In recent years, there has been growing interest in the therapeutic role of exercise in
the context of oncology. Several murine models have demonstrated a reduction in tumor
growth with aerobic exercise, which is partly due to the increased immunogenicity of the
tumor microenvironment (TME). Aerobic exercise has the potential to mobilize cytotoxic
immune cells, particularly those contributing to anticancer immunity (natural killer
cells; NKc, and cytotoxic T lymphocytes; TCD8+), both in healthy individuals and in those
living with cancer. In the latter, a session of aerobic exercise induces a transient rise
in plasma lymphocytes, followed by their extravasation into inflamed tissues in the hours
following exercise. This phenomenon, known as "exercise-immune-enhancement," appears to
be heavily dependent on the adrenergic activation triggered by exercise. In other words,
NKc and TCD8+ cells are mobilized in response to exercise of sufficient intensity,
meaning a minimal physiological threshold must be reached during physical exertion, which
should be identified on an individual basis (i.e., the second lactate threshold).
However, it is crucial that cytotoxic immune cells mobilized by aerobic exercise can
infiltrate the TME and exhibit characteristics that allow them to counter immune evasion
mechanisms. Animal studies have shown that aerobic training increases the number of NKc
and TCD8+ cells within primary tumors and delays tumor growth, supporting the hypothesis
that exercise could stimulate tumor infiltration by cytotoxic lymphocytes acting within
the TME. To date, no human studies conducted during treatment have confirmed this
hypothesis.
The main objective of this study is to determine to what extent Tc and NK cells mobilized
by aerobic exercise will exhibit migratory and functional capacity in patients undergoing
treatment for curable breast or colorectal cancer. The secondary objective is to compare
the effect of a moderate-intensity exercise (MOD) session with an high-intensity interval
exercise (HIIE) session on the magnitude of this anti-cancer immune response to exercise
and on the phenotypic and functional characteristics of the cells that have been
mobilized.
The hypothesis is that exercise will promote cell migration, enhancing anti-cancer
functionality, suggesting its potential as an adjuvant to immunotherapy. Additionally,
higher exercise intensity is expected to increase mobilization of cytotoxic lymphocytes
and expression of markers indicating stronger immunotherapeutic potential.
Forty-four individuals (aged 40-70) undergoing adjuvant treatment for breast or
colorectal cancer will be recruited to participate in a randomized, crossover study with
variable block size and counterbalanced design comparing the effect of two exercise
modalities (MOD and HIIE), on the migratory and functional capacity of cytotoxic immune
cells. An initial visit will be conducted to collect the following variables: resting
heart rate and blood pressure, anthropometry, medical history, physical activity habits
(questionnaire), gender identity, and aerobic capacity, which will be assessed using a
submaximal graded exercise test on a cycle ergometer (modified YMCA). During MOD,
participants will complete 32 minutes of cycling at 50% of the power output achieved
during the last completed stage of the submaximal test. During the HIIE condition,
participants will complete 10 intervals alternating 1 minute of intense effort at a power
corresponding to 110% of the final stage completed in the modified YMCA test and 2
minutes of active recovery at 25% of the same stage, for a total duration of 30 minutes.
Both experimental conditions are thus equivalent in terms of external effort load. During
both exercise sessions, blood samples will be collected before, immediately after
exercise cessation, and at 60 and 120 minutes post-exercise for complete blood counts and
isolation of peripheral blood mononuclear cells (PBMCs) to assess migratory and
functional capacity. Two familiarization sessions will precede the experimental
conditions to test the respective prescriptions for MOD and HIIE to ensure that
participants can complete the sessions at the required intensity to meet the research
objective. A chemotactic gradient migration assay (Transwell assay) will be performed
using the thawed PBMCs, and those that have migrated after 4 hours will be collected to
characterize NKc and TCD8+ subpopulations and assess cytotoxicity potential using surface
and intracellular antibody staining (fluorescence-activated cell sorting [FACS]).
The results of this study will help determine the extent to which the TCD8+ and NKc
mobilized by aerobic exercise can migrate towards cancer cells, as well as the
characteristics associated with anticancer cytotoxicity in individuals undergoing
systemic treatment for curable breast or colorectal cancer. This data will help guide
larger-scale randomized clinical studies with control groups aimed at confirming the
adjuvant therapeutic role of individualized aerobic exercise in individuals undergoing
systemic treatment.