Chapter 01 - Safeguarding Exercise Capacity Throughout and After Cancer Treatment
Given the increasing number of studies showing the safety and benefits of physical activity, exercise should be part of the standard care for all cancer survivors. Several evidence-based physical activity guidelines for cancer survivors have been published.
In 2010, the American College of Sports Medicine (ACSM) published physical activity guidelines for cancer survivors, which were based on extensive systematic review of the literature on adult survivors of breast, prostate, colon, haematological, and gynaecological cancers. The expert panel reported consistent evidence regarding the safety of exercise during and after cancer treatment (including intensive treatments such as bone marrow transplant) and beneficial effects on cardiorespiratory fitness, muscle strength, QoL, and fatigue. The ACSM recommends that cancer survivors should be as physically active as their abilities and conditions allow. Importantly, the recommendation is that cancer survivors should avoid being physically inactive regardless of cancer stage or treatment. Adult cancer survivors are advised to engage in either at least 150 minutes per week of moderate intensity or 75 minutes per week of vigorous intensity aerobic physical activity, or an equivalent combination of both. Muscle-strengthening activities involving all major muscle groups are recommended at least two sessions per week. Several precautions for exercise should be taken into account, including arm and shoulder problems, skeletal fractures, infection risk, ostomy, and swelling or inflammation in the abdomen, groin, or lower extremity.
Lymphoedema is not a contraindication to exercise. A recent RCT showed that women with breast cancer-related lymphoedema can safely lift heavy weights during upper body resistance exercise, without fear of lymphoedema exacerbation or increased symptom severity.
Comparable physical activity guidelines have been published by the American Cancer Society (ACS), Exercise and Sport Science Australia, Comprehensive Cancer Center the Netherlands, the German Cancer Association, and the British Association of Sport and Exercise Science.
Current physical activity guidelines for cancer survivors are rather generic. Additional research is needed in order to develop more specific guidelines for a given exercise prescription (e.g. mode, frequency, intensity, duration), for a given cancer site at a particular phase of the cancer trajectory, and for specific outcomes. Future studies should focus on identifying clinical, personal, physical, psychosocial, and intervention moderators explaining “for whom” or “under what circumstances” interventions work. In addition, more insight into the working mechanisms of exercise interventions on health outcomes in cancer survivors is needed to improve the efficacy and efficiency of interventions. Existing programmes should also embrace the interests and preferences of patients to facilitate optimal uptake of interventions, and must take the principles of exercise training into account.