Gone are the days when patients were told to rest during cancer treatment. Since the first article on exercise for patients with cancer appeared in the literature in 1986, numerous studies have confirmed its benefits on disease- and treatment-related fatigue, anxiety and depression, sleep quality, lymphedema, bone and muscle strength, and risk of recurrence (ONS, 2016).
To help oncology nurses understand exercise recommendations for patients with cancer and incorporating physical activity into care and treatment for patients, the Clinical Journal of Oncology Nursing (CJON) published a special supplement in December 2016 that covered various components of this topic (Musanti, 2016).
Patient-Centered Physical Activity Assessment and Interventions
A multidisciplinary team in the Cancer Prevention Center at the University of Texas MD Anderson Cancer Center developed a physical activity algorithm to aid practitioners in providing safe and effective patient- centered clinical assessments and interventions. The algorithm guides patient conversations using motivational interviewing principles.
The team explained that the algorithm is useful in initiating conversations with patients who are not meeting established activity guidelines and are ambivalent to increasing their activity. It guides practitioners in providing education on the importance of exercise and helps them assess risk of physical activity in patients with cardiovascular, pulmonary, or renal disease so they can be referred appropriately.
For examples of the algorithm and associated materials, refer to the CJON supplement.
Role of Physical Therapy in Survivor Exercise
Few cancer survivors report meeting the minimal public health guidelines for physical activity, often citing that pain and fatigue limitations prevent them from engaging in community- based exercise programs for the general public. Healthcare providers from the University of Alberta in Edmonton, Canada, conducted a literature review to determine whether cancer survivors with physical impairments or functional limitations may benefit from interdisciplinary rehabilitation using tailored therapeutic exercise interventions. They proposed a referral pathway and model of care to support survivors to successfully transition to a self-directed community- or home-based exercise program.
The team assessed common physical limitations in survivors such as cancer- related fatigue, lymphedema, and chemotherapy-induced peripheral neuropathy. They suggested that working with interdisciplinary rehabilitation professionals would enable tailored, person-centered guidance in developing a successful exercise program. As the primary contact for survivors, oncology nurses are well positioned to identify limitations that are preventing physical activity and refer survivors to the appropriate rehabilitation, physical therapy, or community-based exercise programs.
For more information on the referral pathway and model of care, refer to the CJON supplement.
Incorporating exercise Into the Cancer Treatment Paradigm
Despite its numerous benefits and evidence-based support, exercise prescription is still not a standard of care in patients with cancer. Healthcare providers at the University of Texas and the Cancer Foundation for Life in Tyler wrote about the challenges that contribute to the lack of exercise prescriptions for this patient population, including treatment- related side effects; lack of knowledge among providers, patients, and families; and inadequate resources.
Using a case study example, the authors walked through the challenges and provided actionable recommendations to overcome them. A patient with fatigue may be anemic, for example, so evaluating and treating the condition could reduce fatigue, along with incorporating small amounts of exercise several times per day. Awareness could be addressed with staff education and in-services as well as community education in newspaper articles or television interviews. Reimbursement for cost of care could be overcome with seeking community-based sponsorship, using grants and fund-raising, and advocating for health policy change.
For more examples on overcoming challenges with incorporating exercise into cancer treatment, refer to the CJON supplement.
Community-Based Exercise Programs for Cancer Survivors
At many social levels, the popularity of fitness, physical activity, and avoiding a sedentary lifestyle is growing. This is also true for cancer survivorship exercise programs, leading the American College of Sports Medicine and the American
Cancer Society to develop a professional certification for practitioners in this area, the Certified Cancer Exercise Trainer (CET), in 2004. Today, more than 450 CETs are certified in the United States, yet the demand for cancer exercise programs outweighs their availability.
The authors examined several successful community-based exercise programs and investigated where research is leading as technology advances change the fitness landscape. They cited three programs offered at around the United States and even worldwide.
- Dragon Boat Racing Teams: Established in 1996 by Canadian exercise physiologist Donald McKenzie, dragon boat racing uses teams of 10–22 people to paddle a narrow boat. McKenzie found that breast cancer survivors who engage in upper-extremity exercise on the ipsilateral side of their axillary dissection have positive outcomes. Cautionary refinements are made, such as use of compression garments to decrease risk of lymphedema. This program is offered worldwide.
- LIVESTRONG at the YMCA: The 12-week program empowers adult cancer survivors to practice a healthy lifestyle by increasing muscle mass, physical strength, and cardiorespiratory endurance. These factors help improve survivors’ functional ability, energy levels, self-esteem, and quality of life. Many (but not all) YMCA locations offer the program, so check with your local branch.
- FitSTEPS for Life: An outreach of the not-for-profit Cancer Foundation for Life, whose goal is to improve patients with cancer’s physical and mental functioning capacity and quality of life, FitSTEPS for Life offers individual, supervised exercise and nutrition guidance for patients with all types of cancer. It currently only operates in Texas. The authors of this article also compiled a list of patient resources (see Figure 1).
For more information on exercise in patients with cancer, refer to the full CJON supplement (Musanti, 2016).