Real-world feasibility and effectiveness of a personalized exercise program during cancer treatment: results from the CHOiCE prospective study

Background: Despite strong evidence supporting exercise in oncology, real-world data on its feasibility and effectiveness across cancer types remain limited. The CHOiCE (Choose Health: Oncological patients Centered Exercise) study aimed to evaluate a flexible, patient-centered exercise program in routine clinical practice. Materials and methods: This prospective cohort study enrolled 180 adult patients undergoing treatments. Participants completed a 12-week program combining aerobic and resistance training, delivered in person, at home, or hybrid. Primary outcomes were recruitment rate, adherence, dropout, and safety. Secondary outcomes included physical fitness, quality of life, and physical activity. Subgroup analyses explored responses by cancer type, stage, treatment, and delivery mode. Results: Recruitment rate was 82%, with a median attendance of 88%. The dropout rate was 32%, mainly due to personal reasons or disease progression. No serious adverse events were reported. Significant improvements were observed in the six-minute walk test (+39 m, P < .001), leg press strength (+7.1 kg, P < .001), handgrip strength (+1.0 kg, P = .003), and flexibility tests (P < .05). Quality of life improved in physical, role, emotional, and social functioning. Fatigue, nausea, dyspnea, insomnia, and appetite loss were significantly reduced. Patients with gastrointestinal cancer, stage III-IV disease, or undergoing chemotherapy showed the largest gains. Conclusion: A patient-centered exercise program for patients with cancer is feasible and effective in a real-world setting. These findings support integrating tailored exercise into routine oncology care. Trial registration: NCT04226508.