4×4 Training: New Perspectives for Cancer Patients
An interview with Rūdolfs Cešeiko, Ph.D., Exercise Physiologist | Training Expert at OAC by Susa Schreiner
What happens when the highly effective “Norwegian 4×4 Method,” also known as the “Norwegian Protocol” [1], is tailored to meet the specific needs of cancer patients?
Exercise physiologist and OAC-Trainer Rūdolfs Cešeiko, Ph.D., from Riga, Latvia, explored this question during his Master’s studies in Exercise Physiology and Sport Sciences at the Norwegian University of Science and Technology (NTNU), Trondheim, where he first encountered the interval training concept.
The original research by Norwegian scientists focused on optimizing cardiovascular performance, particularly increasing maximal oxygen uptake (VO₂max). Their work demonstrated that longer high-intensity intervals are more effective than traditional endurance training. This research, led by Ulrik Wisløff and Øivind Rognmo, subsequently attracted attention for further development and clinical application in cardiac patients—with impressive results.
Ph.D. candidate and exercise physiologist Cešeiko then shifted his focus to potential benefits for cancer patients. Drawing on initial experiences and discussions during his studies in Norway, he investigated the effects of maximal strength training during chemotherapy in breast cancer patients—yielding groundbreaking results. Building on this, Cešeiko collaborated with the scientific team at Outdoor Against Cancer (OAC) to develop the 4×4 Training program, which is now successfully implemented in Riga and Munich.
What began as a local initiative in Latvia in 2017 has evolved into a significant European movement.
Together with OAC, the 4×4 Training is being further developed into a standardized protocol intended for broad application across healthcare systems, while allowing adaptation to local needs. OAC’s vision is clear: to create specialized programs for different patient groups and launch a research initiative to document outcomes.
In May 2025, Cešeiko led his 100th 4×4 Training session in Riga. This milestone was a great reason for OAC to speak with the founder of the 4×4 Training for cancer patients: about his research and findings, his encounter with Petra Thaller, founder and President of OAC, the resulting collaboration, and future plans.
An interview with Rūdolfs Cešeiko, Ph.D., Exercise Physiologist | Training Expert at OAC by Susa Schreiner
In May 2025, Cešeiko led his 100th 4×4 Training session in Riga. This milestone was a great reason for OAC to speak with the founder of the 4×4 Training for cancer patients: about his research and findings, his encounter with Petra Thaller, founder and President of OAC, the resulting collaboration, and future plans.
OAC: Rūdolfs, how and when did you first become aware of the origin of 4×4 training, the Norwegian Protocol?
PH. D. Rūdolfs Cešeiko: During my studies in Norway between 2014-2016, I completed a Master’s degree in Exercise Physiology, studying under Professor Jan Hoff and Professor Eivind Wang: these academics are the originators of the Norwegian Protocol.
As MSc students, we had two directions to choose from: athletic performance or health care. Because of my background, I chose health care. One opportunity here was to be involved in a larger national breast cancer study, where we measured and evaluated the effectiveness of exercise programs. Considering my personal cancer story, this was the perfect option for me.
During this time, I conducted an in-depth examination of 4×4 training and the physiological rationale behind it. Together with the professors, we had fruitful conversations about the potential effects of 4×4 training in a cancer setting, as the programs in the national breast cancer study were providing unexpected results – patients were getting weaker.
My involvement with 4×4 continued in Riga during my Ph.D. studies, where I tested and measured the effects of adapted 4×4 strength training during chemotherapy for breast cancer patients. The results were groundbreaking and supported by high-level publications. This became the turning point in my involvement with and adaptation of 4×4 training. Importantly, Prof Wang was my Ph.D. supervisor, and we have remained in close contact ever since.
OAC: You met Petra Thaller at a conference in Latvia, became an OAC trainer in 2023, and have since evaluated and established 4×4 training in Riga. What inspired you about Petra and OAC?
PH. D. Rūdolfs Cešeiko: Petra embodies the concept of grounded energy seeking to assist and enhance the well-being of others. OAC both reflects as well as provides this characteristic of Petra where ideas and vision are translated through structures into practical supportive and health promoting activities.
To fully appreciate the significance of meeting Petra and discovering OAC, it’s important to refresh a few key events. It began with a conference in Riga, which initially focused on areas such as precision medicine and the role of exercise in disease management – fields that represented a shared passion and professional interest for both Petra and me.
We had both become actively involved in providing outdoor activities for individuals undergoing chemotherapy or recovering from treatment. My own journey with adapted 4×4 training began in 2017, when I led outdoor 4×4 sessions for cancer patients during rehabilitation camps – something I continued for three years.
Remarkably, even though our event was eventually cancelled, the connection we had formed around the conference resonated deeply. We stayed in touch, and in the summer of 2023, I completed the OAC Training course!
OAC: By the end of May 2025, you had already conducted your 100th training session in Riga, with 40 to 55 participants attending weekly. How challenging was it to establish 4×4 training in Riga?
PH. D. Rūdolfs Cešeiko: Establishing 4×4 training in Riga was remarkably smooth due to the solid foundation I had previously built in Latvia. I was able to collaborate with an extensive professional network that included leading oncologists, pharmaceutical organizations, patient advocacy groups, and active social media communities. This comprehensive support system was crucial to our success. The initial session, co-organized with a prominent oncologist, generated immediate interest and enthusiasm. From there, we established a consistent program that quickly gained momentum. The rapid growth to 40-55 weekly participants reflects both the efficacy of the 4×4 training and the strong need for such evidence-based approaches in our community. The genuine benefits participants experienced became our most powerful dynamic for growing, creating a self-sustaining cycle of referrals and developing.
OAC: What are your wishes for the future regarding 4×4 training in Riga and Latvia?
PH. D. Rūdolfs Cešeiko: My vision for 4×4 training in Latvia extends far beyond our current achievements. Having built a strong foundation with over 100 sessions delivered, I am now focused on expanding our reach beyond Riga to communities across the entire country. This next phase requires training additional qualified instructors who can uphold the integrity of the program while making it accessible to more people.
A key goal is the full integration of 4×4 training into Latvia’s healthcare system – establishing it as a recognized and standard option for patients undergoing or recovering from treatment. Now, as a proud member of the OAC team, I’ve found both validation and a strategic framework for this expansion. Our collaboration has transformed what began as a local initiative into a vital part of a broader European movement.
Together with OAC, we are developing standardized protocols that can be implemented across diverse healthcare settings while remaining adaptable to local needs. Looking ahead, I envision creating specialized programs tailored to different patient populations and launching a research initiative to document outcomes. This evidence-based approach will not only strengthen our case for institutional support but also ensure we continue to serve those who need us most.
The journey from concept to reality has been remarkable – but I believe we are still at the beginning of what’s possible.
