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.

With over 12 million cancer survivors relying on supportive care across the EU, it is essential to provide them with (cost-)effective interventions tailored to their specific needs. Many survivors suffer from long-term side effects that can lower their quality of life (QoL), functioning, and productivity. Exercise interventions have proven to be uniquely beneficial in managing both physical and psychological complaints. However, their effects are strongest when tailored to a patient's specific burden, e.g. fatigue, low physical fitness, anxiety and depressive symptoms or chemotherapy-induced peripheral neuropathy. Moreover, the use of exercise interventions in supportive cancer care is still limited due to a lack of availability, a lack of accessibility caused by time and travel constraints and low awareness. To tackle these hurdles, the PREFERABLE-II consortium sets out to design and demonstrate the (cost-)effectiveness of a novel exercise intervention that: 1) will be tailored to the side effect that bothers the survivor the most, by use of a modular design, 2) can be implemented at home, with live-remote supervision from a national broadcast centre, 3) is available to all cancer survivors, and 4) incorporates improved patient-centred communication and shared decision making. Results of our RCT, enrolling 350 cancer survivors, will be translated into guideline recommendations for exercise-oncology. Extensive ethical, legal and social impact components of the project will reveal barriers and facilitators of live-remote supervised exercise and provide policy recommendations to further support implementation. Finally, we will create communication standards and an education module for healthcare professionals to train the future workforce. As such, PREFERABLE-II contributes to improving the QoL of cancer survivors by lowering the burden of side effects, while also improving availability, access and awareness off exercise-based supportive care interventions.

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.