Exercise Guidelines For Cancer Survivors Research Articles

How do practitioners prescribe exercise to patients with breast cancer? Professional perspectives on the key considerations for aerobic exercise in patients with breast cancer undergoing chemotherapy

ObjectivesThis study aimed to understand the key factors experienced accredited exercise physiologists (AEPs) and medical professionals consider when prescribing/recommending aerobic exercise to patients with breast cancer undergoing chemotherapy. DesignModified Delphi Survey. MethodsA four-round, two-phase survey was conducted. Following a Delphi approach, four cancer-specific AEPs, four oncologists, and one breast cancer surgeon (median 13-yr breast-cancer-specific experience) completed phase one. Eighty-four AEPs (median 5-yr experience) completed phase two. Phase one participants answered open- and close-ended questions regarding key considerations for aerobic exercise in patients with breast cancer undergoing chemotherapy, and what information should be collected to guide exercise prescription. All questions and considerations agreed upon in phase one (>70 % rating 7–9 on a 0–9 Likert Scale) were rated by AEPs in phase two. ResultsKey considerations for exercise assessment and prescription aligned closely with exercise guidelines for cancer survivors. Common strategies for exercise individualisation were identified by AEPs, including separating aerobic exercise into 5‐to‐–9-minute bouts when required and avoiding exercising to complete exhaustion. Exercise intensity and duration should be adjusted throughout chemotherapy to improve tolerance and adherence. Novel considerations for subjective questioning and objective assessments to tailor exercise prescription were outlined. ConclusionsThis study identifies how professionals approach exercise assessment and prescription in patients with breast cancer undergoing chemotherapy. Findings can guide AEPs in practice when prescribing tailored exercise to breast cancer patients undergoing chemotherapy and inform future guidelines.

Adverse Event Assessment and Reporting in Exercise Oncology: A Review

ABSTRACT Exercise oncology trials report few adverse events, but the extent to which these adverse events are assessed and reported has yet to be quantified. The aim of this review was to evaluate adverse events assessment and reporting in exercise oncology trials that informed the American College of Sports Medicine’s 2019 Exercise Guidelines for Cancer Survivors, the leading guidelines document in exercise oncology. All trials that inform the Exercise Guidelines for Cancer Survivors were sourced for evaluation. In total, 231 clinical trials were identified. Approximately one-in-two trials included no detail of adverse event assessment methods and did not report intervention-related harms. Trials that described an adverse event assessment protocol reported higher numbers of adverse events compared with trials that did not. Many trials reported that adverse events were related to exercise; however, the majority of the trials did not define how this relationship was determined. Although the benefit of exercise postcancer is well established, findings from this review highlight the inadequacies of adverse events reporting within the exercise oncology field. The development and evaluation of a standardized adverse events assessment and reporting protocol for use in exercise oncology trials is needed.

Moderators of exercise effects on self-reported cognitive functioning in cancer survivors: an individual participant data meta-analysis.

This individual participant data meta-analysis (IPD-MA) assesses exercise effects on self-reported cognitive functioning (CF) and investigates whether effects differ by patient-, intervention-, and exercise-related characteristics. IPD from 16 exercise RCTs, including 1987 patients across multiple types of non-metastatic cancer, was pooled. A one-stage IPD-MA using linear mixed-effect models was performed to assess exercise effects on self-reported CF (z-score) and to identify whether the effect was moderated by sociodemographic, clinical, intervention- and exercise-related characteristics, or fatigue, depression, anxiety, and self-reported CF levels at start of the intervention (i.e., baseline). Models were adjusted for baseline CF and included a random intercept at study level to account for clustering of patients within studies. A sensitivity analysis was performed in patients who reported cognitive problems at baseline. Minimal significant beneficial exercise effects on self-reported CF (β=-0.09 [-0.16; -0.02]) were observed, with slightly larger effects when the intervention was delivered post-treatment (n=745, β=-0.13 [-0.24; -0.02]), and no significant effect during cancer treatment (n=1,162, β=-0.08 [-0.18; 0.02]). Larger effects were observed in interventions of 12 weeks or shorter (β=-0.14 [-0.25; -0.04]) or 24 weeks or longer (β=-0.18 [-0.32; -0.02]), whereas no effects were observed in interventions of 12-24 weeks (β=0.01 [-0.13; 0.15]). Exercise interventions were most beneficial when provided to patients without anxiety symptoms (β=-0.10 [-0.19; -0.02]) or after completion of treatment in patients with cognitive problems (β=-0.19 [-0.31; -0.06]). No other significant moderators were identified. This cross-cancer IPD meta-analysis observed small beneficial exercise effects on self-reported CF when the intervention was delivered post-treatment, especially in patients who reported cognitive problems at baseline. This study provides some evidence to support the prescription of exercise to improve cognitive functioning. Sufficiently powered trials are warranted to make more definitive recommendations and include these in the exercise guidelines for cancer survivors.

SY02-3 Expectations of home-based exercise research for enhancing cancer survivorship care

Exercise guidelines for cancer survivors issued by multiple international organizations (Campbell KL et al, 2019) updated the recommendations that aerobic, combined aerobic plus resistance training, and/or resistance training could improve common cancer-related health outcomes (eg, anxiety, depression, fatigue, physical function, and health-related quality of life). Despite these guidelines, the majority of cancer survivors are not regularly physically active. A lack of awareness regarding available effective program to help facilitate exercise in cancer survivors was suggested to be a one of barriers to clinicians referring them to exercise.

Cost-Savings Analysis of an Individualized Exercise Oncology Program in Early-Stage Breast Cancer Survivors: A Randomized Clinical Control Trial.

PURPOSE:In an attempt to promote the integration of exercise oncology as a standard part of clinical practice, economic evaluations are warranted. Thus, the purpose of this study was to prospectively analyze cost savings of an individualized exercise oncology program when patients were randomly assigned.METHODS:For this open-label, randomized, prospective, comparative clinical trial, patients with early-stage breast cancer (stage I-II) were randomly assigned into two groups: the control group (CG, n = 120) and the exercise training group (EX, n = 123). Patients in the exercise intervention group completed 12 weeks of prescribed, individualized exercise that aligned with ACSM exercise guidelines for cancer survivors. The CG received the current standard of care, which includes a resource guide with various options available to the cancer survivor.RESULTS:In the EX group, all physical fitness measures significantly improved compared with baseline (P < .001), while remaining unchanged for the CG (P > .05). Patients in the CG had the highest total mean health care utilization across all measures (CG: $8,598 US dollars, compared with EX: $6,356 US dollars) for emergency visits, outpatient visits, and office-base visits that were not a part of their treatment plan. At baseline, the mean Eastern Cooperative Oncology Group (ECOG) scores did not significantly differ (P > .05); however, at follow-up, a larger proportion of the EX group had ECOG scores of 0 or 1, compared with the CG (P < .05). Finally, patient-reported outcomes were significantly higher in the exercise group, compared with the CG at the 12-week follow-up (P < .001).CONCLUSION:A supervised, individualized 12-week exercise intervention led to significant improvements in fitness parameters and ECOG scores, as well as a decrease in unplanned health care utilization among early-stage breast cancer survivors.

Selected Indices Of Physical And Psychological Health Of Lung Cancer Patients Scheduled For Surgery

PURPOSE: Lung cancer surgery offers a curative option but can result in complications. Low physical fitness levels increase the risk of surgical complications. Measuring physical fitness can better risk stratify patients and hence improve patient care. This study aims to investigate cardiorespiratory fitness, strength, physical activity and quality of life in individuals scheduled for lung cancer surgery. METHODS: Recruitment occurred at the patient’s pre-surgical clinic visit. Patients performed a 6-minute walk test (6MWT) to measure cardiorespiratory fitness, 30-second sit-to-stand test (30STS) to assess lower-limb strength and an upper-body grip strength test. The EuroQOL-EQ5D assessed quality of life on a scale from 0, worst health imaginable, to 100, best health imaginable. Step count was recorded by an ActivPAL micro 3 accelerometer (PAL Technologies, Glasgow, Scotland). The International Physical Activity Questionnaire-Short Form assessed self-reported time spent sitting, walking and completing moderate to vigorous intensity physical activity (MVPA). RESULTS: Twenty-two participants were recruited (54.5% male, mean 65 years). Average distance covered during a 6 MWT was 388.1 ± 75.0 m. Mean 30STS repetitions completed was 12.9 ± 2.9. Mean grip strength was 24.5 ± 9.2 kg. The mean EuroQOL-EQ5D score was 73.9 ± 12.9. Mean weekly step count was 45099.4 ± 19989.9 (n = 13). Participant’s reported sitting for an average of 6.1 ± 3.2 hours per day, 184.8 ± 131.2 minutes per week walking and 20.6 ± 41.6 minutes of MVPA per week. CONCLUSIONS: A 6 MWT <400 m is associated with an increased risk of complications within the first 30 days post-surgery. The mean 6 MWT distance in this study was 388.1 m. Research has reported similar pre-surgical 30STS results (12.6 ± 3.3) but higher grip strength (36.75 ± 10.15 kg) in lung cancer patients. This study found participants didn’t meet the the recommended exercise guidelines for cancer survivors. Therefore, interventions to support individuals with lung cancer to increase their activity are required to optimise patient care. This research is part of a larger randomised control trial which aims to identify the optimal peri-surgical exercise intervention and its effects on lung cancer patient’s physical, clinical and psychological health. Funded by the Irish Cancer Society.

Exercise Barriers and Adherence to Recommendations in Patients With Cancer.

The American College of Sports Medicine exercise guidelines for cancer survivors encourage a combination of 150 minutes of moderate-intensity aerobic activity and 2-3 weekly sessions of strength training. Cancer survivors often experience more barriers to meeting recommended guidelines because of side effects from cancer treatments. Our aim was to measure the cancer survivors' adherence and barriers with these recommendations. Two hundred adult cancer survivors completed surveys (Stanford Patient Education Research Center Exercise Behaviors Survey and an exercise barrier scale) reporting their physical activity, barriers to physical activity, and symptom assessment. A total of 68/200 participants (34%) reported adhering to the recommended physical activity guidelines of 150 minutes or more per week. Those who adhered to the guidelines reported fewer barriers to exercise (mean of 2.44 compared with 4.15 barriers, P < .0001). Female participants (P = .01), higher number of barriers, and feeling of poor well-being were less likely to report at least 60 or 150 minutes of exercise time. Lack of interest (P = .003) and self-discipline (P = .001) were reported as barriers. These participants were more likely to report high symptom burden of pain (P = .007) and fatigue (P = .005). Participants who reported < 60 minutes of exercise reported lack of enjoyment (P = .03), lack of equipment (P = .01), and symptoms of poor appetite, poor well-being, and increased dyspnea. Although recommendations are given for exercise, adherence to recommendations is low. Issues of motivation, including lack of interest and self-discipline, and symptoms of pain and fatigue were some of the main reported barriers to adhering to the recommended exercise guidelines. Therefore, interventions aimed at increasing motivation and treating symptoms could improve cancer survivor adherence to recommended exercise guidelines.

Cardio-Oncology Rehabilitation (CORE) Exercise Prescription and Programming: A PRACTICAL GUIDE.

Patients with cancer almost universally report diminished health-related quality of life. Many patients experience persistent fatigue and most have below-average exercise capacities. Despite the publication of exercise guidelines for cancer survivors that encourage physical activity, few patients exercise on a regular basis. Cardiovascular disease is a major cause of death in early-stage malignancies. Exercise training has been demonstrated to decrease cardiovascular events in patients with cancer. In addition, regular exercise improves exercise capacity, reduces fatigue, and improves quality of life in cancer survivors. A 2019 American Heart Association scientific statement, endorsed by the American Cancer Society, provided a framework and rationale for partnering with existing multidimensional, interdisciplinary outpatient cardiac rehabilitation programs to provide supervised exercise training and risk factor control services for patients with cancer and cancer survivors: cardio-oncology rehabilitation. In addition, the American College of Sports Medicine has published recommendations for cancer exercise training. This article provides practical suggestions for incorporating patients with cancer into cardiac rehabilitation and for patient-specific exercise prescription. Illustrative patient case examples are provided.

Correlates Of Exercise Behavior In Korean Cancer Patients: KNHANES 2014-2016

PURPOSE: Most Korean cancer patients do not participate in sufficient physical activity. Understanding the determinants of exercise behavior is important to improve their physical activity level. The purpose of this study was to examine the correlates of meeting exercise guidelines in Korean cancer patients. METHODS: Data were obtained from the Korea National Health and Nutrition Examination Survey 2014-2016. We included 640 cancer patients who had been diagnosed with any type of cancer. Moderate and vigorous physical activity time and frequency of resistance exercise were assessed. Participants were categorized as meeting (1) aerobic only, (2) resistance only, (3) combined, or (4) neither exercise guideline based on the American College of Sports Medicine’s aerobic and resistance exercise guidelines for cancer survivors. Correlates included demographic, medical, and health-related fitness/quality of life variables. Univariate and stepwise multinomial logistic regression were used for statistical analyses. RESULTS: The percentage of participants meeting the combined, aerobic only, resistance only, and neither guideline were 7.5%, 11.4%, 13.0%, and 68.1%, respectively. In univariate analyses, age (p<0.001), sex (p=0.030), region (p=0.011), marital status (p=0.003), education level (p<0.001), and income (p<0.001) were associated with meeting the exercise guidelines among demographic variables. Time since cancer diagnosis (p=0.027) and the number of comorbidities (p=0.030) were associated with meeting the exercise guidelines among medical variables. Hand-grip strength (p<0.001), quality of life for mobility (p<0.001), quality of life for self-care (p=0.047), quality of life for pain/discomfort (p=0.004), and total quality of life index (p<0.001) were associated with meeting exercises guidelines among health-related fitness/quality of life variables. In stepwise multivariate multinomial logistic regression, younger age, higher education level, more hand-grip strength, and better quality of life for mobility independently predicted exercise behaviors. CONCLUSION: Physical activity level is insufficient in Korean cancer patients and their exercise behaviors were correlated with age, education level, muscular strength, and quality of life.

Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable.

The number of cancer survivors worldwide is growing, with over 15.5 million cancer survivors in the United States alone-a figure expected to double in the coming decades. Cancer survivors face unique health challenges as a result of their cancer diagnosis and the impact of treatments on their physical and mental well-being. For example, cancer survivors often experience declines in physical functioning and quality of life while facing an increased risk of cancer recurrence and all-cause mortality compared with persons without cancer. The 2010 American College of Sports Medicine Roundtable was among the first reports to conclude that cancer survivors could safely engage in enough exercise training to improve physical fitness and restore physical functioning, enhance quality of life, and mitigate cancer-related fatigue. A second Roundtable was convened in 2018 to advance exercise recommendations beyond public health guidelines and toward prescriptive programs specific to cancer type, treatments, and/or outcomes. Overall findings retained the conclusions that exercise training and testing were generally safe for cancer survivors and that every survivor should "avoid inactivity." Enough evidence was available to conclude that specific doses of aerobic, combined aerobic plus resistance training, and/or resistance training could improve common cancer-related health outcomes, including anxiety, depressive symptoms, fatigue, physical functioning, and health-related quality of life. Implications for other outcomes, such as peripheral neuropathy and cognitive functioning, remain uncertain. The proposed recommendations should serve as a guide for the fitness and health care professional working with cancer survivors. More research is needed to fill remaining gaps in knowledge to better serve cancer survivors, as well as fitness and health care professionals, to improve clinical practice.

A randomized trial of a healthy lifestyle intervention versus usual care on chemotherapy and endocrine therapy adherence rate in women with breast cancer: The Lifestyle Exercise and Nutrition Early After Diagnosis (LEANER) Study.

TPS11633 Background: The World Cancer Research Fund and the American Cancer Society provide diet and exercise guidelines for cancer survivors. Many women with breast cancer do not follow these guidelines. Adoption of recommended lifestyle behaviors soon after diagnosis may prevent adverse changes in body composition, breast cancer biomarkers, and may improve adherence to treatment thereby improving breast cancer prognosis. The Lifestyle, Exercise, and Nutrition Early after Diagnosis (LEANER) study is testing the impact of a healthy lifestyle intervention on chemotherapy completion and endocrine therapy adherence. Secondary endpoints include changes in inflammatory and metabolic biomarkers, body composition, and patient reported outcomes. Methods: Eligible participants are women with stage I-III breast cancer undergoing chemotherapy. 250 participants are being recruited and randomized 1:1 to a yearlong, 16 session, healthy diet and exercise counseling intervention or usual care group. The intervention is delivered in person and/or via telephone by registered dietitians with training in exercise science. Materials include workbooks, videos, cookbooks, fit bits, and home-based exercise equipment. Intervention is focused on graduated goal setting to meet the recommended diet and exercise guidelines for cancer survivors. The primary endpoint, chemotherapy completion rate, is gathered from the Electronic Medical Record and the average Relative Dose Intensity for the originally planned regimen is calculated based on standard formulas. Assessments are completed at baseline, post chemotherapy, 1- and 2- year time points (to assess adherence to endocrine therapy). Body composition is measured using dual energy X-ray absorptiometry, blood samples and patient reported outcomes are collected. At time of submission, 39 women have been randomized. Discussion: If successful, this study has the potential to make healthy lifestyle interventions initiated shortly after diagnosis a standard component of breast cancer treatment. Clinical trial information: NCT03314688.

Abstract A059: Lifestyle and health-related quality of life in men with metastatic prostate cancer

Abstract Background: Patients with metastatic prostate cancer live with a considerable disease burden that may have a profound impact on physical activity and quality of life. This patient group may survive for many years after disease onset; however, there is little evidence on their habitual levels of physical activity. The aim of this study was to investigate physical activity levels and associated health-related quality of life in prostate cancer patients with bone metastases. Methods: ExPeCT (Exercise, Prostate Cancer and Circulating Tumour Cells: CTRIAL-IE 15-21) (ClincalTrials.gov identifier NCT02453139) is an ongoing multicenter trial examining the effect of a 6-month structured exercise intervention for patients with metastatic prostate cancer. Participants complete questionnaires examining self-reported health-related quality of life (FACT-P), sleep (Pittsburgh Sleep Index), depression (PHQ-9), and physical activity (Harvard Health Professionals Study Questionnaire) at baseline, three, and six months. Analysis of 3- and 6-month data is ongoing. Result: An interim analysis of the baseline outcome measures of 64 patients with bone metastases was completed (mean age 69.4 (SD 7.35) years and mean BMI 29.2 (SD 5.8) kg/m2). Median time since diagnosis was 34 months (IQR 7-54) and 55% (n=35) of participants had &amp;gt;1 region affected by metastatic disease. Preliminary data demonstrated that 38% (n=24) of participants did not meet the current aerobic exercise guidelines for cancer survivors. In total, 20% (n=13) of participants reported engaging in vigorous activity and 16% (n=11) reported completing resistance exercise. There was no correlation found between physical activity levels and quality of life (r=0.01), sleep (r=0.02), or depression (r=-0.15) scores. The majority of participants (61% (n=41)) had sleep scores of &amp;gt;7, indicative of poor sleep quality. Sleep scores correlated negatively with global quality of life (r =-0.55, p&amp;lt;0.05). Patients scored lowest in the “functional” and “additional prostate cancer-related concerns” domains of quality of life. Discussion: Findings highlight the association between reduced quality of life and poor sleep quality among men with metastatic prostate cancer. In addition, data suggest a high prevalence of suboptimal physical activity levels in this population. Patients with metastatic disease may benefit from lifestyle interventions that aim to increase physical activity levels. Citation Format: Gráinne Sheill, Lauren Brady, Emer Guinan, Juliette Hussey, David Hevey, Tatjana Vlajnic, Orla Casey, Anne-Marie Baird, Fidelma Cahill, Mieke Van Hemelrijck, Nicola Peat, Sarah Rudman, Thomas Lynch, Rustom P. Manecksha, Brian Hayes, Moya Cunningham, Liam Grogan, John McCaffrey, Dearbhaile M. O’Donnell, Ray McDermott, John O Leary, Stephen P. Finn. Lifestyle and health-related quality of life in men with metastatic prostate cancer [abstract]. In: Proceedings of the AACR Special Conference: Prostate Cancer: Advances in Basic, Translational, and Clinical Research; 2017 Dec 2-5; Orlando, Florida. Philadelphia (PA): AACR; Cancer Res 2018;78(16 Suppl):Abstract nr A059.

Tailored exercise interventions to reduce fatigue in cancer survivors: study protocol of a randomized controlled trial

BackgroundCancer-related fatigue (CRF) is a common and distressing symptom of cancer and/or cancer treatment that persists for years after treatment completion in approximately one third of cancer survivors. Exercise is beneficial for the management of CRF, and general exercise guidelines for cancer survivors are available. There are multiple potential pathways by which exercise improves CRF, and cancer survivors with CRF are diverse with respect to cancer type, treatments and experienced side effects. While the general exercise guidelines are likely sufficient for most cancer survivors, tailoring of exercise interventions may be more effective in those with persistent fatigue. The primary aim of this research is to investigate the effect of a traditional vs. tailored exercise intervention on CRF severity in cancer survivors with persistent CRF.Methods/designCancer survivors (≥ 3 months and ≤ 5 years since primary treatment) who score ≤ 34 on the Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT-F) will be randomly allocated to one of two parallel treatment arms: traditional (active control) and tailored exercise. Participants in the traditional exercise group will engage in aerobic and resistance exercise that is consistent with exercise guidelines for cancer survivors. The tailored exercise group will be prescribed an intervention designed to address individual deficits identified at baseline, such as loss of muscular strength, cardiorespiratory deconditioning or sleep disturbance. Participants will be assessed before and after the intervention for CRF severity and other patient-reported outcomes, neuromuscular function and fatigue in response to whole-body exercise, sleep quantity and quality, physical activity levels, cardiorespiratory fitness and blood biomarkers.DiscussionTo our knowledge, this will be the first study to compare the effects of a traditional vs. tailored exercise intervention on CRF severity in cancer survivors with persistent CRF. Using physiological, behavioural and patient-reported outcomes, this study will add to the current knowledge about both the factors contributing to CRF, and the potential reduction in CRF severity with an exercise intervention.Trial registrationThe study is registered at ClinicalTrials.gov (NCT03049384), February, 2017.

The Role of Exercise in Pediatric and Adolescent Cancers: A Review of Assessments and Suggestions for Clinical Implementation

In the European Union, five-year survival rates for childhood cancer patients are approaching 72–80%, which is a testament to better diagnostics and improved treatment. As a result, a large proportion of childhood cancer patients go on to live productive lives well past reproductive age. While this is encouraging, childhood cancer treatment is accompanied by multiple long-term adverse effects on physical and mental wellbeing. While there are several approaches to address mental health, reproductive integrity, secondary pathologies, and recurrence, in order to optimize quality of life in childhood cancer patients, exercise and nutrition should also be considered. It is clear that physical activity plays an important role in the prevention and reduction of long-term adverse side effects associated with cancer treatment in both children and adults. However, the current exercise guidelines for cancer survivors are based on adult data and accordingly are not appropriate for children. As children and adults are markedly different, including both the pathophysiology of cancer and exercise response, treatment plans incorporating exercise for children should be age-specific and individually tailored to both reduce the development of future comorbidities and enhance physical health. The purpose of this paper is to review the predominant cancer types and effects of cancer treatment in children, describe several special considerations, and propose a framework for assessment and exercise guidelines for this population.

ES 03.02 Pulmonary Rehabilitation

ES 03.02 Pulmonary Rehabilitation

Randomized Controlled Trial of Peer Led Intervention for Prostate Cancer Patients to Increase Exercise Participation

PURPOSE: To evaluate the effectiveness of a peer-led multimodal intervention for increasing exercise participation in patients with localized prostate cancer. METHODS: A randomized controlled trial with 463 prostate cancer patients 10.8 months post- curative therapy, enrolled from September 2011 until November 2012, from Queensland, Australia were randomized into a peer-led multimodal intervention (INT) (n=232) targeting exercise and unmet supportive care needs or usual care (UC) (n=231). The intervention included self-management materials, exercise equipment, and monthly telephone-based group peer-support for 6 months. Patients were assessed for compliance with exercise guidelines for cancer survivors, psychological distress, and quality of life (QoL) at baseline, 3, 6 and 12 months. RESULTS: 81.6% completed the final assessment at 12 months. Patients in INT engaged in significantly more resistance exercise than UC at 3 months (19.4 [95% CI 6.52 to 32.28] min/wk, p=0.003) and 6 months (14.6 [95% CI 1.69 to 27.58] min/wk, p=0.027). There was no difference between groups for aerobic-based activity at any time point nor for resistance exercise time at 12-month follow-up. At 3 months 40.3% of UC were inactive compared to 29.3% of INT (X2=6.12, p=.013), while 7.8% of UC were sufficiently active compared to 18.0% for INT (X2=8.89, p=.003). INT had significantly higher Assessment of Quality of Life (AQoL)-8D Relationships subscale scores at 3-month follow-up (.03 [95% CI .00 to .06], p=.038) compared with UC, with no change in psychological distress. CONCLUSION: The intervention was effective in increasing patients’ resistance exercise participation in the short- to medium-term, however, this behaviour change was not accompanied by overall improvements in QoL or psychological distress. Further investigation is required to increase effectiveness and maintain long-term adherence.

Associations between aerobic exercise levels and physical and mental health outcomes in men with bone metastatic prostate cancer: a cross-sectional investigation.

Cancer patients with bone metastases have previously been excluded from participation in physical activity programmes due to concerns of skeletal fractures. Our aim was to provide initial information on the association between physical activity levels and physical and mental health outcomes in prostate cancer patients with bone metastases. Between 2012 and 2015, 55 prostate cancer patients (mean age 69.7±8.3; BMI 28.6±4.0) with bone metastases (58.2% >2 regions affected) undertook assessments for self-reported physical activity, physical and mental health outcomes (SF-36), objective physical performance measures and body composition by DXA. Sixteen men (29%) met the current aerobic exercise guidelines for cancer survivors, while 39 (71%) reported lower aerobic exercise levels. Men not meeting aerobic exercise guidelines had lower physical functioning (p=.004), role functioning (physical and emotional) (p<.05), general health scores (p=.014) as well all lower measures of physical performance (p<.05). Lower levels of aerobic exercise are associated with reduced physical and mental health outcomes in prostate cancer patients with bone metastases. While previous research has focused primarily in those with non-metastatic disease, our initial results suggest that higher levels of aerobic exercise may preserve physical and mental health outcomes in prostate cancer patients with bone metastases. Clinical Trial Registry: Trial Registration: ACTRN12611001158954.

Resistance exercise and secondary lymphedema in breast cancer survivors—a systematic review

The aim of the present review was to determine effects of strength exercise on secondary lymphedema in breast cancer patients. Research was conducted by using the databases PubMed/Medline and Embase. Randomized controlled trials published from January 1966 to May 2015 investigating the effects of resistance exercise on breast cancer patients with or at risk of secondary lymphedema in accordance with the American College of Sports Medicine exercise guidelines for cancer survivors were included in the present study. Nine original articles with a total of 957 patients met the inclusion criteria. None of the included articles showed adverse effects of a resistance exercise intervention on lymphedema status. In all included studies, resistance exercise intensity was described as moderate to high. Strength exercise seems not to have negative effects on lymphedema status or might not increase risk of development of lymphedema in breast cancer patients. Further research is needed in order to investigate the effects of resistance exercise for patients suffering from lymphedema.

Compliance to exercise-oncology guidelines in prostate cancer survivors and associations with psychological distress, unmet supportive care needs, and quality of life.

The purpose of this study was to determine prevalence of Australian prostate cancer survivors meeting contemporary exercise-oncology guidelines and identify associations with distress, unmet supportive care needs, and quality of life. A population-based cohort of 463 prostate cancer survivors who were on 10.8months post-curative therapy was assessed for compliance with current exercise guidelines for cancer survivors, motivational readiness for physical activity, psychological distress, unmet supportive care needs, and quality of life. Only 57 men (12.3%) reported sufficient exercise levels (150min of moderate intensity or 75min of strenuous exercise per week and twice weekly resistance exercise), 186 (40.2%) were insufficiently active, and 220 (47.5%) were inactive. Among inactive men, 99 (45.0%) were in the contemplation or preparation stage of motivation readiness. Inactive men had higher global distress (p = 0.01) and Brief Symptom Inventory-Anxiety (p < 0.05) than those who were insufficiently active. Total Supportive Care Needs and International Prostate Cancer Symptom scores were higher in inactive than insufficiently and sufficiently active men (p < 0.05). Lack of physical activity contributed to poorer quality of life. Only a small proportion of Australian prostate cancer survivors met contemporary exercise-oncology recommendations despite increasing recognition of exercise to improve patient outcomes. Strategies are urgently required to increase prostate cancer survivors' participation in aerobic and resistance exercise training.Copyright © 2015 John Wiley & Sons, Ltd.

Physical Therapy Interventions are Beyond Adjunct Care in Improving Quality of Life and Alleviating Pain Related to Cancer and its Treatment: Perspectives and Confronts

Cancer itself and evaluation, treatment procedures are associated with pain and impaired quality of life. Cancer pain relief is one the most difficult task for clinicians due to outsized barriers. Recent evidence suggests that patients with good control of symptoms related to cancer, including pain, helps patients live longer and the quality of life is also bettered at the same time. Analgesic ladder management of WHO is the most accepted and widely used pain management method in patients with cancer pain. But, use of opioids alone is not successful in pain control and improving quality of life. Exercise represents an effective therapeutic intervention for preparing patients to successfully complete treatments, for reducing acute, chronic and late side effects, and for improving QOL during and after treatments. This non systematic narrative review outlines the existing evidences of association between physical exercise, physical therapy intervention strategies, pain control and quality of life, evidence based exercise guidelines for cancer survivors and patients.