The research, published in Supportive Care in Cancer, involved twelve adults with advanced bladder or renal cancer receiving immune checkpoint inhibitor therapy at a tertiary cancer centre in London. Through individual semi-structured interviews lasting between 34 and 69 minutes, the team led by Nicola Peat of Guy’s and St Thomas’ Hospital NHS Foundation Trust explored how patients perceive and experience physical activity during immunotherapy. The interviews were transcribed verbatim and analysed using Braun and Clarke’s six-phase thematic analysis, a rigorous framework for identifying patterns across qualitative data. Four main themes emerged: the purpose of physical activity participation, the factors that help or hinder it, the striking lack of support from healthcare professionals, and the kind of support patients actually want.

The scientific rationale for the study is compelling. Physical activity is known to mitigate many cancer treatment side-effects, including fatigue and anxiety, and is associated with improved physical function and health-related quality of life across cancer populations. More intriguingly, emerging evidence suggests exercise may exert immunomodulatory effects that contribute directly to tumour control. In preclinical research, moderate-intensity exercise has been shown to reduce tumour size by mobilising highly differentiated natural killer cells and increasing the infiltration of CD8-positive T cells into tumours, the very immune mechanisms that checkpoint inhibitors are designed to enhance. This has led researchers to propose that exercise may have both a conditioning effect and a tumour immune surveillance effect, potentially amplifying the benefits of immunotherapy itself.

Current guidelines recommend that adults with cancer engage in at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic exercise per week, plus two resistance-training sessions. Yet physical activity levels typically decline after a cancer diagnosis, with fewer than 30 percent of individuals meeting these recommendations. The new study reveals how this gap plays out in the lives of patients on immunotherapy. Most participants described a decline in activity following diagnosis, driven by frequent hospital visits, debilitating side-effects, and a simple lack of knowledge about what was safe or beneficial. Fatigue emerged as the dominant barrier, with one participant describing having absolutely no energy, and another attributing profound exhaustion to treatment-induced pituitary and thyroid dysfunction, telling researchers they were more worn out than during their army days.

Pain also limited movement, particularly where cancer had spread to bones in the hip and leg, while nausea, vomiting, skin rash and itchiness added further obstacles. Psychological factors mattered too. One participant described falling into a dark period after diagnosis, spending most days in bed with the blanket over their head, and reflected that help to snap out of it might have changed everything. Notably, the study identified barriers unique to checkpoint inhibitor therapy: endocrine-related fatigue, nausea and skin symptoms that fluctuate across treatment cycles, creating a moving target for both patients and anyone prescribing exercise. Social support cut both ways, with some patients encouraged by family members to walk to the shops, and others told by worried relatives to cancel gym memberships and rest.

Against these barriers, participants described powerful motivations. Physical activity represented independence, normalcy and control, a way of living life on their own terms. Walking was the most common activity, woven into daily routines such as commuting, shopping and playing with grandchildren. Immunotherapy itself acted as a beacon of hope, with one patient describing the treatment as a last chance of survival and a reason to be as fit and well as possible. Participants also credited exercise with lifting mood, managing comorbidities such as pre-diabetes, and easing fatigue and pain, with one describing how supervised treadmill sessions at the cancer centre gym restored the ability to walk at a good pace and take grandchildren to the park. Several described physical activity as their therapy place, a source of routine, sanctuary and a happiness factor.

The most striking finding, however, was the silence of the clinical team. Every participant reported receiving little or no physical activity advice during routine appointments. Some recalled only vague encouragement to keep doing what they were doing, while the majority received nothing at all. When asked whether advice would have helped, all but one said yes, with one patient noting that information about exercise would totally have changed the way they felt about it. Several said that simply reading the study information sheet sparked a desire to become more active, and argued that such information should be given to patients at the start of treatment. Participants perceived that clinicians prioritised drug-based management of side-effects over conversations about movement, and physiotherapy referrals, when they occurred, focused on managing impairments rather than broader activity benefits.

What patients want, the study found, is structured, personalised and expert-led support rather than leaflets or generic exhortations. They wanted someone to show them the right exercises for their specific tumour sites and limitations, trusted professionals with knowledge of both cancer and exercise, clear targets and progress tracking, and flexible programmes that accommodate the good and bad days of treatment cycles. Walking and strength training were the most favoured activities, followed by cycling and swimming, and participants favoured hybrid models combining supervised hospital or gym sessions with home-based activity. Crucially, they endorsed a periodised, auto-regulated approach, doing less during treatment weeks and more in the weeks after, an approach consistent with research showing that chemotherapy-periodised exercise improves adherence and symptom management compared with linear progression.

The authors argue that structured physical activity is a promising but underutilised strategy for managing cancer and treatment-related side-effects during checkpoint inhibitor therapy, and that these patients have distinct needs requiring personalised support. Their recommendations include embedding professionals with cancer-specific exercise expertise, such as physiotherapists, directly into cancer clinics and care pathways, improving referral routes to rehabilitation specialists, and training healthcare professionals to close knowledge and confidence gaps. Prior research suggests only between 6 and 44 percent of cancer patients receive physical activity information during oncology appointments, and this study suggests immunotherapy patients are no exception. Given exercise’s potential to enhance both quality of life and possibly immunotherapy response, the researchers call for future studies to evaluate which checkpoint inhibitor side-effects can be mitigated through activity, and to test accessible, scalable interventions across patient groups.

The study has limitations. Recruitment came from a single UK tertiary centre with a relatively homogeneous group of bladder and renal cancer patients, all receiving checkpoint inhibitors, which may limit generalisability to broader populations or other treatments. The supportive context of the specialist unit and good transport links may also have under-represented socioeconomic and environmental barriers reported elsewhere. Nevertheless, the methodology was rigorous, reported against the COREQ checklist, with ethical approval, member-checked transcripts and reflexive analysis. For patients whose treatment is their last hope of survival, the message from this research is clear: they want to move, they believe movement helps, and the healthcare system needs to start telling them how.

Subject of Research: Patient perspectives and experiences of physical activity during immune checkpoint inhibitor treatment for advanced urological cancers

Article Title: Physical activity in advanced urological cancers undergoing immune checkpoint inhibitor treatment: a qualitative study exploring patient perspectives and experiences

Article References: Peat, N., Jones, G. D., Veal, I., Kinsella, N., Karagiannis, S. N., & Van Hemelrijck, M. (2026). Physical activity in advanced urological cancers undergoing immune checkpoint inhibitor treatment: a qualitative study exploring patient perspectives and experiences. Supportive Care in Cancer, 34(10), Article 963. https://doi.org/10.1007/s00520-026-11195-8

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11195-8

Keywords: physical activity, immune checkpoint inhibitors, immunotherapy, bladder cancer, renal cancer, urological cancer, qualitative research, exercise oncology, cancer rehabilitation, fatigue, supportive care, patient perspectives