Summary: Up to 80% of people receiving chemotherapy report cancer-related cognitive impairment—often called “chemo brain”—characterized by memory lapses, trouble concentrating, and difficulty multitasking. A Phase II randomized trial examined whether a home-based exercise program and low-dose ibuprofen can reduce these cognitive side effects. The study found both interventions produced benefits in certain cognitive domains, with exercise showing the most consistent and pronounced effects.
Key Findings
- Exercise improved attention: Participants assigned to the EXCAP exercise program with placebo showed significantly better attention on objective testing compared with placebo alone.
- Ibuprofen had mixed results: Low-dose ibuprofen produced some cognitive improvements, but it was associated with smaller gains in short-term verbal memory compared with participants not taking ibuprofen, a result that requires further study.
- Perceived improvements noticed socially: Both exercise-only and exercise-plus-ibuprofen groups reported that family, friends, or coworkers more often noticed improvements in the patients’ cognitive functioning.
- Exercise showed the strongest signal: Overall, exercise produced more consistent and larger benefits across measured outcomes than low-dose ibuprofen.
Source: Wiley
Cancer-related cognitive impairment affects many patients undergoing chemotherapy, most commonly causing mild to moderate changes in attention, working memory, and multitasking ability. Because both exercise and anti-inflammatory medications can reduce inflammation through different mechanisms, researchers tested whether these interventions—alone or combined—could protect cognitive function during treatment.
This Phase II trial randomized 86 adults receiving chemotherapy who reported cognitive symptoms into four groups for six weeks: Exercise for Cancer Patients (EXCAP) plus low-dose ibuprofen, EXCAP plus placebo, low-dose ibuprofen only, and placebo only. EXCAP is a home-based, progressive program combining low-to-moderate intensity walking and resistance exercises. Cognitive performance and patient-reported outcomes were measured before and after the intervention period.
Study Results
After six weeks, the EXCAP-plus-placebo group showed significantly faster completion times on an attention test (Trail Making Test) than the placebo group, indicating better attention and executive function (a mean difference of −21.57 seconds). The ibuprofen-only group also improved on this attention measure versus placebo, but to a lesser degree (−11.27 seconds).
Both groups that included exercise (EXCAP with ibuprofen and EXCAP with placebo) also reported meaningful improvements on the FACT-Cog “comments from others” scale, reflecting that friends, family, or colleagues more often noticed cognitive improvements. On a sustained-attention task (Rapid Visual Processing), the EXCAP-plus-placebo group again performed better than placebo, and the ibuprofen group showed a trend toward improvement after adjustment for reading ability.
Notably, participants receiving ibuprofen performed worse on a delayed verbal memory test (Hopkins Verbal Learning Test–Revised delayed recall) compared with participants not taking ibuprofen. This unexpected finding suggests potential trade-offs that warrant additional investigation in larger trials.
Conclusions and Next Steps
The trial indicates that a structured, home-based exercise program can help protect cognitive function during chemotherapy, particularly attention and tasks related to processing speed. Low-dose ibuprofen showed some beneficial effects on attention-related measures but had inconsistent results overall and was linked to worse performance on one verbal memory measure. These mixed outcomes point to the need for Phase III trials to confirm benefits, refine dosing and duration, and clarify whether combining exercise with anti-inflammatory medication offers additive advantages.
Lead author Michelle C. Janelsins, PhD, MPH, emphasized that exercise produced the clearest benefits in this study and highlighted the broader health advantages of physical activity for people with cancer. She also recommended that patients discuss any planned interventions, including exercise programs or medications, with their oncology team to ensure safety and rule out contraindications.
Key Questions Answered
A: In this trial, a low-to-moderate walking and resistance program (EXCAP) was safe and effective. Chemotherapy affects individuals differently, so patients should get their oncologist’s approval before starting or changing a fitness routine.
A: This study found that low-dose ibuprofen produced some improvements on attention measures but results were inconsistent and it was associated with reduced performance on a short-term verbal memory test. Exercise was the more reliable option in this trial.
A: Chemotherapy can trigger systemic inflammation and other biological changes that affect brain regions responsible for executive function, attention, and memory, leading to symptoms often described as chemo brain.
Editorial Notes
- This article was edited by a Neuroscience News editor.
- The journal paper was reviewed in full by staff.
- Additional context was added by the editorial team for clarity.
About this neurology research news
Author: Sara Henning-Stout
Source: Wiley
Contact: Sara Henning-Stout – Wiley
Image: The image is credited to Neuroscience News
Original Research: Open access. “Phase II Trial of Exercise and Low-Dose Ibuprofen for Cancer-Related Cognitive Impairment in Patients Receiving Chemotherapy” by Michelle C. Janelsins et al., published in Cancer. DOI: 10.1002/cncr.70323
Abstract
Phase II Trial of Exercise and Low-Dose Ibuprofen for Cancer-Related Cognitive Impairment in Patients Receiving Chemotherapy
Background
Interventions to address cancer-related cognitive impairment are under-researched, especially during active chemotherapy. This trial evaluated the effects of a structured home exercise program and low-dose ibuprofen on cognitive outcomes.
Methods
Eighty-six patients receiving chemotherapy who reported cognitive concerns were randomized in a 2 × 2 factorial design to one of four arms for six weeks: EXCAP with ibuprofen, EXCAP with placebo, ibuprofen only, or placebo only. EXCAP is a progressive, home-based walking and resistance program. Cognitive testing and biological measures were collected at baseline and after the intervention.
Results
Participants (mean age 53.6; 88% female) in the EXCAP-plus-placebo group completed attention tests faster than placebo participants, indicating better attention and processing speed. The ibuprofen-only group also showed some attention gains versus placebo, though smaller. Both exercise groups reported that others noticed improvements in cognition. The ibuprofen group showed less improvement on a delayed verbal memory measure than those not receiving ibuprofen.
Conclusions
A home-based exercise program can improve certain cognitive functions in people receiving chemotherapy. Low-dose ibuprofen produced mixed effects and may impact verbal memory negatively in some cases. Larger Phase III trials are needed to confirm these findings, determine optimal dosing and duration, and assess safety and long-term outcomes.