherapy for breast cancer. This abstract reports on recruitment, intervention adherence, and attrition.

Methods: The PROTECT Trial was a pilot randomized control trial studying the effect of exercise on cognition during breast cancer chemotherapy (NCT05716542). Recruitment was defined as the number of participants enrolled divided by the number approached. Intervention adherence was defined as: educational coaching sessions attended, home exercise sessions completed, and Fitbit wear days divided by the number of eligible days on trial. Attrition was defined as the percentage of participants who withdrew from the trial.

Results: We approached 117 potentially eligible individuals who were approached to participate in the study and enrolled 41 (recruitment rate=35%). Thirty-eight were ineligible and 27 were unwilling to complete screening. Eleven were eligible but declined (e.g., too many obligations, n=4; travel/transportation concerns, n=4; concerned about chemotherapy effects/exercise tolerance, n=2; no longer interested, n=1). Ten participants withdrew due to overwhelm and chemotherapy side effects (attrition rate=24.4%; six intervention, four control). Twelve intervention participants received a mean of 5.83 (SD=0.39) out of 6 educational content sessions (97.2%) and reported engaging in 252 total home exercise sessions, with a mean 2.73 (SD= 1.90) home exercise sessions per completed coaching session. Mean Fitbit adherence was 81.8% (SD=22.7%) across all participants and 86.8±14.3% and 78.5±26.5% for intervention and control participants, respectively.

Conclusions: The overall enrollment rate was low; implementation of lifestyle interventions during cancer treatment remains challenging. However, newly diagnosed breast cancer patients enrolled in the PROTECT Trial had high levels of adherence to exercise intervention components (i.e., coaching sessions, home exercise, Fitbit) with little attrition. Future research should consider how exercise interventions can be personalized during treatment to meet patients’ varied needs.

Speaker: Elizabeth Salerno (University of Michigan)

209 Does the type of endocrine therapy influence the effect of Mat Pilates on pain, anxiety, and depressive symptoms in breast cancer survivors? A randomized controlled trial

Background: Breast cancer survivors (BCS) undergoing endocrine therapy often experience pain, anxiety, and depressive symptoms. Although exercise has been shown to reduce these effects, there is still limited evidence on whether its benefits vary according to endocrine therapy type. Purpose: To analyze the effects of 24 weeks of Mat Pilates on pain severity, pain interference, anxiety, and depressive symptoms in BCS undergoing endocrine therapy, and to determine whether these effects differ according to the type of endocrine therapy, Tamoxifen (TMX) or Aromatase Inhibitors (AIs). Methods: This randomized controlled clinical trial consisted of supervised 60-minute Mat Pilates sessions, three times per week, for 24 weeks. Outcomes were assessed at baseline and post-intervention using the Brief Pain Inventory and the Hospital Anxiety and Depression Scale. Generalized estimating equations were applied. The Bonferroni post-hoc tests applied when appropriate. Statistical significance was set at p ≤ 0.05, with p ≤ 0.10 considered marginally significant for group*time interactions.
Results: Forty-three BCS were equally randomized into a control group (CG; 54.7 ± 6.6 years) and a Pilates group (PG; 55.2 ± 7.6 years). A significant group-time interaction was observed for pain severity (p = 0.031), with a reduction in the PG (Δ = −5.5), and for anxiety symptoms (p = 0.006), with an increase in the CG (Δ = 1.7). When stratified by endocrine therapy type, group-by-time interactions were found among AI users for pain severity (p = 0.025; Δ = −6.1) and for anxiety symptoms, with reductions observed in the PG for both variables with no effects for BCS undergoing TMX. Conclusion: 24 weeks of Mat Pilates reduced pain severity and anxiety symptoms in BCS undergoing endocrine therapy. The same was observed in BCS receiving AIs only, which indicates that the benefits of this intervention may be modulated by the type of endocrine therapy.

Speakers: Dr Josefina Bertoli (Universidade Federal de Santa Catarina), Prof. Cíntia de la Rocha Freitas (Universidade Federal de Santa Catarina)

210 Effect of 36 weeks of regular resistance training on double product in women with breast cancer

Chemotherapy is one of the main treatments for breast cancer. Cardiotoxicity can occur as a side effect of some of its components. On the other hand, regular physical exercise can improve overall and cardiovascular health of cancer patients. However, regarding cardiovascular health, most healthcare professionals still recommend exercises that predominantly involve aerobic metabolism. Unfortunately, during AER, the lower afterload, higher heart rate, and increased distension of the cardiac walls raises the myocardial demand. Resistance exercise, due to its safety, is a useful tool in the rehabilitation of most cardiovascular complications. The double product is a widely used measure in cardiology to estimate cardiac workload, and is also a relevant metric for cancer patients. The aim of this study was to analyze the effect of 36 weeks of periodized RE on the resting DP in women diagnosed with breast cancer.
25 women (51.4±8.5 years old) with breast cancer participating in the exercise program were selected. All participants underwent a periodized exercise protocol, with their blood pressure and heart rate assessed at rest, before and after 12, 24, and 36 weeks of training. The main results showed that resting blood pressure (BP) decreased significantly after the first 24 weeks of ER, becoming even more pronounced after the 36th week. We also noted that when separately analyzing previously hypertensive patients (N=8) and non-hypertensive patients (N=17), the former showed a significant reduction after the first 24 weeks, while the latter only showed a reduction after the 36th week. We concluded that 36 weeks of resistance training resulted in a significant reduction in cardiovascular overload in patients, with this reduction being significant after the first 24 weeks but proving even more effective after 36 weeks of resistance training, representing a lower cardiac workload and improved cardiovascular conditioning.

Speaker: Karen Wonders (Maple Tree Cancer Alliance)

211 Effect of a supervised intermittent exercise program on insomnia in breast cancer patients undergoing chemotherapy

Background: Patients with localized breast cancer receiving (neo)adjuvant chemotherapy often experience sleep disturbances, especially insomnia, which significantly impacts quality of life. This study primarily aimed to evaluate the effects of a 12-week exercise program on insomnia, with secondary outcomes on sleep quality, anxiety/depression, fatigue, pain, and exercise adaptation.

Methods: In this randomized controlled multicenter trial, 20 women (mean age 46.8 years), with non-metastatic breast cancer and clinically diagnosed insomnia were assigned to a control (n=10) or training group (n=10). The training group underwent a 12-week supervised intermittent aerobic exercise program during chemotherapy. The primary outcome was objective total sleep time; secondary outcomes included insomnia severity, sleep architecture, sleep quality, anxiety/depression, fatigue, pain, and cardiorespiratory capacity. Assessments were performed before chemotherapy (T-1), at baseline (between the 1st and 2nd sequences of chemotherapy; T0), and post-intervention (3 months after; T3), using polysomnography, actigraphy, validated questionnaires, and a maximal graded exercise test.

Results: The prevalence of clinical insomnia, assessed according to DSM-5 criteria, increased from 47% before diagnosis to 71% at T-1, reaching 100% at T0. Total sleep time measured by polysomnography did not increase after training (07:16 at T0 to 06:13 at T3; p=0.97), although sleep fragmentation appeared to decrease. Based on the MFI-20 questionnaire, clinical improvement was observed in physical and activity-related fatigue. Finally, both submaximal exercise adaptation parameters (power and VO2/HR) and maximal parameters (power, VO2 peak, VO2/HR) significantly improved.

Conclusions: The supervised exercise program did not extend total sleep time in breast cancer patients undergoing chemotherapy, however, it may have enhanced sleep continuity, reduced certain dimensions of fatigue, and substantially improved physical fitness. Future research is needed to investigate the diverse etiologies of insomnia to develop tailored and personalized management approaches.

Speaker: Chloé Drozd (Université de Haute-Alsace, LISEC (UR 2310), F-68200 Mulhouse, France)

212 Effects of Concurrent Resistance Training on Shoulder Strength and Function in Women with Breast Cancer Undergoing Hypofractionated Radiotherapy

Despite its clinical effectiveness, radiation therapy (RT) is associated with multiple adverse effects that can impair functional capacity and overall recovery in individuals undergoing breast cancer (BC) treatment. Exercise has emerged as an evidence-based adjunctive approach to mitigate treatment-related toxicity and enhance musculoskeletal performance. This study aimed to examine the effects of progressive resistance training (PRT) performed in combination with adjuvant hypofractionated radiation therapy (HFRT) on shoulder complex muscle strength, functional control, and muscle activation patterns in women with BC.

Thirty-one participants were allocated to either an exercise group (EG, n=15) or a control group (CG, n=16). Electromyography (EMG) and torque signals were obtained during isokinetic shoulder internal and external rotation at angular velocities of 1.047 rad/s and 2.094 rad/s on both the surgical and contralateral limbs. Treatment-related side effects were assessed using the Common Terminology Criteria for Adverse Events (CTCAE). Pre and post intervention torque and EMG outcomes were analyzed using linear mixed-effects models.

The EG demonstrated significantly greater increases in internal and external rotation torque across all test velocities compared with the CG (p < 0.0001). A significant group-by-time interaction was observed for mean functional control ratio (FCR) and maximal voluntary contraction torque (p < 0.0001), indicating superior neuromuscular adaptation in the EG. Similarly, peak EMG amplitudes exhibited significant group-by-time interaction effects (p < 0.0001), reflecting enhanced muscle activation following the intervention. No significant differences in CTCAE scores were found between groups (p > 0.05), suggesting that PRT did not exacerbate treatment-related toxicity.

In conclusion, PRT performed concurrently with adjuvant HFRT effectively improves shoulder muscle strength, functional control ratios, and EMG-derived activation parameters in women with BC, without increasing HFRT-related adverse effects. These findings support the integration of resistance training into supportive care protocols during hypofractionated RT.

Speaker: Dr EMEL TUGRUL

213 Effects of Structured Exercise Interventions in Gynecologic Cancer Survivors: A Systematic Review and Meta-analysis of RCT

Background: Gynecologic cancer (GC) survivors frequently experience declines in quality of life (QoL), physical function, and body composition following treatment. Exercise has emerged as a key survivorship strategy. However, previous meta-analyses in this population have shown inconsistent findings and limited coverage of functional and anthropometric outcomes. This systematic review and meta-analysis evaluated the effects of structured exercise interventions on QoL, physical fitness, and anthropometric indicators among GC survivors.
Methods: This review followed PRISMA guidelines and was prospectively registered in PROSPERO (CRD42025104043). PubMed and Embase were searched until March 2025. Eligible studies were randomized controlled trials (RCTs) evaluating structured exercise interventions in survivors of endometrial, ovarian, or cervical cancer. Outcomes included QoL, cardiorespiratory fitness (6-minute walk test, 6MWT), lower-extremity strength (30-second sit-to-stand test, 30STS), and body composition indicators (BMI and waist circumference). Risk of bias was assessed using standard methodological criteria. Random-effects models were applied, and effect sizes were presented as standardized mean differences (SMDs) or weighted mean differences (WMDs).
Results: Fourteen RCTs including 857 participants (456 exercise, 401 control) met the inclusion criteria. Exercise interventions significantly improved QoL (SMD = 0.34; 95% CI: 0.12-0.56; p = 0.002). Cardiorespiratory fitness improved by 27.9 meters on the 6MWT (WMD; 95% CI: 5.1-50.7; p = 0.016), and lower-extremity strength improved by 2.29 repetitions on the 30STS (WMD; 95% CI: 0.68-3.89; p = 0.005). BMI decreased modestly (WMD = -0.78 kg/m²; 95% CI: -1.45 to -0.10; p = 0.024), whereas changes in waist circumference were not statistically significant.
Conclusions: Structured exercise interventions demonstrate meaningful improvements in QoL, functional fitness, and BMI among GC survivors. These findings support integrating exercise into survivorship care pathways and highlight the need for future trials that examine long-term clinical outcomes and mechanistic biomarkers.

Speaker: Susanna Jun (Department of Sport Industry Studies, Yonsei University, Seoul, Republic of Korea)

214 Evaluating Cardiorespiratory Fitness and Functional Outcomes in Women Breast Cancer Survivors: Preliminary Data

Background: Women breast cancer survivors (WBCS) frequently present long-term impairments in cardiorespiratory fitness and functional capacity, which may negatively affect health outcomes and quality of life. Cardiopulmonary exercise testing (CPET) allows an integrative assessment of cardiovascular and metabolic function, while functional tests provide clinically meaningful indicators of physical performance.
Objective: To compare CPET-derived parameters and functional performance between WBCS and women without a history of cancer.
Methods: This cross-sectional study included WBCS (≥6 months post-treatment) (n=9) and age-matched controls (n=5). Participants underwent CPET and functional assessments, including sit-to-stand, upper-limb strength (right and left), stationary march (ME), and Timed Up and Go (TUG). Between-group comparisons were performed using independent t-tests and Welch’s correction. Effect sizes were calculated using Cohen’s d.
Results: WBCS exhibited significantly lower relative VO₂ compared with controls (23.6 ± 2.6 vs. 29.5 ± 1.9 mL·kg⁻¹·min⁻¹; p < 0.001; d = 2.45). Circulatory power was also reduced in WBCS (3708 ± 717 vs. 4911 ± 346 mmHg·mL·kg⁻¹·min⁻¹; p = 0.005; d = 1.94), suggesting impairment in cardiorespiratory function. Although not statistically significant, functional performance was consistently impaired in WBCS, as indicated by moderate-to-large effect sizes in sit-to-stand (d = 1.21), upper-limb strength (right: d = 0.69; left: d = 0.48), TUG (d = 0.86), and stationary march (d = 0.99).
Conclusion: WBCS demonstrate reductions in aerobic capacity and circulatory power. The magnitude of functional impairments, evidenced by large effect sizes, suggests clinically relevant limitations that may become statistically significant in larger samples. These findings underscore the importance of structured exercise-based rehabilitation in breast cancer survivorship.

Speaker: Aline Gurgel

215 Evaluating Exercise Therapy for Managing Breast Cancer-Related Lymphoedema: A Systematic Review Without a Meta-Analysis (SWiM) of Randomised Controlled Trials

Background: Breast cancer is the most prevalent cancer in South Africa with an incidence rate of 31.4 per 100,000 women, with 57.1% of cases reported at advanced stages (1)(2). Since 2009, numerous international studies have demonstrated the benefits of exercise in managing upper-arm lymphedema(3)(4)(5)(6). The executive committee of lymphology 2016 consensus document stated the need for a satisfactory meta-analysis on treatment methods(7). With a lack of research in Sub-Saharan Africa on the effectiveness of exercise for BCRL patients and survivors, it is necessary to determine whether exercise protocols published on western BCRL rehabilitation strategies will be feasible in South Africa(8)(1). The primary outcome of the study is to conduct a systematic review and meta-analysis on Randomised Controlled Trails studying the use of exercise therapy in managing BCRL.
Aim: The aim of this systematic review and meta-analysis is to examine the effectiveness of exercise interventions of RCT’s in treating BCRL .
Methods: A systematic search of RCT’s of healthcare databases over the last decade will be conducted. Medical sub-headings and text-based search terms for BCRL and Complete Decongestive Therapy (CDT) were adapted from prior peer-reviewed literature. This SR will follow the PRISMA guidelines. COVIDENCE will be used to analyse the data, categorise the data, and create visual patterns. The eligible studies will also be manually inserted into an excel spreadsheet which will include title, type of study, year and results section.
Keywords: “physical activity”, “breast cancer-related lymphedema”, “BCRL”, “exercise interventions”

Speaker: Chérien Roux (University of Witwatersrand)

216 Immediate changes in fatigue, pain, dizziness, nausea, and mood after supervised exercise in patients with breast cancer receiving neoadjuvant chemotherapy

Background: Exercise during cancer treatment can reduce symptom burden over time, but the immediate effects of single exercise sessions are unclear. This study examined immediate changes in treatment-related side effects ─ fatigue, nausea, dizziness, pain, and mood ─ following exercise in patients with breast cancer undergoing neoadjuvant chemotherapy (NACT).
Methods: In this study, 28 women participating in the exercise group of the Neo-train randomized controlled trial were included. The intervention consisted of supervised high-intensity interval training and progressive resistance training 3 times per week during NACT. Before and after each exercise session, participants rated fatigue, nausea, dizziness, pain, and mood on 100 mm Visual Analogue Scales. Mixed linear models using all pre- and post-exercise ratings as repeated measures were performed, both unadjusted and adjusted for age and comorbidities. Subgroup analyses were conducted including only observations where participants reported pre-exercise ratings >0 mm.
Results: Participants received NACT for a median of 21 weeks (interquartile range [IQR] 18-23) and attended the exercise intervention for a median of 20 weeks (IQR 16-23). Across all sessions, exercise was associated with statistically significant immediate reductions in fatigue (-5.8 mm, 95% confidence interval [CI]: -6.8; -4.4) and pain (-1.2 mm, 95% CI: -1.8; -0.5), as well as improved mood (-5.3 mm, 95% CI: -6.4; -4.3). The subgroup analyses showed statistically significant reductions in fatigue (-7.5 mm, 95% CI: -8.8; -6.2), pain (-6.9 mm, 95% CI: -9.3; -4.5), dizziness (-6.1 mm, 95% CI: -8.8; -3.4), and nausea (-6.1 mm, 95% CI: -9.5; -2.6), and improved mood (-8.4 mm, 95% CI: -9.9; -7.0).
Conclusion: This study indicates that supervised high-intensity interval training and progressive resistance training can lead to immediate improvements in treatment-related side effects in women with breast cancer undergoing NACT.
Updated results from the full cohort of 50 exercise-group participants will be presented at the conference.

Speaker: Eva Kjeldsted (Danish Research Center for Equality in Cancer (COMPAS), Department of Clinical Oncology and Palliative Care, Zealand University Hospital and Cancer Survivorship, Danish Cancer Institute, Denmark)

217 Impact of Structured Exercise vs. Brief Counseling on Pain in Breast Cancer Survivors on Aromatase Inhibitors - The PAC-WOMAN Trial

Purpose: Breast cancer survivors undergoing hormonal therapy with aromatase inhibitors face a significantly increased risk of developing musculoskeletal pain, leading to treatment discontinuation, greater risk of unemployment and other negative outcomes on their quality of life. While physical activity is a known strategy for symptom management, the comparative efficacy of different delivery models remains understudied. Therefore, this study compared the effects of a brief physical activity counseling intervention versus a structured exercise program on pain scores in breast cancer survivors undergoing aromatase inhibitors, enrolled in the PAC-WOMAN Trial.
Methods: This secondary analysis utilized intent-to-treat data from the PAC-WOMAN pragmatic randomized controlled trial. Participants included 110 women with hormone-receptor-positive breast cancer (Stage I-III; age 56.1±7.6 years) currently treated with AIs (mean duration: 23.4±20.1 months). Participants were randomized to: 1) supervised structured exercise program; 2) brief physical activity counseling; or 3) a wait-list control. The primary outcome for this analysis was the change in pain scores from baseline to 4-months post-intervention, assessed with the pain symptom subscale of the EORTC QLQ-C30, adjusted for relevant covariates.
Results: Pairwise comparisons revealed significant post-intervention differences in pain scores between the exercise group and the brief counseling group. The exercise group reported significantly lower pain scores compared to brief counseling (p=0.001). Conversely, the brief counseling group experienced a significant deterioration in pain symptoms over time (p=0.026).
Conclusions: Supervised structured exercise appears to be a better option than brief physical activity counseling for mitigating pain in breast cancer survivors undergoing aromatase inhibitors. These findings suggest that physical activity interventions targeting pain management likely require a supervised setting with specific exercise dosage prescription, rather than counseling alone.

Speaker: Ines Nobre (CIPER, Faculty of Human Kinectics, University of Lisbon)

218 Improving funcional capacity and strength in breast cancer women and the correlation with mortality

Cancer is affecting more and more people around the world. Among the different types of cancer, breast cancer is the one with the highest incidence worldwide, especially over 50 years. According to the National Cancer Institute (INCA), the estimated number of new cases in Brazil from 2023 to 2025 is 73,610 cases. One of the most important causes in the literature for the emergence of breast cancer is poor lifestyle habits, as sedentary lifestyle and obesity. On the other hand, regular physical exercise has shown to improve overall health and reduce mortality in breast cancer patients. However, still remains doubts about how much exercise is necessary to observe this benefit and whether this protection increases with longer exercise practice.
PURPOSE: The objective of the present study was to analyze the effect of 36 weeks of resistance training on parameters indirectly related to mortality in patients with breast cancer.
METHODS: 32 women (48.4 ± 8 years old) with breast cancer were selected. Among them, 16 performed RT for 36 weeks, and 16 were part of the control group, not practicing physical exercise. The physical tests included assessments of the upper and lower limbs' functional capacity, strength, and muscular endurance. RESULTS: There was a significant increase in the strength of lower limbs mainly after the first 12 weeks, while the Timed Up and Go showed a significant improvement after the first 12 weeks and an even greater significance at the end of the 36th week. CONCLUSION: We conclude that the 12-week practice of RT resulted in a significant improvement, both acute and chronic, in the functional capacity of the sample, and considering that TUG is related to lower mortality from any cause in women with breast cancer, we encourage the recommendation of RT from the initial phase of the oncology rehabilitation program.

Speaker: Dr Karen Wonders (Maple Tree Cancer Alliance)

219 Lifting More Than Weights: Implementing the Strength After Breast Cancer Program across Appalachia

Cancer-related fatigue (CRF) is a prevalent and debilitating symptom experienced by breast cancer survivors, significantly impairing quality of life (QoL). CRF treatment requires a comprehensive approach due to its multifactorial nature. Exercise is an effective treatment for CRF, but it is unclear how socioeconomic status (SES) influences survivors’ participation and retention in exercise programs. Lower-SES is associated with greater fatigue severity, and lower participation in structured exercise programs remains low among Appalachians. We examine how SES affects adherence to the Strength After Breast Cancer (SABC) program, addressing CRF management across SES.

This ongoing mixed-methods study includes adult non-metastatic breast cancer survivors who are 1-3 years post-diagnosis. Participants will be dichotomized into Lower- and Higher-SES groups and will engage in a 3-month SABC program. Participants complete 1-4 supervised sessions and continue the program unsupervised twice weekly. The SABC workout packet is used for reference, and logs are completed to track adherence. Primary outcomes include dropout rate and adherence, with allostatic load as a potential moderator. Measures of fatigue severity, physical performance, exercise self-efficacy, and QoL are collected at baseline and 3 months. Semi-structured interviews are completed at follow-up to examine accessibility, acceptability, outcome expectations, and self-efficacy related to adherence.

Two participants are enrolled, with a goal of 60 total (30 Lower-SES; 30 Higher-SES).

The feasibility criterion is ≤20% dropout. Lower-SES is expected to have higher dropout and lower adherence compared to Higher-SES. High allostatic load is expected to reduce adherence, regardless of SES. Lower-SES reports barriers (financial, geographic constraints, limited support, lower confidence), whereas Higher-SES report facilitators (better access, financial flexibility, stronger support, higher confidence) to adherence.

We aim to advance our understanding of how SES affects participation and retention in exercise programs among individuals with CRF. Findings will support implementing larger-scale oncology exercise programs for underserved and Appalachian cancer survivors.

Speaker: Dr McKinzey Dierkes (Clinical and Translational Science Program, West Virginia University School of Medicine, Morgantown, West Virginia, USA; Cancer Prevention and Control, West Virginia University School of Medicine, WVU Cancer Institute, Morgantown, West Virginia, USA; Exercise Physiology, Division of Human Performance, West Virginia University School of Medicine, Morgantown, West Virginia, USA; Rehabilitation Services, WVU Medicine, Morgantown, WV, USA)

ISEO Poster 2.pdf

220 Optimising Recovery After DIEP Flap Breast Reconstruction: Addressing Post-Discharge Exercise and Education Gaps Through Phase-Based Exercise Oncology

Introduction
DIEP flap reconstruction involves harvesting abdominal skin, adipose tissue, and perforating blood vessels to reconstruct one or both breasts following mastectomy. The procedure requires extensive abdominal wall dissection, affecting trunk muscle function, shoulder mobility, and posture, often leading to difficulty standing upright and shoulder impingement. Despite the complexity and duration of recovery, structured pre- and postoperative education and exercise-based rehabilitation remain limited. Many women access Accredited Exercise Physiologists (AEPs) several months postoperatively, suggesting missed opportunities for earlier intervention. This study aimed to identify postoperative functional limitations and gaps in exercise education to inform a phased, exercise oncology–led rehabilitation program.
Methods
Fifty-eight women (2 months–7 years post-DIEP) participated in a mixed-methods study comprising online surveys (n=22), facilitated roundtable discussions (n=12), and follow-up surveys (n=13). Quantitative data described recovery timelines, persistent functional impairments, and exercise prescription. Qualitative data explored patient-reported experiences of education, recovery expectations, exercise guidance, and unmet rehabilitation needs.
Results
Functional recovery was varied: 32% regained full function by 6 months, 23% by 12 months, 14% by 18 months, while 32%, who were between 2 months and 3.5 years post-surgery, remained functionally limited. Persistent impairments included numbness, limited range of movement and lymphoedema, all reported by 41%, abdominal limitations (36%), postural limitations and abdominal swelling by 23%. Although 85% received postoperative exercise prescription, only 10% included abdominal or core-specific exercises. Early rehabilitation primarily focused on shoulder mobility (77%), ambulation (68%), and safe transfers (64%). Participants reported insufficient preoperative education around expectations and post-operative care regarding abdominal recovery, fatigue management, and restoring posture. Eighty-six percent indicated willingness to engage with an AEP within the first four weeks postoperatively.
Conclusion
DIEP patients experience prolonged functional impairments, often compounded by delayed exercise intervention limited abdominal and trunk specific guidance. A structured, phase-based, exercise oncology–led rehabilitation model, including prehabilitation, early postoperative intervention, and long-term recovery support, may optimise functional outcomes, accelerate recovery, and improve patient confidence, psychological wellbeing, and quality of life.

Speaker: Dale Ischia (Exercise & Sports Science Australia - Accredited Exercise Physiologist specializing in oncology and Founder of Moving Beyond Cancer – an Accredited Exercise Physiologist led cancer rehabilitation program)

221 Patient characteristics related with exercise training response in breast cancer patients undergoing cancer treatment

Background: Exercise is an effective measure for mitigating treatment-related side effects and improving physical functioning in cancer patients (Campbell et al., 2019), but not all patients benefit equally from exercise. Most research in exercise oncology has not sufficiently emphasized this inter-individual variability or explored the factors that may influence it. Goal of this study is to explore how treatment- and patient-related variables influence resistance training (RT) progression trajectories in breast cancer patients undergoing adjuvant therapy.

Methods: Data from 69 breast cancer patients across two randomized controlled trials were analyzed. Participants performed a progressive supervised, machine-based full-body RT program twice weekly for 12 weeks during adjuvant chemotherapy or radiotherapy. A three-level hierarchical Bayesian growth model was fitted to assess the impact of potential predictors on training progression, which was operationalized as the z-standardized volume load (load × repetitions × sets).

Results: Participants showed consistent increases in volume load per training session (TS) (Posterior Mean = 0.053 SMD; 90% HDI = 0.006–0.101) with minimal variability across exercises (Posterior Mean (SD)  = 0.013; 90% HDI = < 0.001 to 0.027) but substantial variability across individuals (Posterior Mean (SD)  = 0.062, 90% HDI= 0.057 to 0.067). Training progression was unaffected by age (Posterior Mean = 0.004; 90% HDI = –0.007 to 0.014). However, Taxane administration (Posterior Mean = -0.013 SMD per session; 90% HDI = -0.033 to 0.005) and time since surgery (Posterior Mean = 0.015; 90% HDI = 0.005 to 0.027) emerged as potential modifiers, while baseline fatigue and physical functioning showed no association with either baseline volume load nor progression.

Conclusion: Resistance training (RT) during adjuvant cancer therapy leads to consistent gains in training volume load. However, these gains are influenced by treatment status. Nevertheless, substantial inter-individual variability remains, highlighting the need for individualized exercise prescriptions in oncology.

Speaker: Maximilian Köppel (Working Group Exercise Oncology, Department of Medical Oncology, National Center for Tumor Diseases Heidelberg (NCT Heidelberg) and Heidelberg University Hospital, Heidelberg Germany)

222 Perceptions and experiences of coping with breast cancer related lymphedema among breast cancer survivors at a tertiary comprehensive cancer care centre in India

Background & Aim: Breast cancer related lymphedema (BCRL) is a chronic sequel affecting the psychosocial aspects of life in breast cancer survivors. Self-management in breast cancer requires active participation by the survivor in recuperation and rehabilitation, thus minimising treatment consequences and promoting health and well-being. Although awareness of BCRL is constantly monitored for prospective exercise program planning, in depth exploration of survivors’ perceptions, experiences and coping strategies is scarcely reported from low resource settings. We aimed to explore the perceptions, experiences and coping strategies of breast cancer survivors diagnosed with BCRL.
Materials and methods: Approval from the institutional research committee was sought. Study procedure was explained and informed consent was obtained from all eligible participants. Focus group discussions using a validated interview guide with ten open ended questions related to perceptions, experiences and coping strategies using contextual factors (sociocultural, financial, BCRL coping strategies related barriers and facilitators) were implemented. Data was audio-recorded, transcribed verbatim and footnotes were collected to prepare the transcript. Identifiable information was omitted for confidentiality. Each investigator was given a copy of the transcript for analysis. Inductive thematic analysis was performed to generate themes, subthemes through relevant coding.
Results: Seven female breast cancer survivors [55 (4) years] were interviewed. Six essential themes were identified (symptoms/triggers of BCRL, effects on daily routines, self-care and monitoring, treatment perceptions, misconceptions and sociocultural stigmas, need for exercise-based education and awareness on BCRL). Three survivors perceived the need of regular self-care, monitoring instructions to be provided during rehabilitation, five survivors identified social factors that led to activity participation restriction. Most participants identified a need for regular tailored exercise programs specific to BCRL.
Conclusion: BCRL encompasses a multitude of survivor perceived experiences that need to be addressed, considered and emphasised when planning a precision-based exercise program for breast cancer in low resource setting.

Speaker: Dr Nivedita Prabhu (Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.)

223 Recruiting and Retaining Breast Cancer Patients undergoing Neoadjuvant Chemotherapy into a Randomized Controlled Exercise Trial

Background. Chemotherapy entails some side effects that may hinder functional performance of women diagnosed with breast cancer (BC), which may result in low exercise levels. Although evidence consistently show favorable effects of exercise on BC, more information on recruitment and adherence rates in the neoadjuvant phase is needed.
Purpose. We describe real-world numbers for the recruitment/adherence to an exercise-based RCT which targeted women with a BC diagnosis undergoing neoadjuvant chemotherapy (NACT) in the Algarve region of Portugal.
Methods. The HOME-COMBO is a 2-arm RCT to compare an online structured and supervised group cardiorespiratory/resistance exercise intervention (twice a week), with an active control group (once a week), during NACT. Inclusion criteria were age>18; BC stage I-III; scheduled to receive NACT; access to a device with internet; with no medical counterindication to perform exercise; not currently enrolled in a structured exercise program. Assessments were performed at baseline, mid-treatment, post-intervention, and on a 3-month follow-up. Different recruitment strategies were used during a complete year from presentations in the four Hospital Units, delivery of leaflets, weekly contacts, and monthly meetings with doctors and nurses. Referral was made by doctors and nurses.

Results. According to the Portuguese National Oncology Register (RON), in the Algarve region of Portugal, there are 405 new female BC diagnoses/year. The broadband internet access in the Algarve region is ~45%, meaning a potential pool of 182 women with BC that could potentially enter the study. We recruited during 1-year, and 24 women entered the Home-COMBO, of whom 4 have dropped-out (attrition 16.7%). Considering this data our recruitment rate is situated around 12.6%. From a total of 353 exercise-sessions, participants missed 93, which means an adherence rate of 73.7%. These findings are paramount for future real-world exercise interventions to be informed about the potential reach during the recruitment phase and adherence.

Speaker: Prof. Pedro Júdice (Lusófona University of Lisbon)

224 Risk-Guided Rehabilitation After Breast Cancer: Development, Validation, and Implementation of the ARM-BCT Tool

Breast cancer treatment frequently leads to postoperative arm morbidity, including shoulder dysfunction, pain, reduced range of motion, seroma, and lymphedema. Despite this burden, many women at highest risk do not receive timely rehabilitation, resulting in preventable functional decline. To address this critical gap, we developed the Arm Morbidity following Breast Cancer Treatment (ARM-BCT) tool—an evidence-based clinical screening system designed to identify patients at elevated risk and guide early referral to physiotherapy. This abstract integrates findings from three complementary research phases: tool development, prospective validation, and clinical implementation.

The ARM-BCT tool was initially constructed through a systematic process that included clinical record review, patient-reported outcomes, literature-based risk factor identification, and multidisciplinary expert consensus. A subsequent prospective validation study confirmed the tool’s predictive accuracy: higher ARM-BCT risk scores were consistently associated with early postoperative morbidity, including restricted shoulder range of motion, increased symptom burden, and delayed return to functional activities. These findings demonstrated strong construct validity and supported the tool’s clinical relevance.

The third phase evaluated real-world implementation. Women receiving ARM-BCT–guided recommendations demonstrated significantly higher physiotherapy attendance when classified as high risk compared to low-risk patients. However, despite increased rehabilitation utilization, morbidity remained more frequent among high-risk women, highlighting the need for intensifying early therapeutic strategies and sustained monitoring.

Collectively, this body of work demonstrates that the ARM-BCT tool offers a practical, patient-centered, and scalable approach for improving postoperative outcomes. By enabling risk-guided referral pathways, the tool supports more efficient resource allocation, reduces delays in rehabilitation initiation, and enhances individualized recovery planning. Clinical integration of the ARM-BCT tool—both in its in-clinic format and digital application—has the potential to transform postoperative care for breast cancer survivors and ensure that women most likely to benefit from physiotherapy receive timely, targeted intervention.

Speaker: Ifat klein (Ben-Gurion University of the Negev, Faculty of Health Sciences, department of Epidemiology and Biostatistics)

225 Short- and Long-Term Effects of Supervised and Home-Based Lifestyle Interventions on Quality of Life and Cardiorespiratory fitness in Breast Cancer Survivors: Results from the MOVIS Trial

Background:
Breast cancer survivors (BCS) often experience impaired quality of life (QoL) due to treatment-related side effects, sedentary behaviour and suboptimal diet. The Movement and Health Beyond Care (MoviS) trial (NCT04818359) investigates lifestyle interventions combining psychological counselling, aerobic exercise and Mediterranean diet (MD).
Methods:
A total of 139 sedentary Italian BCS (52.6 ± 7.8 years) were included in the trial, from February 2020 to December 2025. The first 30 women, recruited during the COVID-19 pandemic, were analysed as the MoviS COVID Group (MCG; n=30) and received a 3-month home-based program with remotely supervised exercise adapted to restrictions. After the pandemic wave, 109 women were randomized to an intervention group (IG; n=53) or a control group (CG; n=56). All participants received baseline physical activity and MD recommendations; the IG additionally completed a 12-week supervised aerobic training program (3 sessions/week, 40–70% HRR). QoL (EORTC QLQ-C30), cardiorespiratory fitness (V̇O₂max) and MD adherence (Mediet) were assessed at 3, 6, 12 and 24 months.
Results:
In the MCG, the home-based intervention produced improvements in emotional, cognitive and social functioning, maintained up to 24 months. These were accompanied by increases in MD adherence (T4 vs T0: +18.62%, p<0.01) and V̇O₂max (+7.04%, p<0.01). In the randomized cohort, the IG showed significant post-intervention improvements versus CG in physical functioning (p<0.05), social functioning (p<0.05), QLQ-C30 Summary Score (p<0.05) and V̇O₂max (p<0.01), with modest gains persisting at 6–12 months. MD adherence increased at 3 and 12 months in both groups, optimal long-term adherence was not reached.
Conclusions:
Across 139 BCS, supervised and home-based lifestyle interventions were effective in enhancing QoL, with supervised exercise providing additional fitness benefits. An approximate +1 MET (~3.5 mL·kg⁻¹·min⁻¹) increase over 3 months—a clinically meaningful threshold associated with reduced mortality—was linked to superior long-term QoL and cardiorespiratory fitness at 24 months.

Speaker: Ms SeyedehMahboobeh Moosavi (Department of Biomolecular Sciences, University of Urbino Carlo Bo, ITALY)

226 Strong Against Fatigue: How Resistance Training Influences Quality of Life in Breast Cancer Patients

Background
Up to 95% of women undergoing adjuvant therapy for breast cancer experience cancer-related fatigue (CRF), which may persist beyond treatment and substantially impair quality of life. CRF is characterized by persistent fatigue that is disproportionate to activity level and not relieved by rest. Resistance training has shown beneficial effects on CRF; however, adherence during active treatment is influenced by multiple facilitating and inhibiting factors.
Objective
This study aimed to explore breast cancer patients’ subjective perceptions of the effects of resistance training on CRF and health-related quality of life (HRQoL) during adjuvant therapy, and to identify perceived support factors, barriers, and preferences regarding resistance training recommendations.
Methods
An exploratory qualitative study design was employed. Semi-structured individual interviews were conducted with six women undergoing adjuvant therapy for breast cancer participating in resistance training programs. Participants were recruited via advertisement in a medical training center. The interviews were audio-recorded, transcribed, and analyzed using qualitative content analysis according to Kuckartz and Rädiker (2024). A combined deductive–inductive category system was developed, supported by MAXQDA software.
Results
Participants reported either an absence (n = 2) or a reduction (n = 4) of fatigue symptoms, alongside improvements in HRQoL. Enhanced physical performance was associated with increased participation in daily and social activities. Key facilitators of training adherence included social interaction, perceived performance gains, reduction of treatment-related side effects, and professional support. Major barriers comprised motivational difficulties, pain, wound healing complications, emotional stressors, and structural or organizational constraints. Training recommendations varied considerably, with a predominantly emphasized reactive symptom management rather than preventive exercise strategies.
Conclusion
Resistance training during adjuvant therapy appears to have a positive subjective impact on CRF and HRQoL in women with breast cancer. Identified barriers and gaps in care highlight the need for improved implementation strategies and preventive, patient-centered exercise recommendations in oncology practice.

Speaker: Jasmin Lange

227 The effect of physical exercise on the biomarkers BDNF, VEGF, and CRP in chemotherapy-exposed breast cancer patients with cognitive complaints

Background
One in three breast cancer survivors develops cognitive complaints after chemotherapy. Physical exercise is a promising non-pharmacological treatment option for these complaints. The Physical Activity and Memory (PAM) study showed that physical exercise positively affects self-reported cognition. To get insight into underlying mechanisms, the role of biological markers needs to be explored. Therefore, this study explored the effect of physical exercise on BDNF, VEGF, and CRP in participants of the PAM study.

Methods
The PAM study is a randomized controlled trial with two study arms. The intervention group followed a 6-month strength and aerobic exercise program (4h per week, 2h supervised). The control group maintained their habitual activity pattern. Measurements (e.g., cognitive complaints (MDASI-MM), Quality of Life (EORTC QLQ-C30), and blood sampling) were performed at baseline and after six months. Between-group differences were analysed with ANCOVA, adjusting for baseline biomarker levels, age, endocrine therapy, and menopausal status. Subgroup analyses were conducted in highly fatigued patients and patients who attended ≥80% of the training sessions. VEGF and CRP were log-transformed, and treatment effect ratios (TERs) were obtained by exponentiating estimates. Increases in BDNF and VEGF and a decrease in CRP were considered favourable.

Results
Of the 181 participants, 175 had biomarker data. Participants were female, on average 52.4 ± 8.7 years old, and had a BMI of 28.7 ± 5.4 kg/m2. We found no significant exercise effects on BDNF (mean difference 4.66, 95% CI: -7.61 to 16.93), VEGF (TER 0.96, 95% CI: 0.88 to 1.06), and CRP (TER 1.07, 95% CI: 0.83 to 1.38). Results were similar in subgroup analyses.

Discussion
The 6-month physical exercise program did not have a significant effect on BDNF, VEGF, and CRP. Therefore, in the present study, these markers represent a less likely explanation for the exercise-related improvements in self-reported cognition.

Speaker: Stefanie Veenhuizen (UMCU)

228 The role of Kinesiologist and Adapted Physical Activity as Integrative Medicine in promoting Lifestyle changes in Breast Cancer Survivors

Purpose: Breast cancer (BC) is the most prevalent malignancy among women worldwide, with continuously improving survival rates. Increasing evidence supports the role of physical activity (PA) in reducing the risk of recurrence and mitigating modifiable risk factors such as obesity and sedentary behavior. However, promoting PA remains challenging, particularly in patients with comorbidities. This study aimed to evaluate the role of a kinesiologist-led exercise intervention integrated into cancer follow-up within the National Health System in promoting lifestyle modification and sustained PA engagement in women with BC and eventually comorbidities.
Methods: 26 women with a history of BC were referred by an oncologist to a supervised exercise program delivered in small groups by kinesiologists for up to two months. The intervention consisted of 60-minute sessions conducted twice weekly, based on an interval-training protocol that incorporated mobility, resistance training, core stability, and balance exercises. Cardiorespiratory fitness and muscular strength were assessed pre- and post-intervention by a kinesiologist and an orthopedic specialist. Upon program completion, participants were encouraged to continue adapted PA independently. PA habits were assessed through a follow-up conducted within one year after the intervention.
Results: 60% of participants had comorbidities, 22% received polypharmacological treatment. 8% were metastatic disease. The mean BMI was 27.27 and 70% were sedentary. At the end of the program, adherence was 87% and 88% of participants rated the intervention as excellent. At follow-up, 65% of women reported continued engagement in PA, while 31% discontinued due to health-related issues; only 4% ceased PA due to time constraints.
Conclusions: Structured kinesiologist-led exercise program implemented within the National Health System appear effective in fostering PA awareness, adherence, and mid-term lifestyle modification in women with BC, even in the presence of comorbidities. These findings support integrating supervised exercise interventions into standard BC care follow-up is effective in promoting lifestyle changes.

Speakers: Laura Gatti, Laura Bernaroli (UOC Department of Sport Medicine AUSL Modena, Italy)

229 Treatment-Phase–Tailored Exercise in Breast Cancer: 6-Month Interim Results from a Randomized Controlled Trial

Background: This randomized controlled trial (RCT) examined the short-term effects of a phase-tailored, home-based exercise program for women with stage I–III breast cancer. The aim was to evaluate whether the intervention improves metabolic biomarkers and postoperative shoulder function (strength and range of motion, ROM) during the first 6 months after surgery.

Methods: In this 12-month, two-arm RCT, women with stage I–III breast cancer (target n=96) were randomized to a phase-tailored exercise group or usual care. Phase 1 (post-surgery) combined supervised, in-person shoulder ROM and strengthening sessions with home-based training, while Phase 2 (during chemotherapy and/or radiotherapy) focused on maintaining physical function and muscle mass through individualized home-based exercise. This interim analysis included 69 participants who completed the 6-month follow-up, assessed at baseline (V1), 1 month post-surgery (V2), and 6 months post-surgery (V3).

Results: Shoulder strength improved over time with significant group-by-time interactions for flexion and abduction, favoring the exercise group. CA 15-3 significantly decreased in the intervention group (10.0±8.42 to 8.74±4.19 U/mL, p=0.01), with no significant change in usual care (10.68±5.93 to 10.30±6.24 U/mL, p=0.46).

Conclusion: In this interim analysis, a phase-tailored, home-based exercise program promoted superior recovery of postoperative shoulder strength and reduced CA 15-3 levels compared with usual care. Longer follow-up will clarify long-term cardiometabolic and clinical benefits.

Speaker: Ms Su Jin Yeon (Yonsei University)

Thematic Poster Session 3: Mixed Session (Hall 2)

Chairs: Pedro Saint-Maurice & Martina Schmidt

230 Does exercise improve survival after a cancer diagnosis? A living systematic review and meta-analysis of randomized controlled trials

Introduction: This project aims to (1) assess the effect of exercise interventions on cancer survival using data from randomized controlled trials (RCTs), and (2) establish an open-access, continuously updated resource synthesizing evidence on exercise and cancer survival.

Methods: A systematic search for this living review (PROSPERO: CRD420251081208) was conducted in October 2025 to identify RCTs evaluating the effect of exercise interventions on survival outcomes in adults diagnosed with cancer. Duplicate study screening is underway. Data extraction, risk of bias, and evidence quality will be independently completed by two authors, with integrity and trustworthiness assessed by one author. Random-effects models will generate pooled hazard ratio (HR) estimates for overall survival and other survival outcomes. When sufficient data exists, subgroup analyses will explore whether participant and intervention characteristics modify effect.

Results: To date, seven eligible trials have been identified after screening 84% of the 26,178 studies retrieved. These trials included 1,942 participants with stage 0-4 hematological, breast, colon, ovarian, or gastrointestinal cancers. Interventions were delivered during treatment (n=2), post-treatment (n=2), or across both periods (n=3), with durations ranging from 12 weeks to 3 years. Most interventions involved aerobic exercise only (n=5); one included a resistance-only arm, and two were mixed-mode. Five trials involved unsupervised exercise. Survival was an exploratory outcome in five trials, with median follow-up ranging from 1.5 to 8.3 years. Preliminary pooled analysis indicates improved overall survival in exercise versus control groups (HR: 0.66, 95% CI: 0.49-0.90; p=0.008). Updated results will be presented following completion of screening and data extraction.

Conclusion: This living review will provide researchers, clinicians, and consumers with real-time, interactive access to evolving evidence on exercise and cancer survival, supporting evidence-based decision-making and accelerating research translation.

Speaker: Rosa Spence (Viertel Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia)

231 Innovations in Supportive Cancer Care: Cost-Effective Integration of Exercise Oncology into Radiotherapy Care

Purpose/Objective
To evaluate the value and cost-effectiveness of two exercise oncology implementation models within radiotherapy care. The study aimed to determine whether embedding accredited exercise physiologists (AEPs) in cancer clinics improves patient quality of life and represents value for money compared to standard care.
Material/Methods
A mixed-methods design was employed across eight GenesisCare sites in Western Australia. Patients undergoing radiotherapy engaged in one of the following exercise programs: 1) Co-located exercise model (i.e. onsite gym and AEP consult); 2) Home-based exercise model (i.e. AEP consult and home-based program design with follow-up); 3) Control (i.e. no structured exercise program). Qualitative data were collected via interviews and focus groups with patients and radiation oncologists to explore experiences and perceived value. A cost-effectiveness analysis from an Australian healthcare-payer perspective was conducted using patient-level data. The primary outcome was cost per quality-adjusted life-years (QALYs).
Results
Patients strongly valued exercise as part of routine cancer care, citing improved control, tailored support, and consistent messaging. Radiation oncologists endorsed exercise benefits but noted limited service availability as a barrier. Provider feedback highlighted enhanced patient engagement and satisfaction when exercise services were integrated into treatment pathways. Health-Related Quality of Life trends showed sustained improvement in the co-located group, modest gains in the home-based group, and decline in controls. Cost-effectiveness analysis demonstrated the co-located model was cost-effective at $29,291 (AUD)/QALY gained.
Conclusion
Embedding AEP-led exercise programs within radiotherapy clinics improves patient quality of life and is cost-effective compared to standard care. Findings support scaling integrated exercise oncology services to enhance patient outcomes and deliver value for money. Broader implementation could inform policy and create employment opportunities for exercise professionals, advancing sustainable cancer care models.

Speaker: Mary Kennedy (Edith Cowan University)

232 Four Cochrane reviews on different exercise types for fatigue in people with cancer

Background: Cancer-related fatigue (CRF) is the most prevalent and severe symptom experienced among cancer patients. It impacts both physical and mental well-being and is not relieved by rest. Research indicates that exercise may improve CRF.

Methods: We conducted four Cochrane systematic reviews to assess the impact of three exercise modalities (i.e., cardiovascular training (CT), resistance training (RT), yoga) on CRF and secondary outcomes in people with cancer before, during, after anticancer therapy with short-, medium- and long-term follow up. We included randomised controlled trials (RCTs) with structured training, at least five sessions, and face-to-face instruction. We followed standard Cochrane methodology, utilized the Cochrane Risk of Bias 1 tool for bias assessment and the GRADE approach for certainty assessments. Data were pooled by follow-up period; results were meta-analysed where applicable.

Results: We searched 8 databases including CENTRAL and MEDLINE up to October 2023. Our search yielded 7182 records, of which we included 71 RCTs across all reviews. Most studies examined breast cancer patients.
No included studies evaluated exercise before anticancer therapy. During anticancer therapy, findings indicate that CT and RT may reduce short-term CRF (moderate certainty). Results for yoga and CT versus RT remain uncertain (very low certainty). After anticancer therapy, findings indicate a positive effect of yoga on short-term CRF (moderate certainty). Evidence for CT, RT an CT versus RT was uncertain. For medium- and long-term CRF, evidence was uncertain during and after anticancer therapy for all exercise modalities.

Discussion: The reviews identified a lack of evidence on exercise before anticancer therapy and on safety outcomes. Evidence on haematological malignancies is severely underrepresented. Furthermore, there is a lack of reporting on whether a fatigue diagnosis had already been made before the intervention starts.

Speaker: Carina Wagner

ISEO 2026_Fatigue Reviews_Presentation_abstract no. 62.pptx

233 Exercise and Return to work after a cancer diagnosis: A prospective observational study

Purpose: Returning to work after a cancer diagnosis can be challenging due to a number of factors, including cancer- and treatment-related side effects such as fatigue. Exercise is known to have beneficial effects on fatigue and may therefore also support return to work. The aim of this study was to investigate whether exercising after diagnosis is positively associated with return to work, and if so, whether this association is mediated by fatigue.
Methods: Data was derived from a survey conducted in Germany as part of the prospective observational LIFT study (Longitudinal Investigation of cancer-related Fatigue and its Treatment). Using logistic regression, we tested for an association between the mean metabolic equivalent of task (MET)-minutes/week patients expended during exercise the year since diagnosis (log-transformed) and return to work (yes/no) until one year after diagnosis. Additionally, we explored the potential mediating role of physical fatigue (EORTC-FA12) using regression-based mediation models with 2,000 bootstrap samples. All models were adjusted for age, education, chemotherapy, and fatigue before diagnosis.
Results: The analysis included 327 patients with cancer who were ≤ 65 years old and employed at the time of diagnosis. The mean exercise-related MET-minutes/week since diagnosis were positively associated with return to work one year after diagnosis (Odds-Ratio=1.15, 95% Confidence-Interval (CI) [1.05-1.27]) and tended to a negative association with physical fatigue (β=-1.63, 95%CI [-2.75 to -0.52]). In turn, physical fatigue was negatively associated with return to work (OR=0.97, 95%CI [0.96-0.98]). However, mediation analysis did not indicate that the effect of exercise on return to work was based on physical fatigue (average causal mediation effect=0.0078, 95%CI [0.0023-0.0146]).
Conclusion: Patients who reported a greater exercise volume after their cancer diagnosis were more likely to return to work one year after diagnosis. The mechanism does not appear to operate primarily through reductions in fatigue.

Speaker: Alina Kias (Division of Physical Activity, Cancer Prevention and Survivorship, German Cancer Research Center (DKFZ), Heidelberg, Germany & Medical Faculty, University of Heidelberg, Heidelberg, Germany)

ISEO 2026_Slides_AK_V2.pptx

234 A Randomized Controlled Trial of a Personalized Telehealth Exercise, Nutrition, and Stress-Management Program for Cancer Survivors

Purpose: Structured exercise, nutrition, and stress-management programs improve survival and quality of life (QoL) in cancer survivors, but adoption is limited by low adherence, cost, and access barriers. We evaluated a synchronous telehealth intervention delivering computationally personalized regimens in exercise, nutrition, and stress relief, guided by oncology-trained health coaches, as a novel treatment for patients.

Methods: We conducted a decentralized, randomized controlled trial across 33 U.S. states (NCT06397651). Adults aged ≥21 years within 12-months of active cancer treatment were randomized 1:1 to a personalized telehealth intervention(n=84) or education-only control(n=74). The intervention used an algorithmic engine to select individualized regimens from >3,600 combinations based on each participant’s case characteristics, functional status, and preferences. Participants attended 45-minute live video sessions—30 minutes structured physical activity, 8 minutes nutrition counseling, and 7 minutes guided meditation—up to five times weekly. Controls accessed self-guided online educational materials. The primary endpoint was change in QoL by FACT-G at 12-months. Secondary endpoints included adherence and work productivity. Analyses followed intention-to-treat principles using difference-in-differences estimation.

Results: Among 158 participants (median age 54 years; 82% female; 63% breast cancer), baseline characteristics were similar across arms. Engagement in the intervention arm remained high: 89% active at 3-months, 75% at 6-months, and 58% at 12-months, averaging 3 sessions/week. QoL improved by +10.8 FACT-G points(p=0.0042), exceeding the 7-point clinical significance threshold, with gains across physical, emotional, social, and functional domains. Participants reported significant improvements in work motivation(p=0.0332) and performance(p=0.013). Session frequency demonstrated a dose-response relationship with QoL improvement(r=0.50). No participation-related adverse events occurred.

Conclusion: A computationally personalized, synchronous telehealth lifestyle intervention produced durable improvements in QoL, adherence, and functional outcomes in a geographically diverse cancer survivor population. Combining algorithm-driven precision with live coaching offers a scalable, human-centered, non-pharmacologic treatment that extends the survival-linked benefits of structured lifestyle therapy into routine oncology care.

Speaker: Anupam Anand (Complement Theory Inc.)

Thematic Poster Session 4: Advanced Cancer (Forum 1)

Chairs: Karen Mustian & Bernd Alt-Epping

235 Acute Effects of Exercise on Fatigue in Patients with Advanced Cancer

PURPOSE: Cancer related fatigue (CRF) is highly prevalent among individuals living with advanced cancer. Although cancer rehabilitation programs can reduce CRF over time (e.g., 8-12 weeks), the immediate or “acute” effect of exercise sessions on CRF is unclear. This study compared CRF from immediately before to after exercise sessions among individuals living with advanced cancer who were participating in an outpatient cancer rehabilitation program. METHODS: Observational, longitudinal cohort study. CRF was assessed using a visual analog scale (0=no fatigue–10=worst fatigue) before and immediately after one exercise session per week over 12-weeks. Exercise sessions included aerobic and resistance exercise, prescribed at a light to moderate intensity (Rating of Perceived Exertion (RPE) 11-14, Heart Rate Reserve (HRR) 40-59%). A mixed-effects model accounting for within effects (time) examined change in CRF from before to immediately after exercise sessions. RESULTS: Participants (N=12) were M= 63(range:34-75) years old, and 83% female. Participants were diagnosed with either stage III (n=1, 8%) or stage IV (n=11,92%) cancer. Diagnoses were colorectal (n=3), endometrial (n=2), or other (n=7) cancers. CRF was measured before and after N=84 exercise sessions (M=2.8±2.2 sessions per participant, range=1-10). Average exercise session intensity was M=12.14±4.51 RPE (range =10-13), and M=32%(19.22) HRR (Range=30-42%). Average CRF was M=2.7±2.6 before exercise sessions, and M=2.8±2.4 immediately after. This difference (i.e., M∆) was not statistically significant (β = -0.08, p=0.80) CONCLUSION: For individuals living with advanced cancer there was no improvement in CRF from immediately before to after exercise sessions, but fatigue was not exacerbated. Further research should explore potential study limitations, including sensitivity of CRF measurement tool, and the potential ceiling effects due to the low pre-exercise CRF.

Speaker: Jeff Eagan (University of Colorado Health)

236 Understanding barriers to exercise participation in those living with metastatic breast cancer: insights from the EMBody trial

BACKGROUND: Patients with metastatic breast cancer (MBC) are often excluded from exercise research and programming, despite potential benefits. Given the unique needs and understudied relationship of this population with exercise, we sought to evaluate barriers to participation in supervised exercise for women with MBC.
METHODS: Eligible patients (n=60) had stable MBC, were not meeting activity guidelines (<150 minutes MVPA/week) and were invited to a 16-week supervised, virtual exercise intervention. Participants who declined (n=17) were “non-intenders,” and those who agreed (n=43) were “intenders.” Both intenders and non-intenders completed questionnaires assessing MVPA (IPAQ), health related quality of life (HRQoL) and subscales of physical function, anxiety, depression, pain interference and fatigue using PROMIS-29 v.2.1. Exercise motivation (values, self-identity and experience), attitudes, social norms, and perceived behavioral control were measured using validated theory-based surveys. Intenders and non-intenders were compared using MANOVA analyses.
RESULTS: Non-intenders and intenders showed no differences in MVPA (p=0.547) or autonomous motivation (p=0.441). Overall HRQoL differed significantly (p=0.015) with intenders reporting higher pain interference compared to non-intenders (p=0.009). Behavioral determinants differed significantly (p=0.012) with intenders reporting higher subjective norms (p=0.013), perceived behavioral control (0.003), and instrumental attitudes toward exercise (p=0.044).
CONCLUSIONS: Those who intended to participate reported worse HRQoL and more pain, but had stronger behavioral determinants. Intenders did not differ from non-intenders in MVPA levels or motivation, but perceived more behavioral control, had more favorable instrumental attitudes toward exercise, and felt stronger social support for exercise. Findings suggest participation was driven by behavioral determinants rather than physical health. This supports a need for programs that focus on improving perceived control through education, removing barriers to participation, and strengthening feelings of social support to improve uptake. A qualitative portion of this work will further inform future study design and exercise programs tailored to fit the needs of women living with MBC.

Speaker: Tarah Ballinger

ISEO poster TB.pptx

ISEO slides_tb.pptx

237 Promoting IMmunotherapy by Exercise in patients with advanced Renal cell carcinoma (PRIMER)

Background:
Immune checkpoint inhibitors (ICIs) have become standard of care first-line therapy for patients with advanced renal cell carcinoma (aRCC). Although ICIs improve survival, treatment outcomes are limited due to primary and secondary resistance as well as immune-related adverse events (irAEs). Preclinical work suggests that exercise may enhance antitumor immunity, reduce immunosuppression within the tumor microenvironment and potentially improve ICI efficacy, with the microbiome playing a key role in this process. However, the feasibility, safety and mechanistic effects of exercise during immunotherapy in patients with aRCC remains unknown.
Objectives:
The PRIMER trial is a pilot randomized controlled trial that aims to evaluate the feasibility and safety of supervised high-intensity interval training (HIIT) during first-line combination ICIs therapy (nivolumab + ipilimumab) in patients with aRCC. Preliminary effects of HIIT on immune status and microbiome are explored as well as physiological and patient-reported outcomes (PROs).

Methods:
30 patients with aRCC initiating first-line dual ICI therapy will be randomized 1:1 to the exercise intervention or usual care arm. Patients in the exercise group will complete two 60-minute exercise sessions per week, including moderate intensity aerobic exercise and HIIT supervised by oncology-specialized physiotherapists during 4 treatment cycles. Primary outcomes are feasibility as defined by exercise adherence, retention to the exercise program, and the incidence of (immune-related) adverse events (irAEs). Secondary outcomes include immune cell phenotype and function (NK cells, CD8+ T cells), cytokines, physical fitness, PROs and clinical endpoints (overall response rate, progression-free survival, overall survival). Blood and fecal sampling will occur prior to treatment and after 2 and 4 cycles of immunotherapy.

Expected impact:
This pilot trial will provide insights into feasibility, irAEs and antitumor immune responses of exercise during ICI treatment in aRCC. Patient recruitment will start in February 2026.

Speaker: Femke Laarakker

238 Resistance Training in Incurable Cancer: A Systematic Review of Exercise Prescription, Principles, and Programming

Background: Exercise is an established supportive therapy in oncology, with growing interest in its role for individuals with incurable disease who commonly experience progressive functional decline. Resistance training is recommended in current guidelines, but its effectiveness and clinical translation depend on appropriate application and transparent reporting of key exercise principles and training variables. Prior reviews have shown suboptimal implementation and reporting in exercise oncology trials, and advanced programming strategies remain underused. However, resistance training interventions in incurable cancer have not been comprehensively evaluated across cancer types with respect to exercise principles, prescription, and programming characteristics.
Aim: To examine resistance training interventions for individuals with incurable cancer with respect to (1) completeness of training variable reporting, (2) adherence to established exercise principles, and (3) use of programming strategies such as autoregulation, flexible programming, and periodization.
Methods and Review Status: This systematic review includes intervention trials involving resistance training for adults with incurable cancer. Six databases (MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, PEDro) were searched without date restrictions, resulting in 725 records, of which 116 potentially relevant studies were identified through title and abstract screening. Full-text screening is currently in process. For each intervention, key training variables (e.g., frequency, intensity, volume) will be recorded, along with adherence to exercise principles (e.g., specificity, individualisation, progression) and use of autoregulation, flexible programming, time-efficient methods, and periodization.
Expected Significance: This review will clarify current resistance training prescription and reporting practices in incurable cancer and identify opportunities for improving methodological quality and clinical implementation. The findings will support the development of safe, feasible, and effective resistance training interventions within palliative rehabilitation.
Conflict of Interest and Ethical Approval: The authors declare no conflicts of interest. Ethical approval was not required for this study.

Speaker: Alexander Olai Varjord (University of Bergen)

ISEO_poster_final.pdf

239 Feasibility and preliminary efficacy of aerobic acute exercise prior chemo-immunotherapy infusion in patients with metastatic non-small cell lung cancer: a randomized controlled trial

PURPOSE: Preclinical evidence suggests that acute exercise can modulate immune responses and enhance tumor perfusion, potentially improving chemo-immunotherapy (ChemoIO) efficacy. The ERICA trial (NCT04676009) evaluated the feasibility, safety, and preliminary effects of acute aerobic exercise performed immediately prior to ChemoIO in patients with metastatic non-small cell lung cancer.

METHODS: Newly diagnosed mNSCLC patients were randomly assigned (2:1) to the exercise or control group. The exercise intervention included supervised, individualized acute exercise before each of four ChemoIO cycles plus a 3-month home-based walking program with an activity tracker and step goals. Feasibility outcomes included adherence, acceptability, tolerability, and safety. Secondary endpoints were assessed at baseline and after 3 months using objective and self-reported measures of physical activity behaviour, cardiorespiratory fitness, muscle strength, body composition, Patient Reported Outcomes’s, treatment completion rates and immune biomakers.

RESULTS: Twenty-six patients (mean age 60.6 ± 10.7 years) were enrolled, with an acceptance rate of 90.9%. In the exercise group (n = 17), adherence to acute exercise sessions averaged 80.8%, with a median interval of 38 minutes (IQR 20–60) between exercise and ChemoIO administration. No exercise-related adverse events were observed. Participants in the exercise group achieved a median daily step count of 8,550, and 60% were classified as physically active. Acute exercise induced minimal immune changes at diagnosis; however, after 3 months of ChemoIO, it was associated with a redistribution of T cells toward more differentiated phenotypes and reduced HLA-DR expression on dendritic cells.

CONCLUSION: Acute aerobic exercise performed immediately before ChemoIO is feasible, acceptable, and safe in patients with mNSCLC. This innovative integration of exercise into cancer management, represents a promising, non-pharmacologic strategy to enhance therapeutic response and patient well-being. Larger trials are warranted to evaluate its efficacy on clinical outcomes and biological mechanisms.

Speaker: Manon Gouez (Centre Léon Bérard - Lyon)

240 Feasibility of Exercise Training in Patients with Advanced Colorectal Cancer During Chemotherapy: Clinical Parameters and Functional Capacity in an Exercise-Oncology Clinical Trial

Background
Patients with advanced colorectal cancer frequently present impairments in clinical parameters and physical function even before initiating chemotherapy, which raises concerns about their participation in an exercise training program. Baseline characterization is essential for designing individualized and feasible exercise interventions and understanding how initial physiological status may influence treatment tolerance and adaptations to training.
Objective
To describe baseline clinical and functional characteristics of a cohort of adults with advanced colorectal cancer (ACRC) (Stages III and IV) enrolled in an exercise-oncology trial prior to chemotherapy.
Methods
Before any treatment or exercise intervention, participants undergo a standardized assessment protocol that includes: Clinical Parameters: 1) Symptoms (MD Anderson Symptom Inventory) and 2) Inflammatory Status (Total leukocyte count); and Functional Capacity: 1) Physical Performance (Eastern Cooperative Oncology Group (ECOG) Scale), 2) Muscle Strength (Maximum Isometric Knee Extension Strength), and 3) Cardiorespiratory Capacity (Six-minute walk test).
Descriptive statistics were used to analyze the data, considering p<0,05 for significant differences.
Results
Ten participants (mean age: 62.8 ± 10.9 years) completed the baseline assessment protocol with no adverse events. Assessments showed that patients did not have significant inflammation (mean leukocytes 8.701 ± 2.616 µL) before chemotherapy and that symptoms were mild (1.46 ± 0.83). Regarding functional parameters, cardiorespiratory capacity was 38% below the value predicted by their age (p<0,05). However, maximum knee extension strength (2.78 ± 0.7 Nm/kg) was significantly above reference values (1.33 Nm/kg), corroborating the data obtained with the ECOG (score between 0 and 2), which classifies all patients as fit to begin a physical training protocol.
Conclusion
Our preliminary data show that, despite advanced cancer, patients have clinical and functional conditions to engage in an exercise training program. Furthermore, appropriate exercise training can potentially contribute to improve the reduced cardiorespiratory capacity, in addition to contributing to the maintenance of functionality, even during chemotherapy.

Speaker: Telma Fátima da Cunha Moraes (Physical Education and Sport School)

Keynote: Helen Croker - Observational Research in Exercise Oncology: Perspectives from World Cancer Research Fund International’s Global Cancer Update Programme (Hall 2)

Convener: Helen Croker (World Cancer Research International)

241 Helen Croker - Observational Research in Exercise Oncology: Perspectives from World Cancer Research Fund International’s Global Cancer Update Programme

Speaker: Dr Helen Croker (World Cancer Research International)

ISEO: Education - Exercise and Bone Metastases (Hall 2)

Chairs: Tina Skinner & Ulrike Dapund

Convener: Michelle B Nadler (Princess Margaret Cancer Centre)

Poster Session 3.1: Prostate Cancer/ Prehabilitation (Posterarea 1)

242 Adherence-dependent longitudinal effects of Nordic Walking on clinical, functional, cardiometabolic outcomes in sedentary men undergoing prostate cancer screening: a real-world prospective study

Background: A sedentary lifestyle increases prostate cancer (PCa) risk and contributes to cardiometabolic disease. Nordic Walking (NW) is a simple, accessible form of physical activity that may improve population health. We investigated adherence-dependent longitudinal effects of supervised NW on clinical, functional, and cardiometabolic outcomes in sedentary men undergoing PCa screening.
Methods: This real-world prospective observational study, embedded within the DP3 trial, enrolled sedentary men aged >50 years undergoing PSA testing. Fifty-seven participants joined a supervised NW program (two sessions/week, up to 12 months), while 49 matched controls maintained usual habits. PSA levels, functional tests, anthropometric measures, and questionnaires on lifestyle, well-being, and disease risk factors were collected at baseline, 6, and 12 months. NW adherence was quantified as the number of sessions attended. Exploratory proteomic profiling was performed in a subset.
Results: At 6 months, NW participants showed significant improvements in physical fitness, activity levels, and body composition compared with controls. After 12 months, benefits included reductions in weight, BMI, waist/hip circumference, and blood pressure, together with enhanced functional capacity. Higher adherence correlated with greater gains in fitness, body shape indices, and PSA reductions. Exploratory proteomics suggested modulation of immune, metabolic, and neurobiological pathways.
Conclusions: A supervised NW program is feasible and effective in sedentary men, with health benefits proportional to adherence. This real-world evidence underscores structured physical activity, such as supervised NW, as a safe, scalable, and non-invasive lifestyle strategy for chronic disease prevention, cancer risk reduction, and healthy aging in the community.
Trial registration: the study has been retrospectively registered in the ISRCTN registry with study registration number ISRCTN86138886

Speakers: Dr Franco Giuseppe Giuliano Scrivano (University of Turin), Giovanna Chiorino (Fondazione Edo ed Elvo Tempia)

243 Comparing aerobic and resistance exercise emphasis during androgen deprivation and radiation therapy for prostate cancer

Background
Most exercise interventions for men with prostate cancer utilise resistance and aerobic exercise, though the optimal combination of each for cardiometabolic health and quality of life (QOL) outcomes is unclear.

Objective
The objective of this study was to compare an aerobic-emphasised (AE) with a resistance-emphasised (RE) exercise intervention in men with prostate cancer undergoing androgen deprivation therapy (ADT) and radiation therapy (RT), with respect to cardiometabolic health, fitness and QOL outcomes.

Methods
A 6-month two-armed randomised pilot and feasibility study was undertaken, with the pilot data presented here. Prostate cancer patients (n=24) undergoing ADT and RT were randomised to either an AE (n=12) or RE (n=12) supervised programme.

Results
There were between group changes favouring RE (p=0.05, Cohen’s d = -0.9) in the BESS balance change scores. There were changes favouring AE in SF-36 physical function (p=0.02, Cohen’s d = 1.2) and role limitation (p=0.01, Cohen’s d = 1.3) values and haemoglobin levels (p=0.04, Cohen’s d = 1.1). There were no other between group differences.

When AE and RE data were combined, improvements were seen in the six-minute walk test (Cohen’s d = 1.4), timed up and go (Cohen’s d = −1.4), sit and reach test (Cohen’s d= 0.5), leg press (Cohen’s d = 0.8), sit-to-stand (Cohen’s d = 1.4), isokinetic peak torque assessments (Cohen’s d~ 0.6) and physical activity levels via the Godin Leisure Time Exercise Questionnaire (Cohen’s d = 3.3). Pre-to post-intervention reductions (p < 0.05) in systolic (Cohen’s d = −0.6) and diastolic (Cohen’s d = −0.65) blood pressure were also observed.

Conclusion
Exercise interventions involving aerobic and resistance exercise can improve functional fitness and blood pressure in prostate cancer patients. Early evidence suggests differential effects from protocols that emphasise aerobic or resistance elements. A larger study is justified.

Speaker: Dr Kira Murphy (UPMC Sports Medicine, Whitfield Hospital, Waterford, Ireland)

244 Does a Multidisciplinary Prehabilitation and Rehabilitation Program Improve Anxiety and Depression in Patients Undergoing Colon Cancer Resection? Preliminary Results from the ONCOFIT Randomized Controlled Trial

Background
Colon cancer is the fifth most common type of cancer worldwide. Its diagnosis and treatment impose substantial physical and psychological stress, frequently leading to anxiety and depression rates that exceed those observed in the general population. These conditions negatively affect postoperative outcomes and quality of life, with effects that may persist during and after treatment. Although non-pharmacological strategies are increasingly recognized as useful complementary approaches, it remains unclear whether a multidisciplinary prehabilitation and postoperative rehabilitation program can improve mental health in patients undergoing colon cancer resection.
Objective
To examine the effects of a multidisciplinary prehabilitation and rehabilitation program on depression and anxiety symptoms in patients undergoing colon cancer resection.
Methods
This preliminary analysis of the ONCOFIT randomized controlled trial included 89 patients scheduled for colon cancer resection. They were assigned to an usual care group or to a multidisciplinary prehabilitation and postoperative intervention group which consisted of (i)supervised concurrent exercise training, (ii)dietary behavior changes, and (iii)psychological support. The Hospital Anxiety and Depression Scale was administered at diagnosis, before surgery (after 4 weeks of prehabilitation), and 12 weeks after surgery.
Results
Postoperatively, the intervention group exhibited a reduction in anxiety symptoms (change:-1.2; 95% CI: -2.2 -0.2; P<0.05), although no significant between-group differences were observed (mean difference:-1.1; 95% CI: -2.6 0.4; P >0.05). Regarding depression, a significant between-group difference favoring the intervention group was observed preoperatively (mean difference:-1.5; 95% CI: -2.9 -0.1; P<0.05). Postoperatively, both groups showed significant reductions (Intervention:-0.1; 95% CI: -1.5 1.4; P <0.01; Control:-2.5; 95% CI: -3.5 -1.5; P <0.01), but no significant differences were detected between them.
Conclusions
This preliminary evidence suggests that the multidisciplinary prehabilitation and rehabilitation implemented program may help mitigate depressive symptoms in patients undergoing colon cancer surgery, although it does not appear to produce a significant effect on anxiety.

Speaker: Sofia Carrilho-Candeias (Department of Physiology, University of Granada, 18016 Granada, Spain.; Comprehensive Health Research Centre (CHRC), Universidade de Évora, Évora, Portugal)

245 Effect of exercise on anxiety and depressive symptoms among men with metastatic prostate cancer: results from the INTERVAL-GAP4 randomized controlled trial

Background: Evidence from observational studies and clinical trials suggests that exercise may reduce anxiety and depressive symptoms. However, data are limited among people with metastatic disease, who have poorer prognoses and higher mental health burden.

Methods: The INTERVAL-GAP4 study is a phase III 2-year randomized controlled trial testing the effect of high-intensity resistance and aerobic exercise vs. self-managed exercise on overall survival among men with metastatic prostate cancer. Participants in the intervention arm received 12 months supervised exercise tapering to self-managed exercise in Year 2. Between 2016-2022, 145 men were randomized (75 intervention, 70 control). A secondary aim of the trial was to evaluate the effects of the intervention on depressive and anxiety symptoms. Participants completed the Center for Epidemiologic Studies Depression Scale (CES-D) and the State-Trait Anxiety Inventory (STAI) at enrollment and every 3 months thereafter for 2 years. We examined whether change in depressive or anxiety symptoms differed over time in the intervention versus control groups using linear mixed models.

Results: At enrollment, participants had a mean (SD) age: 69.9 (8.5) years, mean (SD) depressive symptom score: 10.1 (7.6), and mean (SD) state anxiety score: 21.9 (11.1); 27 (19%) had possible clinical depression (CES-D score 16+) and 2 (1%) had possible clinical anxiety (STAI-S score of 55+). Men randomized to the intervention had lower depressive symptoms over time compared to control (time x group p-value: 0.01). The differences in change in depressive symptoms between intervention and control at each 3-month time point over the 2-year follow-up ranged from -1.2 to -4.7 points, favoring intervention at each time point. There were no significant differences between groups in anxiety symptoms.

Conclusion: Exercise reduced depressive symptoms among men with metastatic prostate cancer. This further strengthens the rationale to include exercise training in the clinical management of men with metastatic prostate cancer.

Speaker: Erin L. Van Blarigan (University of California, San Francisco)

246 Effects of a Home-Based Walking Intervention on Serum Metabolomic Profiles in Men with Prostate Cancer on Active Surveillance

Introduction: The potential for long-term exercise to affect the metabolome in healthy individuals is well established. Given the metabolic underpinnings of prostate cancer, it is important to investigate whether long-term exercise similarly alters the metabolome in disease-affected men. This study is among the first to characterize metabolic changes in individuals with prostate cancer, comparing those assigned to a home-based walking program to those assigned to printed materials with physical activity recommendations.
Methods: Fifty-one men with prostate cancer on active surveillance were randomly allocated to the exercise or control intervention. Metabolomic profiling of primary metabolism, complex lipids, and biogenic amines was performed at the West Coast Metabolomics Center on serum samples collected at baseline and after the 16-week interventions; data were successfully generated for 22 participants in the exercise arm and 23 participants in the control arm. To identify intervention-related differences in metabolic changes, we performed hierarchical clustering and fit mixed-effects models including an arm x time interaction.
Results: Hierarchical clustering indicated limited separation in metabolic profiles between the exercise and control groups at 16 weeks. Although none of the 1,220 named metabolites exhibited statistically significant differences in change between the two groups (q<0.10), 85 (7.0%) demonstrated nominal significance (p<0.05). Among the 15 metabolites with the smallest p-values, six (40%) were sphingolipids – specifically sphingomyelins – though sphingolipids comprised only 11% of all named metabolites. All six sphingomyelins decreased more over time in the exercise group than in the control group.
Conclusions: Although metabolic profiles were not significantly altered overall, a walking intervention may promote the reduction of sphingomyelins, thereby shifting lipid signaling toward pathways that enhance mitochondrial function and reduce inflammation. Such changes are consistent with biologically plausible mechanisms through which exercise could favorably influence prostate cancer biology, even in the absence of broad metabolomic shifts.

Speaker: Stacey A. Kenfield (University of California, San Francisco)

247 Examining the effects of a new training concept during the initial phase of androgen deprivation therapy in men with prostate cancer

Background
Global prostate cancer cases are projected to double to 2.9 million annually by 2040. While androgen deprivation therapy (ADT) is a cornerstone of treatment, it induces rapid and severe adverse effects, including loss of lean mass and increased fat mass. Intervening during the initial phase of ADT is critical, yet a significant evidence gap persists regarding effective, scalable exercise programs and their underlying cellular mechanisms. National guidelines in Sweden recommend supervised exercise; however, resource limitations create a substantial gap between guidelines and practice. This study evaluates a high-intensity program designed to bridge this gap.
Purpose
The primary aim of this study is to determine whether a high-intensity exercise program using cost- and space-efficient equipment can mitigate ADT-related side effects during the initial phase of treatment.
Methods
This study is a multicenter, two-arm randomized clinical trial aiming to recruit 48 men (aged 50-80) with intermediate- to high-risk prostate cancer initiating ADT and scheduled for radiotherapy with curative intent. The intervention group will participate in 12 weeks of twice-weekly supervised sessions, combining high-intensity interval training on a cycle ergometer with resistance training using a mobile flywheel device. The control group will receive usual care. Primary endpoints are cardiorespiratory fitness and isometric squat strength. Secondary endpoints include body composition, physical function, patient-reported outcomes, and molecular analyses from muscle and adipose tissue biopsies.
Significance and implications
This research directly addresses the gap by testing a scalable exercise model designed to overcome known implementation barriers in clinical settings. By evaluating the intervention in both hospital and university settings, this study will provide crucial insights into its real-world feasibility and translational potential. Ultimately, this work will generate evidence to guide the integration of cost-efficient, high-intensity exercise into routine care for men initiating ADT, improving patient outcomes during a critical window of physiological vulnerability.

Speaker: Simon Oesth (Department of Physiology, Nutrition, and Biomechanics, The Swedish School of Sport and Health Sciences, 114 86, Stockholm, Sweden)

248 Exercise Prehabilitation to Optimize Functional Capacity in Head and Neck Cancer Patients Planned for Definitive Chemoradiotherapy: The FIT4TREAT Trial

Objective: This study investigated the effectiveness of exercise prehabilitation on functional capacity, health-related quality of life (HRQoL), and body composition in head and neck cancer (HNC) patients initially proposed for definitive chemoradiotherapy (CRT).
Methods: In this randomized controlled trial (NCT05418842), patients were allocated to an exercise prehabilitation program (EP) or usual care (UC). The EP group completed a pre-treatment supervised program combining low-volume high-intensity cardiorespiratory and resistance exercise training (60 minutes, three times/week). Pre-treatment changes were assessed before randomization and before the start of radiotherapy for functional capacity (6-minute walk test, 6MWT; 30-second sit-to-stand test, STS; isometric handgrip strength), body composition, and HRQoL (EORTC QLQ-C30 and QLQ-HN43).
Results: Forty-one patients completed both pre-treatment assessments (EP: n=21, 63.3±8.9 years, 91% men; UC: n=20, 62.8±10.7 years, 90% men). The median duration of the pre-treatment phase was similar between groups (EP: 28 [IQR 24–28] days; UC: 29 [IQR 21–32] days; p=0.813). Compared with the UC group, the EP group showed greater improvements in 6MWT distance (+32.1 meters; 95% CI, 8.0–56.1; p=0.010) and 30-second STS performance (+3.9 repetitions; 95% CI, 1.8–6.0; p<0.001). No significant differences were observed between groups in handgrip strength, body weight, muscle mass, or body fat. Regarding HRQoL, the EP group showed less deterioration than UC in the EORTC QLQ-C30 summary score (6.4 points; 95% CI, 1.8–11.0; p=0.008), as well as in social functioning (9.9 points; 95% CI, 0.6–19.2; p=0.038), and body image (QLQ-HN43; −13.8 points; 95% CI, −24.3 to −3.3; p=0.011). No serious adverse events related to exercise occurred.
Conclusion: The EP program was safe and improved 6MWT and 30-second STS performance. Additionally, exercise prevented the decline in several HRQoL domains, including social functioning, body image, and the summary score of QLQ-C30 in HNC patients initially proposed for CRT.
Funding: SFRH/BD/149054/2019; UID/04045.

Speaker: Catarina Garcia (Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD - University of Maia; ONCOMOVE®, AICSO - Associação de Investigação de Cuidados de Suporte em Oncologia)

249 Exercise training during neoadjuvant treatment for gastroesophageal cancer: a randomized controlled trial

Background: Perioperative treatment is the standard of care for resectable gastroesophageal cancer; however, physical deterioration during neoadjuvant treatment is common and may ultimately preclude tumor surgery. Here, we compared exercise training with control on the likelihood of not undergoing tumor surgery following neoadjuvant treatment.

Methods: In this parallel-group, two-arm, single-blinded, randomized controlled trial, patients with resectable gastroesophageal cancer undergoing perioperative treatment were randomized 1:1 to exercise training (EX) twice weekly from diagnosis until surgery or control (CON). The primary outcome was not undergoing tumor surgery with curative intent. Secondary outcomes were cardiorespiratory fitness, discontinuation of neoadjuvant treatment, postoperative complications, and overall survival.

Results: In total, 202 participants were included in the modified intention-to-treat analyses. The participants in EX attended a median of 76% of the planned sessions. In EX, 10 patients out of 101 did not undergo tumor surgery with curative intent compared with 8 out of 101 in CON (OR 1.28; 95% CI 0.48-3.38; P = 0.623). Exercise training led to higher cardiorespiratory fitness (+14.5 watt; 95% CI 2.0-26.2). Discontinuation of the neoadjuvant treatment was required for 15% in EX and 18% in CON (OR 0.81; 95% CI 0.38-1.72). Clavien-Dindo grade ≥3 postoperative complications were experienced by 30% in EX and 27% in CON (OR 1.16; 95% CI 0.61-2.20). The overall survival rates at 3-years for EX and CON were 51% (95% CI: 42-62) and 65% (95% CI: 56-75), respectively (HR 1.52 [95% CI: 1.02-2.45]). The 5-year survival rates, included post doc, were 46% (95% CI: 37-58) and 55% (95% CI: 45-67) for the exercise and control group, respectively (HR 1.45, 95% CI: 0.96-2.19].

Conclusion: Preoperative exercise training does not reduce the likelihood of not undergoing surgery following neoadjuvant treatment for gastroesophageal cancer. Our finding that exercise training was associated with an increased mortality rate warrants further investigation.

Speaker: Dr Casper Simonsen (Center for Physical Activity Research (CFAS), University Hospital Copenhagen - Rigshospitalet)

250 Home-Based Exercise Training Reduces In Vitro Prostate Cancer Cell Viability: Roles of Adherence, Fitness, and Inflammation

Exercise attenuates many treatment-related declines, with a growing interest in the direct impact on prostate cancer (PC) cell viability. While supervised exercise decreases PC cell growth, it is unknown if home-based exercise or serum from men with advanced PC have similar impacts. PURPOSE: To assess the effects of home-based exercise training on LNCaP and PC-3 viability in men with metastatic castration resistant PC (mCRPC). The influence of body composition, aerobic capacity, exercise adherence, and cytokine levels on viability was also explored. METHODS: 14 men with mCRPC [71±8 yr, 33.6±6.3 % fat, 18.9±4.4 ml/kg/min] completed a 12 week home-based mixed modality intervention. Participants performed physiological testing [VO2peak, DXA, muscle strength] and provided resting blood samples before (Pre) and after (Post) the intervention. Complete media containing 10% serum from Pre and Post were incubated with LNCaP and PC-3 cells. Cell viability was evaluated using AlamarBlue at 72h and 96h. Data are presented as mean ± SD or mean difference (MD) with 95% confidence intervals. RESULTS: No changes were observed at 72h. At 96h, overall LNCaP cell viability at Post was decreased (MD: -9.6%, 95%CI [-16.7,-2.5], p=0.020), with only a TNF x training interaction (p=0.003) revealing that lower TNF levels further reduced viability (-22.0%, [-31.6,-12.5], p<0.001). No overall PC-3 viability effect was observed (-2.7%, p=0.407). There were interactions for training x VO2peak (p=0.037), total (p=0.019) and resistance training (p=0.025) adherence, and % fat (p=0.023). At Post, lower PC-3 viability was observed with higher VO2peak values (-11.5%, [-23.1,0.2], p=0.053), higher total (-9.6%, [-18.5,-0.7], p=0.037) and resistance training adherence (-9.3%, [-18.4, -0.2], p=0.046), and lower % fat (-9.2%, [-18.1,-0.3], p=0.044). CONCLUSION: Home-based exercise indicates robust effects with longer exposure in androgen-sensitive cells (LNCaP). Androgen-receptor null cells (PC-3) showed only conditional improvements, based on higher adherence and fitness levels and lower % fat.

Speaker: Erik Hanson (University of North Carolina at Chapel Hill)

251 Is it possible to run small group-based exercise classes for prostate cancer patients undergoing ADT & RT in Christchurch hospital, New Zealand: A Feasibility study

Introduction
Prostate cancer is the most diagnosed cancer for men in NZ. It’s treatment often involves androgen deprivation therapy (ADT) and radiation therapy (RT) which can cause some debilitating side effects which can greatly impact patients physical functioning and quality of life for years post treatment completion.
Exercise has consistently been seen to significantly help alleviate some of these short- and long-term treatment related side effects. International guidelines advise oncology patients to be prescribed exercise yet standardly in NZ this is not the case.
In this study we want to assess the feasibility of providing personalised group-based exercise classes for prostate cancer patients’ who are undergoing a course of ADT and RT in Christchurch, New Zealand (NZ).
Methods
10 participants will be recruited to partake in 2x/week personalised group exercise classes for a 12 week period. Participants will start the classes in their first week of radiotherapy treatment and will be run on site at the hospital gym. We will measure feasibility of running the classes based on patient adherence, recruitment capability, acceptability and safety.
Results
Study recruitment starts January 2026. Ww will have preliminary results to present by the conference date in July 2026.

Speaker: adiella stewart (Canterbury Regional Cancer and Haematology Service, Health NZ, Christchurch 8011, New Zealand)

252 Mind the Gap - Prehab to Rehab in surgical oncology patients.

Introduction

Prehabilitation is increasingly recognised as a critical component of cancer surgery pathways. However, data outlining the degree of postoperative functional decline despite prehabilitation is not well documented in this patient group.  

This pilot study aimed to assess postoperative functional decline in a surgical cohort who received prehabilitation, and evaluate the impact of a 12 week rehabilitation programme following major oncology surgery.

Patients and Methods

28 patients who completed prehabilitation were enrolled in a 12 week rehabilitation programme beginning at 6 weeks after surgery (N: Bladder=12 Oesophageal=11, HPB=3, Ovarian=2)
Functional capacity was reassessed using the same measures collected during prehabilitation: the 6 Minute Walk Test (6MWT), 60 second sit to stand test (STS60), and handgrip strength (HGS).
Participants attended twice weekly exercise classes delivered virtually or in person. Outcome measures were repeated at programme completion, and anonymised qualitative feedback gathered via a questionnaire.

Results

Patients demonstrated a statistically significant decline in functional capacity post-surgery (14.5% reduction in 6MWT and 22.9% reduction in STS60, p-value of .001).
Inclusion of a 12 week rehabilitation programme after surgery demonstrated statistically significant improvements in functional capacity (17.6% increase in 6WMT and 39.7% increase in STS60 p-value of .001).

100% of patients would recommend the addition of rehabilitation to their prehabilitation programme.

Conclusion

Results show consistent patterns across tumour groups, demonstrating that surgery causes a marked functional decline, despite prehabilitation, and that rehabilitation restores or exceeds pre surgery function.

Robust rehabilitation provision following surgery for oncological conditions is increasingly expected by patients and should be considered as part of standard care within cancer pathways.

Speakers: Mrs Rachel Brown (Royal Surrey Hospital NHS Foundation Trust, UK), Ms Zoe Price (Royal Surrey Hospital NHS Foundation Trust, UK)

253 Physical activity and prehabilitation in cancer patients

Background
Low physical performance is associated with increased postoperative morbidity, mortality, and cardiopulmonary complications. Physical activity can reduce therapy-related side effects and have a positive impact on disease progression. Despite guideline recommendations of 150 minutes of moderate activity per week, many patients fail to meet these targets.

Methodology
Based on a patient survey conducted by the Comprehensive Cancer Center (CCC) at Hannover Medical School (MHH) in 2022, a concept is to be developed that promotes physical activity in pre- and rehabilitation for patients with cancer. As part of the patient survey, activity behavior was recorded (Freiburger questionnaire). The total physical activity is presented in metabolic equivalent of task (MET) hours/week and classified into three activity categories: <14 MET (too little activity), 14–29 MET (minimum requirement met), >30 MET (sufficient activity).

Results
The sample comprised 567 patients (51% male), of whom <2% were younger than 30 years, 51% were between 30 and 65 years, and 47% were older than 65 years. Overall, 59% achieved the recommended activity level of 150 minutes of moderate activity per week. Only the 30–65 age group was “sufficiently active” (32.7 ± 34.8) and was significantly more active than patients >65 years of age (23.4 ± 26.3, p<0.05). The oldest age group also showed lower sports-related activity than those <30 years of age (2.9 ± 8.2 vs. 9.4 ± 18.1, p<0.05).

Discussion
With increasing age, overall and sports-related activity decreases significantly. This results in a need for specific support and exercise programs especially for older oncology patients. Based on these findings, the Department for Rehabilitation and Sports Medicine and the Department for General, Visceral and Transplant Surgery at MHH are developing a new form of care for patients with operation-indicated carcinomas, which aims to establish app-supported physical training with personal coaching starting in the prehabilitation phase.

Speakers: Mrs Gudrun Protte (Department for Rehabilitation and Sports Medicine, Hannover Medical School), Dr Pauline Lödding (Department for Rehabilitation and Sports Medicine, Hannover Medical School)

254 Presence of sarcopenia among Black prostate cancer survivors undergoing androgen deprivation therapy

Background
Black Prostate Cancer survivors (PCa) undergoing androgen deprivation therapy (ADT) are at higher risk of body composition alterations, such as sarcopenia, which translate to poorer overall survival when compared to non-black PCa. Although the prognostic relevance of sarcopenia has been established, this outcome is understudied among Black PCa on ADT. Therefore, the aim of this first-of-its-kind observation is to assess the presence of sarcopenia among Black PCa on ADT.
Methods
We assessed sarcopenia, defined as the simultaneous presence of low muscle strength and muscle mass according to the Global Leadership Initiative in Sarcopenia (GLIS), among 46 Black PCa on ADT. The cut-offs of the “Sarcopenia Definitions and Outcomes Consortium” were used to determine sarcopenia. Participants’ age and body mass index (BMI) were collected. Sarcopenia was assessed through 1)Handgrip strength assessed using a handheld dynamometer (sarcopenia <35.5kg), and 2)Appendicular Skeletal Muscle Mass Index (ASMI) assessed using whole-body DEXA (sarcopenia <7.26kg/m^2). Difference between age groups (<70 or ≥70) on handgrip strength and ASMI was explored with Mann-Whitney U test.
Results
Participants were 68.7±9.19 years old with a BMI of 29.8±5.17kg/m^2. Mean handgrip strength was 33.8±8.12kg. Mean ASMI was 8.6±1.72kg/m^2. Twenty-seven (59%) participants had handgrip strength <35.5kg, and only seven (15%) also had ASMI lower than <7.26kg/m^2 meeting both criteria for sarcopenia per GLIS definition. Handgrip strength was significantly higher in younger (N=21) than older (N=25) participants (mean difference 5.9kg, 95%CI 0.9–10.4, p=0.018), while ASMI was higher but not significant (0.6kg/m^2, -0.2–1.2, p=0.112).
Conclusions
Although ADT can exacerbate sarcopenia among PCa, only 15% of our participants had sarcopenia. Handgrip strength and ASMI were lower with age but prevalent presence of sarcopenia, as defined by current consensus, cannot be confirmed among Black PCa. Future research is necessary to understand unique features and classification of sarcopenia among Black PCa on ADT.

Speaker: Salvatore Ficarra (Dana-Farber Cancer Institute / Harvard Medical School)

255 ProstaGOAL – Feasibility and psychosocial effects of a supervised football intervention in patients with prostate cancer undergoing androgen deprivation therapy

Background: Androgen deprivation therapy (ADT) is a key treatment for advanced and metastatic prostate cancer (PCa), but is frequently associated with fatigue, metabolic alterations, depressive symptoms, and reduced quality of life. National and international guidelines recommend physical activity to counteract these adverse effects. Previous intervention studies have mainly focused on resistance and endurance training in individual settings. Recreational team sports, such as football, offer an appealing alternative by combining physical exercise with social interaction and psychosocial support. Preliminary evidence suggests that football training has beneficial effects on muscle mass, bone density and muscle strength in patients with PCa.

Methods: ProstaGOAL is a prospective, single-arm pilot study evaluating the feasibility of a supervised group-based football intervention for patients with histologically confirmed PCa receiving ADT. Patients with bone metastases are explicitly not excluded. Following a sports medical screening, participants will engage in a structured football training programme for six months. Assessments will be conducted at baseline, 3 months, and 6 months, including cardiopulmonary fitness testing by spiroergometry (VO2peak), as well as questionnaires assessing quality of life (EORTC QLQ-PR25, FACT-P) and physical activity levels (IPAQ-SF).

Results: The primary endpoint is feasibility, which is assessed by training adherence (a participation rate of at least 70%). The secondary endpoints include changes in physical performance and health-related quality of life. Recruitment is ongoing and the intervention is planned to start on 1 September 2026.

Conclusion: The ProstaGOAL study aims to evaluate whether recreational football is a feasible and beneficial form of exercise for patients with prostate cancer (PCa) undergoing androgen deprivation therapy (ADT). The study may provide valuable insights into innovative, socially engaging exercise interventions in the field of exercise oncology.

Speaker: Verena Krell (Charité - Universitätsmedizin Berlin)

256 Rationales for prehabilitation programs in patients preparing for oncologic surgery: a systematic review

Background: Prehabilitation aims to improve patients’ resilience to surgery and enhance postoperative recovery. Understanding rationales for prehabilitation content may identify opportunities for program optimization. This systematic review provides an overview of rationales, intervention, and outcomes used in prehabilitation studies in oncological populations.
Methods: We searched the databases MEDLINE, Embase, and Scopus on March 1st, 2024. Comparative prehabilitation studies including patients undergoing oncological surgery were included. Prehabilitation was defined as a preoperative exercise program, alone or combined with other components, with the explicit aim to improve postoperative outcomes. Extracted outcomes included reported rationales, program content, and primary endpoints.
Results: In total, 140 studies (N=24,925 patients) were included. Most (N=125, 89%) reported a rationale for improving physical fitness, particularly cardiorespiratory fitness (N=97, 69%). Psychological (N=46, 33%) and metabolic (N=28, 20%) rationales were reported less frequently. Rationales for specific attributes (e.g., intensity) were rarely described. Exercise was predominantly supervised (N=57, 41%), and of these supervised sessions, most were prescribed three times per week (N=25, 44%). Almost all studies (N=121, 86%) included an aerobic exercise component at moderate-intensity continuous (N=39, 32%) or high-intensity interval (N=34, 28%) mode. Intended duration varied from 1 to 12 weeks. Most reported primary endpoints were surgical outcomes (e.g., complications) (N=59, 42%), although definitions varied.
Conclusions: Preoperatively improving physical fitness is a widely used rationale for prehabilitation, however, studies are implicit in rationales for specific program components. Content and duration of prehabilitation showed considerable variation, often determined by feasibility and time to surgery. Prehabilitation studies could benefit from standardized outcomes. Adopting a more mechanistically grounded approach could improve program design and possibly effectiveness.
Trial registration: The review was preregistered in PROSPERO (CRD42024512892).

Speaker: Emine Akdemir (Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands)

257 The impact of cancer prehabilitation and rehabilitation on one-year survival: The Active Together service evaluation

Introduction: Active Together is a prehabilitation and rehabilitation service in South Yorkshire UK providing multi-modal support to people receiving curative cancer treatment. Integrated into local cancer pathways, the service provides exercise, dietetic and psychological support, delivered by clinicians and exercise professionals and tailored to each patient's individual needs. Since its inception in 2022 at a single site, it has expanded to provide a service to the entire region. Survival is a key outcome captured to inform commissioning decisions and patient engagement. This presentation will outline the impact of Active Together on one-year survival.
Methodology: Survival will be collected from January 2022 to March 2026, including an estimated 600 Active Together patients. Patients who participated in Active Together will be compared to patients who declined to join the service (Declined group) or received treatment prior to the inception of the service (Historical group).
Preliminary Results: Preliminary results from March 2024 showed a significant difference in one-year survival between the Active Together group (95%, n = 305) and the Declined group (85%, n = 96, p = 0.013). The survival rate for the Historical group (92%, n = 869, p= 0.140) was not significantly different from the Active Together group. The presentation will include an additional two years of data.
Conclusions: This evaluation will demonstrate the real-world impact of multi-modal prehabilitation and rehabilitation on one-year survival for people with cancer. A positive outcome would strengthen the case for embedding multi-modal rehabilitation services within routine cancer care.
Funding: The Active Together service and evaluation are funded by Yorkshire Cancer Research.

Speaker: Kerry Rosenthal (Sheffield Hallam University)

258 Trimodal prehabilitation during neoadjuvant treatment for resectable non-small cell lung cancer: Preliminary results of a prospective cohort-study.

Purpose
Complex and demanding neoadjuvant treatment regimens lead to reduced performance in patients with Non-Small Cell Lung Cancer (NSCLC), which can increase perioperative morbidity and prolong postoperative recovery. Combining multimodal prehabilitation with chemo- and immunotherapy may provide an opportunity to rapidly initiate cancer-directed therapy while improving functional status in preparation for local consolidation.
Methods
IMPROVE is a prospective cohort study currently conducted at the University Medical Center Freiburg, Germany. Patients with an indication for neoadjuvant treatment for locally advanced NSCLC are offered to undergo concurrent prehabilitation therapy, consisting of a personalized exercise program, an individual dietary plan and a psychosocial support session. Primary outcomes are completion rate of neoadjuvant therapy, postoperative morbidity status, functional status (assessed by 6-minute walk test, handgrip strength, cardiopulmonary exercise testing) and quality of life (EORTC QLQ-C30, EORTC QLQ-LC13). Outcomes are assessed preoperatively (t0), postoperatively (t2) as well as 3, 6, and 12 months (t3, t4, t5) after resection.
Results
Preliminary analyses of the currently available cohort (n = 5, mean age 65.4 years, range 54–70) show that all patients completed three to four cycles of neoadjuvant chemo- (n = 1) or chemo-immunotherapy (n = 4). Participants attended one to two supervised exercise sessions per week, received up to five nutritional counseling sessions, and one psychosocial support session. Data on spirometry, 6-minute walk test, cardiopulmonary exercise testing, and patient-reported outcomes are currently being collected, the final analysis of the entire cohort is pending.
Conclusions
Early observations demonstrate that multimodal prehabilitation can be integrated into neoadjuvant treatment pathways for NSCLC, with good adherence to exercise, nutrition, and psychosocial components. Conclusions on postoperative morbidity, long-term recovery, and overall program impact will be drawn once data collection and analysis are completed.

Speaker: Laurie Assenbaum

259 Understanding adherence to exercise prehabilitation in patients with bladder cancer: a preliminary analysis from the ENHANCE randomized controlled trial

PurposeIn prehabilitation, patients who often have little experience with exercise are challenged to achieve high levels of exercise adherence in a short timeframe. To translate RCT findings into standard care and understand factors influencing feasibility and efficacy, detailed reporting of exercise adherence is important. This may also help tailor exercise to individual patient needs. We aimed to quantify adherence across aerobic (AT) and resistance training (RT) modalities and explore correlations between baseline characteristics and adherence outcomes.
MethodsParticipants of the ENHANCE study randomized to the exercise arm were included. The exercise intervention comprised 3-6 weeks of supervised AT (high-intensity [HI] and low-to-moderate intensity [LMI] interval training) and RT, 3 sessions/week. Attendance and adherence to the Frequency, Intensity, Time, Type – Volume (FITT-V) elements were calculated and reported as median percentages (IQR). Overall adherence metric for AT and RT was computed. Spearman or rank-biserial correlations with age, marital status, co-morbidities, neoadjuvant chemotherapy, sense of coherence, fatigue, anxiety/depression, and self-reported physical functioning were calculated for attendance, overall AT and RT.
ResultsFifty-nine participants were included. Median attendance was 85.7% (58.3-100%). Median overall AT and RT adherence was 89.4% (75.4-94.7%), and 93% (87.6-95.2%), respectively. Adherence to AT frequency was 86% (58-100%), intensity 94.6% (85.2-100%) and 100% (98-100%) for HI and LMI, volume 87.5% (59.1-94.2%), and 95% (75-100%) for HI and LMI, respectively. Adherence to RT frequency was 98% (84-100%), intensity 84.5% (74.7-92%), type 97% (94-99%), and volume 95% (91.3-98%). Correlations were generally small-to-moderate. Neoadjuvant chemotherapy showed the strongest associations with AT adherence (r = –0.50, 95% CI –0.22 - –0.70) and attendance (r = –0.56, 95% CI –0.29 - –0.74).
ConclusionsAdherence to supervised exercise before surgery was high across FITT-V elements. Patients who received neoadjuvant chemotherapy showed lower adherence, indicating the need for additional support when implementing exercise prehabilitation, particularly for AT, in this group.

Speaker: Maria Lopes (Department of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam)

Poster Session 3.2: Individualized Interventions / Case Reports (Posterarea 2)

260 A phase II randomised controlled basket feasibility trial of a personalised, remote-delivered exercise programme on disease-free survival among early-stage, high-risk cancers in Yorkshire: CANFit study in progress

Purpose
Lung, breast, and bowel cancers account for ~40% of new UK cancers and 38% of cancer-related deaths. Despite advances in diagnosis and treatment, an urgent unmet need to improve recovery from cancer treatments remains. Evidence suggests a 38% risk reduction in breast and bowel cancer-specific mortality with exercise, yet most is observational. More clinical trials are needed to build robust evidence for exercise’s impact on recurrence and survival.

Methods
This UK-based, multicentre randomised controlled basket feasibility trial compares personalised, remote-delivered exercise programmes supported by trained exercise professionals against usual care (ISRCTN97662203). Participants were eligible if aged ≥18, diagnosed with high-risk early-stage breast, bowel, or lung cancer, and within 24 weeks of completing primary curative treatment. Consented participants completed objective measures of physical function (submaximal cardiovascular fitness, endurance, strength, balance), body composition (bioelectrical impedance), and self-reported outcomes (physical activity, sleep quality, general and cancer-specific QoL, exercise confidence and motivation). The 12-week programme is delivered remotely, with trainer contact tapering over a further 12 weeks (24 weeks total). Hospital case-note review provides disease-free survival outcomes at 6, 12, and 24 months. Recruitment closed 29 May 2026, with 64 participants randomised.

Analysis
Descriptive statistics will be reported for feasibility outcomes: recruitment, adherence, retention, data quality, adverse events, acceptability, and fidelity. Due to recruitment, survival will be summarised with descriptives at 24 months. Secondary outcomes (physical function, general and cancer-specific QoL, determinants of meeting activity guidelines) will be reported at each timepoint. Process evaluation will provide in-depth understanding of what worked and what needs improvement.

Implications
Though recruitment targets were not met, this trial can strengthen evidence for exercise as a complementary cancer treatment to improve outcomes in those at higher risk of recurrence and will inform future delivery of personalised exercise as standard cancer care.

Speakers: Cindy Forbes (University of Hull), on behalf of CANFit study team

261 Applying a 4-Phase Postpartum Runner Rehabilitation Approach to Stress Urinary Incontinence in a Post-Prostatectomy Patient: A Case Report

Pelvic floor symptoms following robotic-assisted laparoscopic prostatectomy (RALP) can reduce participation in meaningful activities, including exercise. Although pelvic floor physical therapy is becoming a standard intervention for post-prostatectomy patients with symptoms like stress urinary incontinence (SUI), there is limited guidance to safely progress patients into higher-impact activities like running. Evidence-based postpartum pelvic floor rehabilitation programs effectively help women return to running, but have not been studied in males returning to running after prostate cancer treatment. This case report applies an evidence-based protocol, Rehabilitation of the Postpartum Runner: A 4-Phase Approach, in a novel way to address SUI and pelvic girdle weakness post-RALP.

A 60-year-old male with pT3a, R0 prostate cancer with positive extra-capsular extension and perineural invasion presented post-operatively following radical prostatectomy. He reported SUI with all transitional movements. He demonstrated global hip weakness and reduced pelvic girdle stability. He was an avid runner (3-7 miles daily) pre-operatively, but was unable to walk short distances without significant leakage at evaluation. His goal was to return to running daily without leakage.

Use of the Rehabilitation of the Postpartum Runner: A 4-Phase Approach over 15 weeks for asymptomatic return to running. The framework includes progression of hip, core, and pelvic floor musculature’s neuromuscular control and load tolerance, and safe mileage advancement.

All Running Readiness Scale Evaluation Criteria passed. Patient returned to running, work, and recreational activities symptom-free, with 0-1 pad use. The minimal detectable change was exceeded for the NIH-Chronic Prostatitis Symptom Index. Global improvements in lower extremity and pelvic girdle strength were observed.

Minimal research is available to guide returning to running after RALP. Despite being designed for female runners with post-partum pelvic floor weakness, the Rehabilitation of the Postpartum Runner 4-phase approach should be considered for post-operative prostatectomy pelvic floor weakness to facilitate a safe, symptom-free return to high-impact exercise.

Speaker: Dr McKinzey Dierkes (Healthworks Rehab & Fitness, CorVia Pelvic Health, Morgantown, WV, USA; Healthworks Rehab & Fitness, ReVital Cancer Rehabilitation, Morgantown, WV, USA; West Virginia University School of Medicine, Clinical and Translational Science Program, Morgantown, WV, USA)

ISEO Poster 1.pdf

262 Blood flow restriction training in advanced prostate cancer – a case study

Background: Advanced prostate cancer is frequently associated with bone metastases and a decline in skeletal muscle mass (SMM), with the latter partly attributable to androgen deprivation therapy (ADT). Although higher SMM has been linked to improved quality of life (QoL), resistance training at high loads is often not feasible in patients lacking an anabolic androgen stimulus. Blood flow restriction (BFR) training may offer a viable alternative by stimulating muscle adaptations via activation of the potentially anabolic adenosine pathway at low and safe loads.

Methods: A 53 year old man with stage IV prostate cancer undergoing ADT and initially presenting with lumbar vertebral bone metastasis and degenerative disc disease was recruited. Fitness and body composition were assessed at baseline and every 3 months. VO₂peak and hypothetical one repetition maximum from five exercises are reported. Consequently, measurements across four time points were examined to identify changes over time, without applying inferential statistics. The patient followed a supervised progressive resistance training with BFR twice weekly, with pressure adjustments over time. Additionally, acute BFR sessions were conducted to obtain conditions serum samples, which will be applied to C2C12 and PC3 cell lines to explore underlying cellular mechanisms.

Results: Data were analyzed descriptively. One adverse event was reported at 11 months. No substantial changes were observed over time as exemplified by the following variables: Δ φ(T0-T3)= 0, Δ SMM(T0-T3)= 0, Δ VO2peak(T0-T3) = 2 (ml/min/kg). Analyses of the cellular experiments are ongoing and pending.

Discussion: Preserving SMM and muscle function is a key therapeutic goal in patients undergoing ADT. Findings from this ongoing case study indicate that clinically relevant parameters remained stable over 12 months. These preliminary results suggest that BFR training may represent a feasible and promising intervention to maintain body composition and functional capacity in prostate cancer patients with bone metastases under ADT.

Speaker: Nadira Gunasekara (German Sport University Cologne)

263 Effects of high-intensity interval training during or after intravesical therapy for bladder cancer on motivational outcomes: results from a feasibility randomized controlled trial

Background: Understanding the motivational effects of exercise during or after intravesical therapy for non-muscle invasive bladder cancer (NMIBC) may help patients to initiate and sustain exercise behavior. We report the effects of exercise on motivational outcomes, perceived benefits and harms, and perceived barriers to exercise during or after NMIBC intravesical therapy. Methods: NMIBC patients scheduled to receive intravesical therapy or on surveillance were randomized to usual care (UC, n=12) or exercise (n=13) consisting of thrice-weekly, supervised high-intensity interval training (HIIT) for 12 weeks. Using the Theory of Planned Behavior, we assessed motivational outcomes via questionnaire at baseline, 12-weeks and 1-year. Perceived benefits and harms, and perceived barriers of HIIT were assessed post-intervention (12-weeks). Given the small feasibility design, results were interpreted for their meaningful differences of at least a small-to-medium standardized effect size of d≥0.33. Results: The HIIT was perceived as more enjoyable (mean change=0.6; 95%CI:-0.2 to 1.5, p=0.13, d=0.58) and less difficult (0.5; 95% CI=-1.5 to 0.4, p=0.24, d=-0.51) than anticipated, and it elicited higher confidence (0.5; 95%CI=-0.5 to 1.4, p=0.32, d=0.49). Compared to UC, the HIIT group reported greater anticipated difficulty (0.8; 95%CI=-0.2 to 1.8, p=0.13, d=0.97) to exercise on their own over the next 6 month at the 12-week assessment; however, by the 1-year assessment, they reported greater perceived benefits (0.8; 95%CI=-0.2 to 1.8, p=0.13, d=0.97) and control (0.6; 95%CI=-0.2 to 1.4, p=0.11, d=0.69). The most common perceived benefits of HIIT were cardiovascular endurance and physical functioning (91%), and quality of life (82%). The most common exercise barriers were lack of time (46%) and joint pain (36%). Conclusions: HIIT during or after NMIBC intravesical therapy appeared more motivating than anticipated with many perceived benefits and few barriers. Although HIIT initially increased anticipated difficulty with independent exercise, effect sizes suggest perceived benefits and control may improve over time.

Speaker: Fernanda Arthuso

264 Effects of Periodized and Non-Periodized Training Interventions on Psychosocial Parameters in Cancer Survivors: A randomized controlled trial

Introduction: Optimizing exercise training through periodization is important for improving strength and aerobic performance (Boggenpoel, Nel, & Hanekom, 2018; Soares et al., 2022). In this context, periodized exercise training is also considered an effective method for improving psychosocial parameters such as health-related quality of life. However, there are no studies in the field of exercise oncology that have compared the effects of periodized and non-periodized training on psychosocial parameters in cancer survivors.
Methods: 139 breast and prostate cancer survivors were randomly assigned to the undulating resistance training group (UND, n = 34), standard hypertrophy resistance training group (STD, n = 33), polarized training group (POL, n =34) or threshold training group (ThT, n = 31). All groups performed two training sessions per week over an intervention period of 12 weeks. Energy expenditure was matched in the two endurance training groups and volume of the two resistance training groups was also matched. Health-related quality of life, depression, physical activity and mood states were assessed at baseline and post-intervention using questionnaires.
Preliminary Results: 27 (UND, age 60±10 yrs, 13 women), 26 (STD, age 55±11 yrs, 16 women), 27 (POL, age 60 ± 8 yrs, 13 women) and 28 (ThT, age 59 ± 10 yrs, 15 women) cancer survivors could be included in the analysis. Analysis is still ongoing, but the final results will be presented at the ISEO conference.
Conclusion: As the analysis is ongoing, final conclusions cannot be drawn yet. However, based on the current literature, we hypothesize that periodized and non-periodized training interventions have comparable effects on psychosocial parameters in cancer survivors.

Speaker: Nikolai Bauer (NCT Heidelberg)

265 Efficacy of Individualized Exercise Prescription in Cancer Rehabilitation

Background: About one-third of cancer patients participate in a unique three-week rehabilitation program after tumor treatment in Germany. Given the short duration, therapy must be highly efficient, yet exercise prescription is often not individualized.

Methods: In this randomized controlled trial, we compared two exercise arms. The individualized training arm (IT) trained at 50% of hypothetical one-repetition-maximum (h1RM) and 60% of peak power output (PPO). The comparator arm (COM) trained self-directed (BORG 11–14).

Results: COM participants trained at 37–48% of maximum performance. Despite this, they showed significant improvements in all motor tests: PPO (mean = 12.5 W, SE = 4.7, p = 0.009), Leg-Press (24.9 kg, SE = 4.7, p < 0.001), Chest-Press (3.1 kg, SE = 1.1, p = 0.006), Rowing (5.4 kg, SE = 1.3, p < 0.001), and Ventral Flexion (6.8 kg, SE = 1.7, p < 0.001). IT participants demonstrated incremental benefits over COM in all motor tests except ventral flexion: PPO (14.8 W, SE = 5.9, p = 0.014), Leg-Press (15.2 kg, SE = 6.0, p = 0.013), Chest-Press (4.09 kg, SE = 1.4, p = 0.005), Rowing (5.6 kg, SE = 1.7, p < 0.001), and Ventral Flexion (2.9 kg, SE = 2.2, p = 0.182). For quality of life (QoL) and physical functioning, both arms improved significantly, but the additional benefit of IT did not reach significance for QoL (5.8, SE = 3.4, p = 0.090) or physical functioning (3.5, SE = 2.3, p = 0.129).

Conclusion: The conventional three-week rehabilitation effectively improves motor performance, quality of life, and physical functioning in cancer survivors. A personalized approach may further enhance these outcomes.

Speaker: Oliver Növermann (Department of Hemato-Oncology, REHA-Klinik Reinhardshöhe, Bad Wildungen, Germany)

266 Exercise as combination partner for cancer immunotherapy

Background: It is widely recognized that exercise reduces the risk of cancer and disease recurrence. Yet the mechanisms behind these benefits remain to be elucidated. We previously showed that voluntary wheel running in tumor-bearing mice reduced tumor incidence and growth by more than 60% across different tumor models. Moreover, this effect was mediated via exercise-associated increases in serum epinephrine levels, which in turn led to immune cell mobilization and enhanced immune cell infiltration into tumors (Pedersen, 2016).
Aims: To assess the effect of exercise on tumor growth in murine cancer models, either directly or in combination with checkpoint inhibitor therapy.
Methods: We assessed the effects of voluntary wheel-running in two subcutaneous models (B16, MC38), one spontaneous model (Ret), and one chemically induced model (MCA). Mice were divided into exercising (free wheel access) and sedentary (no wheel access) groups. For combination assays, mice were treated with anti-PD1 therapy. Activity levels, tumor growth, and survival were monitored throughout the studies. Flow cytometric analyses of tumors and spleens were performed to assess immune responses.
Results: Voluntary exercise influenced tumor growth in a model-dependent manner. In the Ret spontaneous model, exercise was associated with improved survival, whereas in the chemically induced model it did not reduce tumor incidence or enhance survival. In the MC38 model, however, exercise significantly improved survival when combined with anti–PD-1 therapy. Ongoing analyses are being conducted to unravel the divergent outcomes and to correlate variations in exercise intensity observed across studies with tumor responses.
Conclusion: Integrating activity data with tumor outcomes may allow the identification of exercise intensity thresholds associated with tumor control, thereby informing the rational design of future translational and human exercise-oncology studies.

Speaker: Sara Fresnillo Saló (Center for Cancer Immune Therapy, Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark)

267 Exercise Based Rehabilitation Following CAR-T Therapy: A Case Report

Background:
Chimeric Antigen Receptor T-cell (CAR-T) therapy is an advanced treatment for hematologic malignancies, often associated with significant physical deconditioning, functional decline, and long-term complications. Evidence regarding rehabilitation following CAR-T remains limited.
Case Presentation:
A 26-year-old woman with relapsed disease underwent multiple chemotherapy treatments, followed by CAR-T therapy (August 2020). She completing treatment in March 2021. Her condition deteriorated significantly, including six months of wheelchair dependency, severe dyspnea, generalized weakness, and part dependency in activities of daily living. Additional complications included osteoporosis in hips and lumbar spine 1-4, peripheral neuropathy, fatigue, and weight gain. At initial assessment (May 2022), she required assistance for ambulation, stair negotiation, and personal care. Handgrip strength was 20.7 kg (right) and 20.0 kg (left), and she completed 14 repetitions in the 30-second sit-to-stand test. She also reported recurrent falls and impaired hand function.
Intervention:
The patient completed a 9-month multidisciplinary rehabilitation program including weekly physiotherapy, hydrotherapy, and community-based physical activity. The intervention incorporated progressive resistance training, aerobic conditioning, balance training, and functional exercises, alongside patient education. Resistance loads increased substantially (deadlift: 4 kg to 42 kg; shoulder press: 2 kg to 10.5 kg).
Results:
By February 2023, the patient achieved full independence in daily activities and returned to regular physical activity. Handgrip strength improved to 29.4 kg (right) and 22.6 kg (left), and sit-to-stand performance increased to 27 repetitions. Her osteoporosis has improved to normal for her age, fatigue, dyspnea, and pain significantly decreased.
Conclusion:
Structured, progressive exercise-based rehabilitation following CAR-T therapy may restore functional capacity, improve strength, and reverse treatment-related complications, supporting its integration into survivorship care.

Speaker: Ilan Taussig (Physiotherapist, Department of Physical Therapy, Tel Aviv Sourasky Medical Center (Ichilov), Tel Aviv, Israel.)

268 Exercise tailored to patients with rare cancers.

Background
One in five patients with cancer in the Netherlands has a rare cancer, affecting approximately 20.000 new people per year. However, there is a lack of research on supportive cancer care in this population, resulting in a lack of knowledge on quality of life optimalization.
It is unclear if the beneficial effects of exercise in patients with common cancers can be generalized to patients with rare cancers, with different cancer- and treatment related side effects. In this project we evaluate the specific needs and preferences of patients with rare cancers towards exercise and aim to empower physiotherapists in supporting the delivery of exercise in patients with rare cancer.
Methods
This project consists of three phases: (i) conduction of a mixed methods study to capture patients’ experiences and exercise preferences, using focus groups, interviews, a survey and comprehensive literature review, (ii) development of a manual for physiotherapists to support delivery of exercise programs tailored to patients with rare cancer, (iii) examine the feasibility of tailored goal-directed exercise programs among 12 patients with various types of rare cancer. Preliminary effectiveness on goal-attainment was evaluated using the Patient Specific Goal-setting method.
Results
Of the survey respondents (n=187), 70% experienced at least some symptoms limiting physical exercise, and 60% reported to exercise less compared to pre-diagnosis. Almost half of the participants received information on exercise and in 21% was referred to a physiotherapist. In phase 3, 12 patients were enrolled. To date, five patients completed the study and among these patients 84% of their goals were achieved. The results of the entire project will be ready to present in July-2026.
Conclusion
If the goal-directed exercise program appear feasible, the manual will be finalized and effectiveness of tailored exercise programs in patients with rare cancer will be further evaluated in a sufficiently powered RCT.

Speaker: Dr Marieke ten Tusscher

269 Feasibility and Effects of a Supervised Exercise Program in Patients Receiving Active Oncologic Therapies: Data from a Prospective Interventional Study

Introduction: Exercise in patients undergoing anticancer treatments is recognized for attenuating side effects, improving symptoms, and enhancing quality of life (QoL). However, its implementation in real-world settings remains limited. This study assessed the feasibility and the impact of a structured EX program in patients receiving anticancer therapies on physical fitness and QoL.
Methods: A 12-week supervised exercise program, including moderate-intensity aerobic (10–30 min/session) and resistance training (2–3 sets of 8–12 reps across six exercises), was proposed at the University of Verona. The primary endpoint was feasibility (i.e., recruitment, adherence, and retention). Secondary endpoints included functional capacity (6-minute walk test, 6MWT), muscle strength (handgrip strength test, HST; leg press test), waist-hip ratio (WHR), and QoL (EORTC QLQ-C30). Descriptive analysis and paired t-tests were applied.
Results: Overall, 180 patients participated in the study (out of 214 approached). The most frequent cancer types were gastrointestinal (37.8%) and breast (34.4%), and 50% had a metastatic disease. The median exercise attendance was 88%. The dropout rate was 32%, mainly due to personal reasons or disease progression. No serious adverse events occurred. Significant improvements were observed in the 6MWT (+39 m, p<0.001), leg press strength (+7.1 kg, p<0.001), and HST (+1.0 kg, p=0.003). QoL improved in physical, role, emotional, and social functioning (all p<0.05). Fatigue, nausea, dyspnea, insomnia, and appetite loss were significantly reduced. Financial burden and global health status also improved significantly. Among the subgroup analyses, patients with gastrointestinal cancer, stage III-IV disease, or undergoing chemotherapy showed the largest gains.
Conclusion: A tailored and supervised EX program is feasible and beneficial for cancer patients during active treatment. The intervention led to measurable gains in physical fitness and almost all domains of QoL, supporting integration of EX into oncological care.

Speaker: Alice Avancini (University of Verona)

270 Home-based exercise training for medically underserved men undergoing treatment with ADT

Background: Androgen deprivation therapy (ADT) for intermediate and high-risk prostate cancer (PC) improves survival but leads to negative changes in body composition, muscular strength, and physical fitness that compromises quality of life (QOL) and places men at risk of secondary commorbidities.

Methods: Twenty-seven medically underserved men (≥75 years of age, and/or Black, and/or rural dwelling) were recruited to a single-arm pilot-feasibility study testing a 12-week, home-based exercise intervention designed to increase daily activity, and regular resistance and aerobic training. Men wore accelerometers for 7 days and completed home-based assessments of physical function and self-reported quality of life at baseline, 8 weeks and 12 weeks.

Results: We approached 94 eligible men from 234 screened, enrolling 27 (28.7%). At baseline, 35% of men were 75 years of age or older, 25% percent were Black, and 23% lived in a metropolitan high commuting area (RUCA >2). On average men were 7 years from PC diagnosis, with 60% having had a prostatectomy and 80% having radiation. The average time on ADT was 4.5 years and 54% of men had hypertension. Steps per day and minutes of moderate to vigorous physical activity remained stable at approximately 6500 steps and 10.5 min/day, while daily sitting dropped from 9.76 to 8.89 hours. Daily sit-to-stands increased from 44 to 52, grip strength increased from 70 to 77lbs and 64 to 72lbs in right and left hands, respectively. Chair stands in 30 seconds increased from 9.7 to 13.1 and 6-minute walk distance increased from 437 to 445m. Facit-fatigue improved by 3.5 points, a minimally important change.

Conclusions: In older men with PC, home-based exercise training and assessments are feasible, though resistance training was more effective than aerobic walking, reflected in improved grip and leg strength. Remote interventions show promise, yet higher intensity training is needed to improve cardiovascular fitness.

Speaker: Dr Alexander R. Lucas (Virginia Commonwealth University School of Public Health, VCU Pauley Heart Center)

271 Low-Load Blood-Flow Restriction Training – Initial findings and potentials in Exercise Oncology

Background: Oncological patients experience numerous side effects resulting from disease and treatment. Although exercise is recommended, many side effects and patients’ concerns hamper its regular implementation. Especially patients with reduced physical function are often not able to exercise with the necessary intensity to increase muscle mass. An innovative training approach uses lower loads (20-40% of maximal strength) in combination with blood-flow-restriction to the trained limbs (LL-BFR). It has been shown to induce relevant changes in muscle mass in various healthy but also clinical populations.

Methods: A literature search was performed in PUBMED to identify studies using LL-BFR in oncological patients.

Results: Only five studies used LL-BFR in the oncological setting, two studies in the preoperative setting without neoadjuvant therapy, two studies in aftercare (only available in Arabic) and one case study with a patient during palliative treatment. Concerning ongoing research, there are two registered RCTs with published study protocols. The PREV-Ex trial form Sweden/Norway and the PRESIONA trial from Spain evaluate the effects of LL-BFR training on muscle mass in a perioperative setting and on the onset of chemotherapy induced peripheral neuropathy, respectively. Overall, the quality of published studies is limited, but data shows a good feasibility with no side effects of LL-BFR in this clinical population.

Discussion: The capability to produce muscular growth despite lower training intensities could make LL-BRF a suitable option for cancer patients who are not able to perform a classical hypertrophy-oriented resistance training. Especially patients suffering from cancer-associated cachexia could benefit from this novel training modality.

Conclusion: LL-BFR Training seems to be a promising approach for oncological patients with limited physical function. Further, high quality RCTs are necessary to evaluate safety and effects of LL-BFR in patients with cancer during active therapy.

Speaker: Dr Frieder Krause (Krankenhaus Nordwest)

272 Non-Response to Resistance and Aerobic Training among Cancer Patients and Associated Factors: A Systematic Review

Background: Exercise interventions are consistently evidenced as effective supportive therapy measures in oncology. Meta-analyses and clincial guidelies demonstrate beneficial effects in quality of life, physical function, cardiorespiratory fitness, and improvements in treatment-related adverse effects through resistance and aerobic training. However, individual studies report substantial interindividual variability, including cases of "non-response". To date, no systematic review has exmined non-response to resistance- and aerobic-based exercise interventions in cancer patients. Zhe aim of this review is to quantify the prevalence of non-response and identify associated factors.
Methods: A systematic literature search was conducted between May and October 2025 in PubMed, Embase, and Web of Science. The PICO-based search strategy included terms such as “cancer,” “exercise,” “non-responder,” “response heterogeneity,” “endurance,” and “resistance.” Screening and study selection were performed independently by two reviewers. Inclusion criteria were: (i) adult oncological populations, (ii) supervised endurance and/or resistance training interventions, (iii) explicit quantification of non-responders and/or extractable data showing no or negative changes in relevant health-related outcomes (e.g., VO₂peak, muscular strength, fatigue), and (iv) intervention studies, including randomized controlled trials (RCT), controlled trials, clinical trials, and feasibility studies.
Preliminary Results: Of 1.447 studies identified after deduplication, 250 were selected for full-text screening. Of the five studies identified, one was an RCT with a non-exercising control group, while the remaining four were clinical trials without a control condition. Included studies were targeting both strength- and aerobic-related outcomes. Potential moderators and contributing factors identified include baseline fitness, treatment history, training dose/volume, level of supervision, inflammatory and medication profiles, and adherence.

Speaker: Katharina Maria Herzog

273 Pre- and postoperative energy expenditure in major liver resection: what do we ask of a patient?

Background:
Major liver resections are associated with high postoperative complication rates, reported in up to 43% of cases. Prehabilitation programs that improve preoperative aerobic fitness enhance postoperative outcomes, yet the metabolic demands during recovery remain unclear. Insight into postoperative energy expenditure relative to preoperative metabolism and aerobic capacity is essential to understand how surgery affects the body’s metabolic reserve. This study aims to quantify differences in pre- and postoperative energy expenditure in patients undergoing major liver resection and relate these findings to preoperative aerobic capacity.
Methods:
This ongoing prospective observational study intends to include 10 patients undergoing elective major liver resection at Maastricht University Medical Center+. Energy expenditure is measured pre- and postoperatively using doubly labeled water and indirect calorimetry. Cardiopulmonary exercise testing (CPET) assesses aerobic capacity, accelerometers monitor physical activity, and blood samples evaluate metabolic and immune parameters.
Results:
To date, 8/10 patients have been included of which 5 were male. Age ranged between 56 and 83 years old. In 7/8 patients, surgery was performed with a resection time ranging from 248 up until 574 minutes. For 6 out of 8 patients, postoperative measurements of indirect calorimetry and aerobic capacity could be performed.
Postoperative energy expenditure is expected to increase compared with preoperative values. Patients with lower aerobic capacity are anticipated to show higher metabolic demands and complication rates. Physical activity is expected to decline postoperatively, with faster recovery in fitter patients. Correlations between immune and metabolic markers and changes in energy expenditure may clarify the role of aerobic fitness in recovery. Preliminary data will be presented at the congress.
Conclusions:
By exploring the relationship between energy expenditure and aerobic fitness, this study seeks to provide valuable insights into the metabolic challenges patients face during postoperative recovery, potentially leading to tailored prehabilitation programs for patients undergoing major liver resections.

Speaker: Ms Lis Hoeijmakers (Department of Surgery, Institute of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, Netherlands)

274 Prehabilitation and Rehabilitation for Three Surgeries – Case Study for Exercise Oncology and Multi-Disciplinary Decision Making Background

Background

This case study presents the multidisciplinary clinical management of an 82-year-old colorectal cancer patient through three surgeries. The Clinical Exercise Physiologist runs the General Practitioner (GP) exercise referral scheme and the cancer prehabilitation and rehabilitation service with University Hospital Southampton NHS Foundation Trust.

Case Presentation

All patients undergo a Cardiopulmonary Exercise Test (CPET) to stratify their risk prior to surgery. The CEP receives a summary, along with their medical history and high-intensity interval recommendations expressed in Watts. Patient A came through with an identified higher risk of complications post-surgery, with a leaky tricuspid valve.

Patient A’s exercise prescription post-hip surgery was regressed, involving aerobic work on a stationary bike, during which they completed only 15 minutes in their first session. They barely reached their upper heart rate of 99 bpm during the lower interval but hit 25 watts consistently. This is due to shortness of breath on exertion. They increased their training time to 40 minutes of continuous cycling after three weeks of sessions, prior to their tricuspid valve surgery. They built their fitness up again, ready for the final surgery for their colorectal cancer, improving their cardiovascular fitness to complete the full workload above, comfortably hitting 45-50 Watts during the high intervals.

Discussion

This patient required a multidisciplinary team to help them progress through their cancer journey, from the CEP to the peri-operative team and their cardiologist. This was to ensure the patient was safe to exercise in their recovery between surgeries. Patient A recovered well from all three surgeries and found that their quality of life and fitness improved drastically, especially after their cardiac surgery.

Conclusion

This case study has shown how valuable exercise prescription is to recovery between surgeries. Exercise prescription is a useful tool for cancer patients awaiting surgery and can improve their outcomes post-surgery.

Speaker: Mr Andy Haigh (University of Southampton)

275 The effects of a tailored eight-week therapeutic exercise programme on fatigue, physical and mental parameters in breast cancer survivors: Case series

Introduction: Cancer-related fatigue (CRF) is common amongst breast cancer survivors, severely affecting quality of life (QoL) after treatment. Although targeted exercise, such as aerobic or strength training, appear to be helpful, the optimal type and exercise parameters require further investigation. These case series explored the effects of a fast-track individually tailored combined aerobic and strength training exercise program on fatigue, physical and mental parameters on breast cancer survivors with CRF.

Methods: Breast cancer survivors with self-reported CRF as scored in the Fatigue Severity Scale (FSS) were recruited from the non-profitable breast cancer organization “Alma Zois” of Achaia County, Greece. The program included individualized medium intensity home-based exercises 4 times/week (monitored via telerehabilitation and adherence diaries) and a weekly group-based, supervised session by two physiotherapists for 8 weeks. Progressive programme entailed 50% aerobic and 50% strengthening exercises, while intensity progress was monitored through Borg scale and Karvonen formula. Reported outcomes measured at baseline and post-intervention, included FSS, 6-Minute Walk Test (6MWT), EORTC Basic Quality of Life Questionnaire (QLQ-C30), Hospital Anxiety and Depression Scale (HADS) and International Physical Activity Questionnaire-7 (IPAQ-7) and patient satisfaction questionnaires post intervention. Data was descriptively analyzed.

Results: Three women aged 50.67±4.04 years-old (IPAQ-7=3.576.67±5.129.1 MET-min/week) completed the intervention. The exercise programme reduced fatigue in FSS score by 24.31% and improved all outcome parameters; QoL in QLQ-C30 subscales (20.8%, 15% and 19.9% mean score improvements in patients’ functionality, symptoms and general health, respectively), mental health (33.3% and 30.5% improvements in HADS Anxiety and Depression, respectively), mean walking distance increased by 15.3% (77m) post-intervention (6MWT) while satisfaction was highly rated.

Conclusion: This case-series study showed that a supervised, individualized combined aerobic and strength 8-week training programme improved fatigue, QoL, gait speed and overall physical and mental well-being amongst breast CRF women, though, larger scale studies are needed.

Speaker: Prof. Evdokia Billis (DEPARTMENT OF PHYSIOTHERAPY, UNIVERSITY OF PATRAS)

276 The perceptions of a home-based blood flow restriction training program during and after treatment for hepatopancreatobiliary cancer

Purpose
Blood-flow restricted resistance training (BFR-T), which uses low loads, may reduce mechanical stress and support faster muscle recovery compared with heavy-load training. Delivered at home, it may also improve exercise accessibility for cancer survivors, yet limited research has explored their experiences. This study aimed to qualitatively examine participants’ perspectives of a home-based BFR-T program, focusing on barriers and facilitators to participation and adherence, and experiences with the activity tracker and protein supplement used in the intervention.

Methods
Individual interviews were conducted with nine participants between October and November 2024. All had completed a two-armed randomized controlled trial evaluating whether BFR-T could preserve skeletal muscle mass and enhance functional capacity and mental health in patients with pancreatic, biliary tract, or liver cancer. Interviews were transcribed verbatim and analyzed using reflexive thematic analysis with an inductive approach.

Results
Three themes were developed: From uncertainty to understanding BFR-T (instructions for BFR-T, adherence to BFR-T, expectations vs experience, willingness to recommend BFR-T, cuff experiences); Feeling the change—in body and beyond (perceived effects of BFR-T and its influence on continued exercise); and Beyond the cuffs—additional components shaping engagement (home-based format, activity tracker, protein supplement).

Conclusions and Implications
Participants progressed from initial uncertainty to growing confidence and acceptance of home-based BFR-T, supported by clear instructions, increasing familiarity, and perceived physical and mental benefits. Early challenges included cuff discomfort and skepticism, while the activity tracker, protein supplement, and home-based delivery offered mixed but generally supportive value. Successful implementation should emphasize clear guidance, comfortable equipment, and flexible use of supplementary elements. With appropriate support, home-based BFR-T appears feasible, acceptable, and potentially helpful in promoting sustained exercise participation among cancer survivors.

Speaker: Poorna Anandavadivelan (KI)

277 Ventilatory and metabolic thresholds in colorectal, breast and prostate cancer patients throughout a 6-month home-based exercise intervention – data from the CRBP-TS-study

Background: Cardiovascular diseases are the second leading cause for increased morbidity and mortality in cancer survivors. With ongoing advances in surgical and adjuvant cancer therapies, an increasing number of survivors are living longer and require targeted support to manage long-term cardiovascular risk factors.
Methods: This secondary subgroup analysis includes participants who underwent an additional two-test protocol cardiopulmonary exercise testing (CPET) at baseline and follow-up. The analysis evaluates the effects of a 6-month home-based exercise rehabilitation program in postoperative patients, compared to usual care. Primary outcomes were changes in lactate turning point (LTP) and respiratory compensation point (RCP) and secondary outcomes weekly exercise duration and heart rate during exercise.
Results: A total of 68 participants (45.5% women, 58.5 years [49.3; 63.0], prostate cancer 47.7%, breast cancer 40.1%, colorectal cancer 12.5%) completed the pre and post examinations (intervention group, IG: n=36; control group, CG: n=32). Participants in the IG accumulated an average of 64.9 [43.6; 84.3] additional minutes of exercise per week, at a mean heart rate of 99.1 ± 14.3 bpm (67.1 ± 7.4 %/HRmax) during activities. After 6 months both thresholds were detected at a higher workload in the IG (LTPΔ: 10.8 ± 18.7 watt; p < 0.001; RCPΔ: 10.1 ± 17.0 watt; p < 0.001), whereas no significant changes occurred in the CG: For the RCP a significant group × time interaction (p = 0.006) was observed.
Discussion & Conclusion: The observed improvements in metabolic thresholds are comparable to those reported in supervised endurance training programs, despite lower exercise intensity in our home-based training setting. These findings suggest that digitally supported, individualized home-based exercise can effectively enhance markers of submaximal cardiorespiratory fitness in cancer survivors. Future research should explore individual variability in adherence, training duration, and intensity to refine personalized exercise prescriptions and optimize long-term outcomes.

Speaker: Ms Mailin Beyer (Department for Rehabilitations and Sports Medicine, Hannover Medical School)

Poster Session 3.3: Digital & Remote Interventions / Implementation (Posterarea 3)

278 A 12-Week Remote Exercise Intervention for Older Adults With Cancer and Functional Impairment

Background: Older adults with cancer and reduced functional capacity face barriers to maintaining physical activity during treatment. This study describes the feasibility and preliminary effects of a 12-week telehealth-based exercise program in adults ≥65 years with cancer and instrumental activities of daily living (IADL) scores <70, indicating functional vulnerability.
Methods: We conducted a 12-week, single-arm intervention among adults ≥65 years initiating systemic therapy and presenting with reduced instrumental function (IADL <70). Participants received individualized, remotely delivered exercise counseling with weekly follow-up. Outcomes assessed at baseline and 12 weeks included IADL, IPAQ, sedentary time (minutes/week sitting), BFI, Sit-to-Stand performance, and FACT-G. Descriptive statistics summarized baseline characteristics. Pre-post changes were analyzed using paired t-tests or Wilcoxon signed-rank tests, as appropriate.
Results: Twenty-six participants were included. The mean age was 74 years (SD=5.7); 51% were male, 82% white, 63% married, 70% had ≥high school education, and 87% were retired. The most common cancers were gastrointestinal (34%), genitourinary (20%), lung (16%), and breast (10%); 67% had stage IV disease. IADL improved from 66.6 (SD=23.4) to 78.5 (SD=16.6), an 11.9-point gain (17.9% improvement; d=0.59). Participants were initially highly sedentary, spending an average of 4,997 minutes/week sitting; by week 12, sedentary time decreased to 3,560 minutes/week. Fatigue improved with a 1.2-1.8-point reduction in BFI scores, and functional performance increased, reflected by 2-3 additional Sit-to-Stand repetitions at follow-up. FACT-G increased from 86.1 (SD=11.4) to 95.0 (SD=6.9), an 8.9-point gain (10.3% improvement; d=0.94).
Conclusion: A 12-week telehealth-delivered exercise intervention was feasible for older adults with cancer and baseline function vulnerability. Despite clinical instability in this population, participants who remained engaged experienced meaningful improvements in IADL, physical activity, and quality of life. These results support further exploration of adaptive, remotely supervised exercise strategies for vulnerable older adults with cancer.

Speaker: Cristiane Bergerot (Oncoclinicas&Co, Brazil)

279 A feasibility of a Digital Therapeutics for Improving Bowel Symptoms in Rectal Cancer Patients: a single-center, single-arm feasibility study

Background: With colorectal cancer ranking third globally and survival rates increasing, managing long-term complications is crucial. Most patients who undergo Patients undergoing Low Anterior Resection (LAR) often suffer from symptoms such as constipation, fecal incontinence, and urgency, which significantly compromise their quality of life. Although effective exercise interventions exist, they are often limited by constraints for time, location, and cost. This study aimed to evaluate the feasibility of a 6-week app-based home exercise program for rectal cancer patients experiencing bowel symptoms.

Methods: This was a single-center, single-arm feasibility study. 15 adults (aged 19–80) who underwent LAR for rectal or sigmoid colon cancer were recruited. Participants performed a resistance training program for 6-week using only mobile app. Primary outcomes were feasibility indicators, including retention rate, adherence, app usability. Exploratory outcomes included changes in bowel symptoms measured by the EORTC-QLQ-C30 and CR29.

Results: 11 of 15 participants completed the 6-week program, resulting in a retention rate of 73.3%. Exercise program adherence averaged 91.52% and self-monitoring adherence was also high (diet: 92.42%; bowel: 81.17%). In terms of usability, over 70% reported satisfaction and continued-use intention. Regarding preliminary efficacy, while statistical significance (p=0.05) was not reached, consistent improvement trends were observed. The total bowel symptom score decreased from 40.29±15.77 to 35.40±19.05 (p=0.068). Notably, the group aged 60 years or older showed a relatively greater degree of improvement. In body composition, skeletal muscle mass also showed a positive increasing trend (p=0.076).

Conclusion: This digital intervention home exercise program is feasible and highly acceptable. This indicates that mobile apps alone can deliver exercise interventions to patients without constraints of time, location, or cost, providing improved accessibility. These findings provide foundational data to support future large-scale, long-term randomized controlled trials.

Speaker: Ms Hye Yeon Kim (Yonsei University)

280 A tailored, side effect-targeted, yoga-based intervention for cancer survivors: development and implementation within the PREFERABLE-II LION Multinational Randomized Controlled Trial (RCT)

Background:
Mind-body interventions such as yoga are increasingly recognized as integral components of supportive cancer care. Yoga, combining strengthening mindful movements, breathing, and relaxation techniques, has demonstrated positive effects on common cancer side effects such as cancer-related fatigue (CRF) and emotional distress. However, heterogeneity of patient needs, physical limitations related to the disease or treatment, and logistical barriers often impede participation in yoga interventions. Live-remote sessions may overcome these challenges.
Methods:
As part of the intervention in the LION RCT, live-remote yoga-based sessions were developed for cancer survivors who completed curative therapy 3-12 months ago and continue to report CRF or emotional distress. Participants receive a 12-week live-remote intervention consisting of an aerobic and resistance exercise module (2×/week) and a side effect-specific module, e.g. the CRF and emotional distress modules (1×/week), that include yoga-based exercises. These yoga-based sessions encompass Hatha and restorative yoga postures, elements from Tai Chi, breathing techniques, and guided relaxation. Modifications to floor and standing postures as well as adaptations to postures involving the arms were made to meet the specific needs of patients with limited mobility to ensure safe participation.
Results:
Each yoga-based session begins with a breathing exercise and warm-up. The CRF-focused module comprises 16 postures, designed to enhance energy regulation and reduce perceived exertion, followed by a 10-minute body scan during the relaxation phase. The emotional distress module incorporates 13 yoga postures to facilitate stress release and promote relaxation, followed by a 15-minute relaxation exercise (Body Scan, Progressive Muscle Relaxation, or Guided Imagery).
Discussion:
The developed sessions represent a side effect-targeted approach to integrating yoga into exercise oncology. The emphasis on safety, feasibility and accessibility is intended to inform best practices for evidence-based mind–body interventions. The LION trial will evaluate patient compliance, satisfaction and potential practical barriers.

Speaker: Patricia Blickle (Divison of Physical Activity, Cancer Prevention and Survivorship, German Cancer Research Center, Heidelberg and National Center for Tumor Diseases Heidelberg, a partnership between DKFZ and Heidelberg University Hospital, Heidelberg, Germany)

281 Barriers and facilitators towards exercise in patients undergoing chemotherapy: a systematic review

Background and objective: With rising cancer incidence, also the number of patients receiving chemotherapy and experiencing treatment-related side effects is increasing. While robust evidence shows that exercise during treatment yields beneficial effects in the attenuation of these side effects, exercise participation and adherence during chemotherapy remain critically low. Therefore, the objective of this review is to summarize existing evidence on barriers and facilitators towards exercise in patients undergoing chemotherapy while participating in a supervised exercise program.
Methods: A systematic review was conducted up to 24th of March 2026 following the PRISMA 2020 guidelines, searching PubMed, Embase, and Web of Science. Included studies were required to identify barriers or facilitators influencing participation in exercise therapy, with participants actively undergoing chemotherapy during the study period. Articles were screened double-blinded. Risk of bias was assessed independently and blinded by two reviewers using the Mixed Methods Appraisal Tool (MMAT). The overall certainty of the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach for quantitative evidence and the GRADE-Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) approach for qualitative evidence. Data extraction will include study and population characteristics, adherence, barriers and facilitators, and the methodologies used to assess these factors.
Results: The search yielded 1,352 studies. After duplicate removal and title, abstract and full-text screening, 16 studies were included.
Currently, all relevant data is being systematically extracted and assessed for methodological quality. Final results will be available in July 2026.
Conclusion: The results of this systematic literature study may inform future exercise programs and support the integration of exercise into supportive cancer care during active chemotherapy.

Speaker: Astrid Torrekens (Universiteit Antwerpen)

282 Compliance to a virtually supervised aerobic and resistance exercise program among Latina/Hispanic breast cancer survivors: The ROSA Trial

Introduction: Reporting exercise compliance within intervention trials is critical to establish realistic expectations and inform best practices for cancer survivors. This secondary analysis describes compliance to a virtually supervised, home-based 16-week aerobic and resistance exercise intervention among Latina/Hispanic breast cancer survivors (LHBCS).

Methods: This analysis includes 26 sedentary, overweight or obese LHBCS. The ROSA program was a thrice-weekly, 16-week intervention of virtually supervised, periodized aerobic (50-85% HRmax) and resistance (60-75% 1-RM) exercise. Exercise dosage was calculated as time×heart rate zone (aerobic) and sets×repetitions×load (resistance). Adherence was defined using relative dose intensity (RDI), a ratio of exercise dose completed to prescribed with an RDI ≥100% considered compliant. Apriori compliance cut points included attending ≥80% of sessions or completing ≥80% of sessions at planned dosage. Descriptive statistics are presented as mean±standard deviation, number (percentage), or median [interquartile range] as appropriate.

Results: Participants were 55.96±9.46 years old and overweight (27.85[10.40] kg/m2). Mean attendance was 92.71±10.58% where 23 (88.46%) participants attended ≥80% of sessions. The most common reason for non-attendance was illness (20.98%). Ten (38.46%) participants complied with the aerobic dose and four (15.38%) for resistance dose in ≥80% of sessions. Overall aerobic exercise RDI was 116.67[112.50]% with 29.51% of sessions requiring a dose reduction. Resistance exercise RDI was 89.88±13.77% and 55.03% of sessions required a dose reduction; additionally alternative resistance exercises were prescribed 14.74% of the time and not considered dose reductions. Planned aerobic dose was mostly not met due to low exercising heart rate (64.41%). For resistance exercise, load (41.60%) was commonly reduced due to general pain (34.38%).

Conclusion: Virtual supervised exercise is well attended and aerobic exercise over adhered to; however, resistance exercise often requires modification due to general pain among LHBCS. Exercise practitioners should adapt exercise on an as needed basis in a way that can be safely instructed remotely.

Speaker: Rebekah Wilson (Dana-Farber Cancer Institute, Division of Population Sciences, Department of Medical Oncology, Boston, MA, USA; Harvard Medical School, Boston, MA, USA)

283 Delivering Impact in Practice: Real-World Insights from the ‘Active Together’ Multi-Modal Cancer Prehabilitation and Rehabilitation Service

Introduction
Active Together is a clinician-led cancer prehabilitation and rehabilitation service for adults with cancer receiving curative treatment that is embedded into NHS cancer care pathways across South Yorkshire, UK. This real-world service evaluation assessed the feasibility, engagement, and impact of this multimodal service combining exercise, dietetic, and psychological support before, during and after cancer treatment.
Methods
Data was collected within services across South Yorkshire (Barnsley, Rotherham, Doncaster and Sheffield) between March 2022 and March 2026 (estimated n=1,300). Outcome measures included six-minute walk test (6MWT) distance, sit-to-stand repetitions, handgrip strength and Exercise Vital Sign (EVS) as a behavioural process measure. Linear mixed-effects models will assess longitudinal changes after missing value imputation.
Results
Results from phase one (March 2022-May 2024) of the evaluation in Sheffield are presented here. The presentation will include an additional two-years of data from across South Yorkshire. Prehabilitation completion was 93%, and 62% completed the full programme (median duration 44-weeks). Prehabilitation was associated with improvements in 6MWT (27m, p<0.001, d=0.99) and 30-second sit-to-stand (2 repetitions, p<0.01, d=0.90). Following treatment, all functional measures declined significantly (6MWT −17m, p<0.001, d=0.59; 60-second sit-to-stand −3 reps, p=0.009, d=0.71; handgrip −2kg, p<0.01, d>0.99), and self-reported physical activity (EVS) fell below baseline (−35 min/week MVPA, p=0.011). Following rehabilitation, 6MWT and lower-limb function subsequently recovered, with 6MWT exceeding baseline by +20m (p=0.01, d=0.72), whereas handgrip remained below baseline.
Conclusions
This real-world evaluation demonstrated clinically meaningful improvements in cardiorespiratory fitness and lower-limb function before treatment. Post-treatment declines in cardiorespiratory fitness and lower limb function were restored following rehabilitation. However, hand grip strength was not. Although the absence of a control group limits causal inference, the findings indicate that multimodal prehabilitation and rehabilitation can be feasibly integrated into routine cancer care and may support patient optimisation for treatment, functional recovery and wellbeing throughout the treatment pathway.

Speaker: Anna Myers (Sheffield Hallam University)

284 Digital cancer prehabilitation to improve physical fitness: a scoping review and concept analysis

Background
Cancer prehabilitation which aims to optimize physical fitness before treatment can enhance patient resilience. With increasing digitalization in healthcare, digital cancer prehabilitation has emerged as a promising approach to overcome accessibility and implementation barriers of traditional prehabilitation programs. However, the concept remains inconsistently defined across the literature.
Objective
To systematically map the existing literature and conduct a concept analysis to define and describe “digital cancer prehabilitation to improve physical fitness”.
Methods
We conducted a scoping review combined with a concept analysis following the Walker and Avant framework. Four electronic databases (PubMed, Embase, CINAHL, and CENTRAL) were searched from inception to November 2025. Inclusion criteria were: adult patients awaiting cancer treatment, interventions aiming to improve one or more components of physical fitness, and the use of a digital health component. Data were synthesized to identify how the concept is used and to extract defining attributes, antecedents, consequences, and empirical referents.
Results
Fifty-seven papers were included, most of which were feasibility or pilot studies. Interventions targeted diverse cancer populations, most frequently lung and colorectal cancer, and used multiple exercise modalities, often combined with nutrition, lifestyle education, and psychological support. Digital components included activity coaching, activity tracking feedback, online resources, digital training sessions and virtual reality, usually in multicomponent programs. Three defining attributes were identified: personalized and adaptive interventions, integration of digital technologies and remote monitoring, and a proactive multimodal approach. Key antecedents were digital access and literacy, supportive clinical infrastructure, patient readiness, and social or motivational support. Reported consequences included improvements in physical and mental outcomes, improved clinical outcomes, and indications of improved scalability, accessibility, and cost-effectiveness.
Conclusion
Digital cancer prehabilitation to improve physical fitness is a proactive, digitally delivered, personalized multimodal intervention between diagnosis and treatment. The proposed definition and framework can guide development and implementation in clinical practice.

Speaker: Tycho Zuijlen (Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands)

285 Digital Health Resources promoting Physical Activity among People Living with and beyond Cancer: an Environmental Scan

Background: People living with and beyond cancer experience multiple health challenges. Although physical activity (PA) reduces the most common side effects and successfully improves quality of life, PA levels among this population remain low due to limited support and low self-efficacy. Many survivors seek PA-related information through digital health resources, such as websites, documents, and apps. Online information-seeking behavior has been associated with a greater likelihood of meeting PA guidelines among cancer survivors. Integrating behavior change techniques (BCTs) into digital resources is recommended to enhance PA adoption and maintenance. However, concerns persist regarding the quality, evidence base, and consistency of BCT use in digital resources.
Aims: As part of a broader Environmental Scan examining resources that support PA in cancer survivorship, this study aimed to: i) identify freely accessible digital resources, and ii) evaluate their reliability, accuracy, accessibility, and integration of BCTs.
Methods: Internet searches were conducted in incognito mode to minimize algorithmic bias. Resources were assessed using the eEurope 2002 Quality Criteria, the DISCERN tool, and the Web Content Accessibility Guidelines (WCAG). Incorporation of BCTs was evaluated using the 40-item CALO-RE taxonomy.
Results: A total of 77 digital resources were identified, including 56 websites, 2 online modules, 1 video library, 1 avatar, 1 app, 15 booklets, 1 template, and 1 training program. Nearly half (48%) met reliability standards, while only 34–36% demonstrated medium to high accuracy. Accessibility violations averaged 25 per resource, with only two resources free of Level A or AA violations. The number of BCTs per resource ranged from 1 to 20 (mean = 9).
Impact: These findings indicate inconsistent quality and highlight the need for more balanced, evidence-based information on benefits and safety precautions. Fostering collaborations between resource developers and research institutions could strengthen resources’ credibility and extend their behavioral impact among cancer survivors.

Speaker: Michael O Brien (Technological University of the Shannon)

286 Evaluating the Feasibility of Online Education for Cancer Care Workers to Facilitate Inclusive Prehabilitation (I‑Prehab)

Background
Cancer prehabilitation (prehab) includes exercise, nutritional optimisation, and support for emotional wellbeing, before cancer treatment. Despite demonstrated benefits for recovery, access to and engagement with cancer prehab remain inequitable, particularly among people from minority ethnic backgrounds and socioeconomically disadvantaged communities. To address this, we co‑produced an online Inclusive Prehabilitation education package (‘I‑Prehab’) to support cancer care workers, including physiotherapists, exercise physiologists, and exercise instructors. This study explored the feasibility of delivering and evaluating I‑Prehab.
Methods
This was a single‑arm mixed‑methods feasibility study. I‑Prehab was launched through in‑person, online, and hybrid roadshows at four National Health Service sites (Wales=3, England=1), with additional promotion via Cancer Alliances and Nursing and Allied Health Professional Cancer Leads. Primary feasibility outcomes were recruitment to and completion of all six I-Prehab modules, including understanding and engaging the person with cancer, harnessing support of others, and making resources and services inclusive. Pre‑ and post‑education questionnaires assessed perceived knowledge of inclusive prehabilitation practices using bespoke items rated on a six‑point Likert scale (strongly agree to strongly disagree), and confidence in healthcare communication using the validated Self‑Efficacy‑12 (SE‑12) measure (score range 12–120).
Results
I-Prehab roadshows were accessed by 126 cancer care workers, of whom 50 commenced I-Prehab education (40%). A further 51 commenced I-Prehab via alternative routes. Overall, 95 were recruited for I-Prehab evaluation; 78/95 (83%) completed all I-Prehab modules and provided valid pre- and post-education questionnaires. Self-reported knowledge increased for 67/77 (87%) participants, and in all six areas assessed; Median total score, before=27 (IQR 24-31), after=36 (IQR 31-36) (p<0.05). Median SE-12 scores increased from 91 (IQR 83-95) to 106 (IQR 5-113) (p<0.05). Both outcomes had medium-large effect size (Cohen’s d=0.78 and 0.74, respectively).
Conclusion
Delivering and evaluating I‑Prehab education was feasible and may equip cancer care workers with knowledge and skills to deliver equitable, person-centred prehabilitation.

Speaker: Alexandra Mitchell (Cardiff University)

287 Exploring optimal social dynamics during live-remote exercise following cancer treatment: An international concept mapping study

Purpose The recent surge in live-remote exercise programs may facilitate greater access to exercise interventions for cancer survivors. However, concerns have been raised about altered or weakened interpersonal dynamics among participants and between participants and exercise professionals. This could affect perceived benefits and subsequent opportunity for survivors to play an active role in their recovery.

Methods We conducted a concept mapping study to assess which aspects of social interaction cancer survivors consider important to gain the most benefit from these programs. This mixed methods study included participants from six countries (Australia, the Netherlands, Germany, Sweden, Spain, and Portugal), who had completed a 12-week live-remote exercise program targeting the negative side effects of their cancer treatment. Via an online concept mapping platform (GroupWisdom), participants: (1) generated statements in response to two focus prompts (related to peer-interaction and interaction with the trainer, respectively); and/or (2) sorted these statements into groups of related concepts and/or (3) rated them according to perceived importance. The exercise professionals involved simultaneously rated the statements according to perceived feasibility. We aggregated the data using multidimensional scaling, and performed cluster analysis. A “Go-Zone map” will combine feasibility and importance ratings, providing insights into which aspects of live-remote exercise interventions cancer survivors and exercise professionals believe should- and can be prioritized to optimize social interaction.

Results (in progress) Participants generated 101 unique statements reflecting their preferences for interacting with peers and trainers, sorted optimally into five and seven clusters respectively. As a whole, all clusters were considered more feasible than important. The Go-Zone maps for both topics indicate a substantial set of statements are considered both important and feasible. Results will be finalized by May 2026.

Conclusions This study provides actionable insights on preferences of cancer survivors and involved exercise professionals for optimizing interpersonal dynamics during live-remote exercise.

Speaker: Ms Esther de Jongh (NKI)

288 Feasibility and preliminary efficacy of online group and individual yoga for depression and anxiety in women with breast or gynecological cancer: a comparative mixed-methods study

Background:
Depression and anxiety are common among women with cancer and negatively affect treatment, recovery, and quality of life. Accessible, home-based interventions are needed to address these symptoms.

Purpose:
To evaluate the feasibility, acceptability, and preliminary efficacy of a 6-week online yoga program delivered in either group or individual format for women with breast or gynecological cancer experiencing elevated depression and/or anxiety.

Methods:
This randomized comparative feasibility trial allocated 30 women (1:1) to weekly group or individual online yoga sessions supplemented by short home-practice videos. Eligible participants had completed chemotherapy/radiotherapy within five years and met diagnostic criteria for a mood or anxiety disorder. Outcomes were assessed at baseline, week 4, and week 6. Feasibility thresholds were defined a priori. Quantitative analyses used linear mixed models; qualitative interviews were thematically analyzed.

Results:
All feasibility targets were exceeded: 100% consent among eligible participants, 100% attending ≥50% of sessions, and 93.3% completing post-intervention assessments. Adherence was high (mean 5.9/6 sessions), and adverse events were minimal. Across both formats, depression and anxiety significantly decreased over time (p < 0.01), with medium–large within-group effect sizes. Significant improvements were also observed in distress, perceived stress, fatigue, and quality of life. No significant interaction effects were found for Hospital Anxiety and Depression Scale (HADS) outcomes. Participants rated the program as beneficial (92.8%) and acceptable, valuing breathing and relaxation practices. Qualitative analysis highlighted improved calmness, resilience, and usability of telehealth delivery, despite minor technological challenges.

Conclusions:
Online yoga delivered individually or in small groups is feasible, acceptable, and potentially effective for improving psychological symptoms in women with breast or gynecological cancer. Findings support the conduct of a fully powered randomized controlled trial to evaluate efficacy and inform implementation of remote integrative oncology services.

Speaker: Maria Gonzalez

289 Feasibility of Live Remote Exercise for Adults with Advanced Cancer and Cachexia: Results from the ACE Trial

Background: Cancer cachexia is a debilitating syndrome in advanced cancer, characterized by reduced physical function, high symptom burden, poor quality of life (QOL), and shortened survival. Despite the prevalence of cancer cachexia, supportive care options remain limited. Exercise is recommended in oncology, yet few trials have specifically targeted patients with advanced cancer and cachexia, and access to supervised programs is scarce. Methods: The Advanced Cancer and Cachexia Exercise (ACE) Trial was a two-arm, phase II randomized controlled trial evaluating an 8-week, live remote, tailored aerobic and resistance exercise intervention (3 sessions/week, 30-45 minutes) combined with post-exercise protein supplementation versus usual care. Adults with metastatic or locally advanced cancer meeting international criteria for cancer cachexia were enrolled. Primary outcomes were feasibility (recruitment >40%, adherence >66%, attrition <40%, safety: 0% serious adverse events) and acceptability. Secondary outcomes included physical function (e.g., 30-s sit-to-stand), body composition, physical activity, QOL, fatigue, cachexia-related symptoms, and psychological outcomes. Results: Thirty-three participants were randomized (male n=17, 52%, age (mean ± SD): 63 ± 12 years), and all feasibility benchmarks were achieved. Acceptability for the live remote format was high, with a strong willingness to continue exercising and to recommend the program to others. While no significant between-group differences were observed, participants randomized to the exercise intervention demonstrated greater clinically meaningful improvements in several patient-reported outcomes and superior gains in 30-s sit-to-stand performance over time (∆3.1, 95% CI: 0.4–5.8). Conclusions: Live remote, tailored exercise is feasible and acceptable for adults with advanced cancer and cachexia. Preliminary benefits in physical function and patient-reported outcomes support progression to a phase III trial and highlight the potential role of exercise in cancer cachexia care.

Speakers: Dr Kelcey A. Bland (Department of Physical Therapy, University of British Columbia, Vancouver, Canada), Eva M. Zopf (Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia & Department of Medical Oncology, Cabrini Health, Malvern, Victoria, Australia)

290 Feasibility Trial Protocol Evaluating Workforce Models for Delivering Supervised RT‑HIIT During Chemotherapy in Regional Cancer Centres

Background
Despite strong evidence supporting exercise during chemotherapy, access to supervised programs remains limited in regional settings due to workforce and service delivery constraints. Scalable models that maintain safety, fidelity, and clinical effectiveness across diverse healthcare contexts are urgently needed.
Purpose
To evaluate the feasibility, safety, and implementation of delivering supervised combined resistance and high-intensity interval training (RT-HIIT) during curative-intent chemotherapy across regional cancer centres using three distinct workforce delivery models, explore physiological responses, and monitor external workload across sessions.
Methods
This multi-site, parallel-group, randomised controlled feasibility trial will recruit 66 adults with stage I–III solid tumours undergoing chemotherapy across three centres in Western New South Wales. Participants will be randomised to 12 weeks of supervised RT-HIIT plus usual care or usual care plus a brief exercise education session. The intervention comprises twice-weekly supervised sessions integrating resistance training and cycle-based HIIT (RPE 16–18/20, Borg scale). Sites represent three distinct delivery models: AEP‑led, hybrid AEP–allied health assistant-led, and allied health assistant‑led with remote AEP supervision. Primary outcomes include recruitment, adherence, retention, adverse events, acceptability, and fidelity, assessed against predefined progression criteria. Secondary exploratory outcomes include relative dose intensity, body composition, physical function, and patient-reported outcomes, with perceived exertion, heart rate, and workload monitored across sessions.
Results
The trial is expected to demonstrate that supervised RT-HIIT can be delivered safely with acceptable adherence and fidelity across delivery models. Comparative feasibility will identify implementation barriers and enablers, while exploratory data will inform future trial design and characterise patterns between perceived exertion, heart rate, and workload across repeated sessions and delivery models.
Conclusion
This study addresses a critical implementation gap in exercise oncology in regional cancer settings. Findings will inform the design of definitive trials and support the development of sustainable, scalable models for effectively embedding evidence-based exercise within routine regional cancer care pathways.

Speaker: Dr Jack Cannon (School of Allied Health, Exercise and Sports Sciences, Faculty of Science and Health, Charles Sturt University, Bathurst Campus and Bathurst Cancer Care Services, Bathurst Health Service, Bathurst NSW 2795, Australia.)

291 From Optional to Essential: Embedding Exercise Medicine into Routine Cancer Care in a Real-World Setting

Background:
Exercise is one of the most evidence-based interventions in cancer care, shown to improve treatment tolerance, physical function, symptom burden and quality of life across the cancer continuum. Despite strong international guidelines, exercise remains inconsistently integrated into routine oncology care, with many services struggling to translate evidence into sustainable clinical practice.

Aim:
To describe the implementation of an integrated Exercise Medicine model embedded within a supportive oncology day-hospital setting, and to present real-world outcomes demonstrating feasibility, safety and acceptability.

Methods:
Drawing on eight years of real-world, Lift Cancer Care Services developed and embedded a multidisciplinary Model of Care that positions Exercise Medicine as a core therapeutic intervention alongside medical and supportive cancer treatments. The model integrates exercise physiology and physiotherapy within a governance-led framework, incorporating standardised assessment, risk stratification, oncology referral pathways and ongoing clinical monitoring. The service supports people across tumour streams and treatment phases, including active treatment and survivorship.

Results:
Over eight years of sustained implementation, the model has supported a large cohort of people living with and beyond cancer, with high engagement and strong clinician referral uptake. Exercise interventions have been delivered safely within routine care, with no serious adverse events reported. Service data indicate high adherence to prescribed exercise programs and positive patient-reported experiences. The model has demonstrated operational feasibility, sustainability and adaptability within a real-world clinical environment.

Conclusion:
This implementation demonstrates that Exercise Medicine can be embedded as essential, routine cancer care rather than an optional adjunct. The Lift Model of Care provides a practical, scalable framework informed by sustained real-world delivery, supporting health services to translate exercise oncology evidence into standard clinical practice.

Speaker: Ms Lauren Whiting

292 Healthcare professionals’ perspectives on delivering exercise during chemotherapy infusion: Insights from the EX-FUSION Trial

Objectives/purpose
Intra-infusion exercise (i.e. exercise delivered during chemotherapy infusion) is a novel strategy to integrate exercise into cancer treatment. The EX-FUSION RCT evaluated the feasibility and efficacy of this approach. This qualitative study explored healthcare professionals (HCPs) experiences delivering the EX-FUSION intervention and their recommendations on future program design to inform implementation.

Sample and setting
Participants were involved in the EX-FUSION trial at a metropolitan hospital in Sydney, and included four exercise physiologists (EPs) and one medical oncologist. Recruitment of HCPs is ongoing, but limited by the number of personnel at the study site.

Procedures
Semi-structured one-on-one interviews explored HCPs experiences with intra-infusion exercise, their observations of patients, and considerations for future programs. Thematic analysis was used to identify key themes.

Results
Preliminary analysis identified three themes. (1) Delivering EX-FUSION – HCPs viewed intra-infusion exercise as safe and feasible, but faced scheduling and environmental challenges (e.g. limited space, IV lines, tripping hazards, ice mitts/ booties). (2) Observations of Patient Experience - Patients were receptive and motivated, citing enjoyment, social interaction, and the opportunity to be active during treatment. Barriers included treatment-related side effects and difficulty achieving comfortable positioning while cycling. EPs also provided emotional and practical support beyond exercise guidance. (3) Future Program Design – Recommendations included broader inclusion criteria, clearer safety protocols and better integration with clinical workflows. HCPs emphasised the value of fostering an exercise-supportive organisational culture, securing sustainable funding, and investing in workforce development for future scale-up.

Conclusion and clinical implications
Healthcare professionals viewed EX-FUSION as a safe and promising addition to cancer care. Their insights highlight practical considerations and key areas for refinement, offering valuable guidance for future implementation and scale-up of intra-infusion exercise programs.

Speakers: Catherine Seet-Lee (The University of Sydney), Kate Edwards (The University of Sydney)

293 Inclusion in Cancer Prehabilitation: Qualitative Research to Explore Access, Acceptance, and Adherence to Cancer Prehabilitation

Background
Prehabilitation for patients awaiting cancer treatment comprises support for exercise, nutrition, and emotional well-being. Prehabilitation is associated with faster recovery and improved outcomes. However, practical action to improve inclusion in prehabilitation is needed to reduce inequities in cancer care and outcomes. This study explored prehabilitation practices within cancer services to understand how, when, and why people engage with prehabilitation (or not).
Methods
An exploratory case study of services delivering prehabilitation for adults with upper gastrointestinal, colorectal, lung, prostate, or breast cancer within the National Health Service in Wales, UK. Qualitative data were collected from observations of prehabilitation consultations and semi-structured interviews at six sites, using a sampling frame for a socioeconomically diverse patient sample, and focus groups with cancer care workers at seven sites. Index of Multiple Deprivation (IMD) quintiles were assigned based on postcode. Thematic framework analysis was conducted using an adapted version of the World Health Organisation adherence framework.
Results
We observed prehabilitation consultations with 120 patients (20 per site), 45 (37.5%) from some of the most socioeconomically deprived communities in Wales (IMD quintiles 1 or 2). Interviews were conducted with 40 cancer care workers (168 brief interviews) and 36 patients; Seven focus groups were conducted with 44 cancer care workers. Patterns of modifiable factors for inclusive access to, acceptance of, and adherence to cancer prehabilitation were identified within six themes: personal capacity for prehabilitation; closer alignment of patient, family, and health professional expectations; interpersonal connection and support; potholes and forks in the prehabilitation pathway; diversity of prehabilitation delivery; and person-centred prehabilitation.
Conclusion
For access, acceptance, and adherence to prehabilitation to be inclusive, people with cancer need to understand how prehabilitation can be done to help them through their treatment and recovery. To achieve this, prehabilitation communication and services should be person-centred, flexible, and include interpersonal support.

Speaker: Alexandra Mitchell (Cardiff University)

294 Individualized App-based Exercise Therapy for Cancer Patients: Assessing Patient Adherence and Comprehensive Physical Assessments

Background: Physical activity is essential for improving outcomes and managing side effects in cancer patients. App-based exercise interventions may enhance access to exercise therapy. To provide precise recommendations, accurate assessment of physical function and limitations is crucial. This feasibility study investigated a digitally assisted exercise program and the role of comprehensive assessments in enabling personalized, remote exercise prescriptions.
Methods: In a single-arm design, 14 patients with lung or colorectal cancer at various disease stages underwent 12 weeks of automated, digitally assisted exercise therapy. At baseline (T0), patients completed a comprehensive set of physical assessments, including cardiopulmonary exercise testing, six-minute walk test, handgrip strength, five-times sit-to-stand, and Brief-BESTest, alongside questionnaires. Individualized endurance and resistance training plans were delivered via a smartphone app and monitored with a smartwatch. A decision-support system adapted plans weekly based on patient feedback, needs, and limitations. At follow-up (T1), all assessments and questionnaires were repeated.
Results: Six patients discontinued early due to repeat tumor surgery or hospitalization and one for personal reasons. Across the remaining cohort, adherence to training recommendations declined from ~80% in the first three weeks to ~60% in the last weeks and varied greatly between individuals. No significant changes were observed in walking distance, strength, balance, or self-reported outcomes. Compared to healthy controls, patients exhibited markedly reduced balance, slower sit-to-stand performance, and lower scores for quality of life, self-efficacy, and physical activity.
Discussion: App-based exercise therapy was feasible for cancer patients, but the high dropout rate underscores challenges in sustaining participation during active treatment. Despite most patients being in active treatment, physical function and activity remained stable during intervention, yet significantly lower than those of healthy controls. Declining adherence suggests motivational barriers or technical limitations over time. Future studies should include control group, longer follow-ups, and strategies to enhance engagement.

Speaker: Ms Kira Enders (Institut für Sportwissenschaft, Abteilung Sportmedizin, Prävention und Rehabilitation, Johannes Gutenberg-Universität Mainz)

295 Making physical activity standard care in cancer – a strategic approach

There is a strengthening mandate from the literature, clinical bodies’, clinician experience and the patient voice adding weight to the argument that physical activity should be a standard component of cancer care. What is less clear is how this is implementable in over stretched clinical settings where priorities are significantly influenced by funding and exercise healthcare professionals do not always have access to key decision makers.
At the Royal Marsden we are, to our knowledge, the first specialist cancer hospital who is trying a strategic approach to achieving this aim. The ‘Physical Activity Strategy’ was launched initially in 2019, but due to Covid-19 it was updated and re-launched in 2023. It's ambition is to achieve an 'Active Marsden' with work focused around four themes: workforce, digital, partnerships and active environments.
This poster outlines the steps taken to co-create a Physical Activity Strategy endorsed by the Trust’s senior leadership and incorporated into the Trust’s overarching Strategy.
• It will outline how we are attempting to measure change to the culture around physical activity
• It will explain how stakeholders are being utilised to ensure this continues to be a co-developed piece of work
• It will showcase how we are attempting to reduce the health inequalities often linked to exercise service provision with targeted advocacy
• Lastly it will identify the key challenges we have faced in trying to embed a strategic approach to physical activity within a tertiary centre and make suggestions to help others considering a similar approach

Speaker: Mrs Sarah Dewhurst

296 Nineteen Years of Impact: A Community-Based Non-Profit Providing Free Exercise Support for Individuals Affected by Cancer

Regular physical activity plays a critical role in improving health outcomes and quality of life for individuals affected by cancer. This poster presents the work of a non-profit organization that has been providing free exercise classes for the past 19 years to individuals impacted by cancer, including those in active treatment, survivorship, and recovery.

To date, the program has supported over 8,000 participants, with an average of 90 individuals attending weekly sessions. Classes are designed to be accessible, supportive, and adaptable to varying levels of ability, with a focus on improving physical function, reducing treatment-related side effects, and enhancing overall well-being.

Participant outcomes demonstrate consistent improvements in fatigue levels, exercise adherence, activities of daily living, range of motion, and overall quality of life. The program also fosters a strong sense of community, contributing to emotional and social support alongside physical rehabilitation.

These findings demonstrate the long-term effectiveness, feasibility, and scalability of community-based exercise oncology interventions within real-world settings. From a health systems perspective, this non-profit model represents a potentially cost-effective approach to extending care beyond traditional oncology settings by improving access, enhancing continuity of care, and reducing downstream healthcare utilization associated with cancer-related morbidity. Broader implementation of non-profit delivery models may contribute to improved population-level outcomes while supporting more efficient allocation of healthcare resources across the cancer care continuum.

Speaker: Ms Debra Hughes (Strength For Life)

297 Prehabilitation in Practice: Barriers and Facilitators to Engagement in the Cancer Treatment Outcomes Programme – Preliminary Results

Background: With prehabilitation’s inclusion in the 2026 NHS National Cancer Plan, understanding barriers and facilitators to cancer prehabilitation from an individual to a systems level is vital to scale services. Since 2021, the Cancer Treatment Outcomes Programme (CTOP) has delivered high-quality multimodal prehabilitation across County Durham and Darlington, a rural and deprived community in the North of England.
Aim: This project is part of a larger evaluation of CTOP and prehabilitation services in the North East of England. It aims to assess barriers and facilitators to engagement in CTOP, considering the individual and systems level to inform future service delivery.
Methods: Two independent mixed-methods surveys for patients and healthcare providers (HCPs) were developed using the literature to identify commonly cited barriers and facilitators to prehabilitation. Both surveys were reviewed by cancer prehabilitation providers and cancer experts by experience to determine relevance and applicability.
Results: To date, 23 patients and 16 HCPs have responded to the survey. Patients reported few barriers to engagement, with other health problems and treatment-related side effects as the most common barriers to participation. HCPs identified logistical barriers (appointments and transportation) as the most common patient barriers. Both patients and HCPs acknowledged feeling overwhelmed due to diagnosis as a barrier to participation. Patients identified improved fitness, quality of life and support from HCPs as key facilitators. HCPs cited support from HCPs and reducing treatment complications as facilitators. At the systems level, logistical concerns were the primary barriers reported, including funding, capacity, and physical space.
Conclusions: These data suggest that patients and HCPs are willing and able to engage with prehabilitation programmes, but logistical concerns prevent the development and delivery of prehabilitation services. As all patients surveyed successfully participated in prehabilitation, additional work is needed to identify barriers and facilitators for patients who do not engage in prehabilitation.

Speaker: Katie Di Sebastiano (Department of Sport and Exercise Sciences, Durham University)

298 Preliminary Patterns of Adherence to Remote Exercise During Neoadjuvant Chemotherapy: Insights from the NeoACT Trial

Background:
The Neo-ACT trial is an ongoing, pragmatic RCT evaluating whether structured, home-based exercise during neoadjuvant chemotherapy can improve treatment efficacy in patients with breast cancer. The enrolment target is 712 evaluable participants; as of December 2025, 339 participants have been randomized. The intervention consists of 120 minutes of weekly exercise combining resistance and high-intensity interval training delivered via the Vitala mobile app, alongside encouragement to achieve an additional 150 minutes of moderate physical activity. In real-world settings, insufficient adherence remains a major challenge.

Objective:
To present preliminary data on exercise adherence and its association with exercise self-efficacy during neoadjuvant chemotherapy.

Methods:
Exercise activity was monitored using the Vitala app. A valid exercise session was defined as lasting ≥20 minutes. Adherence was defined as achieving ≥65% of the prescribed exercise dose between randomization and pre-surgery testing. Exercise self-efficacy was assessed at pre-surgery testing using the 9-item Self-Efficacy for Exercise (SEE) scale, measuring confidence to exercise under common barriers. Physiotherapists monitored app activity and contacted patients with low adherence.

Results (Preliminary):
Among 104 participants assigned to and completing the intervention by November 2025, 97 completed the SEE questionnaire. Fifty participants (48%) met the predefined adherence criterion. Adherent participants reported significantly higher exercise self-efficacy than non-adherent participants, both for the total SEE score (Wilcoxon rank-sum test, p = 5.5 × 10⁻⁶) and across all individual barrier items (all p < 0.05). For example, self-efficacy to exercise when feeling stressed was higher among adherent participants (median 8 [IQR 2]) than among non-adherent participants (median 5 [IQR 7], p < 0.001).

Conclusion:
Higher exercise self-efficacy was strongly associated with better exercise adherence, highlighting the importance of behavioural and motivational factors. Preliminary findings suggest that patient heterogeneity and treatment-related side effects may limit adherence to app-based exercise interventions.

Speaker: Lea Stark (Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden)

299 Preliminary Results of a Pragmatic Randomized Controlled Trial Testing a Cancer-Specific Exercise Mobile App in Breast Cancer Survivors

Purpose: Exercise is an evidence-based, effective therapy for breast cancer survivors, relieving treatment side effects (e.g., fatigue, depression), improving quality of life, and possibly extending survival. Geographical barriers create disparities in access to cancer exercise programs. For many breast cancer survivors, accessing an in-person exercise program is a logistical challenge due to traveling, cost, and time. To make the benefits of exercise more accessible, on-demand services such as mobile health (mHealth) are promising solutions. This study aimed to determine the effectiveness of a cancer-specific exercise mobile application (app) compared to usual care to increase exercise in breast cancer survivors.

Methods: Stage I-III breast cancer survivors were randomly assigned to either the mobile app, offering a personalized exercise prescription based on individual fatigue levels, or the usual care group. The primary outcome was moderate-to-vigorous exercise (MVE) minutes per week, measured using the Godin Leisure-Time Exercise Questionnaire. Assessments were conducted at baseline and 12 weeks. Analysis of covariance was conducted for MVE, adjusting for baseline outcome value, age, location, stage, time since diagnosis, and surgery type.

Results: A total of 132 women were assigned to either the app (n=66) or the usual care (n=66) group. To date, 52 participants have completed the 12-week assessment. Most participants lived in an urban area (66.2%), and the mean age was 61.2 years (SD=9.7). From baseline to 12 weeks, MVE increased by 60 min/week in the app group compared to 46 min/week in the control group (adjusted between-group difference, 20 min/week; 95% CI: -60 to 99; p=0.61). Data collection will be completed in February 2026. Final results, including wearable exercise data, will be presented at the conference.

Conclusion: By targeting underserved breast cancer populations, this study addresses critical gaps in access to supportive care by evaluating a cancer-specific exercise app that delivers accessible, evidence-based support remotely.

Speaker: Myriam Filion (Faculty of Kinesiology, Sport, and Recreation, College of Health Sciences, University of Alberta, Edmonton, AB, Canada)

300 PRIME OncoADHERENCE: Real-World Exercise Oncology Data Reveal Distinct Adherence Patterns Across Tumor Types

Background

Long-term adherence remains one of the main challenges in exercise oncology. To address this, the PRIME Center IOR (Cesena, Italy) operates as a multidisciplinary oncology rehabilitation facility integrating physiotherapy and supervised exercise delivered by oncology-trained professionals. However, longitudinal real-world data describing adherence patterns across different tumor types within such structured clinical pathways remain limited.

Materials and Methods

We analyzed real-world clinical data from 422 patients with solid or hematological malignancies attending the PRIME Center between 2022 and 2025. Patients underwent individualized supervised rehabilitation programs including resistance, aerobic and functional exercise, prescribed twice weekly. Adherence profiles were classified using a bidimensional model based on program duration and training sessions, identifying four groups: high adherence (n=184, 44%), low adherence (n=189, 45%), irregular (n=25, 6%) and intensive (n=24, 6%).

Results
The overall cohort exhibited a median age of 59.3 years (IQR: 52.6–66.1), dominated by females (85%). High-adherence rates varied substantially across tumor types, ranging from 20% to 70%. Ovarian cancer showed the highest proportion of high-adherence patients (70%; 7/10), followed by non-small-cell lung cancer (57%; 4/7), prostate cancer (50%; 8/16) and multiple myeloma (50%; 3/6). Breast cancer (65% of the cohort, n=275) showed an intermediate rate (46%). Lower high-adherence rates were observed in colorectal (30%; 10/33), gastric (26%; 5/19) and pancreatic cancer (20%; 3/15).

Conclusions
Real-world adherence to oncology rehabilitation shows marked heterogeneity across tumor types. Differences in long-term participation may reflect disease burden, treatment complexity and accessibility. Real-world adherence profiling may help optimize individualized exercise oncology pathways and improve continuity of supportive cancer care.

Speaker: Mattia Pirani (Prime Center - IOR)

301 UPMC Moving Through Cancer: A Telehealth Exercise Program for Older Adults Receiving Active Infusion Therapy

BACKGROUND: Older adults with cancer are up to 2.5 times more likely to have functional decline and 4 times more likely to be frail compared to older adults without a cancer history or cancer survivors. Exercise is one of the most effective and evidence-based strategies to improve several functional and psychological outcomes and demonstrates elevated benefits on disease-free and overall survival for people living with and beyond cancer. However, less than 30% of people living with and beyond cancer meet the recommended exercise guidelines.
PURPOSE: To assess the effect on objective physical function of the UPMC Moving Through Cancer virtual exercise program for older adults receiving infusion therapy.
METHODS: Participants 65 years and older receiving active infusion therapy for any solid tumor were asked to participate in a 12-week synchronous, telehealth exercise program. Participants met virtually with a trainer once a week for 30-minute sessions. Functional assessments (modified Short Physical Performance Battery) were completed before the start of and at the conclusion of the exercise program.
RESULTS: From September 2024 – December 2025, 113 adults have enrolled- 72.65 years old, 39.8% Female, 85.0% Caucasian, and 13.3% are deceased. The highest proportion of diagnoses included Gastrointestinal (23.0%), Lung and Mesothelioma (20.4%), and Genitourinary (15.9%). A total of 53 adults have completed the 12-week program, spending an average of 12.61 weeks in the program. Physical function significantly improved after twelve weeks— score increases were seen in balance (MD= +0.24, SD= 0.73, p= 0.01), chair stands (MD= +0.95, SD= 1.14, p<.001) and total performance (MD= +1.19, SD= 1.54, p<.001).
CONCLUSION: A partially supervised telehealth exercise program elicits a significant change in objective physical function in older adults during active treatment. This institutional program eliminates barriers to exercise participation during treatment and provides a safe, effective way to mitigate functional decline.

Speaker: Melanie Potiaumpai (University of Pittsburgh; UPMC Hillman Cancer Center)

Poster Session 3.4: Breast Cancer (Posterarea 4)

302 AI-based Skeleton Recognition System for Rehabilitation Exercise in Breast Cancer Survivors: A Randomized Controlled Trial (AiRE-MS)

Abstract
Background: Endocrine therapy remains a cornerstone in hormone receptor-positive breast cancer treatment and lasts many years. Although highly effective, these treatments often cause musculoskeletal symptoms such as joint pain, stiffness, carpal tunnel syndrome, tenosynovitis, myalgia, and muscle weakness, severely compromising quality of life. We designed an AI-driven tele-rehabilitation app using biological image recognition from smartphone cameras to provide real-time exercise guidance.

Methods: We enrolled 82 participants undergoing endocrine therapy in a 16-week, two-arm randomised controlled trial (1:1). Participants received either an AI-driven rehabilitation app or standard home-based exercise program. Assessments occurred at baseline, 4 weeks, 12 weeks, and 4-week postintervention follow-up. Primary outcomes were grip strength, M-SACRAH, and WOMAC. Secondary outcomes included BCTQ and circulating biomarkers.

Results: Participants showed good adherence, with low attrition throughout follow-up. After adjustment for baseline imbalances, the intervention showed greater improvement in functional outcomes than usual care. Grip strength differed significantly between groups over time; by 3 months after the intervention, the intervention group showed a 9.6% increase from baseline (20.34 vs 18.26 kg), whereas the control group declined from 1 to 3 months after intervention. At 1 month after intervention, the intervention group had significantly lower M-SACRAH pain scores than the control group (mean difference, −15.11; p = 0.013), as well as lower WOMAC total scores (mean difference, −13.20; p = 0.046) and WOMAC pain scores (mean difference, −14.67; p = 0.029). At 3 months after intervention, BCTQ outcomes also favored the intervention group, with lower total scores (mean difference, −3.64; p = 0.026) and function scores (mean difference, −2.86; 95% CI, 0.89-4.82; p = 0.004).

Discussion: AI vision–based remote rehabilitation improved pain and function more than conventional home exercise in breast cancer survivors receiving endocrine therapy, especially grip strength, joint symptoms, and hand function.
Trial registration: ClinicalTrials.gov NCT06642948

Speaker: Lingyun Jiang

303 Association between physical activity and mortality among breast cancer survivors

Purpose:
It is known that a greater physical activity (PA) reduces the risk of breast cancer (BC). Nevertheless, there is still limited evidence about what role PA may play in the prognosis of the disease. The aim of this study was to assess the association of pre- and postdiagnosis PA with overall and BC-specific mortality among BC survivors.
Methods:
A total of 13,399 BC survivors from the European Prospective Investigation into Cancer and Nutrition (EPIC) study were included. During the follow-up period (average 8.6 years) 2,380 women died, of whom 1,480 from BC. The main exposure was an overall measure of PA derived from a PA index (PA at work and leisure-time activities). We further analysed recreational PA (walking, cycling and sport activities). A subset of 2,023 survivors completed a second questionnaire within a 6-month to 4-year postdiagnosis. Multivariable Cox and Fine-Gray models were employed to evaluate the association of PA with overall and BC-specific mortality respectively, adjusted for relevant confounders.
Results:
BC survivors who were physically active before diagnosis had a 14% lower risk of all-cause mortality (HR 0.86, 95% CI: 0.78-0.95), and 12% lower risk of BC-specific mortality (HR 0.88, 95% CI: 0.77-1.00). PA postdiagnosis was associated with a lower risk of overall and BC-specific mortality of 43% (HR 0.57, 95% CI: 0.44-0.75) and 52% (HR 0.48, 95% CI: 0.34-0.68), respectively. A significant lower risk of mortality was also observed among those who practiced recreational PA after diagnosis. Women who became active at postdiagnosis had lower risk of overall mortality (HR 0.48, 95% CI 0.27-0.83) and BC-specific mortality (HR 0.35, 95% CI 0.16-0.74).
Conclusion:
Being physically active (pre- and postdiagnosis) reduces the risk of mortality among BC survivors. Additionally, changes towards higher levels of PA seem to have also positive impact on survival.

Speaker: Nuria Nadal Zaragoza (Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology-ICO, L'Hospitalet de Llobregat, Barcelona, Spain /Nutrition and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain/Deutsches Krebsforschungszentrum /Programa de doctorat d’Alimentació i Nutrició, Facultat de Farmàcia i Ciències de l’Alimentació, Universitat de Barcelona, Barcelona, Spain.)

304 Aurora: a home-based, woman-centered design intervention to mitigate the physical and biological consequences of neoadjuvant chemotherapy in women with breast cancer — preliminary results from a Chilean public hospital

Background: Supervised exercise mitigates the adverse physical and biological effects of neoadjuvant chemotherapy (NAC) in breast cancer, but implementation in the Chilean public health system is constrained by travel costs, caregiver burden, and treatment fatigue, demanding scalable autonomous alternatives. Aurora is a 9-week home-based, woman-centered design intervention, developed with and for women undergoing NAC, with its 9-week duration aligned to habit-formation theory and deployed during NAC as a teachable moment.
Methods: Ongoing randomized controlled trial enrolling women <70 years with primary breast carcinoma diagnosis and NAC treatment. Recruitment at public hospital Centro Asistencial Sótero del Río (CASR) in Santiago, Chile. Outcomes include physical activity (MVPA, daily steps), quality of life (EORTC QLQ-C30), functional capacity (upper/lower-body strength, 2-Minute Walk Test [2MWT]), and biological markers (erythrocyte fatty acids, inflammation, tumor response). Per-protocol analyses of the initial cohort (N=13) used non-parametric tests.
Results: The intervention group significantly increased MVPA (+57.5 min/week; p=0.043), while the control group declined (−37.5 min/week). Functional capacity diverged in favor of intervention: upper-body strength (+3.8 vs −3.25 repetitions) and 2MWT (+7.0 vs −10.0 steps; Δ p=0.065). Emotional functioning (EORTC QLQ-C30) improved (+18.1) in the intervention group, whereas it declined (−16.7) in the control group. The erythrocyte omega-6/omega-3 ratio shifted favorably in the intervention group. In the subset with available tumor response data (n=6; 3 per arm), pathological complete response (pCR) was observed in 2/3 (66.7%) intervention participants versus 0/3 (0%) controls (p=0.150), accompanied by greater tumor size reduction in the intervention arm (−86.1% vs −21.8%).
Conclusions: A home-based, woman-centered design product-system can be delivered during NAC within a Chilean public hospital and shows directional benefits across behavioral, functional, and biological domains. These preliminary findings position Aurora as a scalable, equity-oriented alternative when supervised exercise oncology programs are inaccessible, supporting further evaluation in larger cohorts.

Speaker: Denise Montt (Centro para la Prevención y el Control del Cáncer (CECAN), Chile, Universidad católica de Chile,)

305 Combined Aerobic and Resistance Exercise in Breast Cancer Survivors Following Mastectomy: A Retrospective Study

Background
Breast cancer survivors following mastectomy commonly experience persistent physical and psychological impairments, including fatigue, pain, reduced endurance, and functional limitations. Although exercise oncology interventions are increasingly recommended in survivorship care, evidence from real-world community-based rehabilitation settings remains limited. This study evaluated the effects of a physiotherapist-supervised combined aerobic and resistance exercise program on physical and psychological outcomes in breast cancer survivors following mastectomy.
Methods
A retrospective observational pre-post study was conducted using rehabilitation records from a community-based cancer rehabilitation program in Canada between 2015 and 2022. Thirty breast cancer survivors post-mastectomy participated in a 10-week physiotherapist-supervised aerobic and resistance exercise intervention combined with home exercise recommendations. Outcomes included fatigue (Brief Fatigue Inventory), symptom burden (ESAS-R), pain (P4), balance (Single Leg Stance), grip strength, aerobic endurance (6-Minute Walk Test [6MWT]), and functional ability (Patient-Specific Functional Scale [PSFS]). Longitudinal changes were analyzed using linear mixed-effects models with multiple imputation for missing data.
Results
Significant improvements were observed in fatigue, aerobic endurance, and patient-specific functional ability following the intervention. Participants demonstrated improved 6-Minute Walk Test performance and Patient-Specific Functional Scale scores across follow-up assessments. Fatigue severity also decreased over time. Pain and balance demonstrated trends toward improvement; however, findings were not consistently statistically significant across observed and imputed analyses. No significant changes were observed in grip strength or overall symptom burden.
Conclusions
Combined aerobic and resistance exercise delivered within a community-based rehabilitation setting may improve fatigue, aerobic endurance, and functional ability in breast cancer survivors following mastectomy. These findings support the integration of physiotherapist-led exercise oncology rehabilitation into survivorship care. Larger controlled studies are warranted to confirm long-term effectiveness and evaluate implementation in clinical practice.

Speaker: Maryam Abbasi (Western University)

306 Education during Breast Cancer Rehabilitation in Exercise Therapy and Physical Activity: A Standardized Educational Module within the German Pension Insurance

Background:
Each year, approximately 39,000 women with a diagnosis of breast cancer participate in oncological rehabilitation in Germany. Within rehabilitation settings of the German Pension Insurance (Deutsche Rentenversicherung, DRV), exercise therapy represents the largest component in terms of both time and structure among all therapeutic interventions. According to the mandatory DRV rehabilitation therapy standards in oncology, at least 75% of all patients are required to receive active exercise therapy. Despite this central role, no standardized educational module specifically delivered by exercise therapists addressing physical activity and exercise therapy had been available to date. To strengthen patients’ health literacy, the DRV has developed a structured and evidence based curriculum, in which the present module is now systematically integrated.
Objectives:
This work presents a standardized educational module within the DRV health literacy curriculum that aims to improve exercise-related health competence, promote self-management, and support long-term physical activity in women undergoing breast cancer rehabilitation.
Methods:
The 90-minute module is delivered in group settings and combines theoretical input, interactive discussion, and practical planning. Key components include: (1) evidence-based benefits of physical activity in oncology; (2) principles of structured exercise training using the FITT framework; (3) symptom-oriented training adaptation and safe load regulation; (4) identification of contraindications and effective communication with healthcare providers; and (5) development of individualized action plans using behavior change strategies. The module also introduces structured DRV aftercare programs to ensure continuity.
Results:
The module enhances knowledge, attitudes, and action competence regarding physical activity. Participants learn to adapt exercise to treatment-related side effects, regulate intensity, and utilize DRV-supported aftercare services effectively.
Conclusion:
As a standardized component of the DRV curriculum, this module addresses a previous gap and reinforces exercise therapy as a cornerstone of oncological rehabilitation, fostering sustainable physical activity behavior.

Speaker: Oliver Klassen

307 Effect of early exercise on functional recovery and surgical outcomes after post-mastectomy breast reconstruction: A Randomized Clinical Trial

Background: Postoperative shoulder dysfunction and discomfort are common after mastectomy with immediate breast reconstruction and may delay functional recovery and reduce quality of life. This study evaluated the effects of an early structured exercise program on shoulder functional recovery, discomfort, and safety in women undergoing mastectomy with immediate reconstruction.
Methods: Sixty women aged 19–70 years undergoing mastectomy with immediate breast reconstruction were randomized 1:1 to an exercise or control group. The exercise group initiated a structured program on postoperative day 5, consisting of weekly supervised sessions for 4 weeks followed by home-based exercise for 6 months, emphasizing progressive shoulder range-of-motion, resistance, and aerobic training tailored to recovery status. The control group received usual postoperative care. The primary outcome was shoulder range of motion (ROM) and strength of the operated side. Secondary outcomes included upper-extremity discomfort (DASH score), body composition, physical activity, and postoperative complications. Outcomes were assessed at baseline, postoperative day 5, day 10–14, and at 1, 3, and 6 months.
Results: At 3 months, 70% of participants in the exercise group achieved ≥95% recovery of baseline shoulder strength compared with 10% in the control group (p < .001); at 6 months, recovery remained higher in the exercise group (87% vs 47%, p = .004). Recovery of shoulder ROM was also greater in the exercise group at 3 months (73% vs 33%, p = .002) and at 6 months (83% vs 42%, p = .004). DASH scores were lower in the exercise group at 6 months, indicating reduced shoulder discomfort. Body composition, physical activity levels, and postoperative complication rates did not differ significantly between groups.
Conclusions: Early structured exercise after mastectomy with immediate breast reconstruction safely accelerates shoulder functional recovery and reduces postoperative discomfort, supporting its integration into standard postoperative care.

Speaker: Rosa Park (Yonsei University)

308 Evaluation of an Oncological Rehabilitation Program for Therapeutic Physical Activity in Adult Cancer Patients: Analysis of a Breast Cancer Cohort Across Rehabilitation Phases

Background and Objective:
Advances in systemic therapies have improved survival in breast cancer, but many patients experience fatigue, reduced physical performance, and impaired quality of life. Increasing evidence supports exercise and rehabilitation as supportive interventions associated with improved function, reduced fatigue, and better survival outcomes. Since 2023, Luzerner Kantonsspital (Switzerland) has offered a 12-week supervised mutimodal outpatient rehabilitation program for patients before, during, or after cancer therapy. This subgroup analysis evaluated outcomes in breast cancer patients participating in this monocentric before-after study.

Methods:
Breast cancer patients undergoing prehabilitation, rehabilitation, or post-treatment rehabilitation were included (N=61). Lean muscle mass and handgrip strength were assessed before and after the 3-month program. Patient-reported outcomes included FACT-G, Multidimensional Fatigue Inventory (MFI), Distress Score (FBK-R10), and PG-SGA, measured at baseline, post-rehabilitation, and 6 months later. Multivariable regression analyses evaluated self-reported functional performance and ability to work at 6 months.

Results:
Sixtyone patients were included. Overall, rehabilitation significantly improved lean muscle mass (+0.7 kg), handgrip strength (+2.4 kg), fatigue, distress, and nutritional status, while FACT-G scores remained unchanged. Breast Cancer Patients undergoing Prehabilitation showed slight muscle loss and no significant handgrip improvement compared with rehabilitation or post-treatment patients. Higher baseline SMI and level of physical activity at 6 months were independently associated with better functional performance, whereas there was no significant association with physical activity level before diagnosis.
Functional performance trajectories differed according to rehabilitation phase and neoadjuvant treatment. Self-reported functional performance at 6 months was significantly lower in prehabilitation group but improved in rehab and post-rehab groups, this being particualry evident for Patients receiving chemoimmunotherapy.

Conclusion:
Outpatient oncology rehabilitation improved muscle mass, strength, fatigue, distress, and nutritional status in breast cancer patients. Functional performance was lowest during prehabilitation, highlighting the importance of maintaining muscle mass and physical activity throughout neoadjuvant treatment.

Speaker: Dr Andrea Orlando Fontana (Swiss)

309 Maximizing reach of community-based exercise programming for breast cancer survivors: Recruitment strategies, yield, challenges, and adaptations in a Hybrid Type I Effectiveness-Implementation study

Community-based approaches offer a scalable model to deliver exercise programming to cancer survivors; however, public health impact depends on reaching a large, representative population. Hybrid effectiveness-implementation (HEI) trials provide an opportunity to assess reach during program evaluation, as effectiveness-focused eligibility criteria and recruitment may constrain reach. This study examined recruitment reach, challenges, and adaptations during a Type I HEI study for breast cancer survivors (BCS).

The trial aims to recruit 160 BCS randomized to community-based exercise (n=80) or health education (n=80). Recruitment included active strategies (e.g., mailed letters, portal messages, clinician referrals to BCS identified via electronic medical records [EMR]) and passive strategies (e.g., social media, community flyers). Reach was operationalized as recruitment yield and sample representativeness. Recruitment source, challenges, and adaptations were documented.

To date, 1435 BCS were exposed to recruitment, 246 (17%) completed and 127 (9%) passed pre-screening, 95 (7%) completed full screening, and 56 were accrued (4% recruitment yield). Of note, 713 (50%) BCS were ineligible mainly due to being regularly active or outside required time since treatment. Further, 380 (26%) declined participation due to lack of interest or time. The sample is representative of the local BCS population based on ethnicity (78% non-Hispanic White versus 78% locally; 10% Hispanic versus 13% locally). Active and passive strategies accounted for 88% and 12% of accruals, respectively. Respondents to active versus passive strategies were 64.0±8.6 years-old, 76% non-Hispanic White and 63.5±6.0 years-old, 83% non-Hispanic White. Recruitment challenges included effectiveness-focused eligibility criteria, time-consuming telephone protocol, and fragmented cancer care locally. Adaptations included adding portal messages, revising contact protocol and eligibility criteria, and expanding community outreach.

Findings suggest active, EMR-supported recruitment strategies were essential for accrual, while maintaining representativeness. Modest yield, high ineligibility rates, and frequently declined participation highlight the tension between effectiveness-focused trial criteria and pragmatic recruitment for future implementation.

Speaker: Diane Ehlers (Mayo Clinic - Arizona)

310 MOVE AGAIN IN BREAST CANCER: A Randomized Controlled Trial of Structured Exercise on Quality of Life in Premenopausal Women with Aromatase Inhibitor-Induced Arthralgia

Background: Aromatase inhibitor-associated arthralgia (AIA) affects approximately 50% of breast cancer survivors, significantly impairing quality of life (QoL) and treatment adherence. While physical exercise shows promise as a non-pharmacological intervention, optimal prescription parameters remain undefined, particularly in premenopausal women undergoing aromatase inhibitor (AI) therapy with ovarian suppression.

Purpose: To investigate whether structured physical exercise improves health-related QoL in premenopausal breast cancer survivors experiencing AIA, and to compare different exercise modalities.

Methods: This single-blind randomized controlled trial will enroll 54 premenopausal women with hormone receptor-positive breast cancer receiving AI therapy with ovarian suppression and experiencing AIA. Participants will be randomized to: (1) aerobic-focused exercise, (2) resistance-focused exercise, or (3) usual care control. Both intervention groups will receive 10 weeks of supervised bi-weekly exercise sessions, while the control group will receive general exercise recommendations. Primary outcome: health-related QoL assessed by SF-36 Physical Component Summary at 3 months. Secondary outcomes include joint pain (Brief Pain Inventory, Visual Analogue Scale), physical function (handgrip strength, isokinetic dynamometry, balance, Senior Fitness Test Battery), body composition (bioelectrical impedance analysis), and comprehensive biomarker panel including inflammatory markers (hs-CRP, IL-1β, IL-6, TNF-α), bone turnover markers (β-CrossLaps, osteocalcin, calcium, phosphorus), and neurotrophic and vascular factors (BDNF, VEGF, MCP-1). Assessments will be conducted in each group at baseline, 3 and 9 months.

Expected Results: We hypothesize that both exercise intervention groups will demonstrate significant improvements in QoL and arthralgia reduction compared to usual care. We expect favorable changes in physical function, body composition, inflammatory status, bone metabolism, and neurotrophic factors, helping to elucidate biological mechanisms underlying exercise benefits.

Conclusions: This study will provide evidence to define structured exercise prescriptions for managing AIA in premenopausal women, potentially improving treatment adherence and reducing cancer recurrence risk. The comprehensive biomarker assessment will enhance understanding of biological pathways through which exercise exerts therapeutic effects.

Speaker: Dr Federica Duregon (Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy)

311 Oncoactivate: A Woman-Centered mHealth Platform for Perioperative Exercise in Breast Cancer — Feasibility and Preliminary Clinical Outcomes

Background: Perioperative exercise reduces treatment-related impairments in women with breast cancer, yet access to supervised programs remains limited, particularly in Latin American healthcare systems. Digital platforms offer a scalable alternative, provided they are designed to sustain engagement under the physical and emotional demands of cancer treatment. Oncoactivate was developed through an iterative, woman-centered co-design process, grounded in the principle that trust and autonomy are prerequisites for adherence in vulnerable populations, to deliver structured, progressive exercise across the perioperative continuum.

Methods: Following the Medical Research Council framework, platform development proceeded through three phases: clinical conceptualization, prototype development through co-design, and iterative usability testing using think-aloud protocols and the System Usability Scale (SUS). A single-arm pilot feasibility study subsequently enrolled 50 women with confirmed breast cancer diagnosis scheduled for or recently recovered from surgery, recruited digitally across Chile. Primary outcomes were recruitment, retention, platform adherence, and safety. Secondary exploratory outcomes included quality of life (EORTC QLQ-C30).

Results: Preliminary usability testing (n=22) yielded a mean SUS score of 70.2 (±6.3), informing targeted platform refinements prior to pilot deployment. In the pilot cohort (n=50), retention was 100% and platform adherence reached 76%, exceeding the predefined feasibility threshold of 70%. Mean intervention duration was 5.4 ± 2.2 weeks. No exercise-related adverse events were recorded. Exploratory analyses showed significant improvements in global health status (+12.2%, p<0.001) and overall quality of life (+5.0%, p=0.012).

Conclusions: Oncoactivate demonstrated feasibility, safety, and preliminary clinical benefit as a fully digital perioperative exercise intervention for women with breast cancer. Woman-centered design proved essential to achieving high adherence and retention, outcomes that reflect not only platform usability but the alignment between intervention design and users' lived experience. These findings support larger controlled trials and highlight the potential of digitally delivered exercise to improve access to perioperative rehabilitation in resource-constrained settings.

Speaker: Denise Montt (Universidad católica de Chile)

312 Shoulder function in breast cancer survivors with subacromial impingement

Background
Shoulder co-morbidities are common after breast cancer treatment, with recent studies showing a high prevalence of subacromial impingement (SI). However, the functional implications of SI remain uninvestigated.
Methods
We examined 13 breast cancer survivors with SI (SI+ group; age 57.8 ± 7.3 years, height 161.6 ± 7.2 cm, body mass 78.6 ± 12.6 kg) eleven breast cancer survivors without SI (SI- group; age 58.8 ± 6.8, height 164.7 ± 6.3, body mass 77.0 ± 12.9 kg) and twelve cancer-free control women (age 57.8 ± 9.5 years, 162.6 ± 6.5, body mass 59.7 ± 11.1 kg). All survivors received breast conserving surgery and radiotherapy 12-60 months prior. Active shoulder abduction, flexion and extension range of motion (RoM) was measured using an inertial measurement unit (Opal, APDM Inc.) on the upper arm of the treated side in the breast cancer survivors and a randomly chosen side for controls. All participants completed the short version of the disability of arm, shoulder and hand (QuickDASH) questionnaire. Group differences were tested with linear mixed-effects models RoMs and QuickDASH scores as outcome variables, respectively, group as between-subjects factor and participant defined as random intercept.
Results
Abduction and flexion RoM were significantly reduced in the SI+ group compared to controls (both p ≤ 0.012). No RoM differences were found between the two breast cancer groups or between the SI- group and controls. The SI+ group reported significantly worse QuickDASH scores than controls (p=0.022) and trended towards worse QuickDASH scores than the SI- group (p=0.053).
Conclusions
SI is common after breast cancer treatment and significantly impacts shoulder function. Affected survivors show reduced abduction and flexion RoM compared to cancer-free women, which is reflected in lower self-reported shoulder function scores (QuickDASH). These findings highlight the need for targeted rehabilitation strategies to address this specific post-treatment shoulder disorder.

Speaker: Suzi Wolfram (Northumbria University)

313 The effects of a supervised exercise intervention on objectively and subjectively assessed physical activity and physical fitness outcomes in patients with metastatic breast cancer

Purpose
The multinational PREFERABLE-EFFECT study showed beneficial effects of a 9-month supervised exercise program on fatigue and quality of life in patients with metastatic breast cancer (mBC).
Here, we investigate exercise effects on objectively and subjectively assessed physical activity (PA) and on physical fitness outcomes.

Methods
In the PREFERABLE-EFFECT study, 357 patients were randomized to a 9-month supervised exercise intervention (EX=178) or usual care with general PA advice (UC=179). Participants were asked to wear a Fitbit Inspire-HR2 throughout the study and completed the GODIN PA questionnaire at baseline, 3, 6, and 9 months. Raw heart rate (HR) and step data from 5-7 days within the 1-2 weeks surrounding each timepoint, including training days, were extracted and cleaned by removing invalid data, excluding days with <10 hours wear-time, and standardizing sampling rates.
Physical fitness was assessed using daily HR per step (DHRPS), calculated by dividing daily average HR by daily step count (DSC). Intervention effects on DHRPS, DSC and self-reported minutes/week of moderate-to-vigorous PA were analyzed using linear mixed models adjusted for baseline outcome values and stratification factors (i.e., study center and line of treatment).

Results
Fitbit data were available for 129 participants (36.1%; EX=61; UC=68). Sociodemographic characteristics were comparable to the complete study population. Over time, DHRPS was lower and DSC was higher in EX compared to UC. At 9 months, DHRPS was improved in EX compared to UC, albeit not significant (-17.8% [95%CI:0.0-32.5%]), whereas a significant higher DSC was observed for EX (1948 steps [95%CI:698-3197]). Compared to UC, self-reported moderate-to-vigorous PA was significantly increased in EX at 3 months (+46.4 minutes/week [95%CI:9.82–83.0]), but not at subsequent timepoints.

Discussion
A supervised exercise program improves objectively and subjectively assessed PA and DHRPS in patients with mBC. Future analyses will explore intervention effects on time spent in HR-zones and steps-rate categories.

Speaker: David Binyam

Thematic Poster Session 5: Mixed Session (Forum 1)

Chairs: Karen Wonders & Elias Dreismickenbecker

314 Determining the Relationship Between Exercise Intensity and Lymphocyte Mobilization During Cycling Exercise

INTRODUCTION: Exercise elicits a robust leukocytosis, elevating key effector lymphocytes within the circulation. Following exercise, lymphocytes rapidly egress the circulation, and animal models indicate this egress may increase tumor trafficking and infiltration. We sought to define associations between lymphocytes and exercise intensity during cardiopulmonary exercise testing.
METHODS: Nine healthy participants were recruited for cycling exercise trials. Participants completed a VO2max test and returned to the laboratory three times over eight weeks to complete submaximal trials at wattages corresponding to 60%, 70%, and 80% of their VO2max in five minute stages. An intravenous catheter was inserted into the antecubital space, and blood was drawn at rest and each stage. Blood was analyzed for lactate concentrations and assessed via an automated hematology analyzer to determine lymphocyte concentrations. One way ANOVAs were utilized to assess changes across exercise intensities, and Pearson’s correlations were utilized to determine associations between variables.
RESULTS: Participants (23.5 ± 2.6 yrs; 5M, 4F) had a BMI of 24.2 ± 3.0 kg/m2 and VO2max of 40.6 ± 5.4 mL/kg/min. Total lymphocyte counts significantly increased from rest to 60% VO2max (2.3 ± 0.54 to 2.9 ± 0.65 x109/L; p<0.0001), 60% to 70% VO2max (2.9 ± 0.65 to 3.5 ± 0.86 x109/L; p<0.0001), and 70% to 80% VO2max (3.5 ± 0.86 to 4.1 ± 1.1 x109/L; p<0.0001). Heart rate, lactate, and RPE significantly increased from rest to each stage of the protocol (p<0.0001). Considering all exercise intensities, lymphocyte mobilization was significantly correlated with heart rate (r=0.50; p<0.0001), lactate concentrations (r=0.68; p<0.0001), and RPE (r=0.57; p<0.0001).
CONCLUSION: Lymphocytes increased linearly with exercise intensity, and were strongly associated with heart rate, lactate, and RPE. These findings are important for considering exercise intensity prescriptions in patients to maximize potential immune related anti-tumor effects during exercise.

Speaker: Kyle Smith (Florida State University)

315 Mediating role of mitochondrial energetics on the associations between physical activity and muscle function in older adults: a moderated mediation analysis by cancer survivorship in the Study of Muscle, Mobility and Aging (SOMMA)

Background: Habitual physical activity (PA) is associated with preserved physical function in older adults, but underlying biological mechanisms remain unclear. We examined whether skeletal muscle mitochondrial energetics mediated associations of PA with concurrent and future physical function and if pathways differed by cancer survivorship status.

Methods: Participants were 879 adults aged ≥70 years enrolled in the Study of Muscle, Mobility and Aging (SOMMA). Wrist-worn accelerometry collected over 7 consecutive days captured sleep, inactivity, light PA (LPA), moderate-to-vigorous PA (MVPA) and steps. Physical function outcomes included 4m walking speed, 1RM leg strength, leg power, and grip strength. Mitochondrial energetics were assessed via in vivo 31P-magnetic resonance spectroscopy ATPmax and ex vivo high-resolution respirometry maximal oxidative phosphorylation (max OXPHOS). Structural equation modeling examined cross-sectional and 3-year longitudinal mediation and moderated mediation associations, adjusting for demographic and clinical covariates. Cancer survivorship status was tested as a moderator.

Results: Cross-sectionally, MVPA and steps were associated with walking speed, leg strength and power, with both ATPmax and max OXPHOS mediating these associations (indirect effect β p<0.05). Longitudinally, baseline MVPA and steps were only associated with future walking speed; each 30 min/d MVPA and 1,000 steps/d increase predicted a 0.012 m/s faster walking speed 3-years later (β = 0.04 SD; 1 SD = 0.3 m/s). Although baseline MVPA and steps were associated with ATPmax and max OXPHOS, neither mitochondrial measure mediated associations with future walking speed (indirect effect β p>0.05). Results were unchanged after adjustment for D3Cr muscle mass. Cancer survivorship status did not modify the mediation pathways.

Conclusion: Higher PA was associated with improved walking speed 3-years later in older adults, but skeletal muscle mitochondrial energetics did not explain the longitudinal association. Mitochondrial energetics appear more strongly related to current rather than future physical function, suggesting alternative mechanisms underlie long-term functional benefits of habitual PA.

Speaker: Megan Hetherington-Rauth (Champalimaud Foundation)

316 Associations between accelerometry-derived physical activity and cognitive function during breast cancer chemotherapy

Abstract
Background:
Cancer-related cognitive impairment (CRCI) is common among women with breast cancer, yet no pharmacologic prevention exists. Exercise may improve cognition after treatment but less is known about how physical activity (PA) during chemotherapy relates to cognitive outcomes.
Methods:
This secondary analysis included women with breast cancer undergoing chemotherapy (n=38). Step counts were assessed via Fitbit at the beginning of treatment (T1), during treatment (T1-T2), and at treatment completion (T2). Cognitive outcomes at T2 included objective neuropsychological tests and Functional Assessment of Cancer Therapy – Cognition (FACT-Cog). Linear regression and mixed effects models examined associations between step counts and cognitive outcomes, and group (e.g., PA maintainers vs. PA decliners) by time differences.
Results:
T1 step counts were not associated with most cognitive outcomes, although higher T1 steps were associated with faster Trails B completion time (β=−10008 ms, p=0.017). In contrast, maintaining higher step counts T1-T2 was associated with better working memory accuracy on the N-back n2 (β=1.24, p=0.03) and Spatial Working Memory two-dimensional (β=1.24, p=0.02) tasks. Participants with ≥5000 average steps/day showed faster Flanker reaction time (βs=-116.01 & -151.67, congruent and incongruent, both ps=0.02). A significant group by time interaction was observed for Spatial Working Memory two-dimensional accuracy (β=2.30, p=0.020), with more favorable trajectories among PA maintainers over T1-T2. No consistent associations were observed for subjective cognition, although several objective cognitive outcomes showed moderate effect sizes.
Conclusion:
In this secondary analysis of women undergoing chemotherapy, baseline step counts were associated with faster processing speed, whereas higher step counts during chemotherapy were associated with better working memory accuracy. Participants who maintained physical activity over T1-T2 showed more favorable working memory trajectories. Together, these findings highlight a potential time-sensitive exercise-cognition relationship and suggest that maintaining physical activity during chemotherapy may help preserve specific cognitive functions.

Speakers: Elizabeth Salerno (School of Kinesiology, University of Michigan), Hui Jia (School of Kinesiology, University of Michigan)

317 Association between physical activity and mortality among breast cancer survivors

Purpose:
It is known that a greater physical activity (PA) reduces the risk of breast cancer (BC). Nevertheless, there is still limited evidence about what role PA may play in the prognosis of the disease. The aim of this study was to assess the association of pre- and postdiagnosis PA with overall and BC-specific mortality among BC survivors.
Methods:
A total of 13,399 BC survivors from the European Prospective Investigation into Cancer and Nutrition (EPIC) study were included. During the follow-up period (average 8.6 years) 2,380 women died, of whom 1,480 from BC. The main exposure was an overall measure of PA derived from a PA index (PA at work and leisure-time activities). We further analysed recreational PA (walking, cycling and sport activities). A subset of 2,023 survivors completed a second questionnaire within a 6-month to 4-year postdiagnosis. Multivariable Cox and Fine-Gray models were employed to evaluate the association of PA with overall and BC-specific mortality respectively, adjusted for relevant confounders.
Results:
BC survivors who were physically active before diagnosis had a 14% lower risk of all-cause mortality (HR 0.86, 95% CI: 0.78-0.95), and 12% lower risk of BC-specific mortality (HR 0.88, 95% CI: 0.77-1.00). PA postdiagnosis was associated with a lower risk of overall and BC-specific mortality of 43% (HR 0.57, 95% CI: 0.44-0.75) and 52% (HR 0.48, 95% CI: 0.34-0.68), respectively. A significant lower risk of mortality was also observed among those who practiced recreational PA after diagnosis. Women who became active at postdiagnosis had lower risk of overall mortality (HR 0.48, 95% CI 0.27-0.83) and BC-specific mortality (HR 0.35, 95% CI 0.16-0.74).
Conclusion:
Being physically active (pre- and postdiagnosis) reduces the risk of mortality among BC survivors. Additionally, changes towards higher levels of PA seem to have also positive impact on survival.

Speaker: Nuria Nadal Zaragoza (Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology-ICO, L'Hospitalet de Llobregat, Barcelona, Spain /Nutrition and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain/Deutsches Krebsforschungszentrum /Programa de doctorat d’Alimentació i Nutrició, Facultat de Farmàcia i Ciències de l’Alimentació, Universitat de Barcelona, Barcelona, Spain.)

318 Handgrip Strength Predicts Pathologic Complete Response in Breast Cancer Patients Undergoing Neoadjuvant Chemotherapy

Purpose: Breast cancer (BC) is the most common malignancy worldwide. Neoadjuvant chemotherapy (NACT) has become a standard treatment approach, and achieving pathologic complete response (pCR) is strongly associated with favorable long-term clinical outcomes. Although considerable efforts have focused on identifying tumor-specific predictors of treatment response, the role of host-related factors remains underexplored. In this context, handgrip strength (HGS), as an objective marker of muscle function and overall physiological reserve, may provide clinically relevant insights into treatment tolerance and response. However, evidence regarding its association with pCR in BC patients is scarce.

Methods: A total of 185 BC patients’ (Mean age:50,72±11,15 years) data was analyzed in this retrospective study. Demographic and clinical characteristics (Tumor-related parameters, including Ki-67 index, clinical stage, and HER2 status) as well as baseline HGS were obtained from medical records. “pCR” was defined as the absence of residual invasive disease following completion of NACT.

Results: In the multivariable logistic regression in which Ki-67, HGS, HER2 status were entered as covariates, HGS (OR=1.08, 95% CI=1.00–1.17, p=0.041), Ki-67 index (OR=1.04, 95% CI=1.01–1.06, p<0.001), and molecular subtype (compared to the reference group (Luminal A and Luminal B HER2-negative), patients in the HER2-positive group (isolated HER2-positive and Luminal B HER2-positive) had a significantly higher likelihood of achieving pCR (OR=6.10, 95% CI=2.59–14.33, p<0.001) ) were identified as significant predictors of pCR. Model fit index and cumulative variance were acceptable (Hosmer–Lemeshow goodness-of-fit test (χ²=7.893, p=0.444) and Nagelkerke R² of 0.405).

Conclusion: HGS emerged as an independent predictor of pCR in BC patients undergoing systemic NACT, alongside established tumor-related factors such as Ki-67 and molecular subtype. HGS may reflect patients’ physiological reserve and contribute to the prediction of treatment response beyond traditional oncologic parameters. These findings highlight the potential role of functional assessments as complementary tools in clinical decision-making and risk stratification.

Speaker: Alper Tuğral (Bakircay University)

319 A Novel Collaboration between a Large US Health Plan and Providers to Implement Exercise Oncology at Scale

With the publication of the CHALLENGE Trial, in addition to the publication of multiple exercise guidelines from ACS, ACSM, ASCO, ESSA, and other international organizations, the question becomes: how do we broadly implement exercise for all people living with and beyond cancer. In this abstract we focus on the efforts of a large U.S. based health care system (UPMC) to implement exercise oncology as a covered benefit starting January 2027.
The overarching goal is to use exercise oncology to address the quintuple aim of increasing physician satisfaction, decreasing cost savings, improving clinical outcomes, enhancing patient experience, while simultaneously achieving health equity. As of March 2026, the UPMC Commercial Division elected to make exercise oncology a covered benefit for all UPMC employees with breast cancer. A multidisciplinary team is designing the covered benefit, which will start January 2027. There are already systems in place for nurse care managers to reach out to cancer patients to ensure that patients understand their disease and the optimization of its management. The goal of both exercise oncology and these nurse manager efforts are to approach the quintuple aim by decreasing unplanned care. There is published evidence that exercise oncology interventions reduce unplanned care. As part of the effort to roll out exercise oncology as a covered benefit, the plan is to implement exercise oncology by adding it to the nurse care manager system.
As an integrated delivery finance system, UPMC seeks to bring together siloed health care organizations to work as an integrated system to improve care efficiency and effectiveness. Furthermore, the approach allows providers and payers to collaborate in new ways. The collaboration of the Hillman Cancer Center Moving Through Cancer program with the UPMC health plan will lead to the development, implementation, and scaling of novel, evidence-based approaches like adding exercise oncology to nurse care manager efforts. We aim to increase engagement in exercise oncology and nurse care management exponentially increasing the return on investment and providing a covered benefit for exercise oncology in a large US health care system. The executive committee agreed to making exercise oncology a covered benefit starting January 2027. Efforts are underway to design the benefit in a manner that maximizes both reach and effectiveness.

Speaker: Kathryn Schmitz (UPMC Hillman Cancer Center)

thematic poster slides schmitz.pptx

14:45 Coffee Break

Oral Session 7: Mechanism (Forum 1)

Chairs: Helen Rundqvist & Robin Reschke

320 Associations between dynamic metabolic responses to acute exercise and fatigue in survivors of cancer

Metabolic changes have been consistently observed in survivors of cancer. Despite the strong link between exercise and metabolism, the metabolic effects of exercise in survivors remain largely unknown, especially dynamic responses to acute exercise. This study characterized metabolic changes during and after acute exercise and investigated associations with cancer-related fatigue. METHODS: Survivors of breast, prostate, and colorectal cancers (n=11) who had completed all treatment performed a submaximal walking treadmill test. Speed and grade were adjusted to maintain intensity at 55% heart rate reserve for 36 minutes. Capillary blood (~500μL) was collected before, after, and 30 min after exercise. Fatigue was measured using the Functional Assessment of Chronic Illness Treatment – Fatigue scale (FACIT-Fatigue). Metabolomics and lipidomics were obtained via high-throughput liquid chromatography-mass spectrometry. Metabolite fold changes (FC) were calculated from before to after exercise (acute response) and after to 30 min after exercise (recovery), with significant metabolites identified with linear mixed models. Spearman’s correlation coefficients were calculated to investigate associations with FACIT-Fatigue. RESULTS: Participants were 59±11 years old, 70% female, and breast cancer was the most common diagnosis (50%). Acute responses were primarily characterized by increases in fatty acids (FC=1.4-2.1, p<0.01) and acylcarnitines (FC=1.2-1.4, p<0.01). Recovery was characterized by decreases in fatty acids (FC=0.7-0.8, p<0.01), and increases in ketone bodies (FC=1.3-1.4, p<0.01) and hydroxy-acylcarnitines (FC=1.3-1.4, p<0.01). Acute and recovery responses in lactate and pyruvate were positively correlated with higher fatigue (ρ=0.6-0.7, p<0.05), as was arachidonic acid during recovery (ρ=0.7, p<0.05). CONCLUSIONS: Dynamic metabolic responses during exercise displayed patterns of increased fatty acid mobilization and oxidation. Recovery patterns indicated continued beta-oxidation of monolized lipids. Individuals exhibiting markers of impaired fatty acid oxidation and persistent inflammation during and after exercise reported greater cancer-related fatigue. These results reveal associations between dynamic exercise metabolism and fatigue in survivors, providing potential targets for exercise personalization.

Speaker: Ryan Marker (University of Colorado)

321 Exercise suppresses prostate tumor aggressiveness by altering intratumoral lipid metabolism

Although prior work suggests that exercise reduces the risk of high-grade prostate cancer, the underlying biological mechanisms remain unclear. We aimed to uncover potential mechanisms using transcriptomic approaches following a 12-week aerobic exercise intervention utilizing the transgenic adenocarcinoma of the mouse prostate (TRAMP) model.

Methods: Twelve TRAMP mice, 8-10 weeks of age, were randomized to exercise or control group (n=6/group). Mice in the exercise group were singularly housed in cages with voluntary running wheels. Mice in the control group maintained normal group housing and activity. At euthanasia, prostate tumors were excised, weighed and processed for immunohistochemistry and transcriptome analysis. Outputs of sequencing data were assessed for quality and accuracy. Differential expression was filtered to identify genes that had a ≥ 1.5 log fold change with an adjusted p<0.05. Gene ontology and pathway analyses were performed to reveal pathways activated.

Results: No significant difference was observed in body or genitourinary weight between groups. Pathology revealed a 50% reduction in moderately and poorly differentiated tumors in the exercise group. In representative tumor samples 32 genes were significantly modified. Among the top 20 transcripts that decreased in the exercise group were genes involved in lipolysis such as Lipe, Plin1, Slc7A10. Among the top transcripts with higher expression in the exercise group was Dgat2L6 that is involved in the synthesis of diglycerols and triglycerols. Biological processes most impacted centered on triglyceride catabolic process, lipid homeostasis, lipid metabolic process, and triglyceride metabolic process.

Conclusion: Our results suggest that exercise differentially affect pathways that overcome high oxidative stress thresholds and protect against high-grade tumors.

Speaker: Darpan Patel (University of Texas Medical Branch at Galveston)

322 A randomized controlled trial testing the immunological impact of high-intensity interval training for patients with metastatic lung cancer in combination with immunotherapy

Exercise is a potent therapy modality to improve quality of life and physical function in cancer patients, with emerging evidence suggesting benefits for cancer outcomes. Given that the efficacy of cancer immunotherapy relies on sustained antitumor immune responses, high-intensity exercise may enhance its efficacy through immune modulation.

The randomized controlled HI AIM trial (NCT04263467) investigated six weeks of high-intensity interval training (HIIT) in patients with metastatic non-small cell lung cancer (mNSCLC) receiving immune checkpoint inhibitors (ICI) with or without chemotherapy, or under surveillance. Participants in the exercise group completed supervised, group-based HIIT three times weekly. Data on exercise performance, cardiorespiratory fitness, therapy course, psychological distress, and disease outcomes were collected. Peripheral blood samples were obtained before and after acute HIIT sessions and longitudinally for immunological analyses.

Between August 2020 and October 2023, 54 patients (22 males, 32 females) were randomized. Adherence of 83%, resulted in analysis of data from 45 patients (21 exercise, 24 control). Flow cytometry revealed that patients with mNSCLC performed HIIT resulting in mobilization of NK, T cells and catecholamines to the peripheral blood. The primary outcome showed that circulating NK cells from baseline to week 12 was significantly higher in the ex-ercise group compared to control group (log2 ratio week12/bsl -0·012 ±1·057 vs. -0·276 ±0·695; p=0·0247). Secondary outcomes showed feasibility and safety (no severe adverse effect) of the exercise intervention, and a significant increase in power output and VO2peak for the exercise group. Clinical analysis showed that the exercise group experienced less toxicities during active treatment, and reduced anxiety. Notably, in a subgroup analysis, a progression-free survival benefit was observed in the exercise group receiving ICI.

This study shows for the first time, in metastatic cancer patients, that HIIT is not only safe and feasible but elicits immune activation and indicates synergistic clinical activity with immunotherapy.

Speaker: Gitte Holmen Olofsson (National Center for Cancer Immune Therapy (CCIT-DK))

20260723_HIAIM_firstclinicaldata_ISEO_v2_for_pdf.pdf

323 Does exercise have an effect on Breast Cancer Cell Growth?

Background: One way to influence the tumor microenvironment (TME) by exercise through myokines is the cancer-muscle cross talk. The cytokine CXCL9 plays a central role in the regulation of tumor growth and cell proliferation, mediated via the CXC chemokine receptor 3 (CXCR3) signaling pathway. We analyzed whether exercise-conditioned serum has an influence on the CXCL9 concentration in breast cancer (BC) cells in vitro and on BC cell growth.
Methods: Twelve female participants underwent an acute endurance exercise intervention. Serum samples were collected before, immediately after, and two hours post-exercise. Triple-negative BC (MDA-MB-231) cells and estrogen-dependent BC (MCF-7) cells were incubated with the conditioned serum, and cell vitality (MTT assay) and proliferation (Immunohistochemistry with anti-Ki-67 antibody) were assessed.
Results: Endurance exercise-conditioned serum significantly reduced triple-negative BC cell vitality (p= .046) and cell proliferation (p= .032) post-intervention and after the resting period (p<.001). Protein arrays identified CXCL9 as a key cytokine. The corresponding CXCR3 pathway was inhibited and experiments were repeated. Inhibition of the CXCL9 receptor CXCR3 resulted in metabolic (t (10)= 3.064, p=.012) and proliferative inhibitory effects (t (10)= -11.734, p<.01) for the MDA-MB-231 cells. For the MCF-7 cells, the MTT analysis showed a significant decrease in cell vitality after CXCR3 inhibition (Effect size (ES) = 0.75, p=.032), while immunohistochemical analysis revealed increased Ki-67 expression under the inhibitor condition compared to the control condition (ES = 0.85, p=.005).
Discussion: Our results suggest that serum conditioned by an acute endurance exercise causes changes in BC cell growth, but the effects appear to be cell type-specific. This discrepancy suggests that the CXCR3 signaling pathway may be more relevant in metabolic than proliferative processes. Overall, this provides valuable insights into the complexity and possible mechanisms of action of the CXCR3 signaling pathway in the TME and provide important key points for future research.

Speaker: Dorothea Clauss (German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) Heidelberg (a Partnership Between DKFZ and University Medical Center Heidelberg), Heidelberg, Germany)

324 Mitochondrial dysfunction: a key player in doxorubicin-induced skeletal and cardiac muscle damage?

Introduction
Anthracyclines are effective treatments for solid and hematological cancers but can cause long-lasting toxicities, including skeletal muscle loss (20–70%) and cardiomyopathy (5–48%). These toxicities contribute to fatigue, reduced physical fitness, and poorer quality of life (QoL), and may limit the use of optimal chemotherapy doses, decreasing the chance of survival. Understanding mechanisms of anthracycline-induced myo- and cardiotoxicity can guide the development of future trials evaluating (non-)pharmacological strategies, such as exercise, to prevent these toxic effects. This pilot study examines changes in skeletal and cardiac muscle mitochondrial function during (R-)CHOP chemotherapy in patients with lymphoma using non-invasive phosphorus (31P) Magnetic Resonance Spectroscopy (MRS).

Methods
Newly diagnosed patients with lymphoma underwent 31P-MRS of the heart and calf muscle before and after completion of chemotherapy. The PCr/γATP ratio in cardiac muscle and the rate constant of PCr recovery following dynamic plantar-flexion exercise in skeletal muscle were evaluated as measures of mitochondrial function. Additionally, fatigue, QoL and physical fitness were assessed. Linear regression models were performed to assess changes over time.

Results
To date, 12 patients have been enrolled, with 4 patients of whom all scans have been completed and analyzed (mean age = 48.8±19.7 years). The PCr/yATP ratio (-0.45, 95% CI -0.81; -0.13) and PCr recovery rate constant (-0.51 s-1, 95% CI -0.89; -0.13) decreased significantly over time. All other outcomes also demonstrated deterioration over the course of chemotherapy. At the conference, data of all 12 patients will be presented.

Conclusion This pilot study demonstrates the ability to monitor skeletal and cardiac muscle mitochondrial damage using 31P-MRS and provides mechanistic evidence for the role of mitochondria in anthracycline-induced myo- and cardiotoxicity. This informs the design of future randomized controlled trials, which aim to investigate effects of (non-)pharmacological treatment options, including exercise, to mitigate these detrimental toxicities.

Speaker: Anouk Hiensch

Oral Session 8: Symptommanagement through exercise (Hall 2)

Chairs: Helen Croker & Katharina Graf

325 12-Weeks of Precision Exercise Reduces Frailty by Increasing Fitness in Chronic Lymphocytic Leukaemia: A Randomised Controlled Trial

Purpose: Chronic lymphocytic leukaemia (CLL), whether treatment-naïve (TN) or being treated (TRE), increases frailty risk. Underlying this is an abnormal reduction in aerobic fitness and strength. Previous exercise studies have failed to improve aerobic fitness, likely due to their generalised approach. We aimed to evaluate the impact of a 12-week precision exercise intervention in adults with CLL.

Methods: 63 adults with CLL [39M/24F: aged 66.5 ± 8.3 years] were enrolled and 58 completed a prospective RCT assessing a 12-week exercise program designed to target exercise limitations. Consisting of 3 x nonlinear cardiovascular and 2 x resistance sessions/week (~150 mins/week), patients were supervised in person (N=14 SUP), semi-supervised remotely (N=29 REM), or no exercise (N=15 CON). Baseline and 12-week assessments included aerobic capacity (VO₂peak), muscle strength, physical function and frailty. Results are presented as mean absolute change ± SD.

Results: At baseline, TN (N=35) and TRE (N=28) had comparable physiological and frailty profiles and were combined. Significant time×group interactions were observed for changes in Fried frailty phenotype scores (p=0.012, η²=.179). Reductions in frailty for SUP (-0.36±0.50 units, p=0.013) and REM (-0.12 ± 0.43 units, p=0.061) were superior to CON (0.08±0.49 units). Underlying this were time×group interactions for VO₂peak with superior changes for SUP (2.8±3.1 mL/kg/min, p=0.007) and REM (2.2±2.3 mL/kg/min, p=0.002) compared to CON (-0.5±2.6 mL/kg/min). Time×group interactions were also observed for chest press (p<0.001, η²=.266), seated row (p=0.002, η²=.226) and leg press (p<0.001, η²=.423). No main effects were observed for changes in other physical function assessments.

Conclusion: For the first time, we show that 12 weeks of precision exercise personalised to individuals' exercise limitations reduces frailty and improves aerobic fitness and strength in patients with CLL. These findings support integrating precision, targeted exercises into routine CLL care to reduce frailty risk and enhance functional independence

Speaker: Ellie Miles (University of Surrey)

326 Effect of a Multidisciplinary Intervention on Fatigue in Lymphoma Survivors with Persistent Fatigue- A Randomized Controlled Trial (the REFUEL-trial)

Background: Persistent fatigue is a prevalent, complex and distressing late effect after cancer, but few treatment options exist. We tested the effect of a multidisciplinary intervention on fatigue in lymphoma survivors with persistent fatigue (≥6 months).
Patients and methods: Survivors mean 7 years post-treatment were randomly assigned to usual care (n=75) or a 12-week multidisciplinary intervention (n=75), consisting of patient education, exercise, cognitive behavioral therapy and nutritional counseling. The primary outcome was total fatigue score assessed by the Chalder Fatigue Questionnaire (FQ) (range 0 to 33) 3 months post- randomization. Secondary outcomes included physical and mental fatigue assessed by FQ, health-related quality of life assessed by European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30, peak oxygen uptake (VO2peak) and adherence to dietary guidelines measured by a diet index (range 0 to 19). Outcomes were assessed at baseline (T0) and 3 (T1), 6 (T2) and 9 (T3) months post-randomization. Effects were analyzed with baseline-adjusted linear mixed models for repeated measures.
Results: The intervention group reported lower total fatigue than usual care group at T1 (12.8 SD 6.5 vs. 16.9 SD 6.5). The between-group difference (BGD) was -3.5 (95% CI, -5.4, -1.6), P<0.001. The intervention group also had less physical (BGD -2.4, 95% CI, -3.8, -1.0) and mental fatigue (BGD -1.1, 95% CI, -1.7, -0.4), higher physical (BGD 3.8, 95% CI, 0.2, 7.3) and role (BGD 9.2, 95% CI, 0.9, 17.5) functioning, and higher global health status/quality of life (BGD 9.5, 95% CI, 3.5, 15.4), VO2peak (BGD 1.1 mL/kg/min, 95% CI, 0.2, 1.9) and diet index (BGD 2.5, 95% CI, 1.5, 3.6) than usual care group at T1. The BGD was reduced at T2 and T3 for most outcomes.
Conclusions: The 12-week multidisciplinary intervention had a positive short-term effect on fatigue in lymphoma survivors with persistent fatigue.

Speaker: Synne-Kristin Hoffart Bøhn (Oslo University Hospital)

REFUEL Oral ISEO Synne Bøhn.pptx

327 Improving health outcomes after endometrial cancer: the ACUMEN trial

Introduction
Metabolic dysfunction is a key driver of Endometrial cancer (EC), and contributes to disproportionately high rates of cardiometabolic disease, cardiovascular mortality, EC recurrence, and a two-fold reduction in overall survival after EC. Exercise imparts physiological adaptations including improved cardiorespiratory fitness (CRF), body composition, and glucose handling that would be advantageous after EC. Yet, EC is underrepresented in exercise oncology research. Thus, the potential risk-mitigating effects of exercise and the biological mechanisms underlying these remain unclear.

Aim
This sub-study of the ACUMEN clinical trial (ACTRN12621000050853) investigated the effect of a targeted exercise intervention on CRF, physical health, and quality of life (QoL) after EC.

Methods
Women ≤5 years post-EC were randomised to a 12-week supervised aerobic and resistance training intervention (EX) or non-exercise control (CON). Primary outcome CRF (VO2peak) determined via cycling VO2max test and secondary outcomes related to physical function and psychosocial wellbeing were assessed at baseline, 12-weeks, and 24-weeks.

Results
Seventy-eight women post-EC (58.8±12.6 years, 32.5±7.6kg/m2) were randomised (EX=35; CON=43). EX participants attended 16.0±3.6 (Mean±SD) of 18 sessions. Despite high attendance, only 48% and 52% were compliant with target aerobic and resistance training intensities, respectively. No significant improvements in CRF were observed within the EX group (adjusted mean difference = 1.04ml/kg/min; 95%CI= -0.79, 2.86; p=0.26) and there was no difference in CRF between EX and CON at 12-weeks (0.68ml/kg/min; 95%CI= -1.24, 2.61; p=0.48). No intervention effect was observed for muscular strength or physical function (p<0.05).

Conclusions
Exercise prescribed in line with current exercise oncology guidelines did not elicit improvements in CRF among women treated for EC. These findings highlight the need to tailor intervention design and exercise prescription to the EC cohort to optimise exercise compliance and efficacy, and to individualise testing protocols (such as VO2max modality and workload progressions) for maximum data fidelity and sensitivity to change.

Speaker: Eliza Macdonald (UNSW Sydney)

328 Specific exercise is more effective than medication – prevention and treatment of Chemotherapy-induced peripheral neuropathy – State of the art

Chemotherapy-induced peripheral neuropathy (CIPN) is a highly prevalent and clinically relevant side-effect that not only diminishes patients’ quality of life but can also impact their medical treatment and survival. The side effects are burdensome, difficult to treat, and often become chronic. Currently, there are no effective pharmacological treatment options available. A meta-analysis has shown that specific exercise is promising in reducing symptoms (Streckmann et al. 2021). In a prospective, multicenter, randomized clinical study (STOP) (Streckmann et al. 2024), we were now also able to show, that sensorimotor training can prevent CIPN by as much as 70%.

We recruited N=158 patients undergoing treatment with either oxaliplatin or vinca-alkaloids from four center (Cologne, Germany) over 5 years. Patients were randomly assigned in a 1:1:1 ratio to one of three groups: SMT (N=55), WBV (N=53), or treatment as usual (TAU) (N=50). Primary endpoint was the incidence of CIPN. Secondary endpoints included subjective neuropathy symptoms, balance control, physical activity levels, quality of life, and clinical outcomes.

In the intention to treat analysis, CIPN incidence was significantly lower in both intervention groups compared to the control group [SMT=30% (95% CI=17.9-42.1%) and WBV=41.2% (27.9-54.5%) vs. TAU=70.6% (58.0-83.2%); pMH=0.0016]. Patients receiving vinca-alkaloids and engaging in SMT benefited most (pFisher=0.008). In the per-protocol analysis (> 75% adherence to the intervention), the differences were even more pronounced [SMT=28.6% (11.9-45.3%) and WBV=37·5% (18.1-56.9%)vs. TAU=73.3% (59.6-87.0%)]. Furthermore, SMT showed significant benefits over TAU in several secondary endpoints, including balance control [bipedal eyes open (pMH=0.04); bipedal eyes closed (pMH=0.049); monopedal (pMH=0.031)], vibration sensitivity (pMH=0.018), sense of touch (pMH=0.042), lower leg strength (pMH=0.043), pain reduction (pMH=0.048), burning sensation (pMH=0.048), chemotherapy dose-reductions (pMH=0.039) and mortality rates (pMH=0.044).

This study provides initial evidence that neuromuscular training can prevent symptoms of CIPN. Specific exercise is consequently a promising option for the treatment and prevention of CIPN.

Speaker: Fiona Streckmann (Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland; Department of Oncology, University Hospital Basel, Basel, Switzerland)

329 Effects of supervised aerobic and resistance exercise on quality of life in men with metastatic prostate cancer: Results from the INTERVAL-GAP4 trial

Background: Many studies demonstrate exercise is an effective adjunct therapy for prostate cancer, however, limited research has focused on metastatic prostate cancer. The current study examined the effects of supervised exercise on quality of life (QoL) in men with advanced prostate cancer.
Methods: In this multinational, randomized controlled trial, men with metastatic prostate cancer were assigned to either a supervised exercise group receiving 96 weeks of supervised high-intensity aerobic and resistance training or a self-directed exercise group receiving exercise recommendations. QoL was assessed every three months using the EORTC QLQ-C30 and the EPIC-26. Adjusted linear mixed models were used for statistical analyses.
Results: A total of 145 men with metastatic castrate-resistant or hormone-sensitive prostate cancer were randomized to supervised exercise (n=75) or self-directed exercise (n=70). Median intervention adherence to supervised exercise was 84% (IQR: 61%,95%). Baseline global health status scores were 71.5±19.2 in the supervised exercise group and 72.1±17.2 in the self-directed exercise group. Supervised exercise compared to self-directed exercise showed a statistically significant overall beneficial effect across 96 weeks on global health status (adjusted between group difference = 4.8; 95% CI = 1.0 to 8.5; p=0.02) and a trend toward beneficial effects on emotional functioning (p=0.08) and role functioning (p=0.10). There was also a trend toward a time-by-group interaction for cognitive functioning (p=0.08) with significantly higher scores in the supervised exercise group at 15 months (p=0.004). There were no other significant overall or interaction effects, although several other QoL domains showed intermittent between-group differences favoring the supervised exercise group.
Conclusion: Supervised high-intensity aerobic and resistance exercise compared to self-directed exercise produced modest and sporadic improvements in some QoL measures over a 2-year intervention in men with advanced prostate cancer. These findings provide additional evidence supporting the integration of structured exercise into supportive care for this patient population.

Speaker: Ki-Yong An (University of Alberta)

Keynote: Jennifer Ligibel - Exercise as Routine Care in Oncology: Turning Vision into Practice (Hall 2)

Convener: Jennifer Ligibel (Dana-Farber Cancer Institute and Harvard Medical School)

330 Jennifer Ligibel - Exercise as Routine Care in Oncology: Turning Vision into Practice

Speaker: Jennifer Ligibel (Dana-Farber Cancer Institute and Harvard Medical School)

Remarks: Closing (Hall 2)

Conveners: Joachim Wiskemann (Universitätsklinikum Heidelberg), Karen Steindorf (Deutsches Krebsforschungszentrum), Kathryn Schmitz (UPMC Hillman Cancer Center)