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Exercise and Cancer Treatment: The Clinical Application of Exercise Oncology
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Exercise and Cancer Treatment: The Clinical Application of Exercise Oncology

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Clinical Research of Cancer".

Deadline for manuscript submissions: 10 September 2026 | Viewed by 3726

Special Issue Editors

Dr. Helena Batatinha

E-Mail Website
Guest Editor
School of Nutritional Sciences and Wellness, The University of Arizona, Tucson, AZ, USA
Interests: immunology; inflammation; injury repair; regenerative medicine
Special Issues, Collections and Topics in MDPI journals
Dr. Geovana Leite

E-Mail Website
Guest Editor
School of Nutritional Sciences and Wellness, The University of Arizona, Tucson, AZ, USA
Interests: physical exercise; exercise-immunology; microbiome; exercise-oncology; sports nutrition

Special Issue Information

Dear Colleagues,

Exercise is increasingly recognized as a powerful adjunct therapy in cancer treatment, with compelling evidence supporting its role in improving patient outcomes. Exercise oncology has evolved from observational studies demonstrating associations between physical activity and cancer prognosis to rigorous clinical trials exploring its mechanistic benefits and therapeutic potential. Today, structured exercise interventions are being integrated into standard oncology care, aiming to mitigate treatment-related side effects, enhance quality of life, and improve survival in certain cancer populations.

 Despite these advancements, critical challenges remain in optimizing the clinical application of exercise oncology. Questions regarding individualized prescriptions, the most effective exercise modalities, and the biological mechanisms underlying their benefits continue to drive research in the field. Moreover, translating exercise programs into routine cancer care requires addressing barriers such as patient adherence, healthcare provider engagement, and system-wide implementation strategies.

This Special Issue will explore the latest research on exercise as a component of cancer treatment, spanning mechanistic studies, clinical trials, and implementation science. By advancing our understanding of how exercise can be best utilized in oncology settings, we can move closer to establishing it as a standard, evidence-based component of comprehensive cancer care.

Dr. Helena Batatinha
Dr. Geovana Leite
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • exercise oncology
  • cancer therapy
  • immunotherapy
  • patient outcomes

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Published Papers (3 papers)

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Research

17 pages, 2090 KB  
Article
Low-Intensity Exercise Attenuates Immune Checkpoint Inhibitor-Induced Cardiotoxicity via Regulation of Metabolism and Autophagy
by Louisa Tichy and Traci L. Parry
Cancers 2026, 18(1), 138; https://doi.org/10.3390/cancers18010138 - 31 Dec 2025
Viewed by 688
Abstract
Background: Immune checkpoint inhibitors (ICIs) are a new anti-cancer therapy that have improved survival rates in many aggressive cancers. However, while rare, a significant number of patients develop ICI-induced cardiotoxicity. Clinical manifestations are non-specific and underlying cellular mechanisms remain unknown, making diagnosis and [...] Read more.
Background: Immune checkpoint inhibitors (ICIs) are a new anti-cancer therapy that have improved survival rates in many aggressive cancers. However, while rare, a significant number of patients develop ICI-induced cardiotoxicity. Clinical manifestations are non-specific and underlying cellular mechanisms remain unknown, making diagnosis and treatment of these ICI-induced cardiac side effects difficult. Exercise has shown protective effects against chemotherapy-induced cardiotoxicity but has not been investigated in combination with ICIs. High-intensity exercise has shown greatest cardioprotective effects in preclinical (animal) models, but human cancer patients prefer low-intensity exercise in the clinical setting. Therefore, the purpose of this study was to further identify the cardioprotective effects of low-intensity exercise as a treatment strategy against ICI-induced cardiotoxicity. Methods: Female mice were randomly selected and separated into four groups: sedentary (SED), sedentary ICI-treated (SED + ICI), low-intensity treadmill-exercised (TM), and low-intensity treadmill-exercised ICI-treated mice (TM + ICI). Mice either underwent a 4-week low-intensity treadmill exercise protocol (TM) or remained sedentary (SED). During the 4 weeks, ICI mice received anti-PD-1 treatment (200 μg/mouse) via intraperitoneal injections twice each week. Echocardiography was performed at baseline and sacrifice to determine changes in cardiac structure and function. At sacrifice, cardiac tissue was collected, weighed, and frozen for further biochemical analysis. Underlying metabolic signaling pathways were assessed via Western Blot, and autophagic flux was analyzed via fluorescent microscopy. Results: Echocardiography at sacrifice revealed significantly decreased fractional shortening as a measure of cardiac function (−20%), 1.5-fold dilation of the left ventricle, and thinning of the posterior cardiac wall at systole and diastole in SED + ICI mice compared to SED controls (p < 0.05), indicative of a phenotype of ICI-induced dilated cardiomyopathy. TM + ICI mice did not show a significant difference in these cardiac structural and functional parameters, suggesting cardioprotective effects of low-intensity exercise. In line with these findings, Western Blot and fluorescent microscopy analyses revealed upregulation of autophagic flux (p < 0.05), as well as dysfunctional metabolic pathways (p < 0.05) in ICI-treated mice compared to non-ICI controls. Low-intensity exercise was associated with regulation of dysfunctional metabolism and autophagy in TM + ICI compared to SED + ICI mice. Conclusions: The clinically relevant ICI treatment protocol used in this study led to significant cardiac dysfunction and remodeling, accompanied by underlying dysfunctional metabolism and autophagy. Low-intensity exercise was capable of regulating abnormal protein synthesis and degradation and protecting against ICI-induced cardiotoxicity. This study adds knowledge to the characterization of still unclear clinical manifestations of ICI-induced cardiotoxicity, underlying signaling pathways that could shed light on potential pharmacological treatment targets, as well as the protective effects of low-intensity exercise as a non-pharmacological treatment strategy. Full article
(This article belongs to the Special Issue Exercise and Cancer Treatment: The Clinical Application of Exercise Oncology)
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20 pages, 1180 KB  
Article
Associations of Breast Cancer Treatments with One-Year Changes in Health-Related Fitness
by Fernanda Z. Arthuso, Ki-Yong An, Qinggang Wang, Renée L. Kokts-Porietis, Andria R. Morielli, Margaret L. McNeely, Jeff K. Vallance, S. Nicole Culos-Reed, Gordon J. Bell, Leanne Dickau, Myriam Filion, Stephanie M. Ntoukas, Jessica McNeil, Lin Yang, Charles E. Matthews, Christine M. Friedenreich and Kerry S. Courneya
Cancers 2025, 17(24), 4026; https://doi.org/10.3390/cancers17244026 - 17 Dec 2025
Cited by 1 | Viewed by 1018
Abstract
Background/Objectives: Early-stage breast cancer treatments adversely affect components of health-related fitness (HRF) important for treatment tolerability, recovery, and long-term outcomes. Few studies have examined cancer treatment modality-specific effects on HRF. We examined associations of breast cancer treatment modalities, regimens, and combinations with one-year [...] Read more.
Background/Objectives: Early-stage breast cancer treatments adversely affect components of health-related fitness (HRF) important for treatment tolerability, recovery, and long-term outcomes. Few studies have examined cancer treatment modality-specific effects on HRF. We examined associations of breast cancer treatment modalities, regimens, and combinations with one-year changes in HRF. Methods: Newly diagnosed early-stage breast cancer patients were recruited between 2012 and 2019 for the Alberta Moving Beyond Breast Cancer (AMBER) cohort study. HRF assessments were completed within 90 days of diagnosis and at one year, including cardiorespiratory fitness, muscle strength and endurance, and body composition. Analysis of covariance was used to test whether HRF changes differed between treatment modalities, regimens, and combinations. All tests were 2-sided. Results: A total of 1350 participants (mean [SD] age, 55.6 [10.7] years) were included. Women who received chemotherapy (n = 797; 59%) experienced statistically significant smaller increases in upper body strength (−1.7 kg, 95% confidence interval [CI]: −3.0 to −0.5), greater declines in lower body endurance (−118.0 kg, 95%CI: −216.6 to −19.3), and greater declines in total lean mass (−0.7 kg, 95%CI: −1.1 to −0.3), bone mineral density (−0.01 g/cm2, 95%CI: −0.02 to 0.00), and bone mineral content (0.04 kg, 95%CI: −0.06 to −0.02). Other treatment modalities were modestly and inconsistently associated with HRF changes. Treatment combinations that included chemotherapy had the most negative impact on cardiorespiratory fitness and body composition. Conclusions: Chemotherapy—either alone or in combination with other treatments—had the largest and broadest negative impact on HRF recovery in early-stage breast cancer at one-year follow-up. Full article
(This article belongs to the Special Issue Exercise and Cancer Treatment: The Clinical Application of Exercise Oncology)
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11 pages, 2248 KB  
Article
Exercise Delays Human Leukemia Progression and Mitigates Graft-Versus-Host Disease After Donor Lymphocyte Infusion in Xenogeneic Mice
by Helena Batatinha, Nicole A. Peña, Giovannah A. Hoskin, Timothy M. Kistner, Douglass M. Diak, Grace M. Niemiro, Emmanuel Katsanis and Richard J. Simpson
Cancers 2025, 17(17), 2826; https://doi.org/10.3390/cancers17172826 - 29 Aug 2025
Viewed by 1500
Abstract
Background: Donor lymphocyte infusion (DLI) is employed to enhance the graft-versus-leukemia (GvL) effect and improve remission rates following allogeneic hematopoietic cell transplantation (alloHCT). However, graft-versus-host disease (GvHD) remains a significant complication of both alloHCT and DLI. Regular exercise has been shown to reduce [...] Read more.
Background: Donor lymphocyte infusion (DLI) is employed to enhance the graft-versus-leukemia (GvL) effect and improve remission rates following allogeneic hematopoietic cell transplantation (alloHCT). However, graft-versus-host disease (GvHD) remains a significant complication of both alloHCT and DLI. Regular exercise has been shown to reduce cancer risk, enhance treatment responses, and mitigate therapy-related toxicities. This study investigated the effects of voluntary wheel running on GvL and GvHD following DLI in a xenogeneic mouse model. Methods: Immunodeficient NSG-IL15 mice were challenged with a luciferase-expressing chronic myelogenous leukemia cell line (K562), and then they received DLI with peripheral blood mononuclear cells (PBMCs) from healthy volunteers (GvL model). Non-tumor bearing mice received DLI to model GvHD. Half of the mice in each group were then given free access to a running wheel. Tumor growth (bioluminescence), GvHD, and body weight were monitored biweekly for ~40 days. Results: In the GvHD model, exercise extended overall survival by 60% and reduced GvHD severity. In the GvL model, exercise significantly lowered tumor burden and extended tumor-free survival in both DLI and vehicle control groups by 44.5% and 37.5%, respectively, suggesting both immune-dependent and immune-independent mechanisms. RNA sequencing of bone marrow from saline-injected mice revealed that genes associated with mitochondrial function, protein synthesis, and metabolic processes were downregulated in tumors from exercised mice. Conclusions: In summary, voluntary wheel running improved DLI outcomes by enhancing GvL and reducing GvHD. These benefits may be mediated, in part, through exercise-induced metabolic reprogramming of leukemia cells. Full article
(This article belongs to the Special Issue Exercise and Cancer Treatment: The Clinical Application of Exercise Oncology)
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