Moving More

Counseling patients

Do you need some guidance in providing counsel and support to your patients?

Bringing up activity changes with patients

Do you have concerns about introducing lifestyle changes to your patients? 

• I don’t know if there’s evidence that this really will make a difference.
• Will I make my patients feel guilty for being sedentary, being overweight, etc?
• If I bring this up, I won’t have time to adequately counsel them.
• I don’t have the knowledge and resources to support them through making lifestyle changes.

You’re not alone in these concerns,¹Stump TK, Robinson JK et al. Physicians’ perspectives on medication adherence and health promotion among cancer survivors. Cancer. 2019 Dec 1;125(23):4319-4328. and you don’t have to do this alone. Of greatest importance is that you assess your patient’s lifestyle, sensitively introduce the topic of making lifestyle changes and why it’s important, then refer them to resources to support them in making lifestyle changes.

Even a short, focused conversation can lead to changes. Activity advice can help your patients, especially regarding many side effects. Many practitioners have found that patients who feel better tend to tolerate and complete difficult treatments and may be more compliant with other therapies.

Resources you can review or build from on other pages:

• How can Moving More help you? What the research says ›
• A list of recommendations and resources for you to share with your patients in Making changes ›

Here we provide some resources to help you get started engaging your patients in conversations about lifestyle changes in general and specifically Moving More.

Guidance on engaging your patients in lifestyle conversations

Print materials to display or share with patients

Reimbursement

Success stories

Directory of local professionals

Implementing and supporting behavior changes

Research helps us identify intervention strategies with the highest likelihood of success. Keep in mind that different people may have vastly different attitudes, styles of approaching physical activity, and motivations.

Clinical practice guidelines and recommendations for professionals

This report presents health care providers with the best available information with which to help cancer survivors and their families make informed choices related to nutrition and physical activity, with these specifics:

Achieve and maintain a healthy body weight throughout life.

• Keep body weight within the healthy range and avoid weight gain in adult life.

Be physically active.

• Adults should engage in 150-300 minutes of moderate-intensity physical activity per week, or 75-150 minutes of vigorous-intensity physical activity, or an equivalent combination; achieving or exceeding the upper limit of 300 minutes is optimal.
• Children and adolescents should engage in at least 1 hour of moderate- or vigorous-intensity activity each day.
• Limit sedentary behavior, such as sitting, lying down, and watching television, and other forms of screen-based entertainment.

Recommendation for community action: Public, private, and community organizations should work collaboratively at national, state, and local levels to develop, advocate for, and implement policy and environmental changes that provide safe, enjoyable, and accessible opportunities for physical activity.

2013 evidence-based clinical practice guidelines suggests supervised exercise-based pulmonary rehabilitation to improve cardiorespiratory fitness and functional capacity for lung cancer patients

2019 recommendations:

1. Clinicians should assess, advise, and refer patients to either home-based or community-based exercise or for further evaluation and intervention in outpatient rehabilitation.
2. Health care and fitness professionals should use the new recommendations when creating exercise programs for cancer patients and survivors. 
3. This includes formally and systematically using custom exercise prescriptions that best meet the needs, preferences and abilities of individuals living with and beyond cancer.

The 2018 position statement includes these recommendations:

• Exercise to be embedded as part of standard practice in cancer care and to be viewed as an adjunct therapy that helps counteract the adverse effects of cancer and its treatment
• All members of the multidisciplinary cancer team to promote physical activity and recommend that people with cancer adhere to exercise guidelines
• Best practice cancer care to include referral to an accredited exercise physiologist or physiotherapist with experience in cancer care

NCCN Clinical Practice Guidelines in Oncology: Survivorship ›

• Develop a plan for regular physical activity and healthy nutrition as part of management and treatment of anxiety, depression and distress.
• Recommend routine physical activity as part of cancer-associated cognitive dysfunction interventions.
• Exercise/physical activity is one of the nonpharmacologic treatments recommended for vasomotor symptoms (such as hot flashes/night sweats) disruptive to quality of life and for pain/myalgias.
• Regular physical activity in the morning and/or afternoon (but not within 3 hours of bedtime) is recommended for sleep disorders.
• Clinicians should assess individual and community-level barriers to meeting the healthy lifestyle recommendations and support patients in developing strategies to overcome challenges.
• A risk assessment for physical activity-induced adverse events is recommended.

NCCN Clinical Practice Guidelines in Oncology: Cancer-Related Fatigue. Version 2.2022 ›

• For people in active treatment or after treatment: Consider initiation and/or encourage maintenance of a physical activity/exercise program, as appropriate per health care provider, consisting of cardiovascular endurance (walking, jogging, or swimming) and resistance (weights) training.

2009 evidence-based clinical practice guidelines for integrative oncology recommend referral to a qualified exercise specialist for guidelines on physical activity to promote basic health.

Further evidence

Clinical evidence is described in How can Moving More help you? What the research says ›

Improving treatment outcomes: preclinical evidence

• Less proliferation of human colon cancer cells stimulated with serum obtained immediately after exercise from men with lifestyle risk factors for colon cancer (age ≥50 years; body mass index ≥25 kg/m2; physically inactive) compared to before exercise in a small trial³⁹Orange ST, Jordan AR et al. Acute aerobic exercise-conditioned serum reduces colon cancer cell proliferation in vitro through interleukin-6-induced regulation of DNA damage. International Journal of Cancer. 2022 Feb 25.

Optimizing your body terrain: preclinical evidence

• Less DNA damage and increased serum IL-6 in human colon cancer cells stimulated with serum obtained immediately after exercise from men with lifestyle risk factors for colon cancer (age ≥50 years; body mass index ≥25 kg/m2; physically inactive) compared to before exercise in a small trial⁴⁰Orange ST, Jordan AR et al. Acute aerobic exercise-conditioned serum reduces colon cancer cell proliferation in vitro through interleukin-6-induced regulation of DNA damage. International Journal of Cancer. 2022 Feb 25.

Helpful links for professionals