The Exercise and Sports Science Australia position statement: Exercise medicine in cancer management

Abstract

Objectives: Since Exercise and Sports Science Australia (ESSA) first published its position statement on exercise guidelines for people with cancer, there has been exponential growth in research evaluating the role of exercise pre-, during and post-cancer treatment. Design and Methods: The purpose of this report is to use the current scientific evidence, alongside clinical experience and exercise science principles to update ESSA's position statement on cancer-specific exercise prescription. Results: Reported in this position statement is a summary of the benefits accrued through exercise following a cancer diagnosis and the strengths and limitations of this evidence-base. An exercise prescription framework is then proposed to enable the application of cancer-specific considerations for individualisation, specificity, safety, feasibility and progression of exercise for all patients. Additional specific exercise prescription considerations are provided for the presence of haematological, musculoskeletal, systemic, cardiovascular, lymphatic, gastrointestinal, genitourinary and neurological disease-and treatment-related concerns, as well as presence of co-morbid chronic disease. Further, we also identify and discuss cancer-specific pragmatic issues and barriers requiring consideration for exercise prescription. Conclusions: While for the majority, multimodal, moderate to high intensity exercise will be appropriate, there is no set prescription and total weekly dosage that would be considered evidence-based for all cancer patients. Targeted exercise prescription, which includes the provision of behaviour change advice and support, is needed to ensure greatest benefit (as defined by the patient) in the short and longer term, with low risk of harm.

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

“…To date, very few studies have used elements of EIM in the oncology care setting, but there is ample scope and a need to examine integration into cancer care. The evidence base strongly supports adoption of the EIM approach for all patients with chronic conditions, including people living with and beyond cancer . Therefore, we propose the EIM approach as a way forward in the oncology setting.…”

“…The evidence base strongly supports adoption of the EIM approach for all patients with chronic conditions, including people living with and beyond cancer. [1][2][3]5,10,23 Therefore, we propose the EIM approach as a way forward in the oncology setting. Indeed, a recent publication from the American Society of Clinical Oncology recommends the "5 A's" approach that is the basis of the EIM approach noted below.…”

“…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).…”

Evaluating a Web- and Telephone-based Personalised Exercise Intervention for Individuals Living With Metastatic Prostate Cancer (Exerciseguide): Protocol for a Pilot Randomised Controlled Trial

“…Metastatic disease and the subsequent treatments cause considerable physical and psychological burden (5). Androgen deprivation therapy, radiotherapy and chemotherapy can result in increased fat mass, fatigue, and pain sizes in cancer populations on both quality of life and physical function when compared to face-to-face exercise (10,23). Lack of supervision and personalised support, reduced intervention adherence, and limited individualisation are all possible causes of this discrepancy (10,24,25).…”