The Alliance for Clinical Trials in Oncology is spearheading a pioneering clinical trial that evaluates the feasibility and effectiveness of delivering a structured exercise regimen through telehealth to cancer patients undergoing chemotherapy. This innovative initiative, known as the DEFEND trial (Distance-based Exercise to Preserve Function and Prevent Disability), addresses the critical need to mitigate the debilitating effects of fatigue and functional decline commonly experienced during cancer treatment by leveraging advances in telemedicine. By bringing supervised resistance and aerobic exercise training directly into patients’ homes through virtual platforms, the study aims to revolutionize supportive care in oncology.
Traditionally, exercise interventions for cancer patients have required in-person attendance at rehabilitation centers or fitness facilities, presenting logistical challenges such as transportation barriers, scheduling conflicts, and treatment-related fatigue. DEFEND proposes a paradigm shift by harnessing remote technologies to deliver exercise programs. Specifically, participants will engage in twice-weekly supervised exercise sessions conducted via video calls, led by oncology-trained exercise coaches experienced in tailoring interventions to the unique physiological and psychosocial needs of cancer patients. This model not only facilitates accessibility and adherence but also maintains professional oversight critical to safety and efficacy.
Eligible participants, between the ages of 18 and 65, are currently receiving chemotherapy with curative intent. After enrollment, each will be equipped with resistance bands and a stationary bicycle, enabling a diverse range of strength and aerobic training exercises vital for maintaining muscular function and cardiovascular health. In addition, continuous activity monitoring will be employed using wearable devices such as Fitbit trackers, allowing objective quantification of physical activity levels throughout the intervention. This hybrid monitoring strategy integrates subjective and objective metrics, enhancing the granularity of data collected for rigorous analysis.
The DEFEND trial’s primary objective is to determine the feasibility of implementing a remote exercise intervention in a representative cohort of cancer patients. This encompasses evaluating recruitment capabilities, adherence rates, and retention, with a particular focus on inclusivity across diverse populations, including individuals from rural areas and underserved communities often excluded from conventional trials due to geographical or socioeconomic constraints. By addressing these disparities, the study aspires to create scalable models that could be broadly adopted in clinical oncology settings.
Secondary exploratory outcomes will assess changes in physical function, utilizing validated measures such as grip strength dynamometry and the 6-Minute Walk Test to quantify exercise-related improvements objectively. Furthermore, patient-reported outcomes capturing fatigue levels, quality of life, and employment status over time will be analyzed to elucidate the broader psychosocial impact of sustained exercise during chemotherapy. These multidimensional assessments are crucial given that cancer-associated fatigue is one of the most pervasive and disruptive symptoms adversely affecting patient well-being and functionality.
Crucially, DEFEND builds upon an expanding corpus of literature demonstrating exercise’s salutary effects in oncology, including reductions in treatment-related adverse effects and enhanced survival. Yet, despite robust evidence supporting exercise as a non-pharmacological adjunct therapy, implementation barriers have hindered its integration into routine care. The emergence of telehealth, accelerated by recent healthcare transformations, presents an unprecedented opportunity to surmount these barriers, making exercise interventions more accessible, personalized, and adaptable.
The trial’s design integrates oncology expertise with exercise science, deploying oncology-trained exercise coaches to deliver individualized guidance. These professionals will leverage telecommunication tools to safely modulate exercise intensity and address patient concerns in real time, ensuring that the program responds dynamically to fluctuations in treatment tolerance and side-effect profiles. This real-time interaction, combined with remote monitoring of adherence and physiological responses, exemplifies the forward-thinking integration of technology and clinical care.
By circumventing common logistical challenges such as transportation difficulties and fatigue-induced motivation losses, the DEFEND trial’s at-home exercise model aspires to achieve higher adherence and durability of physical activity behaviors. The anticipated maximum duration of the intervention is six months, coinciding with the chemotherapy treatment timeline, with assessments at baseline, chemotherapy completion, and three months post-treatment to evaluate both immediate and sustained effects.
If successful, the DEFEND trial could herald a transformative shift in oncology supportive care, establishing telehealth-delivered exercise programs as integral components of comprehensive cancer treatment protocols. Given the expanding embrace of telemedicine across healthcare disciplines, this model could serve as a blueprint for scalable interventions that enhance patient outcomes while mitigating the burden on healthcare infrastructure.
The trial is slated to commence participant enrollment in late 2025, with data collection culminating in early 2027. It is supported by the National Institutes of Health and the National Cancer Institute, underscoring the significance attributed to innovative supportive care strategies that promote physical function, reduce fatigue, and prevent disability—key determinants of cancer survivorship and quality of life.
In summary, the Alliance’s DEFEND trial embodies a confluence of technological innovation, clinical expertise, and patient-centered care, aiming to redefine the landscape of exercise oncology. By enabling virtual access to supervised training customized to the unique challenges faced by cancer patients during chemotherapy, DEFEND could demonstrate that fidelity to exercise interventions and meaningful clinical outcomes are attainable beyond traditional rehabilitation paradigms. This endeavor exemplifies a forward-thinking approach to harnessing telehealth for durable improvements in cancer care.
Subject of Research: People
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Web References: https://www.clinicaltrials.gov/study/NCT07059884
References: Alliance A222302 / NCT07059884 – Distance-based exercise to preserve function and prevent disability (DEFEND)
Image Credits: Dana-Farber Cancer Institute
Keywords: Oncology, Cancer, Breast cancer, Blood cancer, Bone cancer, Brain cancer, Physical exercise, Public health, Clinical trials, Chemotherapy, Radiation therapy, Physical rehabilitation, Physical therapy, Personalized medicine, Wearable devices
