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American College of Sports Medicine: Exercise guidelines for cancer survivors

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A review of research, conducted by an international group of experts under the aegis of the American College of Sports Medicine, has resulted in the development of new exercise guidelines for cancer survivors. The updated recommendations outline specific ‘exercise prescriptions’ to address common side effects, such as anxiety and fatigue, associated with cancer diagnoses and treatment.

In general, the new guidelines recommend survivors perform aerobic and resistance training for approximately 30 minutes per session, three times a week. This is a departure from earlier guidelines, published nearly a decade ago, which advised cancer survivors to meet the general public health guidelines for all Americans – 150 minutes of exercise a week.

“Exercise has been regarded as a safe and helpful way for cancer survivors to lessen the impact of cancer treatment on their physical and mental health, but the precise type and amount of exercise to treat the many different health outcomes related to cancer treatment hasn’t been clear,” says the paper’s lead author, Kristin Campbell, associate professor at UBC’s department of physical therapy. “In the absence of this information, cancer survivors were advised to strive toward meeting the general public health guidelines for all Americans – an amount of physical activity that may be difficult for people to achieve during or following cancer treatment.”

The new recommendations are based on a substantive review and analysis of the growing body of scientific evidence in the field. Since the first guidelines were put forward in 2010, there have been more than 2,500 published randomised controlled exercise trials in cancer survivors – an increase of 281%.

The new paper is just one of three papers published that summarise the outcomes of an international roundtable that explored the role of exercise in cancer prevention and control. The roundtable brought together a group of 40 international, multidisciplinary experts from various organisations who conducted a thorough and updated review of the evidence on the positive effects of exercise in preventing, managing and recovering from cancer.

Together, the three papers offer new evidence-backed recommendations for incorporating exercise into prevention and treatment plans and introduce a new Moving Through Cancer initiative, led by the American College of Sports Medicine, to help clinicians worldwide implement these recommendations.

The new recommendations include: or all adults, exercise is important for cancer prevention and specifically lowers risk of seven common types of cancer: colon, breast, endometrial, kidney, bladder, esophagus and stomach; or cancer survivors, incorporate exercise to help improve survival after a diagnosis of breast, colon and prostate cancer; exercising during and after cancer treatment improves fatigue, anxiety, depression, physical function, quality of life and does not exacerbate lymphedema; continue research that will drive the integration of exercise into the standard of care for cancer; and translate into practice the increasingly robust evidence base about the positive effects of exercise for cancer patients.

Abstract
Purpose: 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.

Methods: 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.
Results: 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.

Conclusions: 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.

Authors
Kristin L Campbell, Kerri M Winters-Stone, Joachim Wiskemann, Anne M May, Anna L Schwartz, Kerry S Courneya, David S Zucker, Charles E Matthews, Jennifer A Ligibel, Lynn H Gerber, G Stephen Morris, Alpa V Patel, Trisha F Hue, Frank M Perna, Kathryn H Schmitz

University of British Columbia material

Medicine & Science in Sports & Exercise abstract

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