A new clinical trial led by University of Alberta researchers is exploring whether heavy strength training is a safe and beneficial way to help combat the long-term physical challenges faced by head and neck cancer survivors.
Despite treatments for these types of cancers improving in recent years, survivors still face devastating side-effects including speech and hearing impairments; issues with swallowing, eating and drinking; dental and oral complications; shoulder dysfunction; weakness or paralysis of facial muscles and bones leading to asymmetry and mouth opening restrictions; and fibrosis, a side-effect of radiation therapy that causes debilitating tissue-tightening over time in the neck region.
"It's one of the cancers that has a major impact on day-to-day activity. You can actually see and notice these side-effects. It's not one of the hidden cancers, it's more obvious," says Stephanie Ntoukas, a doctoral student in the Faculty of Kinesiology, Sport, and Recreation who is leading the trial and is first author of a recently published paper outlining the trial protocol.
The LIFTING 2 Trial is a Phase 2 randomized controlled trial that aims to enrol 38 head and neck cancer survivors for 12 weeks. Participants are randomly assigned to one of two groups: One receives the usual standard of care, with no specific exercise instructions; the other performs targeted heavy lifting exercises twice weekly under Ntoukas's supervision.
Though some studies have looked at the benefit of light to moderate-intensity strength training for head and neck cancer survivors, heavy lifting has yet to be studied. Ntoukas speculates it's because "there's a perception that cancer patients are fragile, they should rest. That was the mentality in the past."
She adds that, while lighter forms of strength training are ideal during the rehabilitation phase while patients are recovering from treatment-related nerve damage, "after that, there's not a good reason as to why they're not able to push themselves."
Many of the side-effects faced by head and neck cancer patients and survivors can lead to a significant loss of both muscle mass and strength. For example, problems with eating and swallowing can trigger weight loss — mainly in the form of muscle mass. Many patients with head and neck cancer also experience nerve damage during surgeries that can result in the muscles of the upper back, shoulders, face and neck becoming extremely weak or even non-functioning.
"Heavy load strength training seems to be the most effective and time-efficient way of rebuilding muscle strength and muscle mass, while serving as another way for cancer survivors to physically and mentally push themselves," says Ntoukas.
In addition to her expertise in the field, Ntoukas brings first-hand experience as a three-time survivor of head and neck cancer. "My experience allows me to relate to my patients very well. They really trust me because I personally developed and tested this exercise study on myself first, and I live with many, if not all, of the same side-effects that they deal with as well."
Ntoukas knows just how much these side-effects can affect quality of life, and what it feels like to have few interventions aimed at alleviating them.
"I was first diagnosed in 1993 as an infant, and there was nothing at that time," she says. "Even now, head and neck cancer is quite an underfunded, understudied cancer type."
Along with alleviating a variety of physical side-effects, strength training can be beneficial for cancer survivors' self-esteem and confidence, Ntoukas adds.
"In this population, there's a lot of body image challenges. You look different, you sound different, there are a lot of muscle transplants from other locations that change your appearance. This is the cancer group with the highest suicide rate for many reasons."
When she was first introduced to powerlifting, Ntoukas noticed the difference on a mental level as well as physically. "Cancer is something happening to you that you have no control over. For me, at least, powerlifting made me feel stronger.
"It gives you a sense of control and empowerment."
The trial began enrolling patients in April 2025 and is still ongoing. Some participants have already completed the 12-week trial, and Ntoukas says she is encouraged by the results.
"I'm seeing some patterns and improvements in muscle strength," she notes, adding that patients also report improvements in quality-of-life measures such as fatigue, self-esteem and anxiety.
Ntoukas says the next step after this trial is to compare heavy lifting with lighter-intensity strength training to find a "definitive answer of what the optimal dose is to reach specific outcomes in this cancer population."
The research team behind the LIFTING 2 trial includes Margaret McNeely, professor in the Faculty of Rehabilitation Medicine and adjunct professor in the Department of Oncology; Carla Prado, professor in the Faculty of Agricultural, Life & Environmental Sciences; and Kerry Courneya, Ntoukas' supervisor, professor in the Faculty of Kinesiology, Sport, and Recreation, and Canada Research Chair in Physical Activity and Cancer.
