Tailoring the Evidence for Exercise Oncology within Breast Cancer Care

Abstract

Exercise is safe and effective for those living with and beyond breast cancer, with evidence supporting exercise guidelines, and position statements from international organizations. Despite the clearly recognized benefits of exercise for these individuals, many do not participate or maintain recommended exercise levels throughout the breast cancer continuum, highlighting the lack of translation from research into practice. In addition, discerning how exercise can be tailored to address breast cancer-related impairments, so that individuals are able to participate safely and effectively, has also not been studied extensively. Thus, we propose that implementing exercise screening, triage, and referral pathways across the breast cancer continuum may allow for increased accessibility and adoption among those living with and beyond breast cancer. This paper provides an overview of exercise prescription tailoring for common breast cancer and treatment-related impairments, proposes a simplified screening tool for identifying physical activity and movement-related impairments, and considers how best to channel evidence into practice via proposed implementation pathways that may better connect individuals living with and beyond breast cancer with exercise oncology resources through screening, triage, and referral.

A Qualitative Study of Patient and Healthcare Provider Perspectives on Building Multiphasic Exercise Prehabilitation into the Surgical Care Pathway for Head and Neck Cancer

“…Despite these limitations, the current qualitative findings, in conjunction with the quantitative findings [ 23 ] support the role of a multiphasic exercise prehabilitation program across HNC clinical care. To support implementation, screening, triage, and referral pathways across the HNC continuum may support earlier access to evidence-based exercise resources for patients, as well as support better adherence to exercise programming [ 19 , 42 , 43 , 44 ]. In addition, supporting exercise adherence needs to extend beyond the individual.…”

“…The Social Ecological Model [ 45 ] posits that behavior change is indeed influenced by interactions between these multiple environments. Thus, exercise oncology interventions must target multiple levels to support exercise adherence, considering interactions between patients, their healthcare providers, and the exercise specialist team, in order to build a pathway that supports a multiphasic exercise prehabilitation approach, ultimately building resources to support exercise into cancer survivorship that are sustainable in community-based settings [ 19 , 42 ]. To that end, tailoring interventions that focus on tumor type, treatment type, place on cancer continuum, side-effects from treatment, and individual factors is also important to enhance recruitment and adherence to exercise programming [ 42 ].…”

Breast cancer: how hippotherapy bridges the gap between healing and recovery. A randomized controlled clinical trial.

“…It has been shown that self-induced movement has key effects in the synthesis and release of hormones and peptides strongly involved in brain modulation [94][95][96] . Exercise has been suggested as the must for improvement of quality of life after breast cancer [97][98][99][100] . However, patients are constantly dealing with fatigue, sleeping disorders and pain, which may prevent them from regular voluntary exercise routines.…”

First-Year Implementation of the EXercise for Cancer to Enhance Living Well (EXCEL) Study: Building Networks to Support Rural and Remote Community Access to Exercise Oncology Resources

“…Since targeted outreach began, there have been 22 participants in two successful, lung-specific exercise classes in 2022. This targeted outreach and delivery of classes will be expanded to reach other underserved tumour types, including for individuals with an advanced cancer diagnosis that require specific exercise tailoring to meet functional and movement needs [25,26].…”

“…This is not surprising, given commonly reported HCP barriers to exercise-oncology referral, including a lack of time, knowledge, and resources about exercise and cancer [33], as well as limitations to in-person interactions associated with the COVID-19 pandemic (i.e., less facetime between HCPs and patients in clinical settings). Although enrolment through self-referral highlighted the effective community-based outreach from the EX-CEL hubs, the HCP referral pathway is critical for sustainability within the cancer care system [14,25]. Ongoing work in both neuro-oncology [34] and head and neck cancer [35] populations are utilizing rehabilitation triage clinics in collaboration with physiatrists within cancer care settings to embed both exercise screening and referral into clinical workflows.…”