Exercise-Induced Modulation of Inflammation and Fatigue in Patients with Head and Neck Cancer Undergoing Chemoradiotherapy: A Pilot Randomised Controlled Trial

Abstract

Objectives: Fatigue and systemic inflammation are among the most prevalent and distressing complications in patients with head-and-neck cancer (HNC) undergoing chemo-radiation therapy (CRT). Exercise has emerged as an effective supportive care intervention; however, high-quality evidence supporting its use during active CRT remains limited. This pilot randomised controlled trial evaluated the efficacy of a supervised exercise programme in reducing fatigue and systemic inflammation in patients with HNC undergoing CRT. Materials and Methods: Forty-one patients with HNC (mean age: 58 ± 3.75 years), diagnosed with tumour node metastasis stage III–IVB disease and receiving CRT with an Eastern Cooperative Oncology Group score <2, were randomly allocated into two groups. Group A ( n = 20) performed walking for 10 min, 3 times daily, 5 days/week, while Group B ( n = 21) underwent a supervised combined aerobic and resistance training programme for 7 weeks. Outcome measures included C-reactive protein (CRP), brief fatigue inventory and six-minute walk distance (6MWD) assessed at baseline and post-intervention at the end of 7 weeks. Within-group changes were analysed using the Wilcoxon signed-rank test, and between-group comparisons were performed using the Mann–Whitney U test. Results: No exercise-related adverse events were reported, and adherence to both interventions was high, supporting the feasibility of the intervention. Baseline characteristics were comparable between groups. Both groups demonstrated significant improvements in CRP (Group A: effect size = 0.87, p < 0.05; Group B: effect size = 0.90, p < 0.05) and fatigue (Group A: effect size = 0.83, p < 0.05; Group B: effect size = 0.87, p < 0.05). Between-group analysis revealed significantly lower post-intervention CRP levels (effect size = 0.505, p < 0.005) and reduced fatigue scores (effect size = 0.626, p < 0.001) in Group B as compared to Group A. No statistically significant between-group difference was observed for 6MWD ( p > 0.05). Conclusion: A supervised combined aerobic and resistance exercise programme appears to be feasible and may offer greater benefits than walking alone in attenuating systemic inflammation and fatigue in patients with HNC undergoing CRT. Given the pilot nature of the study, these findings should be interpreted as preliminary. If confirmed by larger trials, they support integrating structured exercises into supportive oncology care during active treatment.