New exercise guidelines for patients with cancer can “improve physical and psychological outcomes from cancer diagnosis and for the balance of life,” concluded representatives from 17 organizations participating in the Second Roundtable on Exercise and Cancer Prevention and Control.1 Attention focused on the new guidelines, including coverage in The New York Times2 and medical publications, offers an opportunity for oncology clinicians to answer the roundtable’s call to action and assess patients’ physical activity at regular intervals, advise patients about desired levels of activity, and refer patients to appropriate exercise programs.
“One key point to clarify,” the roundtable report noted, “is that oncology clinicians are not expected to give specifics of exercise prescriptions (eg, to prescribe specific resistance training exercises, equipment, or progression of weights) or to do extensive screening and triage to determine whether exercise needs to be done in a rehabilitative vs community setting. Oncology clinicians, however, play a vital role in telling patients that it is important to exercise and pointing patients in the right direction to make that happen.”
The guidelines for patients with cancer vary according to the outcome of interest. For prevention of recurrence, the recommendation is similar to those for the general population: 150 minutes per week of aerobic activity and twice weekly strength training. For cancer health-related outcomes, such as fatigue and sleep disturbance, the roundtable’s recommendations vary, such as 30 minutes of moderately intense aerobic activity three times a week and 20 to 30 minutes of resistance or strength training two times a week for cancer-related fatigue.
Patient education materials developed by the Moving Through Cancer initiative to help patients stay more physically active and a registry of health-care provider–supervised and community-based exercise programs are available online at www.exerciseismedicine.org/movingthroughcancer.
Varied Responses
How might patients respond to advice to exercise? “It varies,” Kathryn H. Schmitz, PhD, MPH, lead author of the roundtable report, said in an interview with The ASCO Post. Dr. Schmitz is Professor, Department of Public Health Sciences and Department of Physical Medicine and Rehabilitation at Penn State Cancer Institute in Hershey, Pennsylvania, and Immediate Past President of the American College of Sports Medicine.
“The majority of Americans—and this is probably true beyond the United States—are sedentary, and that is going to include people who are diagnosed with cancer. Now they are facing this additional threat that they have to deal with, and we tell them that we also want them to exercise. Some people respond to the diagnosis of cancer by saying, ‘What can I do?’ Other people are going to respond by saying, ‘How quickly can I get through this? How little do I have to do? How many appointments are there? How do I minimize my contact with the world of cancer?’”
Dr. Schmitz noted, “The ones who come in saying ‘What can I do? How can I empower myself?’ do better. But even the patients who are trying to minimize their cancer experience may recognize at some point that it is worth considering how to make the experience as positive as it can be, and they become receptive to learning more about how physical activity and referrals to exercise programs could help.”
DISCLOSURE: Dr. Schmitz reported no conflicts of interest.
REFERENCES
1. Schmitz KH, Campbell AM, Stuiver M, et al: Exercise is medicine in oncology: Engaging clinicians to help patients move through cancer. CA Cancer J Clin. October 16, 2019 (early release online).
2. Reynolds G: Exercise advice for surviving cancer, and maybe avoiding it. The New York Times, October 16, 2019.
