Principal Investigator

William Gregory
Awardee Organization

Wake Forest University Health Sciences
United States

Fiscal Year
Activity Code
Early Stage Investigator Grants (ESI)
Not Applicable
Project End Date

Improving Exercise Capacity with a Tailored Physical Activity Intervention in Lymphoma Patients Undergoing Treatment

Cardiovascular (CV) events related to the receipt of potentially cardiotoxic anthracycline-based chemotherapy (Anth-bC), are emerging as leading causes of morbidity and mortality for survivors of lymphoma (the 5th most common cancer in North America). The objective of our proposal is to reduce this cancer treatment related CV morbidity by developing, enabling, and testing a physical activity intervention that commences and continues throughout receipt of Anth-bC for the purpose of attenuating physical inactivity, preserving exercise capacity, CV & cognitive function, strength, and health-related quality of life (HRQOL) for those with lymphoma. The need for and the design of this program is based in part on feedback from lymphoma survivor focus groups treated in our NIH funded Comprehensive Cancer Center - preliminary pilot data (Section 3.C.1). Several novel features of this proposal include: 1) Performance of physical activity during receipt of cancer treatment where exercise intolerance originates. 2) Creation of patient communities that enable cancer patients to support one another during treatment. 3) Administration of aerobic & strength activities suited to one's individual lifestyle in the home guided by instruction provided from 4 close to home cardiac rehabilitation facilities experienced in exercising immunocompromised individuals and those with other pre-existing activity limitations due to cancer. 4) Utilization of newly developed magnetic resonance cardiopulmonary exercise treadmill testing methods to measure the two components (cardiac function and peripheral factors) that contribute to peak VO2 (a measure of maximal exercise capacity). This new information will provide mechanistic insight into how physical activity helps preserve exercise capacity and reduce fatigue. 5) Assessment of the relationships between cognitive function, activity, and exercise capacity thereby helping to unravel the association between physical activity, HRQOL and cognitive function in cancer patients. In this application, we propose to refine the physical activity intervention during the R21 Phase in patients who participate in the intervention for 6 months. If suitable milestones are achieved, we will conduct a randomized clinical trial in the R33 Phase to test the utility of the integrated physical activity intervention for sustaining peak V02, 6-min walk distance, cardiac and cognitive function, strength, activity, and HRQOL. If we achieve our study goals, this proposed intervention could reduce CV mortality and heart failure related hospital admissions, translate into clinical practice via extension through cardiac rehabilitation centers (often located close to cancer centers), increase health-related quality of life, reduce fatigue to perform activities of daily living, and attenuate cognitive function decline in lymphoma survivors. The results of this study could help to change existing sedentary behavior paradigms during receipt of chemotherapy and ultimately lead to improved long term outcomes for those with lymphoma and potentially other forms of cancer.


  • Bottinor W, Trankle CR, Hundley WG. The Role of Cardiovascular MRI in Cardio-Oncology. Heart failure clinics. 2021 Jan;17(1):121-133. Epub 2020 Oct 28. PMID: 33220881
  • Manisty CH, Jordan JH, Hundley WG. Automated Noncontrast Myocardial Tissue Characterization for Hypertrophic Cardiomyopathy: Holy Grail or False Prophet? Circulation. 2021 Aug 24;144(8):600-603. Epub 2021 Aug 23. PMID: 34424773
  • Jordan JH, Hundley WG. MRI of Cardiotoxicity. Cardiology clinics. 2019 Nov;37(4):429-439. Epub 2019 Aug 31. PMID: 31587784
  • Sachs BC, Gaussoin SA, Brenes GA, Casanova R, Chlebowski RT, Chen JC, Luo J, Rapp SR, Shadyab AH, Shumaker S, Wactawski-Wende J, Wells GL, Hayden KM. The relationship between optimism, MCI, and dementia among postmenopausal women. Aging & mental health. 2022 Jun 11: 1-9. Epub 2022 Jun 11. PMID: 35694859
  • Heiston EM, Hundley WG. Statins for Cardiac and Vascular Protection During and After Cancer Therapy. Current oncology reports. 2022 May;24(5):555-561. Epub 2022 Feb 24. PMID: 35199294