Kim M; University College of Medicine, Seoul,  Korea.
Lee J; Yang T; Oh J; Kang SM; Lee CJ

International Journal of Obesity. 50(2):338-345, 2026 Feb.

BACKGROUND: High-grade glioma (HGG) patients experience enormous disease
burden both from tumor- and treatment-related symptoms. Exercise can
improve physical fitness and quality of life (QoL); yet experience in
neuro-oncology, especially with high-intensity exercise, remains limited.
This study evaluated feasibility, safety, and efficacy of the intensive,
structured 16-week strength and endurance program, “Active in
Neuro-Oncology” (ActiNO) for HGG patients undergoing chemotherapy.

METHODS: In this prospective, oligocentric, single-arm proof-of-concept
trial, 54 HGG patients participated in ActiNO, with twice-weekly
supervised exercise sessions. The primary endpoint was cardiorespiratory
fitness, assessed via physical working capacity (PWC75%)-the workload
(W/kg body weight) achieved at 75% of age-adjusted maximum heart rate
during a maximal cardiopulmonary exercise test. Secondary endpoints
included peak oxygen uptake (VO2peak), peak power output (Ppeak), and QoL
(EORTC QLQ-C30). Analyses focused on within-subject changes from pre- to
post-intervention. Additionally, comparisons to normative data were
performed. Feasibility was assessed via accrual, adherence, and attrition;
safety via adverse event monitoring (CTCAE).

RESULTS: Program tolerance was high, with few exercise-related adverse
events (all CTCAE grade 1-2). Over 16 weeks, significant improvements were
observed in PWC75% (1.023-1.256 W/kg BW, +23%), VO2peak (23.04-26.09
ml/min/kg BW, +13%), and Ppeak (1.771-2.104 W/kg BW, +19%). QoL, including
global health and physical functioning, improved, reaching normative
values. Adherence was high (85%), though attrition was 48%, mainly due to
disease progression or physical constraints.

CONCLUSIONS: High-intensity exercise is feasible and safe in HGG patients
undergoing chemotherapy. The observed improvements in physical fitness and
QoL support incorporating structured exercise into neuro-oncology care.