Yvonne Wengström

Physical exercise has a protective effect against cancer recurrence and survival. Effects of physical training reduce systemic inflammation and increase anti-tumoral cell function as well as immune cell function. The effect of a training session in humans releases immune cells into the blood circulation, in mouse models where training has been tested effects can be demonstrated on reduced tumor growth. Physical training affects the possibility of undergoing chemotherapy without reducing the dose due to side effects, thus increasing the effect of the treatment on the tumor through anti-inflammatory effects and increasing the possibility of a full dose of the chemotherapy. Neoadjuvant chemotherapy is standard treatment today for patients with tumors larger than 20 mm and/or spread to lymph nodes. Evaluation of the effectiveness of neoadjuvant treatment is done by examining the effect on the tumor if there is any invasive tissue remaining after the treatment (pCR). The purpose of the study is to influence the effectiveness of the neoadjuvant treatment during ongoing treatment and thus reduce the need for locoregional treatment through physical exercise - a lifestyle intervention with few side effects. The effect of physical training on the effectiveness of neoadjuvant treatment has previously never been tested. The goal of the study is to study whether the training can improve the outcome of the treatment in a clinically relevant way. Quality of life, physical activity levels, muscle strength and fitness, side effects, cognitive impact, heart health and sick leave are also examined. The study will also investigate in a group of the participants how exercise affects anti-tumoral mechanisms that are important for the treatment through hypothesis-generating translational analyses.

Neoadjuvant chemotherapy (NACT) is increasingly used in breast cancer. The best proof of NACT efficacy is pathological complete response (pCR), i.e. the absence of invasive tumour on post-NACT surgical histopathology. While it is known that physical exercise can help patients to better tolerate and complete often harsh cancer treatments, it is an emerging area of research to understand if and how exercise exerts anti-tumour effects and improves oncological outcomes. The main aim of the Neo-ACT trial is to examine if a physical exercise intervention during NACT can increase pCR rates in breast cancer. Secondary aims are patient-related outcomes (health-related quality of life, physical activity), physiological outcomes (muscle strength, cardiorespiratory fitness), cancer treatment-related toxicities (cognitive dysfunction, chemotherapy completion rates) and long-term sick leave. Furthermore, the trial will explore how physical exercise affects anti-tumoral mechanisms inherent to therapy or host by hypothesis-generating translational analyses.712 patients with primary invasive breast cancer will be randomized to either a supervised intervention of high-intensity interval and resistance training during NACT, supported by an exercise app, or to usual care, and followed for two years. Physical activity is meticulously tracked. By offering patients active involvement, the trial contributes strongly to the concept of personalized medicine.

Advances in cancer therapy have led to more people surviving cancer. As cancer treatments become more effective, but also more aggressive, it also means that more people suffer from negative long-term effects such as disabilities, late side effects and symptoms of the treatment, which leads to a negative impact on quality of life and daily life. Physical exercise is an intervention that can counteract several of these harmful effects. There is today a demand among those who have undergone treatment for cancer to participate in customized training programs led by trained trainers, which today does not exist for people with cancer in Sweden. The purpose of the Ex-Med Cancer project is to develop, implement and evaluate a sustainable model for supportive care for patients with cancer by implementing evidence-based exercise medicine in existing exercise organizations in society that can be implemented and run by trained exercise leaders. People with various cancer diagnoses who have undergone adjuvant treatment for cancer will follow a care plan that involves four different parts

a referral, contact with a central coordinator, screening and a meeting with a training specialist at a gym (SATS) for participation in a 3-month training program. The results of the study will help people with cancer to gain access to evidence-based exercise medicine that is easily accessible in society with the support of exercise-specialized leaders. The results of the study will provide a basis for a national implementation of evidence-based training available to anyone who is diagnosed with cancer.

Advances in cancer therapy have led to more people surviving cancer. As cancer treatments become more effective, but also more aggressive, it also means that more people suffer from negative long-term effects such as disabilities, late side effects and symptoms of the treatment, which leads to a negative impact on quality of life and daily life. Physical exercise is an intervention that can counteract several of these harmful effects. There is today a demand among those who have undergone treatment for cancer to participate in customized training programs led by trained trainers, which today does not exist for people with cancer in Sweden. The purpose of the Ex-Med Cancer project is to develop, implement and evaluate a sustainable model for supportive care for patients with cancer by implementing evidence-based exercise medicine in existing exercise organizations in society that can be implemented and run by trained exercise leaders. People with various cancer diagnoses who have undergone adjuvant treatment for cancer will follow a care plan that involves four different parts

a referral, contact with a central coordinator, screening and a meeting with a training specialist at a gym (SATS) for participation in a 3-month training program. The results of the study will help people with cancer to gain access to evidence-based exercise medicine that is easily accessible in society with the support of exercise-specialized leaders. The results of the study will provide a basis for a national implementation of evidence-based training available to anyone who is diagnosed with cancer.