Revised COSA exercise guidelines embrace a more inclusive approach

The Clinical Oncology Society of Australia has overhauled its exercise guidelines to promote physical activity as a core part of cancer care.

A COSA working group on exercise and cancer released the revised advice with little fanfare in March, after taking on board criticism that the 2018 guidelines were too prescriptive and would benefit from a softer, more inclusive approach.

The new version urges all health practitioners to discuss the role of exercise in cancer recovery with patients, recommend cancer patients follow exercise guidelines where possible and offer a referral to an accredited exercise physiologist or physiotherapist with experience in cancer care.

Andrew Murnane, chair of the COSA working group, has been an exercise physiologist at the Peter McCallum Cancer Centre’s ONTrac program for adolescent and young adult cancer patients since 2014. He says the take-up of so-called exercise oncology in Australia has been swift, albeit from a small base.

“When I first started in cancer care (in 2014), exercise really was not really promoted as a therapy for patients. As that evidence base has grown over the past 10 years, more patients are asking for it and more clinicians are referring their patients for exercise. It has been an exponential growth in activity over the past few years, which is great to see.”

But he says there is still a way to go, and the new guidelines are intended to smooth the way.

“We were initially a bit prescriptive,” he said.  For example, the group has amended a call for patients to follow the guideline of 150 minutes of at least physical exercise per week, or 75 minutes of vigorous exercise, recognising that cancer patients need an approach tailored to their individual abilities and conditions.

“We’ve changed that to say all members of the cancer care team should promote physical exercise and recommend people with cancer should follow the exercise guidelines.”

Mr Murnane says exercise professionals with expertise in cancer care can help optimise patients for surgery and “goal shift” to reverse the effects of treatment, such as deconditioning and loss of muscle mass and weight – to improve physical health.

Starting a prescribed exercise program can also boost mental health by giving patients a sense of control and the satisfaction of taking action to help themselves.

“It can have numerous positive effects on their mental health and well-being; it allows them to recover more quickly and get back to things they enjoy, and it allows them to interact with peers and get back to work or study.

“The psycho-social component is huge, probably as big as any of the physical changes you see.”

“It is really kind of magical in some ways, the multi-layered effect that exercise prescription can have on a patient over time.”

Mixed messages over rest vs exercise and the role of the GP

Working group member Dr Elysia Thornton-Benko, a Sydney GP and UNSW research fellow with a special interest in cancer survivorship, says there are “mixed messages” among health professionals about the need for rest as opposed to the benefits of exercise.

“There is varied awareness out there among health professionals about this growing role of exercise.  Today, it has significantly changed from just a year or two ago, but that notion of maybe ‘up-regulating’ the body, being more physically active, rather than saying just rest, has not (cut through).

“The idea is to get people to avoid inactivity, encourage them to build up to their normal daily activities, and then work towards the key exercise recommendations, which haven’t changed significantly, and if you can achieve them, to maintain those goals.”

Some GPs may not see the need to advise cancer patients who were previously active to consider seeing an exercise professional, she says.

“We say it’s important for GPs to inform the patient that there’s definitely a role for exercise in cancer recovery and mounting evidence that it can help manage potential side-effects and reduce the risk of fatigue and recurrence.  Then, offer a referral to an exercise professional.

The new COSA guidelines will be featured at a webinar hosted by the Cancer Nurses Society of Australia on April 20 and at other events through the year.


More info about the COSA and Exercise Group: 

 To find an Accredited Exercise Physiologist:
To find a Physiotherapist:
CNSA and COSA webinar on exercise and cancer:

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