NEOBIC-XR: a home-based extended reality exercise platform and multicenter evaluation framework for supportive oncology care

Exercise is increasingly recognized as part of supportive cancer care, but many patients face barriers to structured, safe, and sustainable exercise during treatment. Extended reality (XR) may support home-based delivery by combining immersive guidance, standardized sessions, and embodiment-related features. However, reproducible oncology deployment models remain limited. This Methods paper describes NEOBIC-XR, a home-based XR exercise platform for people with cancer, and the multicenter workflow used to evaluate its implementation. NEOBIC-XR integrates multilingual guidance, avatar-based self-representation, structured tutorials, adjustable intensity, mixed-reality components, and linked subjective, telemetry, and movement-derived data streams. The associated evaluation is a multicenter, implementation-oriented methods study conducted in three hospitals in Spain, with common baseline and 3-month follow-up assessments. Adults with stage IV solid tumors who are clinically suitable for light-to-moderate exercise are enrolled in the XR-supported pathway or the Written-recommendation pathway. XR-supported participants complete a 4-week home program with three prescribed sessions per week; Written-recommendation participants receive evidence-based physical activity recommendations and complete the same hospital-based questionnaires. The main planned comparative endpoint is baseline-to-3-month change in self-reported physical activity. Additional questionnaire-defined domains include health-related quality of life, symptom burden, psychological distress and screening items, cognitive complaints, supportive care needs, nutritional indicators, and other supportive-care measures. XR-specific analyses will describe first-to last-day changes in exercise-related readiness, coping self-efficacy, exercise self-efficacy, wellbeing, avatar representation, trainer-led versus body-double tutorial delivery, adherence, tolerability, embodiment-related experience, telemetry, and movement-derived indicators. Overall, this paper presents NEOBIC-XR as a privacy-preserving, analyzable, and clinically deployable methodological platform for exploring how home-based XR exercise can be implemented, experienced, and evaluated in oncology supportive care.