Exercise for People with Cancer: A Clinical Practice Guideline

Abstract

Background Development of this guideline was undertaken by the Exercise for People with Cancer Guideline Development Group, a group organized by Cancer Care Ontario’s Program in Evidence-Based Care (pebc). The purpose of the guideline was to provide guidance for clinicians with respect to exercise for patients living with cancer, focusing on the benefits of specific types of exercise, recommendations about screening requirements for new referrals, and safety concerns.Methods Consistent with the pebc’s standardized approach, a systematic search was conducted for existing guidelines, and systematic literature searches were performed in medline and embase for both systematic reviews and primary literature. Content and methodology experts performed an internal review, which was followed by an external review by targeted experts and intended users.Results The search identified three guidelines, eighteen systematic reviews, and twenty-nine randomized controlled trials with relevance to the topic. The present guideline provides recommendations for the duration, frequency, and intensity of exercise appropriate for people living with cancer. It also provides recommendations for pre-exercise assessment, safety concerns, and delivery models.Conclusions There is sufficient evidence to show that exercise provides benefits in quality of life and muscular and aerobic fitness for people with cancer both during and after treatment, and that it does not cause harm. The present guideline is intended to support the Canadian Society for Exercise Physiology’s Canadian physical activity guidelines. The recommendations are intended for clinicians and institutions treating cancer patients in Ontario, and for policymakers and program planners involved in the delivery of exercise programs for cancer patients.

Effectiveness of Oncologist-Referred Exercise and Healthy Eating Programming as a Part of Supportive Adjuvant Care for Early Breast Cancer

“…Clinical experience suggests a high demand and interest among breast cancer survivors for lifestyle‐based programs, and this population consistently reports health goals related to increasing physical activity, eating a healthier diet, and managing body weight . Furthermore, there are calls to action from health care professionals for institutions, policy makers, and other leaders to include exercise and healthy eating in the supportive care services provided for cancer survivors . The NExT study was designed to translate efficacy trials into a clinical care setting and address the reported barriers to delivery of this programming as supportive care for cancer survivors .…”

Exercise is medicine in oncology: Engaging clinicians to help patients move through cancer

“…The current article, the third in this triad, identifies and uses elements from the ACSM's Exercise Is Medicine (EIM) initiative to propose solutions to overcoming barriers to exercise referrals by oncology clinicians …”

“…The current article, the third in this triad, identifies and uses elements from the ACSM's Exercise Is Medicine (EIM) initiative to propose solutions to overcoming barriers to exercise referrals by oncology clinicians. [1][2][3][4][5]11 Despite the exercise recommendations noted above, an analysis of greater than 9000 cancer survivors from the ACS Study of Cancer Survivors II (SCS-II) cohort indicated that only between 30% and 47% met current physical activity guidelines. 12,13 In the Health Information National Trends Survey (HINTS) cohort, approximately 45% of cancer survivors reported regular physical activity, although this varied by tumor site (32% vs 53% in breast cancer vs prostate cancer survivors, respectively).…”

A multidisciplinary rehabilitation programme for cancer cachexia improves quality of life

“…However, though previously published data from the CNR-JGH clinic showed a correlation between weight gain and improvement in certain aspects of patient-reported physical functioning,29 there is little prior evidence in patients with advanced cancer that weight gain correlates with improvements in QoL. Similarly, patients enrolled in exercise training when undergoing active anticancer treatment can improve functional capacity, but the results for improving QoL are more mixed 43. The clear correlation between improved QoL scores in the CNR-JGH clinic and improved 6MWT (figure 3) suggests that the combined focus on improving nutrition and physical rehabilitation is beneficial and possibly synergistic in promoting QoL improvements in patients with advanced cancer and cachexia.…”