Phys-Can (Physical Training and Cancer)

Background

Physical exercise has positive health effects for everyone, both physically and mentally. For individuals undergoing cancer treatment, exercise can also improve health-related quality of life and reduce specific symptoms, such as cancer-related fatigue. Additionally, being in good physical condition can improve the ability to complete oncological treatments. However, there is a lack of knowledge about how intensely one should exercise to achieve the best health effects, as well as the behavioral support needed to adhere to the exercise regimen.

Objectives

1. Phys-Can aims to compare the effect of aerobic and strength training at high versus low/moderate intensity concerning cancer-related fatigue and health-related quality of life.
2. The study also compares the effect of receiving extra behavioral support in the form of planning and follow-up regarding the implementation of the training.
3. Furthermore, possible physiological mechanisms explaining the effect of exercise on fatigue are investigated.
4. Finally, health economic evaluations of the training are conducted.

Design

Phys-Can is a randomized controlled study where participants are randomized into four groups:

1. high-intensity
2. high-intensity with extra behavioral support
3. low/moderate intensity
4. low/moderate intensity with extra behavioral support. Measurements are performed before, during, and after the 6-month training period, as well as 1, 2, and 5 years after the end of the training period. Follow-ups via medical records and registry data are conducted after 10 years.

Participants

600 individuals undergoing adjuvant treatment (chemotherapy, radiation, and/or hormone therapy) for breast cancer, prostate cancer, or colorectal cancer at the university hospitals in Uppsala, Linköping, or Malmö/Lund. Since participants can be randomized to high-intensity training, there must be no medical obstacles for this, and therefore, each potential participant is assessed by a physician before being asked to participate.

Exercise intervention

The training period lasts for 6 months. Strength training is conducted under the guidance of an instructor twice a week at Friskis & Svettis along with other participants. Loads are adjusted for each individual; higher loads emphasizing strength in the high-intensity group and lower loads in the low/moderate intensity group emphasizing muscular endurance. Aerobic training is home-based after instruction with an instructor. The high-intensity group performs interval sessions twice a week, with individually tailored levels. The low/moderate intensity group trains at a moderate intensity level for at least 150 minutes per week.

Behavioral support

Groups receiving extra behavioral support are assisted with planning and follow-up of the training. At the end of the 6-month training period, they also receive help in developing a plan for their continued training, with follow-up from the instructor after 3 and 9 months.

Measurements

Physical tests are conducted for maximum oxygen uptake capacity (aerobic fitness), strength, and body composition. Questionnaires with self-reports of cancer-related fatigue and health-related quality of life using validated instruments. Training logs and heart rate monitors are used to measure the implementation of the training. Blood samples are taken for the measurement of physiological mechanisms related to training. Medical records and registry data are used, among other things, for the health economic analyses.

The exercise intervention was completed in 2018 and long-term follow-ups will be performed until 2028.