Cancer care

Exercise prescription gets personal for cancer patients

A new position statement on exercise prescription for patients with cancer has moved away from the Holy Grail of 150 minutes of moderate activity per week in lieu of more individualised approach.

The Exercise and Sports Science Australia (ESSA) statement recognises there is no set exercise prescription or dosage that would be considered evidence-based for all patients.

Instead the statement provides detailed guidance for accredited exercise physiologists to deliver exercise prescription targeted by factors such as patient goals and preferences, cancer type, comorbidities, and stage and type of treatment.

Lead author Professor Sandra Hayes told the limbic that implementation of the statement relies on members of the multidisciplinary cancer management team promoting the benefits of exercise to their patients.

“Patients need to understand the treatment-related side effects they will experience as a consequence of their specific diagnosis and they need to understand what can exercise do for them,” she said.

Professor Hayes, from the Institute of Health Biomedical Innovation at Queensland University of technology, was also involved in last year’s Clinical Oncology Society of Australia (COSA) Position Statement on Exercise in Cancer Care.

She said the difference was that COSA focused more on promotion of physical activity during cancer care while the ESSA statement expands on the details of targeted exercise prescription.

“That’s where this position statement really stands out – very specific clear advice on how to target an exercise prescription towards an individual.”

She said the document gives patients permission not to meet rigid weekly goals depending on how they were feeling at various stages of treatment.

“There will be certain weeks where no matter how much they try or want to meet the exercise prescription dosage, for various reasons they are not going to get there.”

“And what matters is not what they do on any given week but what matters over a period of time. It’s about giving them the skills and the knowledge to help them go through cyclical periods of capacity.”

The document includes an exhaustive list of recommendations for exercise in the context of anaemia, bone loss and cachexia through to pain, urinary incontinence and vomiting.

It also includes pragmatic considerations such as infection control, exercising with portacaths and stoma bags, and dealing with the transition from curative to palliative treatment.

She said exercise physiologists had to work with patients on understanding and prioritising their goals and setting realistic goals.

“Maybe someone with advanced stage disease might prioritise their quality of life …and that’s where you would be using a much more general multimodal exercise program that actually really addresses the patient’s preference for exercise. So …we might take the focus a little bit off weight training and place it on aerobic based exercise when we know they thoroughly enjoy going for a walk with their neighbour.”

“Across any given month, every week might look quite different and it becomes very specifically targeted not just towards their goals but to what is actually happening in their lives during that time.”

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