The effect of progressive resistance training on lean soft tissue mass in head and neck cancer patients during concomitant chemoradiotherapy: the DAHANCA 31 randomized controlled trial.
Progressive resistance training initiated at concurrent chemoradiation treatment onset did not attenuate loss of lean soft tissue mass or muscle strength in head and neck cancer patients, but did result in significantly increased functional performance.
Key Findings
Results
Progressive resistance training did not significantly attenuate loss of lean soft tissue mass compared to usual care during concurrent chemoradiotherapy.
PRT group lost 3.4 ± 0.6 kg LSTM (6%) from baseline to 12 weeks
CON group lost 3.4 ± 0.6 kg LSTM (6%) from baseline to 12 weeks
The difference between groups was not statistically significant
LSTM was the primary endpoint of the trial, assessed via Dual-Energy Absorptiometry
The trial was underpowered, with 50 patients enrolled versus the a priori required sample size of 72
Results
Both groups experienced substantial body mass loss during the 12-week concurrent chemoradiotherapy period.
PRT group lost 8.6 ± 1.0 kg body mass (10%) from baseline to 12 weeks
CON group lost 7.4 ± 1.0 kg body mass (9%) from baseline to 12 weeks
PRT group lost 5.2 ± 0.8 kg fat mass (21%) from baseline to 12 weeks
CON group lost 4.0 ± 0.8 kg fat mass (17%) from baseline to 12 weeks
Differences in body mass and fat mass losses between groups were not statistically significant
Results
Maximal muscle strength as measured by 1 repetition maximum decreased equally in both the PRT and control groups.
1RM chest press and leg press tests were used to assess maximal muscle strength
1RM decreased from baseline to 12 weeks in both groups
The decrease in 1RM was not significantly different between the PRT and CON groups
This finding indicates that 36 sessions of progressive resistance training over 12 weeks did not preserve maximal muscle strength during CCRT
Results
Functional performance improved significantly more in the PRT group compared to the control group.
Chair rise performance improved significantly more in PRT compared to CON (p < 0.05)
Arm curl performance improved significantly more in PRT compared to CON (p < 0.05)
Functional performance was assessed using 30-second chair-rise, 30-second arm curls, and stair climb tests
Stair climb was also included as a functional performance measure
Methods
The trial was a randomized controlled design with patients allocated to 12 weeks of progressive resistance training or usual care with no exercise.
Intervention consisted of 36 PRT sessions over 12 weeks initiated at CCRT onset
Assessments were conducted at baseline, 6 weeks, 12 weeks, 6 months, and 12 months
Outcomes included body composition (DXA), muscle strength (1RM), functional performance, dietary intake, and Quality of Life (EORTC QLQ-C30 and QLQ H&N-35)
A priori sample size was 72 patients (36 per group) with LSTM as primary endpoint
Only 50 patients were enrolled (25 per group), meaning the required sample size was not met
What This Means
This research examined whether supervised weight training (progressive resistance training, or PRT) could help head and neck cancer patients maintain muscle mass and strength during a grueling combined chemotherapy and radiation treatment. Patients were randomly assigned to either complete 36 exercise sessions over 12 weeks or receive usual care with no structured exercise. Body composition, muscle strength, and physical function were measured at multiple time points over one year. The study found that both groups lost a similar and substantial amount of muscle mass and body weight during treatment — roughly 6% of lean tissue and about 10% of total body weight — and that the exercise program did not prevent these losses. Maximal muscle strength also declined similarly in both groups.
Despite not preserving muscle mass or strength, the exercise group did show significantly greater improvements in functional performance tasks such as chair stands and arm curls compared to the non-exercise group. This suggests that even when the underlying muscle tissue is being lost at similar rates, exercise training may help patients maintain or improve their ability to perform everyday physical tasks during treatment.
An important limitation of this study is that it enrolled only 50 patients out of the 72 needed to reliably detect a difference between groups, meaning the trial was underpowered and may have missed a true benefit of exercise on muscle mass. This research suggests that progressive resistance training during head and neck cancer treatment has functional benefits worth exploring further, but larger trials are needed to determine whether it can also protect muscle mass and strength.
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Lonkvist C, Lønbro S, Vinther A, Zerahn B, Rosenbom E, Svart M, et al.. (2026). The effect of progressive resistance training on lean soft tissue mass in head and neck cancer patients during concomitant chemoradiotherapy: the DAHANCA 31 randomized controlled trial.. Acta oncologica (Stockholm, Sweden). https://doi.org/10.2340/1651-226X.2026.45545