The Clinical Oncology Society of Australia (COSA) position stand on “Exercise in Cancer Care” was released in May this year, followed by an article promoting exercise and cancer titled “Tough love and hard exercise for people with cancer”, published in the May edition of the Exercise and Sports Science Australia MOVE magazine.
This represents an exciting move forwards in integrating exercise into cancer care and is generating the much needed discussions about what represents optimal patient care and what needs to be done to make this happen. Right now, we have sufficient evidence to support the integration of physical activity including planned exercise into standard cancer care. Exercise science in oncology strongly supports the notion that doing something is better than nothing, and more is generally better than less. While not all cancer types have been included in the more than 500 clinical trials that have evaluated the effect of exercise following a diagnosis, the theoretical underpinning, as well as consistency of findings across the cancer types that have been studied indicate this message will be relevant for the majority of those diagnosed with cancer. However, what represents the optimal exercise prescription and for who, remains unclear.
The exercise targets presented in the COSA position stand represent an ideal. Current and future research will continue to explore who can meet this target, what patient outcomes specifically benefit from such a prescription and when following a diagnosis would it be appropriate to meet or exceed these targets. ESSA (Exercise and Sports Science Australia) will release their updated position stand on exercise and cancer towards the end of this year. The intent of this document will be to help Accredited Exercise Physiologists (AEPs) understand the strengths and limitations of the current state of evidence in exercise and cancer (in particular the gaps in the evidence), and to develop an understanding of how to use this information to individualise their exercise prescription.
Further, earlier this year, the American College of Sports Medicine held an international, multidisciplinary roundtable on exercise and cancer prevention and control. Key exercise and oncology groups from around the world were represented at this meeting, including ESSA, to ensure that the subsequent products will be relevant internationally, with the theme for the meeting being ‘one voice, global impact’. Products from this roundtable will summarise the current evidence-base evaluating exercise in cancer care and will use this evidence to develop best practice guidelines with solutions for influencing practice immediately.
Until such time of the release of these practice-guiding documents, it is prudent that AEPs recognise what ‘tough love’ and ‘hard exercise’ means. ‘Tough love’ is showing care and compassion while encouraging and supporting the planned integration of exercise into their cancer care. ‘Hard exercise’ may mean encouraging a patient to spend more time sitting than lying down, may mean going for a walk before fatigue sets in for the day, or it may mean integrating heavy resistance exercise into what is currently an aerobic only exercise program.
Importantly, it is our duty to use our knowledge, skills and experiences wisely in the clinical setting. This includes listening to patients about what matters most to them (that is, why would they even be interested in making exercise part of their cancer care), helping them understand how exercise can be used to achieve their goals, working with them in developing an exercise prescription that will work given their desires and constraints, and to garner support from the wider treating team for integrating exercise as part of their care plan. Without buy-in from the patient and their treating clinician, using exercise to improve the lives of those with cancer will continue to be underutilised.
Professor Sandi Hayes, Research Executive Committee Member of the COSA Exercise and Cancer Position Stand and Senior Research Fellow in Cancer Survivorship