Exercise as a Treatment Tool for Cancer Patients
The Role of Exercise in Cancer Care
Exercise is increasingly recognized as a vital component of treatment for cancer patients. While it is well-established that exercise benefits individuals with cardiovascular diseases and those who are healthy, its importance for cancer patients is becoming more evident. Conventional treatments such as chemotherapy, radiation, and surgical resections can weaken the body and negatively affect patients’ psychological well-being.
Evidence Supporting Exercise in Cancer Treatment
A recent meta-analysis published in the Cancer Journal for Clinicians reviewed the integration of exercise into cancer treatment plans. Previous studies demonstrate that exercise can prevent at least seven types of cancer, including colon, breast, endometrial, kidney, bladder, esophageal (adenocarcinoma), and stomach cancers. Moreover, exercise has shown potential to improve cancer-related outcomes such as fatigue, depression, physical function, anxiety, and overall quality of life. Recommendations suggest engaging in 30 minutes of aerobic activity three times a week, coupled with resistance training twice weekly.
Barriers to Implementing Exercise in Treatment
Despite the acknowledgment of exercise’s benefits, barriers exist in implementing exercise protocols within healthcare systems. Research indicates that 80% of cancer survivors express a desire for guidance from healthcare professionals regarding exercise during and after treatment. However, clinicians face challenges, including uncertainty about the safety and appropriateness of exercise for individual patients, a lack of awareness of available cancer-specific exercise programs, and the perception that exercise programming falls outside their scope of practice.
Bridging the Gap Between Patients and Clinicians
Both patients and clinicians agree on the benefits of exercise as a therapeutic tool, yet concerns about exercise safety, monitoring, and support create a disconnect. To address these issues, clinicians can adopt the Exercise is Medicine (EIM) approach, endorsed by the American College of Sports Medicine (ACSM). This model involves three key steps: assessing physical activity levels, advising on increased activity, and referring patients to appropriate exercise programs.
Steps in the Exercise is Medicine Approach
The first step involves assessing a patient’s physical activity, similar to measuring vital signs like blood pressure. This assessment highlights the importance of exercise for recovery. The second step is advising patients to elevate their activity levels to meet recommended guidelines. If these levels are not achieved, referrals to structured programs become necessary. The final step allows clinicians to leverage medical history and activity status to identify suitable exercise programs tailored to each patient’s needs.
Options for Cancer Patients
Under the EIM framework, patients can choose from several exercise options, including healthcare professional (HCP) supervised exercise, community programs, or self-directed exercise. While integrating fitness instructors into hospital settings is ideal, logistical challenges persist regarding hiring and coordinating with oncology teams. Monitoring patient health and ensuring proper care during exercise programs remain significant hurdles in many healthcare systems, except in countries like Canada and the Netherlands.
Healthcare Professional Supervised Programs
HCP-supervised exercise programs typically occur in rehabilitation units, hospital exercise facilities, and palliative care settings. Professionals involved may include psychiatrists, physical therapists, clinical exercise physiologists, nurses, and occupational therapists, all of whom focus on enhancing physical fitness and function throughout the cancer journey. These programs aim to mitigate treatment side effects and functional decline while facilitating a smooth transition to community-based or self-directed exercise.
Community and Self-Directed Programs
Community exercise programs are often held in local centers or gyms, where trainers receive specialized training for working with cancer patients. Programs such as the UK-based MoveMore and LIVESTRONG at the YMCA in the United States equip trainers with the skills necessary to support cancer patients. These community options offer patients a more affordable means of engaging in exercise compared to HCP-supervised programs, although they may not provide the same level of supervision.
The Role of Oncology Clinicians
Ultimately, the responsibility for implementing exercise assessments, providing patient advisement, and facilitating referrals lies with oncology clinicians. While they have the challenging task of integrating exercise into standard treatment practices alongside traditional therapies, support from policymakers, researchers, clinical educators, and healthcare providers is crucial for successful implementation.
Conclusion
Despite the challenges in incorporating exercise into healthcare systems worldwide, there are currently viable options for cancer patients and survivors to enhance their physical and psychological well-being. The movement towards recognizing exercise as a form of medicine continues to evolve, paving the way for more integrative approaches in cancer care.
Written by P. Sukumar
Reference(s): Schmitz, KH., et al. (2019). Cancer Journal for Clinicians. Exercise is Medicine in Oncology: Engaging Clinicians to Help Patients Move Through Cancer. Bohn, K. (2019) Eurekalert!. Exercise can now be prescribed like medicine for people with and beyond cancer.