Changes in circulating immune cells and cytokines after high-intensity aerobic exercise in patients with prostate cancer undergoing active surveillance from the ERASE randomized controlled trial.
Kang D, Patel D, et al. • Frontiers in immunology • 2026
A 12-week supervised HIIT program significantly increased the proportion of the circulating major NK-cell subset and PBMC-mediated cytotoxicity while reducing IL-4 and IL-12p70 concentrations in men with prostate cancer undergoing active surveillance.
Key Findings
Results
HIIT significantly increased the proportion of the circulating major NK-cell subset (CD3-CD56+CD16+) compared with usual care.
Adjusted between-group difference of 2.0% (95% CI, 0.3 to 3.7; p=0.024)
52 men with localized prostate cancer on active surveillance were randomized to HIIT (n=26) or usual care (n=26)
Intervention lasted 12 weeks with three sessions per week at 85% to 95% of peak oxygen consumption
Immune cell subsets were assessed via flow cytometry from fasting blood samples collected at baseline and post-intervention
Results
HIIT significantly increased PBMC-mediated cytotoxicity against K562 target cells compared with usual care.
Adjusted between-group difference of 2.9% (95% CI, 0.3 to 5.4; p=0.031)
NK cell cytotoxicity was assessed from peripheral blood mononuclear cells (PBMCs)
No significant between-group differences were observed in T cell or B cell subsets
Results
HIIT significantly reduced circulating basophil counts compared with usual care.
Adjusted between-group difference of -0.04 ×10⁹/L (95% CI, -0.07 to -0.01; p=0.011)
No significant differences were observed in other leukocyte populations
Results
HIIT significantly reduced plasma levels of IL-4 compared with usual care.
Adjusted between-group difference of -0.02 pg/mL (95% CI, -0.03 to -0.01; p=0.011)
Plasma cytokine concentrations were measured from fasting blood samples
No significant between-group differences were observed in other inflammatory cytokines including IL-6 and TNF-α
Results
HIIT significantly reduced plasma levels of IL-12p70 compared with usual care.
Adjusted between-group difference of -0.14 pg/mL (95% CI, -0.23 to -0.06; p=0.002)
This was among the most statistically robust cytokine findings in the study
Analyses of covariance were used to compare between-group differences
Results
The HIIT group demonstrated high adherence to the prescribed exercise program.
The HIIT group attended 96% of prescribed sessions
Sessions were supervised and conducted three times per week
Exercise intensity was set at 85% to 95% of peak oxygen consumption
Results
No significant between-group differences were observed in T cell subsets, B cell subsets, or several inflammatory cytokines.
No significant differences were found in T cell or B cell phenotypes assessed by flow cytometry
IL-6 and TNF-α did not differ significantly between groups
The study was a secondary analysis of the ERASE randomized controlled trial, a single-center study
Conclusions
The authors characterized the findings as hypothesis-generating due to the exploratory design, peripheral-blood measurement context, and number of comparisons made.
Immune measures were peripheral-blood readouts rather than tumor-level readouts
The authors noted the exploratory design and number of comparisons as limitations requiring caution in interpretation
Findings were stated to 'require confirmation in larger, adequately powered studies'
What This Means
This research suggests that a structured high-intensity interval training (HIIT) program can meaningfully change certain aspects of the immune system in men with early-stage prostate cancer who are being monitored rather than immediately treated (a strategy called active surveillance). Over 12 weeks, men who did supervised HIIT three times per week showed increases in a key type of immune cell called natural killer (NK) cells — cells known to play a role in identifying and destroying cancer cells — and their immune cells were better at killing cancer cells in laboratory tests. The exercise group also showed reductions in basophils (a type of immune cell) and in two signaling proteins called IL-4 and IL-12p70 that help regulate immune and inflammatory responses.
However, many other immune measures — including T cells, B cells, and inflammatory markers like IL-6 and TNF-α — did not change significantly between the exercise and control groups. The study involved 52 men and was designed as a secondary, exploratory analysis, meaning it was not the primary purpose of the original trial. The immune changes observed were measured in the bloodstream, not directly in tumor tissue, so it is not yet known whether these changes affect cancer progression itself.
This research suggests that high-intensity aerobic exercise may beneficially shift certain immune cell populations and reduce some inflammatory signals in men with localized prostate cancer on active surveillance. These findings are preliminary and hypothesis-generating, and larger studies will be needed to confirm whether these immune changes have meaningful clinical effects on prostate cancer outcomes.
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Kang D, Patel D, Field C, Boulé N, Fairey A, Schadler K, et al.. (2026). Changes in circulating immune cells and cytokines after high-intensity aerobic exercise in patients with prostate cancer undergoing active surveillance from the ERASE randomized controlled trial.. Frontiers in immunology. https://doi.org/10.3389/fimmu.2026.1923463