New research in the March 2026 issue JNCCN – National Comprehensive Cancer Network Journal It has been suggested that exercise, through chemotherapy given in fortnightly cycles, may help cancer patients become mentally sharp and better able to cope with daily life, work and social activities. In this first-of-its-kind, national, multicenter, Phase III trial, patients were randomly assigned to receive an exercise prescription, Exercise for Patients with Cancer (EXCAP©®). In addition to regular chemotherapy, this regimen includes personalized walking and simple resistance band exercises. By the end of the study, patients who underwent two-week chemotherapy cycles and followed the EXCAP exercise regimen while receiving chemotherapy reported less cognitive impairment than patients who received chemotherapy without an exercise plan. The effects were less pronounced in patients who received chemotherapy in 3- to 4-week cycles.
This means that safe and simple exercise programs can be an important part of supportive care for people undergoing chemotherapy. Cancer care providers should consider incorporating structured home exercise regimens, such as walking and resistance band exercise, into routine chemotherapy care. Healthcare providers should educate patients about these benefits, monitor cognitive and fatigue symptoms throughout treatment, refer patients to an exercise therapy oncologist as needed as part of optimal supportive care, and tailor prescriptions to individual abilities. ”
Karen M. Mustian, PhD, MPH, co-lead author, Wilmot Cancer Institute, University of Rochester Medical Center
The study enrolled 687 patients from 20 community oncology clinics across the United States affiliated with the University of Rochester Cancer Center (URCC) NCI Community Oncology Research Program (NCORP) Center of Excellence. Patients enrolled did not have distant metastases, and the majority were women, had undergone surgery, or had breast cancer. The patients were receiving chemotherapy for the first time and were enrolled in the trial between 2009 and 2014.
EXCAP participants received individual walking and resistance band instruction in a teach-back fashion to ensure correct technique. They were also instructed to record their daily steps with a pedometer and to keep a daily diary of the time they spent in resistance band activities. Patients who underwent two-week chemotherapy cycles and received the EXCAP regimen showed significantly less overall cognitive decline, cognitive impairment, and mental fatigue compared to patients receiving usual care. They were also able to maintain daily walking with chemotherapy, whereas those who did not participate in the exercise program saw a 53% reduction in walking.
“We were striking to find that without a structured exercise plan, patients undergoing chemotherapy experienced a reduction in daily walking volume by half and significantly increased problems with thinking, memory, and mental fatigue,” added co-lead author Po-Ju Lin, Ph.D., MPH, RD, also from the Wilmot Cancer Institute at the University of Rochester Medical Center. “Non-pharmacological interventions, such as exercise, cognitive training, and mindfulness, are important in managing cognitive impairment during chemotherapy because they are safe, accessible, often low-cost or can be performed even at home, and are more accessible to patients compared to expensive treatments or clinic-based treatments.”
The researchers acknowledged that during chemotherapy, “patients often walk less because the treatment can cause extreme fatigue, muscle weakness, nausea, and other side effects.” They noted that two-week chemotherapy cycles may be the “sweet spot” for patients to recover enough to participate in EXCAP, as patients on three- and four-week chemotherapy cycles showed no benefit. Future studies with expanded patient populations may further generalize these findings.
“Many patients who require chemotherapy are concerned that they will experience ‘chemical brain,'” commented Lindsay L. Peterson, MD, MSCR, a medical oncologist at Washington University School of Medicine in St. Louis who treats patients at Barnes-Jewish Hospital and WashU Medicine-based Siteman Cancer Center. He was not involved in this research. “This study provides encouraging news. There may be things patients can do to reduce their risk of cognitive impairment during chemotherapy and exercise.”
Dr. Peterson, who chairs the NCCN Oncology Clinical Practice Guidelines (NCCN Guidelines®) Survivors Committee, “Participants who received weekly chemotherapy and were randomized to an individualized exercise program reported less cognitive impairment, improved cognitive function, and less mental fatigue than the control group. For many patients, maintaining the ability to think clearly, remember details, and mentally focus during treatment is essential to maintaining independence, continuing to work, and staying mentally focused.” These findings support the NCCN Survivor Guidelines recommendation that survivors with cancer-related cognitive impairment engage in daily physical activity. Importantly, the NCCN Guidelines state that available, low-cost interventions, such as planned physical activity, not only support long-term survival, but also provide a powerful opportunity to help patients maintain cognitive function and mental strength. You will remain as resilient as possible during your treatment. ”
sauce:
National Comprehensive Cancer Network
Reference magazines:
Mustian, K.M. Others. (2026) Effect of exercise on cognitive impairment in patients receiving chemotherapy: a multicenter phase III randomized controlled trial. JNCCN – National Comprehensive Cancer Network Journal DOI: 10.6004/jnccn.2025.7118. https://jnccn.org/view/journals/jnccn/24/3/article-p91.xml
