Exercise for Toxicity Management in Cancer—A Narrative Review

Abstract

Although the treatment of cancer is more effective now than ever, patients with cancer still face acute and chronic toxicities such as fatigue, cardiotoxicity, pain, cognitive impairment, and neurotoxicity. In this narrative review, we briefly discuss the use of exercise for toxicity management in patients with cancer, biological mechanisms underlying the toxicities and the effects of exercise, barriers that patients—especially underserved patients—face in adopting and adhering to exercise programs, and new technologies to overcome barriers to exercise. Our conclusions and clinical suggestions are: (1) exercise is safe and effective for treating many toxicities; (2) patients can benefit from a variety of exercise modalities (e.g., walking, cycling, resistance bands, yoga); (3) exercise should be started as soon as possible, even before treatments begin; (4) exercise should be continued as long as possible, as a lifestyle; and (5) barriers to exercise should be identified and addressed, (e.g., continually encouraging patients to exercise, using mobile technology, advocating for safe communities that encourage active lifestyles). Future research should inform definitive clinical guidelines for the use of exercise to ameliorate toxicities from cancer and its treatment.

Response to Crevenna and Ashbury, Vallance and Bolam, and Crevenna and Keilani regarding the effects of exercise on chemotherapy-induced peripheral neuropathy

“…Taken together, there are many reasons to be excited about the use of exercise during chemotherapy in the prevention of CIPN as part of both supervised and self-management interventions [1]. Exercise has relatively little risk, it can be conducted in conjunction with other therapies, and it is also beneficial for attenuating other chemotherapy-induced toxicities such as fatigue, sleep disturbances, cognitive deficits, and distress [10]. We agree wholeheartedly with the commenting authors that we need more high quality research on the effects of exercise on CIPN, and we hope to contribute to that research in the future.…”

Systematic Review of Randomized Controlled Trials of Exercise Interventions Using Digital Activity Trackers in Patients With Cancer

“…1,3,4 Exercise is a promising intervention to prevent and ameliorate cancer- and treatment-related toxicities. 5 Prior studies, 6–11 including a systematic review of 34 exercise interventions for patients with cancer during and after treatments, 6 report that exercise in survivors improves strength, endurance, and cardiopulmonary function, thereby resulting in improved physical and mental health and health-related quality of life (HRQoL). Based on these benefits, efforts to integrate exercise interventions in cancer care are increasing.…”

An exercise oncology clinical pathway: Screening and referral for personalized interventions

“…A pragmatic approach to promoting exercise is to then repeatedly screen for clinically meaningful changes in these baseline measures and refer for exercise prescription when indicated. Proactively prescribing exercise throughout cancer treatment may prevent the onset of some symptoms and mitigate the progressive severity of treatment‐related functional impairments 19,20 …”