Effects of Home-Based Exercise With Telehealth Guidance in Lymphoma Survivors Entering Cardio-Oncology Rehabilitation: A Randomized Controlled Trial.

Abstract

IntroductionLymphoma survivors are at increased cardiovascular risk due to cardiotoxic therapies and commonly experience reduced cardiorespiratory fitness and quality of life. Telehealth-supported home-based exercise (HBE) may extend access to cardio-oncology rehabilitation (CORE); however, evidence from randomized trials in lymphoma survivors remains limited. This trial compared the short-term effects of telehealth-supported HBE versus center-based exercise (CBE) in lymphoma survivors entering CORE.Materials and MethodsIn this single-center, single-blind, parallel-group randomized controlled trial, lymphoma survivors in remission were randomized 1:1 to a 12-week telehealth-supported HBE program or supervised CBE. The primary endpoint was cardiorespiratory fitness, operationalized as peak oxygen uptake (pVO₂, mL·kg^-1·min^-1) assessed by cardiopulmonary exercise testing (CPET) at 12 weeks. Key secondary outcomes were maximal workload (W) and SF-36 Physical Functioning. Between-group effects were estimated using ANCOVA with baseline adjustment (intention-to-treat; missing outcomes handled by multiple imputation).ResultsEighty participants were randomized (HBE n=40; CBE n=40); post-intervention CPET outcomes were available for 69 participants (HBE n=34; CBE n=35). pVO₂ improved in both groups, with no significant baseline-adjusted between-group difference at 12 weeks (adjusted mean difference HBE-CBE -0.60 mL·kg^-1·min^-1, 95% CI -2.38 to 1.17; p=0.504). No between-group differences were observed for maximal workload (2.05 W, 95% CI -9.20 to 13.30; p=0.721) or SF-36 Physical Functioning (1.69 points, 95% CI -3.37 to 6.74; p=0.512). Adherence was high in both groups (HBE 80.1% vs CBE 77.9%). No adverse events were reported. Costs per participant were CZK 13,032 for HBE versus CZK 24,900 for CBE (48% lower for HBE).ConclusionTelehealth-supported HBE achieved comparable short-term improvements in exercise capacity and physical functioning to supervised CBE among lymphoma survivors entering CORE, with high adherence, no reported adverse events, and substantially lower provider costs. Telehealth-guided HBE represents a pragmatic, lower-cost delivery option to expand access to CORE.