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December 08, 2025
5 min read
Key takeaways:
- A Mediterranean diet and exercise intervention may improve anxiety, fatigue and depression for patients with lymphoma receiving chemotherapy.
- Patients receiving the intervention also had improved handgrip strength and gait speed scores.
ORLANDO — During her clinic shift, Melissa Lopez, PhD, RDN, received word that a participant in a trial evaluating the impact of Mediterranean diet and exercise among patients receiving chemotherapy for lymphoma wanted to speak with her.
Lopez, a registered dietitian and postdoctoral research fellow at Sylvester Comprehensive Cancer Center part of the University of Miami Miller School of Medicine, expected a complaint — and got one.
A Mediterranean diet and exercise intervention may improve anxiety, fatigue and depression for patients with lymphoma receiving chemotherapy. Image: Adobe Stock.
The patient reluctantly joined the trial at the behest of his wife. Before the trial, he had experienced “extreme” anxiety and “significant symptom burden” from the very beginning of his treatment, and had few expectations for success, Lopez recalled.
Melissa Lopez
“I’m very, very upset,” Lopez said the patient told her. “I’ve been calling the cancer center because I’ve been wanting to make a donation to the [Lifestyle Intervention of Food and Exercise for Lymphoma Survivors] study. There seems to be no way for me to do that. To see him so motivated and so happy during his last cycle, and for him to acknowledge that even though at the beginning there might have been some preconceptions about the role of diet and exercise, but that he gave it a shot, and that he benefited so greatly from it, it was definitely one of those moments where you remember how much this means to people.”
At ASH Annual Meeting and Exposition, Lopez presented early results from the randomized trial, which showed the intervention may improve anxiety, constipation, depression, fatigue and pain among participants.
“Small changes can lead to great benefits,” Lopez told Healio.
‘Perfect combo’
As Healio previously reported, Urvi A. Shah, MD, a myeloma specialist at Memorial Sloan Kettering Cancer Center, received the David M. Goldenberg Clinical Research Training Institute Award at ASH Annual Meeting and Exposition in 2024 for research showing a high-fiber, plant-based diet could slow progression of multiple myeloma.
Tracy Crane
However, outside of that work, little research has been done on lifestyle interventions on hematologic malignancies, particularly in lymphoma, Tracy Crane, PhD, RDN, director of lifestyle medicine, prevention and digital health at Sylvester Comprehensive Cancer Center, told Healio.
“Virtually nothing,” she said.
Crane spoke with Craig H. Moskowitz, MD, professor and director of Academic Clinician Development at the Miller School of Medicine at Miami, about the No. 1 complaint patients with lymphoma have during treatment.
“He said fatigue,” Crane said.
Crane and colleagues previously found that a Mediterranean diet, a plant-based diet with an “emphasis” on healthy fats, could improve fatigue among patients with cancer. Prior studies have shown exercise can improve fatigue, too.
“We hypothesized that this Mediterranean diet plus exercise during treatment for lymphoma would help these patients achieve optimal treatment doses and outcomes,” Crane said.
That led to the Lifestyle Intervention of Food and Exercise for Lymphoma Survivors trial, which enrolled patients with Hodgkin and non-Hodgkin lymphomas receiving chemotherapy.
Researchers randomly assigned them 2:1 to the intervention or a waitlist groups.
The intervention arm received weekly remote coaching sessions on diet and exercise during their treatment. The dietary portion of the study included daily and weekly goals for consumption of various foods. The exercise portion consisted of resistance and aerobic exercise.
The exercise included strength training, and researchers encouraged participants to do 150 minutes of moderate to vigorous activity outside of that during the week.
“Diet and exercise is the perfect combo,” Lopez said. “They both have benefits on health through different mechanisms, but they’re complementary. As dietitians, we can’t really talk about diet without talking about exercise and we can’t talk about exercise without diet. Their complementary benefits are what make the greatest impact on health, and this is what we wanted for our patients.”
Feasibility (goal of 50% of eligible survivors participating), retention and completion (80%), and satisfaction (80%) with the intervention served as primary endpoints.
The current update includes results from 72 adults (median age, 54 years; range, 18-82; 60% men; 75% white).
‘Very promising’
Overall, 81% of eligible participants enrolled in the study.
Dietary coaching sessions had an 86% attendance rate and exercise sessions had 81%.
“I knew we could shift diet in a variety of ways with patients, but during active treatment, to be able to ask somebody to exercise and to shift their diet pattern, I wasn’t sure how feasible it was going to be, but it turns out, we accrued this trial extremely fast,” Crane said. “They were very interested.”
Following treatment completion, patients who received the intervention had numerically lower rates of anxiety (17% vs. 34%), depression (46% vs. 67%), pain (22% vs. 39%), fatigue (46% vs. 67%) and constipation (17% vs. 25%).
Researchers did not observe a difference in moderate or severe shortness of breath.
“This is not the whole sample that we were powered for,” Crane said. “This is our teaser of the people who have completed it, so far. I don’t think you can draw any real strong conclusions quite yet, but we have enough of a signal here to say, something is going on in a positive direction. You can clearly see a trend here among several of the symptoms.”
The intervention arm also had significantly higher handgrip strength (30.2 kg vs. 23.2 kg; P = .02) and gait scores (3.5 vs. 3; P = .04).
“These are important findings when you’re actively going through treatment,” Crane said.
Lopez added that the intervention arm had improved protein consumption during the study, whereas the waitlist group consumed less.
“That’s very promising, as it may offer a way we can help patients from severe decline into malnutrition and cachexia,” she said.
The next steps in research are to investigate the intervention in a larger study.
Lopez and colleagues also have stored blood samples as well as wearable data to evaluate.
Future studies could investigate the intervention among patients receiving other treatments, such as chimeric antigen receptor T-cell therapies and immunotherapies, as well.
“The science is building,” Crane said about evaluating interventions during treatment. “There’s a big shift. Patients want it. We don’t have super strong evidence yet, but we’re building that evidence. Something is better than nothing. Do something now while we figure out the science of what exactly it should be for each different cancer type and treatment modality. [Encouraging] patients to move their body and eat a plant-focused diet as much as they can during treatment are good, solid recommendations to be making.”
“During cancer treatment, a lot of things can be very intimidating, and there are a lot of things that are outside of the patient’s hands,” Lopez added. “But diet and exercise are something that they have control over, and it doesn’t have to be intimidating. Little changes can have a great impact in their care, in their mental health and in their physical health.”
For more information:
Tracy Crane, PhD, RDN, can be reached at tecrane@med.miami.edu.
Melissa Lopez, PhD, RDN, can be reached at mxl2197@miami.edu.
Sources/Disclosures
Source:
Lopez-Pentecost M, et al. Abstract 4547. Presented at: ASH Annual Meeting and Exposition; Dec. 6-9, 2025; Orlando.
Disclosures:
Lopez and Crane report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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