PURPOSE: With the rising survival rate among children and adolescents with acute lymphoblastic leukemia (ALL), prioritizing patient-centered care to address the long-term effects of chemotherapy through tailored rehabilitation interventions is essential for optimizing their quality of life. The purpose of this study was to investigate the impact of an 8-week intervention using adaptive variable-resistance training (Adaptive-VRT) on chemotherapy-induced sarcopenia, fatigue, and functional restrictions in pediatric survivors of ALL. METHODS: A prospective randomized controlled trial included a total of 62 survivors of ALL, aged 12-18 years, and completed maintenance chemotherapy. Participants were randomized into two groups: the Adaptive-VRT group (n = 31), assigned the Adaptive-VRT intervention, and the control group (n = 31), which adhered to the standard exercise protocol. Baseline and post-intervention measurements were undertaken to analyze sarcopenia-related variables (i.e., muscle thickness and muscle strength), fatigue, and functional performance. RESULTS: The Adaptive-VRT group exhibited more favorable changes in muscle thickness [thigh thickness (P <
.001
η CONCLUSION: The findings suggest that Adaptive-VRT is a promising intervention for ameliorating chemotherapy-induced sarcopenia, fatigue, and functional limitations in pediatric ALL survivors. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06338020.