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This section does not replicate the other information on this page but provides additional details or context most relevant to professionals.

Clinical Oncology Society of Australia position statement on exercise in cancer care

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.

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:

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

American College of Lifestyle Medicine

Colorful, engaging handouts and flyers

Free accounts give access to materials

Print Resources

Success stories

American College of Lifestyle Medicine

Stories of transformation and healing, of patients, physicians and organizations using evidence based Lifestyle Medicine

Lifestyle Medicine Story Project

Directory of local professionals

American College of Sports Medicine

A searchable directory to help health care professionals, exercise professionals,and patients find appropriately trained professionals and programs in their communities

Exercise Program Directory

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.

What kind of exercise should patients do?

Both aerobic and resistance training provide benefits.

Does supervision matter?

Yes, supervised programs produce better results than unsupervised programs for most people.

Are remote interventions successful?

Yes, remote interventions (online, phone, email, mail) or technology support (such as a Fitbit) can lead to behavior change, although perhaps not as great as with in-person interventions.

Who benefits most?

Patients with better baseline aerobic fitness benefit more from exercising during treatment, while those with lower baseline fitness benefit more after treatment. Older populations with existing physical limitations benefit less.

What impacts patient motivation?

Interest in physical activity (PA), knowledge about PA/quality of life and PA before diagnosis are main predictors of a motivated attitude.

Fatigue and depression are predictors of less success.

Behavioral incentives may encourage physical activity among adolescents.

How long? How often? How intense does exercise need to be?

Session timing, length, intensity, and frequency, and intervention duration make a difference in outcomes. More than 12 weeks is better for quality of life, aerobic fitness, and reduced body fat, but less than 12 weeks to relieve fatigue.

Three or more sessions a week, and an hour or more at each session, yields better outcomes than less frequent sessions, except with depression, for which more than 25 to 30 minutes of exercise did not provide more benefit.

Scheduling to accommodate treatment side effects, such as fatigue, can improve compliance.

Is social or other support important?

Yes, a personal connection and some support can improve adherence and success.

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

The strongest evidence is described in How can Moving More help me? What the research says ›

Treating cancer: 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.

Professional resources

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Authors

Nancy Hepp, MS

Lead Researcher and Program Manager
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Ms. Hepp is a researcher and communicator who has been writing and editing educational content on varied health topics for more than 20 years. She serves as lead researcher, program manager, and writer for CancerChoices. Her graduate work in research and cognitive psychology, her master’s degree in instructional design, and her certificate in web design have all guided her in writing and presenting information for a wide variety of audiences and uses. Nancy’s service as faculty development coordinator in the Department of Family Medicine at Wright State University also provided experience in medical research, plus insights into medical education and medical care from the professional’s perspective.

Nancy Hepp, MS Lead Researcher and Program Manager

Laura Pole, RN, MSN, OCNS

Senior Clinical Consultant
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Laura Pole is senior clinical consultant for CancerChoices. Laura is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation, and education services for over 40 years. She is the co-creator and co-coordinator of the Integrative Oncology Navigation Training at Smith Center for Healing and the Arts in Washington, DC. Laura also manages the “Media Watch Cancer News That You Can Use” listserv for Smith Center/Commonweal. In her role as a palliative care educator and consultant, Laura has served as statewide Respecting Choices Faculty for the Virginia POST (Physician Orders for Scope of Treatment) Collaborative as well as provided statewide professional education on palliative and end-of-life care for the Virginia Association for Hospices and Palliative Care.

For CancerChoices, Laura curates content and research, networks with clinical and organizational partners, brings awareness and education of integrative oncology at professional and patient conferences and programs, and translates research into information relevant to the patient experience as well as clinical practice.

Laura sees her work with CancerChoices as a perfect alignment of all her passions, knowledge and skills in integrative oncology care. She is honored to serve you.

Laura Pole, RN, MSN, OCNS Senior Clinical Consultant

Reviewers

Ted Schettler, MD, MPH

Physician, advocate, author, and CancerChoices advisor
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Dr. Schettler is science director of the Collaborative on Health and the Environment and the Science and Environmental Health Network and author of The Ecology of Breast Cancer. He has worked extensively with community groups and non-governmental organizations throughout the US and internationally, addressing many aspects of human health and the environment. He has served on advisory committees of the US EPA and National Academy of Sciences. He is co-author of Generations at Risk: Reproductive Health and the Environment, which examines reproductive and developmental health effects of exposure to a variety of environmental toxicants. He is also co-author of In Harm’s Way: Toxic Threats to Child Development, which discusses the impact of environmental exposures on neurological development in children, and Environmental Threats to Healthy Aging: With a Closer Look at Alzheimer’ and Parkinson’s Diseases.

Ted Schettler, MD, MPH Physician, advocate, author, and CancerChoices advisor

Whitney You, MD, MPH

Research Consultant
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Dr. You is a physician specializing in maternal-fetal medicine (MFM) with a specific interest in cancer in the context of pregnancy. She completed a postdoctoral fellowship in health services research with a focus in health literacy and received a Master of Public Health.

Whitney You, MD, MPH Research Consultant

Andrew Jackson, ND

Research Associate
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Andrew Jackson, ND, serves as a CancerChoices research associate. As a naturopathic physician practicing in Kirkland, Washington, he teaches critical evaluation of the medical literture at Bastyr University in Kenmore, Washington. His great appreciation of scientific inquiry and the scientific process has led him to view research with a critical eye.

Andrew Jackson, ND Research Associate

Last update: August 3, 2022

CancerChoices provides information about integrative in cancer care, a patient-centered approach combining the best of conventional care, self care and evidence-informed complementary care in an integrated plan cancer care. We review complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocial therapy, and acupuncture therapies and self-care lifestyle actions and behaviors that may impact cancer outcomes; examples include eating health-promoting foods, limiting alcohol, increasing physical activity, and managing stress practices to help patients and professionals explore and integrate the best combination of conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy and complementary therapies and practices for each person.

Our staff have no financial conflicts of interest to declare. We receive no funds from any manufacturers or retailers gaining financial profit by promoting or discouraging therapies mentioned on this site.

 

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