MS-N313 · Exercise and rehabilitation · Cognitive symptoms · Sleep and distress · Human evidence · Appraised 12 November 2026

Can a nurse-led, theory-based aerobic and resistance exercise program improve cognition, sleep or psychological distress during lymphoma chemotherapy?

Evidence at a glance

• Evidence label: Two recent single-center randomized trials; promising symptom outcomes with important reporting and registration limitations
• Benefit: Both trials reported improved cognitive or quality-of-life outcomes; the 90-person trial also reported less anxiety, depression, fear of progression and poor sleep through six months.
• Certainty: Low to moderate. Results are consistent but single-center, largely unblinded behavioral trials; effect sizes and harms were incompletely reported, and one registry entry was retrospective.
• Risk: Exercise was screened for contraindications and adherence exceeded about 79%, but trial abstracts did not provide adverse-event counts. Fifteen participants in the 90-person trial withdrew for transfers, health problems or death without attribution to exercise.

What was studied

Trial 1: Eighty-six adults with lymphoma in Fujian, China, were randomized to a multi-theory-model exercise program plus usual care or usual care. Outcomes at the end of treatment and four weeks later included subjective cognition, fitness and quality of life. Thirty-eight of 43 intervention participants completed the program; mean adherence was 79%.

Trial 2: Ninety people with lymphoma receiving chemotherapy were randomized to a 12-week nurse-led aerobic and resistance program or usual care, with assessor blinding and follow-up to six months. All 90 were included in intention-to-treat analyses; missing data were multiply imputed.

What the evidence found

The 86-person trial reported between-group improvements in subjective cognition, fitness and quality of life at program end and four weeks later (all P<.001), but the abstract did not provide absolute effects or confidence intervals.

The 90-person trial reported improvements in anxiety, depression, fear of progression, sleep quality and objective cognition across six months (all P<.001), with aerobic and resistance adherence above 80%. Fifteen participants withdrew; retention was 82.2% in intervention and 84.4% in control.

The reports use separate registry numbers (ChiCTR-2400083827 and ChiCTR2500107928) and are treated as separate trials, not independent publications of one trial. The second registry entry was posted retrospectively in August 2025.

How to interpret it

The findings are encouraging for supportive symptoms, but unusually broad positive results, incomplete absolute effects, added nurse/peer attention and open-label delivery increase risk of bias. Independent multicenter replication is needed.

Neither study tested lymphoma response, treatment completion, recurrence or survival. Cognitive and sleep improvement must not be recast as cancer control.

Practical safety context

Chemotherapy-related anemia, neutropenia, thrombocytopenia, neuropathy, infection, cardiotoxic therapy, bulky disease and bone involvement may require modification or a pause. The second registry excluded severe anemia, marrow suppression, extensive metastases that limited exercise, major cardiovascular disease and other contraindications.

Unreported adverse-event counts are a limitation. Symptom improvement does not mean strenuous exercise is safe for every chemotherapy cycle.

Questions for the care team

• Were my blood counts, cardiac risk, neuropathy and fall risk reviewed for this week’s cycle?
• Is the proposed program comparable to the tested nurse-led aerobic-plus-resistance protocol?
• How will cognition and sleep be measured, and what change would be meaningful to me?

Funding and conflicts

The 90-person report declared no external funding and no conflicts; its registry described self-funding. The 86-person abstract reported no competing interests; funding was not verified.

Sources

• MTM exercise trial (PMID 42538450; ChiCTR-2400083827)
• Nurse-led MTM exercise trial (PMID 42727513; ChiCTR2500107928)
• Chinese registry record ChiCTR2500107928

Last literature search: 12 November 2026. Record appraisal: 12 November 2026. Journal abstracts, the second journal report’s accessible sections and the official registry were appraised; unavailable absolute-effect and harm data are not inferred. This page is educational and does not replace individualized medical advice. These supportive-care outcomes do not establish tumor shrinkage, delayed recurrence or longer survival.