Heavy Lifting Strength Training In Head And Neck Cancer Survivors (The Lifting Trial)

PURPOSE: Despite improvements in surgical neck dissection (ND) procedures, head and neck cancer survivors (HNCS) still experience acute and chronic side effects such as loss of muscular strength, limitations in physical functioning, and fatigue, that impact quality of life (QoL) and return to work. Light-to-moderate intensity strength training (LMST) improves muscular strength, physical functioning, and some side effects in HNCS. Heavy lifting strength training (HLST) may further improve these outcomes, however, it has not been studied in HNCS. The primary aim of the LIFTING trial was to examine the feasibility and safety of a HLST program in HNCS ≥1-year post-surgical neck dissection. METHODS: In this single arm feasibility and safety study, HNCS were asked to complete a twice weekly, 12-week, supervised HLST program, gradually progressing to lifting heavy loads of 80%-90% of 1 repetition maximum (1RM) for barbell squat, bench press, and deadlift. Feasibility outcomes included recruitment rate, 1RM completion rate, program adherence, and follow-up assessment rate. The primary efficacy outcomes were changes in upper and lower body strength from baseline to postintervention assessed via reliable 1RM tests. Wilcoxon signed rank tests were used to compare the pre-post changes in efficacy outcomes. RESULTS: Sixteen HNCS were assessed for eligibility. Nine were recruited over an 8-month period during the COVID-19 pandemic. All 9 (100%) successfully completed the baseline1RM tests and progressed to heavy loads at approximately 5-weeks. Seven participants (77.7%) completed all follow-up 1RM tests. Median attendance was 95.8% (range: 71%-100%). Weight lifted increased for squat/leg press (median change: +34 kg; 95% CI: +25 to +47; p = 0.008), bench press (median change: +6 kg; 95% CI: +2 to +10; p = 0.012), and deadlift (median change: +12 kg; 95% CI: +7 to +24; p = 0.012). No adverse events were reported. CONCLUSIONS: HLST may be feasible and safe for HNCS at least 1-year post-ND, and result in significant improvements in muscular strength. Future research should consider additional recruitment strategies and compare HLST to LMST to determine the optimal strength training regimen for this understudied population.