High-intensity interval resistance and cardiorespiratory training in cancer survivors

Main Article Content

Tracey Robinson
https://orcid.org/0000-0003-3873-2445
Peggy Johnson
https://orcid.org/0009-0007-9794-4567
Nicolas Alvarez
https://orcid.org/0009-0007-7900-6606
Alexandria Miles
Abigial Adiong
https://orcid.org/0009-0001-5416-9667
Maureen Cooper

Abstract

Both resistance (RT) and cardiorespiratory (CRT) exercise can improve physical fitness and quality of life (QoL) in cancer survivors (CS). However, the order of exercises may alter benefits as fatigue from the first modality may affect adaptations from the second. To determine which order (i.e., RT or CRT first) is most beneficial in CS during a 10-week supervised, individualized and progressive exercise intervention, 50 CS (40 females, 10 males, age = 71 ± 14 years) were randomized into either RT followed by CRT, or CRT followed by RT. Pre- and post-intervention tests included: sit-to-stand, biceps curl, grip strength, seated medicine ball throw (SMBT), plank, sit-ups/crunches for muscle strength and endurance, six-minute walk test (6MWT) and 20-step test for cardiorespiratory fitness, eight-foot up-and-go, unipedal balance, and sit-and-reach for functional testing, 7-site skinfolds for body composition, and self-reported questionnaires for QoL. There were no significant differences between groups for any measure (p > .05). CS significantly improved muscle strength (SMBT, sit-ups/crunches, plank, biceps curl), cardiorespiratory fitness (6MWT distance, time for 20-step test), body composition (decreased fat mass, increased lean mass) and QoL. CS showed physical fitness, function, body composition, and QoL improvements after a 10-week high-intensity interval training exercise intervention.

Article Details

How to Cite
Robinson, T., Johnson, P., Alvarez, N., Miles, A., Adiong, A., & Cooper, M. (2026). High-intensity interval resistance and cardiorespiratory training in cancer survivors. Physical Activity, Exercise and Cancer, 3(1), 1–19. https://doi.org/10.55860/RQJN6720
Section
Exercise and cancer survivors
Author Biographies

Tracey Robinson, Adams State University

Department of Kinesiology.

Peggy Johnson, Adams State University

Department of Kinesiology.

Nicolas Alvarez, Adams State University

Department of Kinesiology.

Alexandria Miles, Adams State University

Department of Kinesiology.

Abigial Adiong, Adams State University

Department of Kinesiology.

Maureen Cooper, San Luis Valley Health

Department of Oncology.

Funding data

References

Abbass, T., Dolan, R.D., Laird, B.J., & McMillan, D.C. (2019). The relationship between imaging-based body composition analysis and the systemic inflammatory response in patients with cancer: A systematic review. Cancers, 11(9), 1304-1307. https://doi.org/10.3390/cancers11091304

American Cancer Society. (2022). Physical Activity and the Person with Cancer. American Cancer Society. Retrieved from [Accessed 2026, 17 February]: https://www.cancer.org/canceer/survivorship/be-healthy-after-treatment/physical-activity-and-the-cancer-patient.html

Au, P. C. M., Li, H. L., Lee, G. K. Y., Li, G. H. Y., Chan, M., Cheung, B.M. Y., et al. (2021). Sarcopenia and mortality in cancer: A meta-analysis. Osteoporosis and Sarcopenia, 7, 28-33. https://doi.org/10.1016/j.afos.2021.03.002

Bishop, D. J., Jones, E., & Woods, D. R. (2018). Concurrent training: a review of the effects of resistance and endurance training on muscle strength, endurance, and body composition. J Sports Sci. Med., 17(2), 191-205.

Bohannon, R. W., Steffl, M., Glenney, S. S., Green, M., Cashwell, L. Prajerova, K. & Bunn, J. (2018). The prone bridge test: Performance, validity, and reliability among older and younger adults. Journal of Bodywork and Movement Therapies, 22(2), 385-389. https://doi.org/10.1016/j.jbmt.2017.07.005

Bordignon, C., Dos Santos, B.S., & Rosa, D.D. (2022). Impact of cancer cachexia on cardiac and skeletal muscle: Role of exercise training. Cancers, 14(2), 342-349. https://doi.org/10.3390/cancers14020342

Bushman, B. (Ed.). (2025). Fitness Professional's Handbook (8th edition). Human Kinetics.

Campbell, K. L., Winters-Stone, K. M., Wiskemann, J., May, A. M., Schwartz, A. L., Courneya, K., et al. (2019). Exercise guidelines for cancer survivors: Consensus statement from international interdisciplinary roundtable. Med. Sci. Sports Exerc., 51(12), 2375-2390. https://doi.org/10.1249/MSS.0000000000002116

Cao, C., Friedenreich, C. M., & Yang, L. (2022). Association of daily sitting time and leisure-time physical activity with survival among US cancer survivors. JAMA Oncol., 8(3), 395-403. https://doi.org/10.1001/jamaoncol.2021.6590

Catala-Vilaplana, I., Cao, S. E., Zadravec, K., LeVasseur, N., Kimple, R. J., Lim, A. J., et al. (2025). Exercise may improve completion of standard and emerging cancer treatments. Exerc. Sport Sci. Rev., 53(3), 110-124. https://doi.org/10.1249/JES.0000000000000360

Cormie, P., McKenzie, D. C., McAuley, E., & Friedenreich, C. M. (2018). The role of exercise in cancer survivorship. Curr. Treat. Options Oncol., 19(5), 28.

Courneya, K. S. & Friedenreich, C. M. (2011). Physical activity and cancer: An introduction to the special issue on exercise and cancer. Cancer Prev. Res., 4(4), 507-511. https://doi.org/10.1158/1940-6207.CAPR-10-0376

Courneya, K. S., McNeeley, M. L., Booth, C. M., & Friedenreich, C. M. (2024). An integrated framework for the study of exercise across the postdiagnosis cancer continuum. Front. Oncol., 14:1432899. https://doi.org/10.3389/fonc.2024.1432899

De Luca, V., Minganti, C., Borrione, P., Grazioli, E., Cerulli, C., Guerra, E., & Parisi, A. (2016). Effects of concurrent aerobic and strength training on breast cancer survivors: A pilot study. Public Health, 136, 126-132. https://doi.org/10.1016/j.puhe.2016.03.028

Di Blasio, A., Gemello, E., Di Iorio, A., Di Giacinto, G., Celso, T., Di Renzo, D., et al. (2012). Order effects of concurrent endurance and resistance training on post-exercise response of non-trained women. J Sport Sci. Med., 11(3), 393-399.

Dieli-Conwright, C. M., Courneya, K. S., Demark-Wahnefried, W., Sami, N., Lee, K., Sweeney, F. C., & Mortimer, J. E. (2018). Aerobic and resistance exercise improves physical fitness, bone health, and quality of life in overweight and obese breast cancer survivors: A randomized controlled trial. Breast Cancer Res., 20(1), 1-10. https://doi.org/10.1186/s13058-018-1051-6

Esparza-Ros, F., Moreira, A. C., Vaquero-Christobal, R., Barrigas, C, Albaladejo, M., & Vieira. F. (2022). Differences between four skinfold calipers in the assessment of adipose tissue in young adult healthy population. Nutrients, 14(10), 2081-2085. https://doi.org/10.3390/nu14102085

Friedenreich., C. M., Ryder-Burbidge, C., & McNeil, J. (2021). Physical activity, obesity and sedentary behavior in cancer etiology: Epidemiologic evidence and biologic mechanisms. Mol. Oncol., 15(3), 790-800. https://doi.org/10.1002/1878-0261.12772

Harris, C., Wattles, A. P., DeBeliso, M., Sevene-Adams, P. G., Berning, J. M., & Adams, K. J. (2011). The seated medicine ball throw as a test of upper body power in older adults. J Strength Cond. Res., 25(8), 2344-2348. https://doi.org/10.1519/JSC.0b013e3181ecd27b

Herranz-Gomez, A., Cuenca-Martinez, F., Suso-Marti, L., Varangot-Reille, C., Calatayud, J., Blanco-Diaz, M., & Casana, J. (2022). Effectiveness of HIIT in patients with cancer or cancer survivors: An umbrella and mapping review with meta-meta-analysis. Scand. J Med. Sci. Sports, 32, 1522-1549. https://doi.org/10.1111/sms.14223

Iravani, K., Jafari, P., Akhlaghi, A., & Khademi, B. (2018). Assessing whether EORTC QLQ-30 and FACT-G measure the same constructs of quality of life in patients with laryngectomy. Health Qual. Life Outcomes 16, 183-184. https://doi.org/10.1186/s12955-018-1012-x

Islami, F., Goding Sauer, A., Miller, K. D., Siegel, R., Fedewa, S. A., Jacobs, E. J., & Jemal, A. (2018). Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States. CA: Cancer J Clin., 68(1), 31-54. https://doi.org/10.3322/caac.21440

Jones, C. J., Rikli, R. E., & Beam, W. C. (1999). A 30-second chair-stand test as a measure of lower body strength in community-residing older adults. Res. Quarterly for Exerc. Sport, 70(2), 113-119. https://doi.org/10.1080/02701367.1999.10608028

Kenney, W.L., Wilmore, J.H., Costill, D.L. (2022). Physiology of Sports and Exercise (8th edition). Human Kinetics.

Knols, R., Aaronson, N. K., Uebelhart, D. Fransen, J., & Aufdemkampe, G. (2005). Physical exercise in cancer patients during and after medical treatment: A systematic review of randomized and controlled clinical trials. J Clin. Oncol., 23(16), 3830-3842. https://doi.org/10.1200/JCO.2005.02.148

Langhammer, B., & Stanghelle, J. K. (2015). The Senior Fitness Test. J Physiother., 61(3), 163-165. https://doi.org/10.1016/j.jphys.2015.04.001

Madeira, R., Neiva, H. P., Maia, A., & Esteves, D. (2023). The effect of concurrent training on cancer survivors: An update of the scientific evidence. Physiother. Sport Inj., 1(2), 25-33. https://doi.org/10.3390/healthcare13010033

Marini, J. A., Haff, G. G., Johnson, B. T., Smith, M. A., & Tavares, J. (2017). Concurrent training: A systematic review and meta-analysis. J Strength Cond. Res., 31(5), 1429-1440. https://doi.org/10.1519/JSC.0000000000001603

Markov, A., Hauser, L., & Chaabene, H. (2023). Effects of concurrent strength and endurance training on measures of physical fitness in healthy middle-aged and older adults: A systemic review with meta-analysis. Sports Med. (Auckland, N.Z.), 53(2), 437-455. https://doi.org/10.1007/s40279-022-01764-2

McNeely, M. L., Campbell, K. L., Mackey, J. R., & Courneya, K. S. (2006). Effects of exercise on quality of life and fatigue in cancer survivors: A randomized controlled trial. J Clin. Oncol., 24(16), 2470-2476.

Mijwel, S., Jervaeus, A., Bolam, K. A., Norrbom, J., Bergh, J., Rundqvist, H., & Wengstrom, Y. (2019). High-intensity exercise during chemotherapy induces beneficial effects 12 months into breast cancer survivorship. J Cancer Surviv., 13, 244-256. https://doi.org/10.1007/s11764-019-00747-z

Moon, H. G., Ju, Y. T., Jeong, C. Y., Jung, E. J., Lee, Y. J., Hong, S. C., & Choi, S. K.. (2008). Visceral obesity may affect oncologic outcome in patients with colorectal cancer. Ann. Surg. Oncol., 15, 1918-1922. https://doi.org/10.1245/s10434-008-9891-4

Mugele, H., Freitag, N., Wilhelmi, J., Yang, Y., Cheng, S., Bloch, W., & Schumann, M. (2019). High-intensity interval training in the therapy and aftercare of cancer patients: A systematic review with meta-analysis. J Cancer Surviv., 13, 205-223. https://doi.org/10.1007/s11764-019-00743-3

Neuendorf, T., Haase, R., Schroeder, S., Schumann, M. & Nitzsche, N. (2023). Effects of high-intensity interval training on functional performance and maximal oxygen uptake in comparison with moderate intensity continuous training in cancer patients: A systematic review and meta-analysis. Support Care Cancer, 31, (11), 854-876. https://doi.org/10.1007/s00520-023-08103-9

Okada, T., Huxel, K. C., & Nesser, T. W. (2011). Relationship between core stability, functional movement, and performance. J Strength Cond. Res., 25(1), 252-261. https://doi.org/10.1519/JSC.0b013e3181b22b3e

Palma, S., Hasenoehrl, T., Jordakieva, G., Ramazanova, D., & Crevenna, R. (2021). High-intensity interval training in the prehabilitation of cancer patients: A systematic review and meta-analysis. Support Care Cancer, 29(4), 1781-1794. https://doi.org/10.1007/s00520-020-05834-x

Reverte-Pagola, G., Sanchez-Trigo, H., Saxton, J., & Sanudo, B. (2022). Supervised and non-supervised exercise programs for the management of cancer-related fatigue in women with breast cancer: A systematic review and meta-analysis. Cancers, 14(14), 3428-3435. https://doi.org/10.3390/cancers14143428

Riebe, D., Ehrman, J. K., Liguori, G., & Magal, M. (2018). General principles of exercise prescription. ACSM's Guidelines for Exercise Testing and Prescription (10th ed., pp.143-179), Wolters Kluwer Health.

Rikli, R. E., & Jones, C .J. (2013a). Senior Fitness Test Manual. Human Kinetics.

Rikli, R. E., & Jones, C. J. (2013b). Development and validation of a functional fitness test for community-residing older adults. Gerontologist, 53(2), 255-267. https://doi.org/10.1093/geront/gns032

Rock, C. L., Thomson, C. A., Sullivan, K. R., Howe, C. L., Kushi, L. H., Caan, B. J., et al. (2022). American Cancer Society nutrition and physical activity guideline for cancer survivors. CA: Cancer J Clin., 72, 230-262. https://doi.org/10.3322/caac.21719

Schmid, D., & Leitzmann, M. F. (2014). Association between physical activity and mortality among breast cancer and colorectal cancer survivors: A systematic review and meta-analysis. Ann. Oncol., 25, 1293-1311. https://doi.org/10.1093/annonc/mdu012

Schmitz, K. H., & Troxel, A. B. (2009). A pilot study of the effectiveness of a fitness program on balance and mobility in breast cancer survivors. Oncol. Nursing Forum, 36(3), 300-308.

Schmitz, K. H., Courneya, K. S., Kahn, A. M., & Demark-Wahnefried, W. (2019). Exercise in medicine in oncology: Engaging clinicians to help patients move through cancer. CA: Cancer J Clin., 69(6), 404-423. https://doi.org/10.3322/caac.21579

Schneider, C. M., Dudgeon, W. D., & McKenzie, D. C. (2018). The impact of exercise on immune function in cancer patients: A review. Cancer Med., 7(12), 5860-5867. https://doi.org/10.1002/cam4.1792

Scott, J. M. & Iyengar, N. M. (2022). Exercise therapy across the cancer care continuum. ASCO Post: News and Views from the World of Clinical Oncology and Hematology, 13(18), 24-25.

Siegel, R. L., Miller, K. D., Fuchs, H. E., & Jemal, A. (2022). Cancer Statistics, 2022. CA: Cancer J Clin., (72), 7-33. https://doi.org/10.3322/caac.21708

Smith, J. A., & Doe, R. B. (2021). The role of concurrent training in cancer rehabilitation: A comprehensive review. J Cancer Surviv., 15(2), 123-125.

Strasser, B., Steindorf, K., Wiskerman, J., & Ulrich, C. M. (2013). Impact of resistance training in cancer survivors: A meta-analysis. Med. Sci. Sports Exerc., 45(11), 2080-2090. https://doi.org/10.1249/MSS.0b013e31829a3b63

Sullivan, G., & Feinn, R. (2012). Using the effect size-or why the p value is not enough. J Grad. Med. Educ., 4(3), 279-282. https://doi.org/10.4300/JGME-D-12-00156.1

Sweegers, M. G., Altenburg, T. M., Chinapaw, M. J., Kalter, J., Verndonck-De-Leeuw, I. M., Courneya, K. S., & Buffart, L. M. (2018). Which exercise prescriptions improve quality of life and physical function in patients with cancer during and following treatment? A systematic review and meta-analysis of randomized controlled trials. Br. J Sports Med., 52(8), 505-513. https://doi.org/10.1136/bjsports-2017-097891

Toohey, K., Pumpa, K., McKune, A., Cooke, J., & Semple, S. (2018). High-intensity exercise interventions in cancer survivors: A systematic review exploring the impact on health outcomes. J Cancer Res. Clin. Oncol., 144, 1-12. https://doi.org/10.1007/s00432-017-2552-x

Tsuji, K., Matsuoka, Y. J., & Ochi, E. (2021). High-intensity interval training in breast cancer survivors: A systematic review. BioMed Cent. Cancer, 2(1), 1-11. https://doi.org/10.1186/s12885-021-07804-w

Uysal, C. S., Tonak, H. A., & Kitis, A. (2022). Validity, reliability and test-retest study of grip strength measurement in two positions with two dynamometers: Jamar Plus and K-Force Grip. Hand Surgery & Rehab., 41(3), 305-310. https://doi.org/10.1016/j.hansur.2022.02.007

Yang, L., Morielli, A. R., Heer, E., Kirkham, A. A., Cheung, W. Y., Usmani, N., Friedenreich, C. M., et al. (2021). Effects of exercise on cancer treatment efficacy: A systematic review of preclinical and clinical studies. Cancer Res., 81(19), 4889-4895. https://doi.org/10.1158/0008-5472.CAN-21-1258

Zhuang, C. L., Zhang, F. M., Li, W., Wang, K. H., Xu, H. X., Song, C. H., Gou, Z. Q., et al. (2020). Associations of low handgrip strength with cancer mortality: A multicentre observational study. J Cachexia, Sarcopenia and Muscle, 11(6), 1476-1486. https://doi.org/10.1002/jcsm.12614