Remote Exercise Program Improves HRQOL and Fatigue in Metastatic RCC Patients on Immunotherapy

A 12-week supervised remote exercise program was feasible and associated with meaningful improvements in health-related quality of life (HRQOL), fatigue, and symptom burden among patients with metastatic renal cell carcinoma (mRCC) undergoing immune checkpoint inhibitor (ICI)-based therapies.

Nineteen patients with mRCC (median age 67 years; 57.9% male) participated in a 12-week home-based exercise program supervised via telehealth. The program included aerobic, resistance, and mobility exercises delivered through weekly virtual consultations and supported by the Vedius platform. Treatment regimens among participants included ipilimumab plus nivolumab (31.6%), nivolumab plus cabozantinib (26.3%), pembrolizumab plus axitinib (26.3%), and nivolumab monotherapy (15.8%).

Outcomes were assessed at baseline and post intervention using the Functional Assessment of Cancer Therapy-Immune Checkpoint Modulator (FACT-ICM), Brief Fatigue Inventory (BFI), and Edmonton Symptom Assessment System (ESAS). Participants demonstrated significant improvements in overall HRQOL (FACT-General mean increase, 9.8 points; P = .001; Cohen d = 0.8), treatment-related toxicity (ICM mean increase, 10.1 points; P = .017), and fatigue (BFI mean decrease, 21.1 points; P = .018; ESAS fatigue mean decrease, 5.0 points; P = .001; Cohen d = -1.5). Symptom burden (ESAS mean decrease, 12.3; P = .001) and key patient-reported outcomes, including anxiety, depression, appetite loss, and sleep disturbances, also improved (P ≤ .02).

The exercise prescription followed the Frequency, Intensity, Time, Type principle: Resistance training was performed twice weekly targeting major muscle groups (2-3 sets of 8-12 repetitions each), aerobic activity consisted of brisk walking or stationary cycling 3 to 5 days per week (20-40 minutes/session), and mobility exercises were incorporated into each session. Intensity levels were guided by the Borg Rating of Perceived Exertion scale, targeting a moderate range (RPE, 12-14) with progressive overload applied every 1 to 2 weeks. Adherence was defined as completing at least 8 of the 12 weeks of the program.

The findings support the integration of structured exercise into supportive care for mRCC, highlighting the potential of remote interventions to enhance physical and emotional well-being. Future studies should confirm these results in larger randomized trials and identify the most effective program components.