Effects of a remote physical activity program on immune-related side effects and quality of life: A Brazilian study.
Authors: Bergerot Paulo Gustavo , Bergerot Cristiane Decat , Silva Jonas Ribeiro Gomes , Paes Marcio Almeida , Farias Janice , Lages Dr. Paulo Sergio , Fuzita William Hiromi , Buso Daniel Sobreira de Oliveira , Matos Neto Joao Nunes , Portieri Prata Augusto , Ferreira Ana Carolina Salles de M. , Franca Marcos V S , Patriota Carolina Bezerra , Tapia Camila Donini , Hada Aline Lury , de Souza Douglas Manfroi , Azeredo Andressa Cardoso , Buso Murilo , Florez Narjust , Soto Pérez de Celis Enrique 
Published: October 2023

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Background: Immunotherapy has revolutionized cancer treatment, but immune-related side effects can significantly impact patients' quality of life and treatment outcomes. Physical activity and exercise have been shown to be beneficial in managing these adverse events. This study aims to investigate the effects of a low-cost and accessible remote physical activity program on quality of life and immune-related side effects in patients undergoing immunotherapy for solid tumors. Methods: Patients with cancer who were undergoing immunotherapy, either as monotherapy or in combination with other treatments, were enrolled in the study. Recruitment took place within a network of cancer practices in Brazil. Eligible patients were offered participation in a 12-week supervised and remote physical activity program, which encompassed resistance exercise, aerobic exercise, and mobility exercises. Assessment of patients was conducted at two time points: baseline and a 3-month follow-up. The FACT-ICM, ESAS, and BFI scales were utilized to measure various aspects of patient well-being. Descriptive statistics were employed to summarize the data, and ANOVA-RM was employed to examine changes in these measures over time. Results: The study enrolled 38 patients receiving immunotherapy, with a high adherence rate of 87.5% to the remote physical activity program. The most prevalent cancer types were breast (26.3%), kidney (24.3%), and lung cancer (13.2%), with 68.4% of patients diagnosed with metastatic disease. Baseline assessment revealed common issues such as short-term treatment reactions (71.1%), fatigue (65.8%), and weakness (52.6%), which significantly improved at the 3-month follow-up (P<0.01). Notably, symptoms assessed through ESAS have significantly decreased over time: pain (21.1% vs 2.6%), fatigue (47.4% vs 16.1%), anxiety (36.8% vs 3.2%), depression (21.1% vs 3.2%), P=0.01. Overall, the mean score of quality of life (MT1=87.1 vs MT2=97.4, P=0.001) and fatigue (MT1=21.5 vs MT2=8.0, P=0.001) also showed an improvement over time. Conclusions: These findings demonstrate the potential benefits of a remote physical activity program in reducing immune-related side effects and enhancing quality of life in a Brazilian population. This study contributes to the limited existing literature on this subject. The remote aspect of the program can improve patient adherence and reduce costs. Further randomized controlled trials are needed to validate and build upon these promising results, enabling more comprehensive interventions for this patient population.