New research in the March 2026 issue of JNCCN-Journal of the National Comprehensive Cancer Network suggests that exercise can help people with cancer stay mentally sharp and better able to handle daily tasks, work and social activities through chemotherapy delivered in a two-week cycle. This first-of-its-kind, nationwide, multicenter, phase III trial randomized patients to receive an exercise prescription, Exercise for Cancer Patients (EXCAP©®), which included individually tailored walking and simple resistance band exercises, along with their usual chemotherapy. By the end of the study, patients who received 2-week cycles of chemotherapy who followed the EXCAP exercise regimen while receiving chemotherapy reported less cognitive impairment than those who received chemotherapy without an exercise regimen. The results were not as significant in patients who received chemotherapy in 3- to 4-week cycles.
This means that a safe, simple exercise program could be an important part of supportive care for people undergoing chemotherapy. Cancer care providers should consider incorporating structured home-based exercise regimens, such as walking and resistance band exercises, into routine chemotherapy. Providers should educate patients about these benefits, monitor cognitive and fatigue symptoms throughout treatment, and, as part of optimal supportive care, refer patients to oncology specialists when needed to tailor prescriptions for individual abilities.”
Karen M. Mustian, PhD, MPH, co-lead author, Wilmot Cancer Institute, University of Rochester Medical Center
The study involved 687 patients from 20 community oncology practices in the United States that are part of the University of Rochester Cancer Center’s (URCC) NCI Community Oncology Research Program (NCORP). Enrolled patients did not have distant metastases and the majority were female, had undergone surgery, and/or had breast cancer. Patients were receiving chemotherapy for the first time and were enrolled in the trial between 2009 and 2014.
EXCAP participants received individualized walking and resistance band instruction in a teaching method to ensure proper technique. They were also instructed to record daily steps via a pedometer and to keep a daily diary of time spent doing resistance band activities. Patients who received two-week cycles of chemotherapy prescribed EXCAP experienced significantly less overall cognitive decline, perceived cognitive impairment, and mental fatigue than those who received usual care. They were also able to maintain daily walking through chemotherapy, while those who did not participate in the exercise program reduced their walking by 53%.
“It was striking to find that without a structured exercise plan, patients receiving chemotherapy often cut their daily walking in half and showed marked increases in problems with thinking, memory, and mental fatigue,” added co-lead author Po-Ju Lin, PhD, MPH, RD, also with the Wilmot Cancer Institute, University of Rochester Medical Center. “Non-pharmacological interventions such as exercise, cognitive training and mindfulness are important for managing cognitive decline during chemotherapy because they are safe, accessible and can often be delivered at low cost or even at home, making them easier for patients to use, compared to expensive or clinical treatments.”
The researchers acknowledged that during chemotherapy “patients often walk less because treatment can cause excessive fatigue, muscle weakness, nausea, or other side effects.” They noted that the two-week chemotherapy cycle may be the “sweet spot” for recovery enough to participate in EXCAP, as benefits were not seen in patients with 3- and 4-week cycles. Future studies expanding the patient population may further generalize these findings.
“Many patients who need chemotherapy worry that they will experience ‘chemobrain,'” commented Lindsay L. Peterson, MD, MSCR, a medical oncologist at Washington University School of Medicine in St. Louis, who treats patients at the Siteman Cancer Center, based at Barnes-Jewish Hospital and WashU Medicine, and who was not involved in this research. “This study offers encouraging news: there may be something patients can do to reduce their risk of cognitive decline during chemotherapy-exercise!”
Peterson, who serves as Chair of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®The Panel for Survivorship, continued: “Participants who received chemotherapy every two weeks and were randomized to an individualized exercise program experienced less cognitive decline compared to those in the control arm, reporting better cognitive function and less mental fatigue. Families and maintaining overall quality of life. survival, but to help patients remain as sharp and mentally resilient as possible in throughout the treatment”.
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