BACKGROUND: Participation in cardio-oncological rehabilitation is low, and the effects incline to decrease after the initial rehabilitation term. Home-based exercise has the potential to enhance involvement in cardio-oncology rehabilitation and was demonstrated to be feasible, safe, and helpful in increasing short-term cardiorespiratory fitness. The lasting effects on cardiorespiratory fitness and physical activity are uncertain. Hence, a novel approach via telehealth management based on objectively measured exercise at home was proposed. OBJECTIVES: To improve self-monitoring, such as self-confidence, behavioral change, and goal setting for individual exercise, and afterward, increase long-term effects concerning cardiorespiratory fitness. DESIGN: This randomized controlled trial compares a 12-week guided home exercise telehealth intervention with a center-based exercise intervention of the same duration and intensity of exercise in lymphoma cancer survivors entering cardio-oncology rehabilitation after treatment. Participants will be instructed to exercise gradually at 60-85% of their maximum heart rate for 30-50 min 3 times a week. Participants will receive individual remote guidance (feedback about frequency, duration, and exercise intensity) by preferred contact (phone call, text message) once a week based on shared exercise data through the web platform. The primary outcome is a change in cardiorespiratory fitness expressed as maximal oxygen uptake assessed through cardiopulmonary exercise test at baseline, 12 weeks, and 1 year. Secondary objectives are quality of life, muscle strength, body composition, incidence of adverse events, and exercise adherence. This study will determine whether a telehealth model is effective and safe compared to a center-based model in cancer survivors and whether exercise prescriptions are followed by participants. Additionally, an overview of the long-term effectiveness of telehealth cardio-oncology rehabilitation will be provided. This approach aligns with the trend of moving non-complex healthcare services into the patients' home environment. TRIAL REGISTRATION: ClinicalTrials.Gov Identifier: NCT05779605.

Clinical Exercise Physiology and Rehabilitation Research Laboratory Physiotherapy Department School of Health Sciences University of Thessaly Lamia Greece

Department of Internal Medicine and Cardiology University Hospital Brno Brno Czech Republic

Department of Internal Medicine Hematology and Oncology University Hospital Brno Brno Czech Republic

Department of Physiotherapy and Rehabilitation Faculty of Medicine Masaryk University Brno Czech Republic

Department of Rehabilitation and Sports Medicine 2nd Faculty of Medicine Charles University University Hospital Motol Prague Czech Republic

Department of Rehabilitation University Hospital Brno Brno Czech Republic

School of Nursing Tung Wah College Hong Kong China

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Shapiro CL. Cancer survivorship. New Engl J Med. 2018;379:2438–50. 10.1056/NEJMra1712502 PubMed DOI

Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2020;68(6):394–424. PubMed

Bower JE. Cancer-related fatigue–mechanisms, risk factors, and treatments. Nat Rev Clin Oncol. 2014;11:597–609. 10.1038/nrclinonc.2014.127 PubMed DOI PMC

Vejpongsa P, Yeh ET. Prevention of anthracycline-induced cardiotoxicity: challenges and opportunities. J Am Coll Cardiol. 2014;64:938–45. 10.1016/j.jacc.2014.06.1167 PubMed DOI

Phillips JL, Currow DC. Cancer as a chronic disease. Collegian. 2010;17:47–50. 10.1016/j.colegn.2010.04.007 PubMed DOI

Schmitz KH, Campbell AM, Stuiver M, Pinto BM, Schwartz AL, Morris GS, et al. exercise is medicine in oncology: engaging clinicians to help patients move through cancer. CA Cancer J Clin. 2019;69:468–84. 10.3322/caac.21579 PubMed DOI PMC

Spence RR, Heesch KC, Brown WJ. Exercise and cancer rehabilitation: a systematic review. Cancer Treat Rev. 2010;36:185–94. 10.1016/j.ctrv.2009.11.003 PubMed DOI

Stubblefield MD. The underutilization of rehabilitation to treat physical impairments in breast cancer survivors. PMR. 2017;9:317–23. PubMed

Bjerring AW, Smeland KH, Stokke T, Haugaa KH, Holte E, Rösner A, Kiserud CE, Edvardsen T, Sarvari SI. Long-term cardiac effects of modern treatment for Hodgkin’s lymphoma. Cardiooncology. 2024;10(1):19. 10.1186/s40959-024-00222-4. 10.1186/s40959-024-00222-4 PubMed DOI PMC

Divakaran S, Lopez DM, Parks SM, Hainer J, Ng AK, Blankstein R, Di Carli MF, Nohria A. Functional testing, coronary artery calcifications, and outcomes in Hodgkin lymphoma survivors treated with chest radiation. Cardiooncology. 2023;9(1):5. 10.1186/s40959-023-00157-2. 10.1186/s40959-023-00157-2 PubMed DOI PMC

Shen R, Zou T. Association between cancer and cardiovascular toxicity: a nationwide cross-sectional study on NHANES 1999–2018. Cardiovasc Toxicol. 2024;24(4):351–64. 10.1007/s12012-024-09845-6. 10.1007/s12012-024-09845-6 PubMed DOI

Lee SF, Luque-Fernandez MA, Chen YH, Catalano PJ, Chiang CL, Wan EY, Wong IC, Chen MH, Ng AK. Doxorubicin and subsequent risk of cardiovascular diseases among survivors of diffuse large B-cell lymphoma in Hong Kong. Blood Adv. 2020;4(20):5107–17. 10.1182/bloodadvances.2020002737. 10.1182/bloodadvances.2020002737 PubMed DOI PMC

Antoniou V, Davos CH, Kapreli E, Batalik L, Panagiotakos DB, Pepera G. Effectiveness of home-based cardiac rehabilitation, using wearable sensors, as a multicomponent, cutting-edge intervention: a systematic review and meta-analysis. J Clin Med. 2022;11(13):3772. 10.3390/jcm11133772. 10.3390/jcm11133772 PubMed DOI PMC

Thomas RJ, Beatty AL, Beckie TM, Brewer LC, Brown TM, Forman DE, Franklin BA, Keteyian SJ, Kitzman DW, Regensteiner JG, Sanderson BK, Whooley MA. Home-based cardiac rehabilitation: a scientific statement from the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Heart Association, and the American College of Cardiology. Circulation. 2019;140(1):e69–89. 10.1161/CIR.0000000000000663. 10.1161/CIR.0000000000000663 PubMed DOI

Ijsbrandy C, Hermens RPM, Boerboom LWM, Gerritsen WR, van Harten WH, Ottevanger PB. Implementing physical activity programs for patients with cancer in current practice: patients’ experienced barriers and facilitators. J Cancer Surviv. 2019;13:703–12. 10.1007/s11764-019-00789-3 PubMed DOI PMC

Batalik L, Chamradova K, Winnige P, Dosbaba F, Batalikova K, Vlazna D, et al. Effect of exercise-based cancer rehabilitation via telehealth: a systematic review and meta-analysis. BMC Cancer. 2024;24(1):600. 10.1186/s12885-024-12348-w PubMed DOI PMC

Stefani L, Klika R, Mascherini G, Mazzoni F, Lunghi A, Petri C, et al. Effects of a home-based exercise rehabilitation program for cancer survivors. J Sports Med Phys Fitness. 2019;59:846–52. 10.23736/S0022-4707.18.08908-9 PubMed DOI

Filakova K, Janikova A, Felsoci M, et al. Home-based cardio-oncology rehabilitation using a telerehabilitation platform in hematological cancer survivors: a feasibility study. BMC Sports Sci Med Rehabil. 2023;15(1):38. 10.1186/s13102-023-00650-2. Published 2023 Mar 23. 10.1186/s13102-023-00650-2 PubMed DOI PMC

Batalik L, Filakova K, Radkovcova I, et al. Cardio-oncology rehabilitation and telehealth: rationale for future integration in supportive care of cancer survivors. Front Cardiovasc Med. 2022;9:858334. 10.3389/fcvm.2022.858334. Published 2022 Apr 15. 10.3389/fcvm.2022.858334 PubMed DOI PMC

Mikkelsen MK, et al. The effect of a supervised exercise intervention on physical activity and quality of life in cancer survivors: a randomized controlled trial. Acta Oncol. 2016;55(10):1367–74.

Lahart IM, et al. The effects of home-based exercise interventions on health-related quality of life in cancer survivors: a systematic review and meta-analysis. Psychooncology. 2018;27(7):1675–87. PubMed

Buffart LM, et al. Physical and psychosocial benefits of home-based exercise training for cancer survivors: a systematic review and meta-analysis. Psychooncology. 2017;26(9):1239–51. PubMed

Rossi A, Garber CE, Ortiz M, Shankar V, Goldberg GL, Nevadunsky NS. Feasibility of a physical activity intervention for obese, socioculturally diverse endometrial cancer survivors. Gynecol Oncol. 2016;142:304–10. 10.1016/j.ygyno.2016.05.034 PubMed DOI

Sagarra-Romero L, Butragueño J, Gomez-Bruton A, Lozano-Berges G, Vicente-Rodríguez G, Morales JS. Effects of an online home-based exercise intervention on breast cancer survivors during COVID-19 lockdown: a feasibility study. Support Care Cancer. 2022;30(7):6287–97. 10.1007/s00520-022-07069-4. 10.1007/s00520-022-07069-4 PubMed DOI PMC

Velikova G, Booth L, Smith AB, et al. Measuring quality of life in routine oncology practice improves communication and patient well-being: a randomized controlled trial. J Clin Oncol. 2004;22(4):714–24. 10.1200/JCO.2004.06.078. 10.1200/JCO.2004.06.078 PubMed DOI

Schmitz KH, Courneya KS, Matthews C, et al. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors [published correction appears in Med Sci Sports Exerc. 2011 Jan;43(1):195]. Med Sci Sports Exerc. 2010;42(7):1409–26. 10.1249/MSS.0b013e3181e0c112. 10.1249/MSS.0b013e3181e0c112 PubMed DOI

Caan BJ, Cespedes Feliciano EM, Kroenke CH. The importance of body composition in explaining the overweight paradox in cancer-counterpoint. Cancer Res. 2018;78(8):1906–12. 10.1158/0008-5472.CAN-17-3287. 10.1158/0008-5472.CAN-17-3287 PubMed DOI PMC

World Health Organization. International Clinical Trial Registry Platform: trial registration data set (version 1.3). World Health Organization; 2017. Available at: https://www.who.int/clinical-trials-registry-platform/network/who-data-set. Cit. 23.5.2021.

Miller WR, Rollnick S. Motivational interviewing: helping people change. New York: Guilford Press; 2012.

Campbell KL, Winters-Stone KM, Wiskemann J, May AM, Schwartz AL, Courneya KS, et al. Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable. Med Sci Sports Exerc. 2019;51:2375–90. 10.1249/MSS.0000000000002116 PubMed DOI PMC

Janicki GJ, Porcari JP, Jagim AR, Emineth K, Dorberstein S, et al. The accuracy of heart rate and energy expenditure measurements using the PolarM430 watch during exercise. Int J Res Ex Phys. 2020;15(2):91–105.

Etiwy M, Akhrass Z, Gillinov L, et al. Accuracy of wearable heart rate monitors in cardiac rehabilitation [published correction appears in Cardiovasc Diagn Ther. 2020 Jun;10(3):644-645]. Cardiovasc Diagn Ther. 2019;9(3):262–71. 10.21037/cdt.2019.04.08. 10.21037/cdt.2019.04.08 PubMed DOI PMC

Gloc D, Nowak Z, Nowak-Lis A, et al. Indoor cycling training in rehabilitation of patients after myocardial infarction. BMC Sports Sci Med Rehabil. 2021;13(1):151. 10.1186/s13102-021-00379-w. Published 2021 Nov 29. 10.1186/s13102-021-00379-w PubMed DOI PMC

Viamonte SG, Joaquim AV, Alves A, et al. Impact of a COmprehensive cardiac REhabilitation framework among high cardiovascular risk cancer survivors: protocol for the CORE trial. Int J Cardiol. 2023;371:384–90. 10.1016/j.ijcard.2022.09.075. 10.1016/j.ijcard.2022.09.075 PubMed DOI

Schmid D, Leitzmann MF. Cardiorespiratory fitness as predictor of cancer mortality: a systematic review and meta-analysis. Ann Oncol. 2015;26(2):272–8. 10.1093/annonc/mdu250 PubMed DOI

Gitt AK, et al. Peak oxygen uptake – a critical reappraisal with reference to the new recommendations of the European Society of Cardiology. Eur Heart J. 2002;23(9):1332–6.

Hansen JE, Sue DY, Wasserman K. Predicted values for clinical exercise testing. Am Rev Respir Dis. 1984;129(2 Pt 2):S49-55. 10.1164/arrd.1984.129.2P2.S49 PubMed DOI

Guazzi M, Adams V, Conraads V, Halle M, Mezzani A, Vanhees L, et al. EACPR/AHA Scientific Statement. Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Circulation. 2012;126:2261–74. 10.1161/CIR.0b013e31826fb946 PubMed DOI PMC

Mezzani A, et al. Aerobic exercise intensity assessment and prescription in cardiac rehabilitation: a joint position statement of the European Association for Cardiovascular Prevention and Rehabilitation, the American Association of Cardiovascular and Pulmonary Rehabilitation, and the Canadian Association of Cardiac Rehabilitation. Eur J Prev Cardiol. 2009;16(4):375–82. PubMed

Petr P. Dotazník SF-36 o kvalitě života podmíněné zdravím. Kontakt. 2000;2:26–30.

Aaronson NK, Muller M, Cohen PD, Essink-Bot ML, Fekkes M, Sanderman R, et al. Translation, validation, and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations. J Clin Epidemiol. 1998;51:1055–68. 10.1016/S0895-4356(98)00097-3 PubMed DOI

Hawley-Hague H, et al. The feasibility of recruiting older adults to a community-based exercise programme: a mixed-methods study. BMC Public Health. 2014;14:650. PubMed

Marcus BH, Williams DM, Dubbert PM, et al. Physical activity intervention studies: what we know and what we need to know: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity); Council on Cardiovascular Disease in the Young; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research. Circulation. 2006;114(24):2739–52. 10.1161/CIRCULATIONAHA.106.179683 PubMed DOI

Drummond MF, et al. Methods for the economic evaluation of health care programmes. 4th ed. Oxford: Oxford University Press; 2015.

Kraal JJ, Van den Akker-Van Marle ME, Abu-Hanna A, Stut W, Peek N, Kemps HM. Clinical and cost-effectiveness of home-based cardiac rehabilitation compared to conventional, centre-based cardiac rehabilitation: results of the FIT@Home study. Eur J Prev Cardiol. 2017;24(12):1260–73. 10.1177/2047487317710803. 10.1177/2047487317710803 PubMed DOI PMC

Batalik L, Filakova K, Sladeckova M, Dosbaba F, Su J, Pepera G. The cost-effectiveness of exercise-based cardiac telerehabilitation intervention: a systematic review. Eur J Phys Rehabil Med. 2023;59(2):248–58. 10.23736/S1973-9087.23.07773-0. 10.23736/S1973-9087.23.07773-0 PubMed DOI PMC

Gresham G, et al. Wearable activity monitors in oncology trials: current use of an emerging technology. Contemp Clin Trials. 2018;64:13–21. 10.1016/j.cct.2017.11.002 PubMed DOI PMC

Caperchione CM, et al. An interdisciplinary approach to understanding the cost-effectiveness of supervised and unsupervised physical activity programs among breast cancer survivors. Cancer Causes Control. 2019;30(8):873–80.

Snoswell CL, Taylor ML, Comans TA, Smith AC, Gray LC, Caffery LJ. Determining if telehealth can reduce health system costs: scoping review. J Med Internet Res. 2020;22(10):e17298. 10.2196/17298. Published 2020 Oct 19. 10.2196/17298 PubMed DOI PMC

Polisena J, Coyle D, Coyle K, McGill S. Home telehealth for chronic disease management: a systematic review and an analysis of economic evaluations. Int J Technol Assess Health Care. 2009;25(3):339–49. 10.1017/S0266462309990201. 10.1017/S0266462309990201 PubMed DOI

Kim EY, Kim SR, Won DD, Choi MH, Lee IK. Multifrequency bioelectrical impedance analysis compared with computed tomography for assessment of skeletal muscle mass in primary colorectal malignancy: a predictor of short-term outcome after surgery. Nutr Clin Pract. 2020;35(4):664–74. 10.1002/ncp.10363. 10.1002/ncp.10363 PubMed DOI

Ogawa H, Fujitani K, Tsujinaka T, et al. InBody 720 as a new method of evaluating visceral obesity. Hepatogastroenterology. 2011;58(105):42–4. PubMed

Zhuang CL, Zhang FM, Li W, et al. Associations of low handgrip strength with cancer mortality: a multicentre observational study. J Cachexia Sarcopenia Muscle. 2020;11(6):1476–86. 10.1002/jcsm.12614. 10.1002/jcsm.12614 PubMed DOI PMC

Loke YK, et al. Systematic review of adverse effects: framework for a structured approach. BMC Med Res Methodol. 2006;6:22. PubMed PMC

Courneya KS, Sellar CM, Stevinson C, McNeely ML, Peddle CJ, Friedenreich CM, Tankel K, Basi S, Chua N, Mazurek A, Reiman T. Randomized controlled trial of the effects of aerobic exercise on physical functioning and quality of life in lymphoma patients. J Clin Oncol. 2009;27:4605–12. 10.1200/JCO.2008.20.0634 PubMed DOI

Courneya KS, Sellar CM, Trinh L, et al. A randomized trial of aerobic exercise and sleep quality in lymphoma patients receiving chemotherapy or no treatments. Cancer Epidemiol Biomarkers Prev. 2012;21(6):887–94. 10.1158/1055-9965.EPI-12-0075. 10.1158/1055-9965.EPI-12-0075 PubMed DOI

Streckmann F, Kneis S, Leifert JA, et al. Exercise program improves therapy-related side-effects and quality of life in lymphoma patients undergoing therapy. Ann Oncol. 2014;25(2):493–9. 10.1093/annonc/mdt568. 10.1093/annonc/mdt568 PubMed DOI

Furzer BJ, Ackland TR, Wallman KE, et al. A randomised controlled trial comparing the effects of a 12-week supervised exercise versus usual care on outcomes in haematological cancer patients. Support Care Cancer. 2016;24(4):1697–707. 10.1007/s00520-015-2955-7. 10.1007/s00520-015-2955-7 PubMed DOI

Morrison KS, Paterson C, Toohey K. The feasibility of exercise interventions delivered via telehealth for people affected by cancer: a rapid review of the literature. Semin Oncol Nurs. 2020;36(6):151092. 10.1016/j.soncn.2020.151092. 10.1016/j.soncn.2020.151092 PubMed DOI

Batalik L, Winnige P, Dosbaba F, Vlazna D, Janikova A. Home-based aerobic and resistance exercise interventions in cancer patients and survivors: a systematic review. Cancers (Basel). 2021;13(8):1915. 10.3390/cancers13081915. Published 2021 Apr 15. 10.3390/cancers13081915 PubMed DOI PMC

Hills AP, Mokhtar N, Byrne NM. Assessment of physical activity and energy expenditure: an overview of objective measures. Front Nutr. 2014;1:5. 10.3389/fnut.2014.00005. Published 2014 Jun 16. 10.3389/fnut.2014.00005 PubMed DOI PMC

Gilchrist SC, Barac A, Ades PA, et al. Cardio-oncology rehabilitation to manage cardiovascular outcomes in cancer patients and survivors: a scientific statement from the American Heart Association. Circulation. 2019;139(21):e997–1012. 10.1161/CIR.0000000000000679. 10.1161/CIR.0000000000000679 PubMed DOI PMC

Brouwers RWM, Kemps HMC, Herkert C, Peek N, Kraal JJ. A 12-week cardiac telerehabilitation programme does not prevent relapse of physical activity levels: long-term results of the FIT@Home trial. Eur J Prev Cardiol. 2022;29(7):e255–7. 10.1093/eurjpc/zwac009. 10.1093/eurjpc/zwac009 PubMed DOI

Antoniou V, Kapreli E, Davos CH, Batalik L, Pepera G. Safety and long-term outcomes of remote cardiac rehabilitation in coronary heart disease patients: a systematic review. Digit Health. 2024;10:20552076241237660. 10.1177/20552076241237661. Published 2024 Mar 25. 10.1177/20552076241237661 PubMed DOI PMC

Pepera G, Antoniou V, Su JJ, Lin R, Batalik L. Comprehensive and personalized approach is a critical area for developing remote cardiac rehabilitation programs. World J Clin Cases. 2024;12(12):2009–15. 10.12998/wjcc.v12.i12.2009. 10.12998/wjcc.v12.i12.2009 PubMed DOI PMC

Goode AD, Reeves MM, Eakin EG. Telephone-delivered interventions for physical activity and dietary behavior change: an updated systematic review. Am J Prev Med. 2012;42(1):81–8. 10.1016/j.amepre.2011.08.025 PubMed DOI

Argent R, Daly A, Caulfield B. Patient involvement with home-based exercise programs: can connected health interventions influence adherence? JMIR Mhealth Uhealth. 2018;6(3):e47. 10.2196/mhealth.8518. Published 2018 Mar 1. 10.2196/mhealth.8518 PubMed DOI PMC

Rabin C, Bock B. Desired features of smartphone applications promoting physical activity. Telemed J E Health. 2011;17(10):801–3. 10.1089/tmj.2011.0055 PubMed DOI

Chakrabarti O. Telehealth: emerging evidence on efficiency. Int Rev Econ Financ. 2019;60:257–64.10.1016/j.iref.2018.10.021 DOI

Národní strategie elektronického zdravotnictví ČESKÉ REPUBLIKY. Ministerstvo zdravotnictví České republiky; 2016. Available at: https://ncez.mzcr.cz/sites/default/files/Attachment/Narodni_strategie_elektronickeho_zdravotnictvi_v1.0_1.pdf. Cit. 31.5.2021.

Těšinová JK, Dobiášová K, Dušek Z, Tobiášová A. Development of telemedicine in the Czech Republic from patients' and other key stakeholders' perspective. Front Public Health. 2023;11:1202182. Published 2023 Oct 23. 10.3389/fpubh.2023.1202182. PubMed PMC

Kasi PM, Tawbi HA, Oddis CV, Kulkarni HS. Clinical review: Serious adverse events associated with the use of rituximab - a critical care perspective. Crit Care. 2012;16(4):231. 10.1186/cc11304. Published 2012 Aug 31. 10.1186/cc11304 PubMed DOI PMC

Feasibility, safety, and adherence of home-based exercise interventions in people diagnosed with cancer: a systematic review

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NCT05779605