Background:
Equitable and widespread uptake of exercise into standard cancer care requires concurrent evidence of exercise benefit, tolerability, and safety across cancer and treatment types. While potential benefits of exercise oncology have been widely reported, robust evidence supporting safety and tolerability is scarce for any cancer population, but particularly for understudied, medically-complex cancer groups, or those with cancer types associated with poor prognosis.
Methods:
The primary objective of the ECHO trial was to evaluate the impact of exercise during chemotherapy for patients with newly diagnosed ovarian cancer on survival and physical function. The weekly exercise target dose for those randomised to the intervention group was in line with exercise oncology guidelines. During intervention implementation, data on type, grade, causality, and impact of adverse events that occurred in the prior week were collected. These data were used to inform individualised exercise prescription for the coming week and to ensure robust and replicable collection of exercise safety (rates of grade 3+ exercise-related adverse events[ExAE]) and tolerability (rates of grade 1-5, all-cause adverse events[AEs]; % intervention that AEs impacted exercise).
Results:
231 people receiving chemotherapy for ovarian cancer were randomised to the exercise group. Over an average of 19 weeks of exercise per participant, two participants each reported one grade 3 ExAE (Grade 4-5 ExAEs: n=0). All participants (i.e.,100%) reported grade 1-5 AEs (median=25; range 2-81), with 98% of AEs graded 1-2. AEs impacted exercise participation for 100% of participants in 65% of intervention weeks (range 9-100%).
Conclusion:
Risk of serious harm from exercise was low in this population. However, exercise tolerability was limited by high rates of grade 1-2 AEs (primarily treatment-related). Desire and capacity to engage in exercise therapy will likely vary between individuals, influenced by tolerability and perceived or experienced benefits. Exercise professionals can support participation through modified exercise dosage and behaviour change tools.