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Current Cancer Therapy Reviews


ISSN (Print): 1573-3947
ISSN (Online): 1875-6301

Review Article

Implementing Cancer Exercise Rehabilitation: An Update on Recommendations for Clinical Practice

Author(s): Kirsten Suderman, Carolyn McIntyre, Christopher Sellar and Margaret L. McNeely*

Volume 15 , Issue 2 , 2019

Page: [100 - 109] Pages: 10

DOI: 10.2174/1573394714666180730100432

Price: $65


A growing body of research evidence supports the benefit of exercise for cancer survivors both during and after cancer treatment. The purpose of this paper is to provide an update on our previously published review in 2006 on the state of the evidence supporting exercise for survivors of cancer as well as guidelines for integrating exercise programming in the cancer clinical setting. First, we provide a brief overview on the benefits of exercise as well as preliminary evidence supporting the implementation of community-based exercise programs. Second, we summarize the principles and goals of exercise, and the identified barriers to exercise among cancer survivors. Finally, we propose an interdisciplinary model of care for integrating exercise programming into clinical care including guidelines for medical and pre-exercise screening, exercise testing and programming considerations.

Keywords: Exercise, physical activity, rehabilitation, physical therapy, cancer survivors, pre-exercise screening.

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Speck RM, Courneya KS, Masse LC, Duval S, Schmitz KH. An update of controlled physical activity trials in cancer survivors: A systematic review and meta-analysis. J Cancer Surviv 2010; 4(2): 87-100.
Rock CL, Doyle C, Demark-Wahnefried W, et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin 2012; 62(4): 243-74.
Cramp F, Byron-Daniel J. Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev 2012; 11CD006145
Ibrahim EM, Al-Homaidh A. Physical activity and survival after breast cancer diagnosis: Meta-analysis of published studies. Med Oncol 2011; 28(3): 753-65.
Richman EL, Kenfield SA, Stampfer MJ, Paciorek A, Carroll PR, Chan JM. Physical activity after diagnosis and risk of prostate cancer progression: Data from the cancer of the prostate strategic urologic research endeavor. Cancer Res 2011; 71(11): 3889-95.
Courneya KS, Segal RJ, Mackey JR, et al. Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: A multicenter randomized controlled trial. J Clin Oncol 2007; 25(28): 4396-404.
van Waart H, Stuiver MM, van Harten WH, et al. Effect of low-intensity physical activity and moderate- to high-intensity physical exercise during adjuvant chemotherapy on physical fitness, fatigue, and chemotherapy completion rates: Results of the PACES randomized clinical trial. J Clin Oncol 2015; 33(17): 1918-27.
Ballard-Barbash R, Friedenreich CM, Courneya KS, Siddiqi SM, McTiernan A, Alfano CM. Physical activity, biomarkers, and disease outcomes in cancer survivors: a systematic review. J Natl Cancer Inst 2012; 104(11): 815-40.
Moorman PG, Jones LW, Akushevich L, Schildkraut JM. Recreational physical activity and ovarian cancer risk and survival. Ann Epidemiol 2011; 21(3): 178-87.
McNeely ML, Peddle C, Parliament M, Courneya KS. Cancer rehabilitation: Recommendations for integrating exercise programming in the clinical practice setting. Curr Cancer Ther Rev 2006; 2(4): 351-60.
Cormie P, Zopf EM, Zhang X, Schmitz KH. The impact of exercise on cancer mortality, recurrence, and treatment-related adverse effects. Epidemiol Rev 2017; 39(1): 71-92.
Schmitz KH, Courneya KS, Matthews C, et al. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc 2010; 42(7): 1409-26.
Cormie P, Atkinson M, Bucci L, et al. Clinical Oncology Society of Australia position statement on exercise in cancer care. Med J 2018; 209(4): 184-7.
Tomasone J, Zwaal C, Kim GM, Yuen D, Sussman J, Segal R. Moving guidelines into action: A report from cancer care Ontario’s event let’s get moving: Exercise and rehabilitation for cancer patients. Curr Oncol 2017; 24(1): e65-74.
Cormie P, Lamb S, Valentine L, et al. Eds. Translating exercise oncology research into practice: Effectiveness of a community based exercise program for cancer patients and survivors. MASCC/ISOO Annual Meeting Supportive Care in Cancer; 2015. June 25-27; Copenhagen, Denmark.
Heston AH, Schwartz AL, Justice-Gardiner H, Hohman KH. Addressing physical activity needs of survivors by developing a community-based exercise program: LIVESTRONG at the YMCA. Clin J Oncol Nurs 2015; 19(2): 213-7.
Haas BK, Kimmel G, Hermanns M, Deal B. Community-based FitSTEPS for life exercise program for persons with cancer: 5-Year evaluation. J Oncol Pract 2012; 8(6): 320-4.
Cheifetz O, Park Dorsay J, Hladysh G, Macdermid J, Serediuk F, Woodhouse LJ. CanWell: Meeting the psychosocial and exercise needs of cancer survivors by translating evidence into practice. Psycho-oncol 2014; 23(2): 204-15.
Irwin ML, Cartmel B, Harrigan M, et al. Effect of the LIVESTRONG at the YMCA exercise program on physical activity, fitness, quality of life, and fatigue in cancer survivors. Cancer 2017; 123(7): 1249-58.
White SM, McAuley E, Estabrooks PA, Courneya KS. Translating physical activity interventions for breast cancer survivors into practice: an evaluation of randomized controlled trials. Ann Behav Med 2009; 37(1): 10-9.
Hardcastle SJ, Cohen PA. Effective physical activity promotion to survivors of cancer is likely to be home based and to require oncologist participation. J Clin Oncol 2017; 35(32): 3635-7.
Canadian Cancer Statistics 2018. Toronto, ON: Canadian Cancer Society; 2018. Available at: (Accessed on: 8th June, 2018).
Heywood R, McCarthy AL, Skinner TL. Safety and feasibility of exercise interventions in patients with advanced cancer: A systematic review. Support Care Cancer 2017; 25(10): 3031-50.
Dittus KL, Gramling RE, Ades PA. Exercise interventions for individuals with advanced cancer: A systematic review. Prev Med 2017; 104: 124-32.
Hoffmann TC, Maher CG, Briffa T, et al. Prescribing exercise interventions for patients with chronic conditions. CMAJ 2016; 188(7): 510-8.
McArdle WD. Exercise physiology: Energy, nutrition, and human performance. Philadelphia: Lippincott Williams & Wilkins 2006.
Cavalheri V, Granger C. Preoperative exercise training for patients with non-small cell lung cancer. Cochrane Database Syst Rev 2017; 6CD012020
Courneya KS. Physical activity and cancer survivorship: A simple framework for a complex field. Exerc Sport Sci Rev 2014; 42(3): 102-9.
Courneya KS. Exercise guidelines for cancer survivors: Are fitness and quality-of-life benefits enough to change practice? Curr Oncol 2017; 24(1): 8-9.
Weaver KE, Foraker RE, Alfano CM, et al. Cardiovascular risk factors among long-term survivors of breast, prostate, colorectal, and gynecologic cancers: A gap in survivorship care? J Cancer Surviv 2013; 7(2): 253-61.
Courneya KS, Friedenreich CM. Physical activity and cancer control. Semin Oncol Nurs 2007; 23(4): 242-52.
Clifford BK, Mizrahi D, Sandler CX, et al. Barriers and facilitators of exercise experienced by cancer survivors: A mixed methods systematic review. Support Care Cancer 2018; 26(3): 685-700.
Fernandez S, Franklin J, Amlani N. DeMilleVille C, Lawson D, Smith J. Physical activity and cancer: A cross-sectional study on the barriers and facilitators to exercise during cancer treatment. Can Oncol Nurs J 2015; 25(1): 37-48.
Sander AP, Wilson J, Izzo N, Mountford SA, Hayes KW. Factors that affect decisions about physical activity and exercise in survivors of breast cancer: A qualitative study. Phys Ther 2012; 92(4): 525-36.
Kirkham AA, Bonsignore A, Bland KA, et al. Exercise prescription and adherence for breast cancer: One size does not FITT all. Med Sci Sports Exerc 2018; 50(2): 177-86.
Cheifetz O, Dorsay JP, MacDermid JC. Exercise facilitators and barriers following participation in a community-based exercise and education program for cancer survivors. J Exerc Rehabil 2015; 11(1): 20-9.
Spector D, Battaglini C, Groff D. Perceived exercise barriers and facilitators among ethnically diverse breast cancer survivors. Oncol Nurs Forum 2013; 40(5): 472-80.
Brunet J, Taran S, Burke S, Sabiston CM. A qualitative exploration of barriers and motivators to physical activity participation in women treated for breast cancer. Disabil Rehabil 2013; 35(24): 2038-45.
Hefferon K, Murphy H, McLeod J, Mutrie N, Campbell A. Understanding barriers to exercise implementation 5-year post-breast cancer diagnosis: A large-scale qualitative study. Health Educ Res 2013; 28(5): 843-56.
Chou YJ, Lai YH, Lin BR, Liang JT, Shun SC. Factors influencing amount of weekly exercise time in colorectal cancer survivors. Cancer Nurs 2017; 40(3): 201-8.
Black KZ, Johnson LS, Samuel-Hodge CD, Gupta L, Sundaresan A, Nicholson WK. Perceived barriers and preferred components for physical activity interventions in African-American survivors of breast or endometrial cancer with type 2 diabetes: The S.U.C.C.E.S.S. framework. Support Care Cancer 2018; 26(1): 231-40.
Ventura EE, Ganz PA, Bower JE, et al. Barriers to physical activity and healthy eating in young breast cancer survivors: Modifiable risk factors and associations with body mass index. Breast Cancer Res Treat 2013; 142(2): 423-33.
Olson EA, Mullen SP, Rogers LQ, Courneya KS, Verhulst S, McAuley E. Meeting physical activity guidelines in rural breast cancer survivors. Am J Health Behav 2014; 38(6): 890-9.
Garber CE, Blissmer B, Deschenes MR, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal and neuromotor fitness in apparently healthy adults: Guidance for prescribing exercise. Med Sci Sports Exerc 2011; 43(7): 1334-59.
American College of Sports Medicine. ACSM's Guidelines for Exercise Testing and Prescription 10th ed Philadelphia, PA Wolters Kluwer Health. 2017.
American College of Sports Medicine. American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc 2009; 41(3): 687-708.
Riebe D, Franklin BA, Thompson PD, et al. Updating ACSM’s Recommendations for Exercise Preparticipation Health Screening. Med Sci Sports Exerc 2015; 47(11): 2473-9.
Kirkham AA, Neil-Sztramko SE, Morgan J, et al. Health-related physical fitness assessment in a community-based cancer rehabilitation setting. Support Care Cancer 2015; 23(9): 2525-33.
McNeely ML, Dolgoy N, Onazi M, Suderman K. The interdisciplinary rehabilitation care team and the role of physical therapy in survivor exercise. Clin J Oncol Nurs 2016; 20(6)(Suppl.): S8-S16.
Demark-Wahnefried W, Aziz NM, Rowland JH, Pinto BM. Riding the crest of the teachable moment: Promoting long-term health after the diagnosis of cancer. J Clin Oncol 2005; 23(24): 5814-30.
Jones LW, Courneya KS, Fairey AS, Mackey JR. Effects of an oncologist’s recommendation to exercise on self-reported exercise behavior in newly diagnosed breast cancer survivors: A single-blind, randomized controlled trial. Ann Behav Med 2004; 28(2): 105-13.
Jones LW, Sinclair RC, Rhodes RE, Courneya KS. Promoting exercise behaviour: An integration of persuasion theories and the theory of planned behaviour. Br J Health Psychol 2004; 9(Pt 4): 505-21.
Paxton RJ, Nayak P, Taylor WC, et al. African-American breast cancer survivors’ preferences for various types of physical activity interventions: A Sisters Network Inc. web-based survey. J Cancer Surviv 2014; 8(1): 31-8.
Smith-Turchyn J, Richardson J, Tozer R, McNeely M, Thabane L. Physical activity and breast cancer: A qualitative study on the barriers to and facilitators of exercise promotion from the perspective of health care professionals. Physiother Can 2016; 68(4): 383-90.

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