Tailoring Exercise Prescriptions to Cancer Treatment Plans

In October 2019, exercise oncology experts released a series of guidelines on how to use exercise to lower risks for cancer and improve the lives of those living with cancer through the survival phase. The guidelines recommend the systematic use of an “exercise prescription” by healthcare workers and fitness professionals in designing and delivering exercise programs that aim to lower the risk of developing certain cancers and best meet the needs, preferences, and abilities of people with cancer.

The American College of Sports Medicine (ACSM) convened a roundtable of experts from 17 partner organizations, which included the American Cancer Society and the National Cancer Institute—part of the National Institutes of Health, to review the latest scientific evidence and offer recommendations about the benefits of exercise for prevention, treatment, recovery, and improved survival.

Exploring the Key Points

Two academic papers—“Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable” and “American College of Sports Medicine Roundtable Report on Physical Activity, Sedentary Behavior, and Cancer Prevention and Control”—were published in Medicine & Science in Sports & Exercise (MSSE) and outline a comprehensive review and guidelines of these findings and recommendations.

Let’s take a look at the key findings of each study.

“Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable”¹ reported:

• There are more than 16.9 million people living with and beyond cancer in the United States—a figure expected to double by 2040. Improved prognosis has created a growing need to address the unique health issues facing cancer survivors that result from the disease, its treatment, and related co-morbid conditions.
• Exercise is a safe and effective way for cancer survivors to lessen the impact of cancer treatment on their physical and mental health, but the precise type and amount of exercise to treat the many different cancer-related health outcomes has been unclear until now. In the absence of this information, cancer survivors have been advised to strive toward meeting the general public health guidelines for all Americans—an amount of physical activity that may be difficult for people to achieve during or following cancer treatment.
• Updated exercise guidelines have created specific exercise prescriptions that address different health outcomes relative to cancer survivors. These prescriptions are part of a movement to use exercise medicine to prevent and manage chronic illnesses, including cancer.
• These evidence-based exercise prescriptions, along with additional guidance for exercise screening and testing, can be used by fitness professionals, rehabilitation specialists, health care providers, and community educators to design and deliver exercise programs that best meet the needs, preferences, and abilities of people living with and beyond cancer.
• The minimum exercise prescription is moderate intensity aerobic exercise three times per week for at least 30 minutes plus resistance exercise training two days per week completing two to three sets at 60 percent of 1-repetition maximum. Sun protection when exercising outdoors is important.
• Continued research and education will increase engagement of healthcare professionals in referring patients and increase patient access to exercise programs and rehabilitation that will ultimately expand and integrate exercise oncology into the standard of care for people living with and beyond cancer to live longer and better lives.

“American College of Sports Medicine Roundtable Report on Physical Activity, Sedentary Behavior and Cancer Prevention and Control”² reported:

• Globally, an estimated 18.1 million individuals were diagnosed with cancer in 2018, and 9.6 million individuals died from the disease. Given the high direct and indirect costs related to the cancer burden, there is an increasing need to understand how modifiable behaviors like physical activity may help prevent and control cancer.
• In the last decade, evidence has linked physical activity to a lower risk of seven types of cancer (colon, breast, kidney, endometrium, bladder, stomach cancer, and esophageal adenocarcinoma).
• Physical activity before and after a breast, colorectal, or prostate cancer diagnosis is beneficial for survival. Additional studies of other cancer survivors are needed.
• Approximately one-fourth of adults worldwide are physically inactive. While the optimal dose of physical activity needed for cancer prevention is still unclear, being physically active is one of the most important steps people of all ages and abilities can take for cancer prevention, treatment, and control.
• Emerging evidence supports that prolonged sitting time may increase the risk of some types of cancer (endometrial, lung, and colon cancer), but there is currently insufficient evidence to draw clear conclusions for most cancer types.

These two papers bring the science of exercise oncology into useable terms for the clinician. The guidelines provide direction for working with people living with and beyond cancer during and following treatment and with specific information for patients with acute, long-term, and late effects of cancer.

Healthcare and exercise professionals should use these recommendations when creating exercise programs for people living with and beyond cancer, including the formal, systematic use of custom exercise prescriptions that best meet the needs, preferences, and abilities of individuals to live their fullest life.