CHICAGO—Cancer patients and survivors should strive to get 150 minutes per week of moderate-intensity aerobic exercise, according to new national guidelines. That is the same recommendation for the general public.
Although the evidence indicates that most types of physical activity, from swimming to yoga to strength training, are beneficial for cancer patients, the guidelines say clinicians should tailor exercise recommendations to individual patients.
The new national guidelines (Exercise Testing and Prescription for Cancer Survivors: Guidelines from the American College of Sports Medicine) call for taking into account the patient’s general fitness level, specific diagnosis, and factors about his or her disease that might influence safety.
Change in body mass, both weight gain and weight loss related to disease symptoms and treatment side effects, is a persistent area of concern for patients with cancer. Patients with hormone-based tumors, such as breast and prostate cancers, tend to gain weight during treatment and frequently have difficulty losing it. Other patients, especially those with gastrointestinal tumors, experience weight loss caused by loss of appetite and changes in their ability to swallow and properly digest food. Both groups can benefit from exercise, according to the new guidelines.
Several published studies have shown that exercise for weight control and reduction in body mass may actually reduce the risk of recurrence for breast cancer patients, and, ultimately, reduce breast cancer mortality. For patients with cancer-related weight loss, physical activity can help to maintain lean body mass, which can contribute to in creased strength and well-being. Over all, the guidelines suggest avoiding in activity as a means of boosting quality of life, strength, and fitness.
Kathryn Schmitz, PhD, MPH, an associate professor of epidemiology and biostatistics at the University of Pennsylvania School of Medicine, Philadelphia, presented the guidelines. She said one of the aims of the new guidelines is to make cancer exercise rehabilitation programs as common as those offered to people who have had a myocardial in farction or undergone cardiac surgery. Schmitz led a 13-member American College of Sports Medicine expert panel that developed the new recommendations after reviewing and evaluating literature on the safety and efficacy of exercise training during and after cancer therapy.
“We have to get doctors past the ideas that exercise is harmful to their cancer patients. There is still a prevailing attitude out there that patients shouldn’t push themselves during treatment. But our message ‘avoid inactivity’ is essential,” said Schmitz. “We now have a compelling body of high-quality evidence that exercise during and after treatment is safe and beneficial for these patients, even those undergoing complex procedures such as stem cell transplants. If physicians want to avoid doing harm, they need to in corporate these guidelines into their clinical practice in a systematic way.”
Schmitz and her colleagues analyzed published studies related to five adult cancer types (breast, both during and after treatment; pro state; hematologic, with and without stem cell transplant; colon; and gynecologic), and reviewed the evidence for multiple health outcomes. The panel found that although there are specific risks associated with cancer treatments that need to be considered when patients exercise, there is consistent evidence that exercise training can lead to improvements in aerobic fitness, muscular strength, quality of life, and fatigue in breast, prostate, and hematologic cancer patients and survivors.
“Individuals who undergo a treatment for cancer often lose about 10 years worth of function. They feel slower, and it is a physiologic effect, and exercise training can reverse that. There are also effects on quality of life,” Schmitz said.
The panel found that the data for colon and gynecologic cancers were insufficient to draw firm conclusions, and identified several areas requiring further study. Age, for instance, is a critical variable. Schmitz noted that more research is needed to determine the effects of physical activity in cancer patients more than 65 years of age and to develop interventions that may help these patients continue to live and function independently. The panel urges fitness professionals to enhance their capacity to serve the unique needs of cancer survivors.
“Oncology nurses are the ones who started the field of exercise and cancer. They were the ones back in the 1970s and early 1980s who were trying to push patients to exercise to see if it was safe,” said Schmitz in an interview with The Oncology Nurse. “The pioneers for this work were nurses at Ohio State University.”
She said oncology nurses are the most important players in getting the message out to patients that exercise during and after treatment can help with fatigue, weight problems, and well-being. “The big word for the oncology nurse is that they are the ones who are going to be able to deliver this message. We don’t believe that physicians are going to be the ones to deliver this message. We think oncology nurses are the way that information is going to get disseminated,” Schmitz said.
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