Exercise During Chemotherapy Supports Brain Health

Key Points Summary

• A nationwide clinical trial found that structured exercise during chemotherapy helps patients maintain physical activity and cognitive performance.
• The EXCAP home-based exercise program (walking and resistance bands) enabled many patients to maintain their usual daily step count.
• Up to 75% of cancer patients experience chemotherapy-related cognitive impairment (“chemo brain”), and regular exercise may help reduce symptoms.
• Benefits were most evident among patients receiving bi-weekly chemotherapy cycles.
• Researchers highlight exercise as a safe, low-cost supportive care strategy for patients with cancer.

Exercise During Chemotherapy Supports Physical and Cognitive Health

Exercise during chemotherapy supports physical and cognitive health, according to new findings from a nationwide clinical trial led by researchers at the Wilmot Cancer Institute at the University of Rochester.

The study highlights how a structured, home-based exercise prescription helped patients undergoing chemotherapy maintain daily activity levels and report better cognitive clarity compared with patients receiving standard care without exercise.

Published in the March issue of the JNCCN – Journal of the National Comprehensive Cancer Network, the research underscores the growing role of exercise oncology as an important component of supportive cancer care.

What Is Chemo Brain? Exercise May Help Reduce Cognitive Symptoms

Chemotherapy-related cognitive impairment, often referred to as “chemo brain,” affects a significant portion of patients undergoing cancer treatment. Researchers estimate that up to 75% of cancer patients experience cognitive difficulties, including brain fog, reduced concentration, and challenges managing daily tasks such as medications or finances.

Lead investigator Karen Mustian, PhD, MPH, and colleague Po‑Ju Lin, PhD, MPH, RD, examined whether a structured exercise prescription could help address these symptoms.

Their program, known as EXCAP (Exercise for Cancer Patients)-was developed in collaboration with specialists from the American College of Sports Medicine. The program includes:

• Progressive aerobic walking goals
• Resistance band exercises
• A personalized home-based approach tailored to each patient’s ability

Researchers note that even mild-to-moderate exercise may produce meaningful benefits by supporting immune health and reducing inflammation.

Clinical Trial Findings: Exercise Preserves Activity and Cognitive Clarity

The phase 3 clinical trial enrolled nearly 700 patients across 20 community oncology clinics in the United States, all of whom were receiving chemotherapy for the first time.

Participants were randomly assigned to either:

• Standard cancer care without a structured exercise plan, or
• A six-week EXCAP exercise program during chemotherapy
• Before treatment began, patients averaged 4,000–4,500 daily steps.

Key findings included:

• Patients in the exercise group maintained their daily walking levels during chemotherapy.
• Those in the standard-care group reduced activity by 53% on average.
• Patients who exercised reported better mental clarity and fewer cognitive complaints.

According to Lin, the results emphasize the importance of structured exercise guidance, noting that patients without an exercise prescription often experience both declining activity and worsening cognitive symptoms.

Why Chemotherapy Schedule May Influence Exercise Benefits

Interestingly, the benefits of exercise were most pronounced among patients receiving chemotherapy every two weeks, compared with patients treated on three- or four-week cycles.

Researchers suggest this difference may relate to variations in drug toxicity or side-effect profiles, which could influence patients’ ability to stay physically active during treatment.

Regardless of treatment schedule, investigators emphasize that non-pharmacologic strategies, including exercise, mindfulness, and cognitive training, offer accessible and low-cost options for managing chemotherapy-related symptoms.

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Guidelines for physical activity during cancer treatment are also supported by the National Comprehensive Cancer Network, which encourages clinicians to discuss safe exercise options such as walking and resistance training with patients undergoing therapy.

Source:

University of Rochester Medical Center