Abstract
Although exercise is widely recommended for survivors of cancer, readily implementable approaches for evaluating exercise tolerance enabling exercise prescriptions at appropriate levels of cardiovascular exertion are not always available. We evaluated the utility of modified Harvard Step tests within the context of a standard physical examination for fitness evaluation and exercise prescription for survivors of cancer across a range of age, BMI and exercise history. While 52% of presenting individuals with a past cancer diagnosis were able to complete a 3-min test at pace with a reduced 9-in. step, adoption of self-determined pacing, test duration and completion on a flat surface enabled relative fitness rating and appropriate exercise prescription for the remaining survivors. Younger age and more vigorous exercise histories correlated with completion of the standard 3-min test at pace, but all 9-in. formats led to exercise prescriptions more vigorous than current activity. The physical examination setting expedited inclusion of core and specific muscle group strength testing. The approach is adaptable to a range of health care settings, providers, and patients, providing a shared opportunity for providers and patients to evaluate exercise tolerance. It can be used to further expand incorporation of exercise testing and prescription into routine care.
Highlights
Exercise is widely recommended for survivors of cancer, readily implementable approaches for evaluating exercise tolerance enabling exercise prescriptions at appropriate levels of cardiovascular exertion are not always available
Clinicians advised cancer patients to refrain from physical activity; in the late 1990s, research outlined the benefits of physical activity, including improving survivorship, physical wellbeing, and quality of life[1,2,3]
The majority of survivors presented to clinic with appropriate indications for exercise intervention, with documentation of significant increases in sedentary activity and demonstration of average or below ageand gender-adjusted relative fitness ratings
Summary
Exercise is widely recommended for survivors of cancer, readily implementable approaches for evaluating exercise tolerance enabling exercise prescriptions at appropriate levels of cardiovascular exertion are not always available. Recent studies have found that survivors of cancer who exercise have lower relative risks of cancer mortality, improved quality of life, and reduced fatigue[5,6,7,8] Despite these recommendations, up to 80% of survivors of cancer may not meet ACS and ACSM physical activity recommendations and both survivors and providers are not always aware of all the recommended exercises, which include aerobic, balance, stretching, and muscle and bone s trengthening[2,3,9]. Cancer patients with distant metastasis are not typically counseled on exercise, studies have found that exercise in advanced cancer can improve fitness, function, fatigue, and overall quality of life[16,17] It is important for survivors of cancer to consult a physician before engaging in physical fitness programs in order to clear the patient for appropriate e xercise[1,3,18,19]. Clinic total Cancer survivor total, no. (%) Employment status, no. (%) Currently working Not currently working Information unavailable Economic sector, no. (%) Service Business/finance/consultant Art/design/media/journalism Administration/HR/manager/director Healthcare Public/government service Law Education, research and development Education/academia Science/technology/engineering Information unavailable Residence, no. (%) Established place of residence Living situation, no. (%) Living with life partner Living with family including children Living alone Living with roommate Information unavailable
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