The effect of progressive resistance training on lean soft tissue mass in head and neck cancer patients during concomitant chemoradiotherapy: the DAHANCA 31 randomized controlled trial

BACKGROUND AND PURPOSE: Head and neck cancer patients undergoing concurrent chemoradiation treatment (CCRT) lose a significant amount of lean soft tissue mass (LSTM) reducing muscle strength and performance. Progressive resistance training (PRT) may mitigate this loss and improve muscle strength and performance. The purpose was to investigate the effects of PRT initiated at CCRT onset on LSTM, muscle strength, and functional performance compared with usual care. PATIENTS/MATERIAL AND METHODS: Patients were randomized to 12 weeks of PRT (36 sessions) or usual care with no exercise (control group [CON]). At baseline, after 6 and 12 weeks, 6 and 12 months, Dual-Energy Absorptiometry evaluated total body mass (BM), LSTM, and fat mass (FM); 1 repetition maximum (1RM) chest press and leg press test assessed maximal muscle strength and functional performance (30 seconds chair-rise; 30 seconds arm curls; stair climb) was evaluated. Dietary intake was registered as were Quality of Life questionnaires European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ) C30 and QLQ H&N-35. A sample size of 72 patients (36 per group) was determined a priori with LSTM as the primary endpoint. RESULTS: Fifty patients were included (required sample size was not met), 25 in each group. From baseline to 12 weeks, patients in the PRT group lost 8.6 ± 1.0 kg BM (10%), 3.4 ± 0.6 kg LSTM (6%), and 5.2 ± 0.8 kg FM (21%). This was not significantly different from the CON group losing 7.4 ± 1.0 kg BM (9%), 3.4 ± 0.6 kg LSTM (6%), and 4.0 ± 0.8 FM (17%). Likewise, 1RM decreased equally in both groups. Chair rise and arm curl performance improved significantly more in PRT compared with in CON (p < 0.05). INTERPRETATION: In this study PRT initiated at CCRT onset did not attenuate loss of LSTM or muscle strength. However, PRT did result in significantly increased functional performance.