Feasibility and Safety of Aerobic Exercise for Head and Neck Cancer Patients
Feasibility and Safety of Aerobic Exercise for Head and Neck Cancer Patients
Treated head and neck cancer patients are subject to tissue swelling and scarring, known as
 lymphedema and fibrosis (LEF). LEF in the head and neck cancer patient occurs in up to 90% of
 treated patients and is associated with inflammation cells. Aerobic exercise is known to
 mediate these same inflammatory cells in an anti-inflammatory manner due to chronic
 adaptation of the cells. The investigators are therefore proposing a prescription exercise
 study for head and neck cancer patients. This study's primary aim is feasibility and safety
 of the aerobic exercise prescription. Feasibility of gathering study participant inflammation
 markers, visible LEF, and patient LEF symptoms will be a secondary aim of the study. Patient
 will be asked to journal their experience for a qualitative analysis. The prescription
 aerobic exercise is that of high intensity interval exercise, since this form of exercise can
 achieve similar or better results to moderate exercise with less time and patient burden.
 Each exercise session will take place on a cycle ergometer, will be 5 minutes warm up, 5
 minutes cool down, and 20 minutes of exercise (1 minute intervals alternated by 1 minute
 rests x 10 each).
Treated head and neck cancer patients are subject to tissue swelling and scarring, known as
 lymphedema and fibrosis (LEF). LEF in the head and neck cancer patient occurs in up to 90% of
 treated patients, is associated with inflammation cells. Aerobic exercise is known to mediate
 these same inflammatory cells in an anti-inflammatory manner due to chronic adaptation of the
 cells. The investigators are therefore proposing a prescription exercise study for head and
 neck cancer patients. This study's primary aim is feasibility and safety. Feasibility of
 gathering study participant inflammation markers, visible LEF, and patient LEF symptoms will
 be a secondary aim of the study. Patient will be asked to journal their experience for a
 qualitative analysis.

 Based on the evidence, the aerobic exercise prescription for those who provide informed
 consent will consist of 10 intervals of intensity, and 10 intervals at rest. Each interval of
 intensity will be 1 minutes long and each rest period will be 1 minute long, and there will
 be a five-minute warm-up and five-minute cool down of easy pedaling for a total of 30
 minutes. Participants will complete two sessions per week, and there will be at least one
 business day in between each session, for a total of 10 total exercise sessions. The total
 study duration will be less than 35 days.

 The supervised prescribed HIIE intervention will be performed on a stationary cycle
 ergometer. A cycle ergometer is preferred for safety reasons since it requires less gross
 motor coordination than might be required with a treadmill. To assist in establishing safety
 (primary aim), the study participants heart rate will be continually monitored by a clinician
 during the exercise, guiding them to keep their heart rate within their specifically
 calculated 80-95% of their maximum HR during the periods of intensity.

 The investigators will compare outcomes at baseline with outcomes at the end of the 5-week
 study period.
Inclusion Criteria:

 -  18 years of age

 -  Histologic proof of primary diagnosis of head and neck cancer

 -  Follow routinely with primary care doctor/general practitioner as evidenced by proof
 of appointment within the last 24 months)

 -  Ability to understand English in order to understand instructions and complete
 questionnaires

 -  Willing to participate in the supervised exercise intervention

 -  In the planning stages of/or actively receiving IMRT

 -  Must sign study-specific informed consent

 -  Medical clearance by attending physician

 Exclusion Criteria:

 -  Evidence of distant metastasis prior to enrollment

 -  Simultaneous primaries or unknown primary

 -  Medical conditions that would prohibit the safe implementation of a an aerobic
 exercise practice per ACSM guidelines: cardiovascular disease, pulmonary disease,
 metabolic disease, or renal disease or signs/symptoms suggestive of cardiovascular
 disease at rest or during activity which include pain, discomfort in the chest, neck
 (other than caused by malignancy), jaw, arms, or other areas that may result from
 ischemia; shortness of breath at rest or with mild exertion; dizziness or syncope;
 orthopnea or paroxysmal nocturnal dyspnea; ankle edema; palpitations or tachycardia;
 intermittent claudication; known heart murmur; or unusual fatigue or shortness of
 breath with usual activities

 -  An answer of "no" on any of the Physical Activity Readiness Questionnaire (PAR-Q+)
 screening questions

 -  Pregnant or lactating women