Exercise Program For Cancer Survivors Research Articles

Benefits of Personalized Diet, Nutrition, And Exercise Programs for Cancer Survivors

Nutrition, diets, and exercise are critical pillars in fortifying the well-being of cancer survivors. A balanced and nutrientrich diet serves as a linchpin in the recovery process for cancer, providing essential vitamins and minerals crucial for rejuvenating weakened immune systems and promoting overall health. The comprehensive influence of nutritional variables, including weight, food, physical activity, and alcohol use, goes beyond cancer development and affects outlook; the standard of living, concurrent health conditions, reappearances, and the incidence of recurrent malignancies are important factors to consider. However, despite their undeniable importance, a comprehensive understanding of their correlating effects on cancer survivors is hindered by the relatively recent and limited literature. This review aims to address existing gaps in current research, emphasizing recent studies and reviews related to nutrition, diets, alcoholic beverages, obesity, and exercise in cancer patients. This review focuses on specific areas necessitating further investigation by synthesizing and scrutinizing the latest findings. By exploring recent advancements, the goal is to contribute to a profound understanding of tailored nutrition plans, specific diets, lifestyle modifications, and exercise regimens, which can strategically enhance cancer survivors' well-being and long-term outcomes.

Scoping Review of Videoconference Online Exercise Programs for Cancer Survivors in Community Settings

ABSTRACT Context Given the rapid transition of many cancer-specific community-based exercise programs to videoconference-delivered online exercise (VOE) during the coronavirus disease 2019 pandemic, little is known about the reach, effectiveness, adoption, implementation, and maintenance of these programs. Objective The purpose of this scoping review was to synthesize practice-based information regarding VOE programs for cancer survivors in community-based settings. Design To identify relevant programs, searches were conducted for peer-reviewed articles published in electronic databases and programs listed in the Moving Through Cancer directory. Eligibility Criteria To be included, programs had to meet the following criteria: 1) participants were adult (>18 yr) cancer survivors, 2) included one or more VOE sessions in addition to any preprogram assessment/intake, and 3) defined as a community-based program with a primary focus of delivering a service to cancer survivors. Study Selection A total of 16 programs were included in the review. Main Outcome Measure Descriptions of 1) reach, 2) effectiveness, 3) adoption, 4) implementation, and 5) maintenance of the identified programs. Results All studies described at least one element of reach (80%), adoption (86%), and implementation (80%). Fewer programs reported on indicators of efficacy/effectiveness (25%) and individual-level maintenance (0%). Conclusions VOE programs may be viable for engaging cancer survivors, but more information is needed to understand VOE programs in community-based settings. Findings from this review reveal that more work is needed, particularly in the elements of reach, efficacy/effectiveness, and individual-level maintenance. Research on community-based programs should continue in order to better understand what contributes to successful implementation of VOE programs and the effects for cancer survivors.

Independent Exercise During a Videoconference Exercise Program for Cancer Survivors

ABSTRACT Background Independent exercise beyond supervised sessions can help program participants achieve recommended exercise levels and contribute to health benefits. However, independent exercise is rarely reported, making it unclear how much program effects may be attributed to the supervised sessions. The aim of this study was to describe independent exercise during a videoconference-delivered exercise program for cancer survivors. Methods Cancer survivors (N = 46) completed an 8-week program that included videoconference-delivered (i.e., Zoom) exercise sessions once per week and three behavior change discussions. Each week, participants reported frequency, duration, intensity, type, and context (e.g., where, type, with whom) of independent aerobic and resistance exercise. Results Participants (mean ± SD age = 59 ± 10 years; 96% female) had been diagnosed with either ovarian (61%), breast (30%), colorectal (4%), or other (4%) types of cancer. Days per week of independent exercise were 2.7 ± 2.7 for light, 2.8 ± 2.2 for moderate, and 0.67 ± 1.3 for vigorous aerobic exercise. For resistance exercise the days per week performed was 1.3 ± 1.5. Median weekly independent minutes were 60 (range: 0–120) for light aerobic, 120 (range: 36–270) for moderate-to-vigorous aerobic, and 30 (range: 0–60) for resistance exercise. Independent exercise performed was most frequently brisk walking or weightlifting at home or in the neighborhood and with a spouse/partner, other family, or friends. Conclusion Most participants engaged in substantial independent exercise outside of the supervised sessions. These findings provide detailed contextual information regarding independent exercise during an 8-week program and have implications for interpreting program effectiveness.

Evaluating individual level change in physical function response following an exercise program for cancer survivors

Cancer survivors physical function response to exercise programs at the group level is well-established. However, to advance toward a more personalized approach in exercise oncology, a greater understanding of individual response is needed. This study utilized data from a well-established cancer-exercise program to evaluate the heterogeneity of physical function response and explore characteristics of participants who did vs. did not achieve a minimal clinically important difference (MCID). Physical function measures (grip strength, 6-min walk test (6MWT), and sit-to-stand) were completed pre/post the 3-month program. Change scores for each participant and the proportion achieving the MCID for each physical function measure were calculated. The independent t-tests, Fisher's exact test, and decision tree analyses were used to explore differences in age, body mass index (BMI), treatment status, exercise session attendance, and baseline value between participants who achieved the MCID vs. those who did not. Participants (N = 250) were 55 ± 14years old, majority female (69.2%), white (84.1%), and diagnosed with breast cancer (36.8%). Change in grip strength ranged from - 42.1 to + 47.0lb, and 14.8% achieved the MCID. Change in 6MWT ranged from - 151 to + 252m, and 59% achieved the MCID. Change in sit-to-stand ranged from - 13 to + 20 reps, and 63% achieved the MCID. Baseline grip strength, age, BMI, and exercise session attendance were related to achieving MCID. Findings illustrate wide variability in the magnitude of cancer survivors' physical function response following an exercise program, and that a variety of factors predict response. Further investigation into the biological, behavioral, physiological, and genetic factors will inform tailoring of exercise interventions and programs to maximize the proportion of cancer survivors who can derive clinically meaningful benefits.

Determinants of exercise adherence and maintenance for cancer survivors: Implementation of a community-based group exercise program. A qualitative feasibility study.

Despite verified knowledge that physical exercise plays an important part in recovery after cancer treatment, multiple studies have shown that maintaining a physically active lifestyle after cancer is challenging. There is a need for qualitative studies to increase understanding into patient experiences and perspectives, and facilitate the design of more sustainable exercise program. This qualitative descriptive feasibility study explores experiences from the implementation of a novel four-month community-based group exercise program for cancer survivors within municipality health service after completion of rehabilitation in the specialist health care service. Fourteen cancer survivors participated in focus group interviews after completing Rehabilitation: Physical activity and Coping - feasibility study. Data were analyzed using the systematic text condensation method. We identified a main category, Determinants for exercise adherence and maintenance and four subcategories: peer-support, environment, structure and knowledge. A social and supportive exercise environment promotes exercise adherence and maintenance among cancer survivors. This knowledge can be useful for further efforts to implement high quality community-based group exercise programs for cancer survivors. This study adds knowledge of survivors' experience of a novel community-based group exercise program in clinical practice and can promote the implementation of sustainable community-based exercise programs for cancer survivors.

Health Fitness Professionals’ Perceptions to Offering a Cancer Exercise Program: A Qualitative Study

ABSTRACT Introduction/Purpose The purpose of this study is to qualitatively investigate fitness professionals’ perceptions of barriers and enablers to offering community-based exercise programs targeting cancer survivors at their fitness and/or community centers. Methods A qualitative case study approach incorporating Web-based survey and semistructured interview components was used to evaluate community-based fitness professionals’ programming perceptions. Results A total of seven subjects completed a semistructured interview. Data analysis using content analysis and the constant comparative method process revealed three primary domains with 11 underlying themes: 1) program barriers (education and awareness, physician referral, cost, and care along the cancer continuum); 2) program enablers (champion advocacy, sponsor/funding, personnel, and propositional solutions); and 3) program perceptions (social support, gym atmosphere, and cancer-specific modifications). Conclusions Findings from this qualitative study identified multiple domains and themes articulating health and fitness professionals’ perceptions of key barriers, enablers, and programmatic aspects in offering community-based exercise cancer programming. These results have important implications for guiding the design and delivery of community-based exercise programs for cancer survivors and represent an advance in the current literature surrounding implementation strategies in a clinic-to-community translational model of exercise-based supportive cancer care.

Beta-testing Of A Synchronous, Virtually-delivered Group-based Exercise Program For Cancer Survivors

PURPOSE: The COVID-19 pandemic forced many face-to-face exercise programs for cancer survivors to shut down or transition to online delivery. Supervision from a qualified instructor and social support from other participants are integral components for successful exercise program adherence, but it is challenging to create opportunities for tangible social connection when delivering exercise programs asynchronously (i.e., online without real-time interaction). A group-based exercise program delivered online, in real-time, is an innovative way to help cancer survivors increase physical activity (PA), improve health outcomes, and connect with other participants. This study examined the preliminary feasibility of an 8-week synchronous, group-based exercise program for cancer survivors. METHODS: The Fitness Therapy for Cancer (Fit Cancer) program has been operating since 2017, and was adapted for virtual delivery in August 2020. All program content remained the same, including group-based exercise and PA behavior change discussion sessions, and individual pre-and post-program assessments of PA, QOL, strength, and balance. The virtual program was delivered via Zoom, and participants were provided with a set of resistance bands. Preliminary feasibility was assessed by adherence, attrition, safety, and acceptability. RESULTS: Participants (n = 3 female, n = 1 male), were M = 54.3 ± 15.6 years old, diagnosed with breast, endometrial and head and neck cancer. Three participants completed treatment before program start (range 4.4 months to 3 years), and one was undergoing chemotherapy. Adherence was 100% for exercise and discussion sessions. All participants completed the post-program assessment, and no adverse events were reported. All participants responded “yes” to enjoying the program, feeling stronger, looking forward to exercise sessions, a sense of community and support from participants and staff, and would recommend the program to others. CONCLUSIONS: Preliminary results suggest a synchronous, virtual, group-based exercise program for cancer survivors is feasible. A larger pilot study (N = 40) is underway, with feasibility and effectiveness results expected by summer 2021. This work will contribute to advancements in remote delivery of group-based exercise programs for cancer survivors.

Predictors of attendance during an exercise program for cancer survivors.

Exercise programs delivered in community- or clinic-based settings improve physical and psychosocial outcomes among cancer survivors; however, adherence is essential to achieve such benefits. This study examined predictors of attendance to an exercise program in a large, diverse sample of cancer survivors. Participants (n = 302) were enrolled in BfitBwell, an exercise program for adults diagnosed with cancer, and currently receiving or within 6 months of completing chemotherapy or radiation therapy. Participants were offered two supervised aerobic and resistance exercise sessions per week for 3 months. Predictors of attendance included demographics, cancer-related information, quality of life (QOL), fatigue, physical fitness, activity level, and importance of making various changes (e.g., improving fitness). Univariate linear regression first explored associations between predictor variables and adherence, and any important variables (p < .10) were included in a multivariate linear regression model. Participants were M = 54.9 ± 13.9 years old, mostly female (67.3%), white (83.6%), and most commonly diagnosed with breast cancer (34.8%). Average attendance was 16.2 ± 6.6 exercise sessions. Six-minute walk test distance, QOL, and fatigue were associated with exercise session attendance (p < .05). The multivariable model revealed that higher QOL predicted higher attendance (β = .351, p = .005), and working full- or part-time significantly predicted lower attendance (β =- .221, p =.021). Higher pre-program QOL and not working full- or part-time predicted higher exercise program attendance. Existing and future exercise programs for cancer survivors should consider ways to adapt program delivery to provide support to survivors who start with low QOL, and accommodate those who may face barriers to attending due to work schedule/conflict.

Addendum: MacDonald, A.M., et al. CaRE @ Home: Pilot Study of an Online Multidimensional Cancer Rehabilitation and Exercise Program for Cancer Survivors. J. Clin. Med. 2020, 9, 3092

The authors wish to make the following corrections to this paper [...]

CaRE @ Home: Pilot Study of an Online Multidimensional Cancer Rehabilitation and Exercise Program for Cancer Survivors.

Background: Although facility-based cancer rehabilitation and exercise programs exist, patients are often unable to attend due to distance, cost, and other competing obligations. There is a need for scalable remote interventions that can reach and serve a larger population. Methods: We conducted a mixed methods pilot study to assess the feasibility, acceptability and impact of CaRE@Home: an 8-week online multidimensional cancer rehabilitation and exercise program. Feasibility and acceptability data were captured by attendance and adherence metrics and through qualitative interviews. Preliminary estimates of the effects of CaRE@Home on patient-reported and physically measured outcomes were calculated. Results: A total of n = 35 participated in the study. Recruitment (64%), retention (83%), and adherence (80%) rates, along with qualitative findings, support the feasibility of the CaRE@Home intervention. Acceptability was also high, and participants provided useful feedback for program improvements. Disability (WHODAS 2.0) scores significantly decreased from baseline (T1) to immediately post-intervention (T2) and three months post-intervention (T3) (p = 0.03 and p = 0.008). Physical activity (GSLTPAQ) levels significantly increased for both Total LSI (p = 0.007 and p = 0.0002) and moderate to strenuous LSI (p = 0.003 and p = 0.002) from baseline to T2 and T3. Work productivity (iPCQ) increased from T1 to T3 (p = 0.026). There was a significant increase in six minute walk distance from baseline to T2 and T3 (p < 0.001 and p = 0.010) and in grip strength from baseline to T2 and T3 (p = 0.003 and p < 0.001). Conclusions: Results indicate that the CaRE@Home program is a feasible and acceptable cancer rehabilitation program that may help cancer survivors regain functional ability and decrease disability. In order to confirm these findings, a controlled trial is required.

Community-based Exercise Programs For Cancer Survivors: Using The Consolidated Framework For Implementation Research To Identify Barriers And Facilitators To Program Implementation

PURPOSE: Exercise is recommended as an intervention to reduce the side effects of cancer treatment both during treatment and beyond. New ACSM guidelines for cancer survivors have been recently published, alongside a recommendation for all oncology clinicians to ‘Ask, Advise and Refer’ to appropriate exercise programs. Based on this, there is a need to understand how to best translate exercise oncology programs from research into community-based settings. The purpose of this scoping review is to describe the characteristics of existing exercise programs for cancer survivors conducted outside of a research laboratory (i.e., home- or community-based settings) mapped to a common implementation science framework in order to identify potential strategies for future implementation interventions. METHODS: A systematic search of published literature was conducted for exercise programs or interventions including individuals diagnosed with cancer either undergoing treatment or who have completed treatment in which participants exercise at home, or in a community-based setting. Data were extracted using the Oxford Implementation Index and coded under the five domains of the Consolidated Framework for Implementation Research. RESULTS: A total of 46 publications describing 30 individual programs from around the world were identified. Only 11 publications had the specific goal of reporting on program implementation and development. Most programs included both aerobic and resistance exercise, targeting either breast cancer survivors, or any cancer. A variety of intervention and individual characteristics were described. Reporting of implementation factors related to the inner and outer setting and implementation process were minimal. Partnerships with oncology clinicians appears to be a key facilitator to implementation success. CONCLUSIONS: This scoping review summarizes the implementation characteristics of existing programs that have been reported in the literature and can serve as a resource for those developing future community-based exercise oncology programs. Findings support the need for implementation science to inform best practices for program implementation.

A Qualitative Investigation Of Fitness Professional’s Perceived Barriers And Enablers To Community-based Cancer Exercise Programming

Access to community-based interventions is valuable for promoting regular exercise participation in cancer survivors. Although cancer survivors perceived exercise barriers have been consistently investigated, fitness professionals’ perceptions of the barriers and enablers to offering community-based exercise programming targeting cancer survivors has yet to be systematically explored. PURPOSE: The primary purpose of this study is to qualitatively investigate health and fitness professionals’ perceptions of barriers and enablers to offering community-based exercise programs targeting cancer survivors at their fitness and/or community centers. METHODS: A mixed-method qualitative case study approach incorporating web-based survey and semi-structured interview components was used to evaluate the fitness professionals’ programming perceptions. A total of 82 community-based health and fitness professionals were contacted about the web-based survey. A total of 7 subjects volunteered to participate in a follow-up semi-structured interview based on their consent to participate in the further interview as indicated on the initial survey. RESULTS: A total 12 survey responses (14.6%) were completed online and 7 of 12 (58.3%) of the individuals completed the semi structured interviews. Data analysis using content analysis and the constant comparative method process revealed 3 primary domains with 11 underlying themes: 1. Program Barriers: a. Education and Awareness; b. Physician Referral; c. Cost, and d. Care Along the Cancer Continuum; 2. Program Enablers a. Champion Advocacy, b. Sponsor/Funding, c. Personnel, and d. Propositional Solutions; and 3. Program Perceptions a. Social Support, b. Gym Atmosphere, and c. Cancer Specific Modifications. CONCLUSIONS: Findings from this mixed method, qualitative study identified multiple domains and themes articulating health and fitness professionals’ perceptions of key barriers, enablers, and programmatic aspects in offering community-based exercise cancer programming. These results have important implications for guiding the design and delivery of community-based exercise programs for cancer survivors and represent a meaningful advance in developing a clinic-to-community translational model of exercise-based supportive cancer care.

Physical activity platform to improve bone health in cancer survivors.

e24054 Background: Cancer treatment-induced bone loss and the risk of fractures is a significant burden on national health care with the annual cost of osteoporosis at $25.3 billion. Clinical studies report that moderate-intensity resistance exercises prevent a decline in bone health and reduce complications such as fatigue, muscle wasting, and bone loss. Only a small percentage cancer survivors engage in exercise. Several factors account for this low level of engagement such as poor awareness of the benefits, lack of motivation, and access to exercise programs for cancer survivors. Web- and mobile app-based programs that encourage physical activity can potentially address these problems and can be scaled for dissemination. Methods: Thrivors plus Bone Health (Thrivors+BH) is first-of-its-kind, clinically validated platform of bone health exercises that adapts to a cancer survivor's pain and energy levels with several interactive feedback features. The product has physical activity, mindfulness, nutrition, survivorship resources, and bone health education. The platform's back-end tracks and reports module activity. We conducted a single-blind RCT of 142 breast cancer survivors adherence to a 20-week program of resistance and impact exercises. Participants in the control arm accessed Thrivors Basic which lacked interactive feedback. Results: The primary outcome was higher adherence. High adherence equals completion of at least 40 of 60 recommended exercise sessions during the 20-week intervention. The intervention group showed higher measures of platform usage, duration and activity. Intervention group completed the validated jumping protocol after an 8-week program of strength training to prepare for increased intensity exercises. Although some participants discontinued due to various reasons (time constraints or health complications), the supportive modules and feedback from the PI influenced participants to resume exercise after a period of inactivity. The mean scores in the PAM and SF-36v surveys were higher for the intervention group. Conclusions: The study demonstrates breast cancer survivors' willingness to utilize a digital platform with prescribed exercise routines. Feedback suggests that more personalized and interactive features may encourage a higher frequency of engagement in bone-health specific physical activity. A follow-up study will examine the impact of the exercise program on bone health and the role of coaching to impact sustainable behavior change. Clinical trial information: NCT03651037 .

Implementation Characteristics of Community-Based Exercise Programs for Cancer Survivors

Implementation Characteristics of Community-Based Exercise Programs for Cancer Survivors

Community-based exercise programs for cancer survivors: a scoping review of practice-based evidence.

Based on randomized controlled trials, exercise is an efficacious strategy to improve quality of life (QOL) among cancer survivors. However, the effectiveness of exercise programs to improve QOL in real-world settings is unknown, as are factors related to external validity. This hinders dissemination and scalability. This scoping review synthesized published research on community-based exercise programs for cancer survivors and reported on the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM). A systematic literature search identified community-based exercise programs for adult cancer survivors (1980-March 2018), that met the following inclusion criteria: at least one face-to-face exercise session, the primary aim of program evaluation (i.e., feasibility/effectiveness), and pre/post measure of QOL. Data were coded using the RE-AIM framework. The effect size was calculated for overall QOL. Electronic database search yielded 553 articles; 31 studies describing unique programs were included for review. All studies described at least one element of implementation and most (80.6%) reported a significant (p < .05) improvement in at least one subscale, or total QOL. Few studies reported on indicators of reach (16.1%), adoption (6.5%), individual (16.1%), or system-level maintenance (32.3%). Community-based exercise programs are effective for improving QOL in adult cancer survivors. Recommendations are provided to improve reporting across RE-AIM dimensions, which is an important step to enhance the scalability of programs and thus, the potential for exercise to be fully integrated into system-level standard care for cancer survivors. Community-based exercise programs are a resource to improve QOL for adult cancer survivors.

Personal Training vs. Group-based Exercise Prescription Compliance In Breast Cancer Survivors

PURPOSE: Exercise interventions can improve fitness and quality of life among breast cancer survivors. The magnitude of these effects may be dependent on compliance to the intended exercise prescription (ExRx), but few studies in cancer survivors have reported this information. This study examined breast cancer survivors’ ExRx compliance during a personal training (PT) or group-based exercise (GBE) intervention. METHODS: Women (N=26) with stage I-II breast cancer who had completed chemotherapy and/or radiation treatment within the previous year were randomly assigned to PT or GBE for 8 weeks. All participants received supervised exercise twice per week for 60 minutes a session. Participants were compliant to aerobic ExRx if they completed 20-30 minutes at 50-80% of heart rate reserve. Participants were compliant to upper and lower body resistance ExRx if they completed 2-3 sets of 8 repetitions within 50-80% of 1RM for chest and leg press. Compliance to aerobic, upper, and lower resistance ExRx was coded dichotomously (yes/no) for each session, then summed and divided by the number of sessions attended to calculate percent compliance. Independent t-tests examined differences in ExRx compliance between PT and GBE. Results are reported as mean±SD. RESULTS: Participants were aged 52±8.5 years, and 13.4±5.1 months post diagnosis. Of the N=24 who completed the intervention, exercise session attendance was 15.8±0.5 (99%) in PT, and 13.4±1.0 (82%) in GBE out of 16 possible sessions (p=.000). Compliance for aerobic ExRx was 77.2±0.17% in PT, and 70.1±0.17% in GBE (p=.41). Compliance for upper body resistance ExRx was 76.0±0.37% in PT and 82.4±0.20% in GBE (p=.597). Compliance for lower body resistance exercise was 80.2±0.23% in PT and 87.9±0.21% in GBE (p=.40). CONCLUSION: Exercise session attendance was higher in PT. Overall ExRx compliance was >70% for aerobic, >80% for resistance, and similar in PT and GBE. With growing support for establishing exercise programs for cancer survivors, it is important to determine sustainable and scalable delivery modalities. GBE may be more resource conscientious than PT, and this study suggests GBE can achieve comparable ExRx compliance to PT. Future exercise intervention studies in breast cancer survivors should examine how ExRx compliance affects health and/or fitness outcomes.

A RE-AIM Evaluation of a Community-Based Exercise Program for Cancer Survivors

A RE-AIM Evaluation of a Community-Based Exercise Program for Cancer Survivors

Tracking steps in oncology: the time is now.

PurposeAccurate evaluation of patients’ health status is a key component of the workup, treatment, and follow-up of cancer patients. Assessments by clinicians (eg, performance status, toxicity grade) and patients (eg, quality of life) play a critical role in current practice but have significant limitations. Technological advances now provide an opportunity to track a new class of objective measures of patient activity, such as daily step counts. Here, we describe recent efforts to incorporate this technology into the field of oncology.DesignWe conducted a structured literature search using MEDLINE electronic database to identify published observational studies of tracking steps in cancer patients and trials of exercise programs for cancer survivors incorporating pedometers until February 2016.ResultsData indicate that physical activity information may supplant existing scales for the assessment of cancer patients’ functional capacity.ConclusionObjective activity monitoring is poised to revolutionize the way health care providers assess cancer patients at the time of diagnosis, during treatment, and in the survivorship setting.

Factors influencing non-participation in an exercise program and attitudes towards physical activity amongst cancer survivors.

The purposes of this study are to investigate factors influencing non-participation in a structured exercise program for cancer survivors and to explore survivors' experiences and attitudes in relation to physical activity participation. Face-to-face or telephone interviews were conducted with individuals who had registered for, or engaged in, the 'Life Now' exercise program run by Cancer Council Western Australia. Participants were 20 cancer survivors (mean age 63.90years, SD 15.29) who had either cancelled their registration or withdrawn from the exercise program during the preceding 2years. Interview transcripts were analysed using thematic analysis. Seven main themes emerged: availability of the program; access, time and cost; lack of motivation or confidence; unwell or fatigued; physical activity preferences; knowledge of physical activity guidelines; and lack of referral or advice. The main barriers were contextual and included availability of, and access to, the program. Participants expressed a preference for home-based physical activity. Interventions aimed at promoting physical activity in cancer survivors should offer home-based programs and include referral and advice from oncologists. Increasing cancer survivors' participation in, and compliance with, exercise programs may require home-based strategies and referrals from oncologists to allied health professionals to individualise care.

Efficacy Of An Adaptive Clinical Exercise Program For Cancer Survivors During And After Treatment

Exercise programs for cancer survivors improve endurance, strength, and quality of life. Survivors exercising during cancer treatment tend to show smaller improvements, or performance maintenance, compared to those who have completed treatment. Adapting exercise to the day-to-day status of survivors during and after treatment is recommended and may improve program efficacy. PURPOSE: To investigate a three month adaptive clinical exercise program for cancer survivors during and after treatment. METHODS: Cancer survivors undergoing treatment (chemotherapy and/or radiation) at enrollment or within six months of completing treatment were included. No cancer types were excluded. Estimated VO2peak, grip strength, the Piper Fatigue Scale (PFS), and the Beck Depression Inventory (BDI) were assessed at baseline and program completion. The number of exercise sessions completed was recorded. Age, sex, and body mass index (BMI) at baseline were compared between treatment groups (undergoing treatment and completed treatment). ANOVAs (Exercise [within-participant] x Treatment [between-participant]) were performed for each performance measure in all participants and separately for breast cancer survivors. RESULTS: Participants undergoing treatment (N=58) did not significantly differ from those who had completed treatment (N=61) in age (57±12 years; Mean±SD), sex (71% women), or BMI (26.4±5.6 kg/m2). The number of exercise sessions completed was not different between groups (18±5 out of a possible 24, p>0.05). The main effect of Exercise was significant for all measures (p<0.01), with improvements seen from baseline to program completion (estimated VO2peak: 3.1±4 ml/min/kg, grip strength: 1±3 kg, PFS: -1±2, BDI: -3±6), while the main effect of Treatment and Treatment-Exercise interactions were not significant (p>0.05). These results were replicated when only breast cancer survivors were analyzed (N=48, 24 undergoing treatment). CONCLUSIONS: Cardiorespiratory fitness, strength, fatigue, and depressive symptoms improved significantly with exercise, regardless of treatment status. These results suggest that cancer survivors currently undergoing treatment can experience benefits equal to those of survivors who have completed treatment through an adaptive exercise program.