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OBJECTIVE: A consistent body of evidence supports participating in physical activity (PA) post-cancer diagnosis as beneficial to function, quality-of-life and potentially survival. However, diagnosis of late stage disease, poor prognosis, receipt of high doses of adjuvant therapy and presence of severe acute and persistent treatment-related side-effects may alter how these findings translate to women with ovarian cancer. Therefore, the objectives of this review were to (I) describe PA levels post-diagnosis of ovarian cancer, (II) explore the relationship between PA levels and health outcomes, and (III) evaluate the effect of exercise interventions for women with ovarian cancer. METHODS: PubMed, EMBASE, Scopus and CINAHL were systematically searched to December 31, 2019. Two independent reviewers assessed articles for eligibility. Studies were eligible if they evaluated the relationship between PA levels or an exercise intervention and health outcomes following ovarian cancer. Methodological quality was assessed by two independent reviewers using the Joanna Briggs Institute Critical Appraisal Tools. Descriptive statistics were used to collate relevant data. RESULTS: 34 articles were eligible for inclusion. Results demonstrated that most women decrease PA from pre- to post-diagnosis and remain insufficiently active following diagnosis. Higher levels of PA were associated with higher health-related quality-of-life (HRQOL), and lower levels of anxiety and depression. Exercise appears safe and feasible during and following treatment and leads to improvements in HRQOL, fatigue and additional physical and psychological outcomes. CONCLUSIONS: Findings suggest that PA is relevant to health outcomes for women with ovarian cancer. Interventions that aid women to stay or become sufficiently active, including through exercise interventions during or following treatment have potential to improve the lives of those with ovarian cancer. Future work evaluating targeted interventions that can accommodate disease-specific challenges is now required to ensure scientific findings can translate into improved ovarian cancer care.
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Carcinoma Epitelial do Ovário/fisiopatologia , Carcinoma Epitelial do Ovário/terapia , Exercício Físico/fisiologia , Neoplasias Ovarianas/fisiopatologia , Neoplasias Ovarianas/terapia , Carcinoma Epitelial do Ovário/psicologia , Exercício Físico/psicologia , Feminino , Humanos , Neoplasias Ovarianas/psicologia , Prognóstico , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
BACKGROUND: This meta-analysis evaluated the safety, feasibility and effect of exercise among individuals with colorectal cancer. METHODS: A database search (CINAHL, Ebscohost, MEDLINE, Pubmed, ProQuest Health and Medical Complete, ProQuest Nursing, Science Direct) for randomised, controlled, exercise trials involving individuals with colorectal cancer, published before January 1, 2020 was undertaken. Safety (adverse events), feasibility (withdrawal and adherence rates) and effect data (health outcomes including quality of life, QoL) were abstracted. Risk difference (RD) and standardised mean differences (SMD) were calculated to compare safety and effects between exercise and usual care (UC). Subgroup analyses were conducted to assess whether outcomes differed by exercise mode, duration, supervision and treatment. Risk of bias was assessed using the Physiotherapy Evidence Database tool. RESULTS: For the 19 trials included, there was no difference in adverse event risk between exercise and UC (RD = 0.00; 95% CI:-0.01, 0.01, p = 0.92). Median withdrawal rate was 12% (0-22%) and adherence was 86% (42-91%). Significant effects of exercise compared to UC were observed for QoL, fatigue, aerobic fitness, upper-body strength, depression, sleep and reduced body fat (SMD = 0.21-0.66, p < 0.05). Subgroup analyses suggested larger benefits (p < 0.05) for QoL and fatigue for supervised interventions; for QoL, aerobic fitness and reduced body fat for ≥12-week interventions; and for aerobic fitness when interventions were during chemotherapy. CONCLUSION: Although reporting of safety and compliance data was lacking in most trials, findings support that exercise is safe and feasible in colorectal cancer. Further, participation in mixed-mode exercise, including unsupervised exercise, leads to improvements in various health-related outcomes.
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Neoplasias Colorretais/terapia , Terapia por Exercício/efeitos adversos , Terapia por Exercício/métodos , Avaliação de Resultados em Cuidados de Saúde , Segurança do Paciente , Cooperação e Adesão ao Tratamento , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de VidaRESUMO
OBJECTIVE: To systematically evaluate the safety, feasibility, and effect of exercise among women with stage II+ breast cancer. DATA SOURCES: CINAHL, Cochrane, Ebscohost, MEDLINE, Pubmed, ProQuest Health and Medical Complete, ProQuest Nursing and Allied Health Source, Science Direct and SPORTDiscus were searched for articles published before March 1, 2017. STUDY SELECTION: Randomized, controlled, exercise trials involving at least 50% of women diagnosed with stage II+ breast cancer were included. DATA EXTRACTION: Risk of bias was assessed and adverse event severity was classified using the Common Terminology Criteria. Feasibility was evaluated by computing median (range) recruitment, withdrawal, and adherence rates. Meta-analyses were performed to evaluate exercise safety and effects on health outcomes only. The influence of intervention characteristics (mode, supervision, duration and timing) on exercise outcomes were also explored. DATA SYNTHESIS: There were no differences in adverse events between exercise and usual care (risk difference: <0.01 ([95% CI: -0.01, 0.01], P=0.38). Median recruitment rate was 56% (1%-96%), withdrawal rate was 10% (0%-41%) and adherence rate was 82% (44%-99%). Safety and feasibility outcomes were similar, irrespective of exercise mode, supervision, duration, or timing. Effects of exercise for quality of life, fitness, fatigue, strength, anxiety, depression, body mass index and waist circumference compared with usual care were significant (standardized mean difference range: 0.17-0.77, P<0.05). CONCLUSION: The findings support the safety, feasibility, and effects of exercise for those with stage II+ breast cancer, suggesting that national and international exercise guidelines appear generalizable to women with local, regional, and distant breast cancer.
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Neoplasias da Mama/reabilitação , Terapia por Exercício/métodos , Adulto , Idoso , Ansiedade , Índice de Massa Corporal , Neoplasias da Mama/patologia , Neoplasias da Mama/psicologia , Depressão , Fadiga , Estudos de Viabilidade , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Aptidão Física , Qualidade de Vida , Resultado do TratamentoRESUMO
INTRODUCTION: The benefits of exercise in reducing treatment-related morbidity and improving quality of life following a primary diagnosis of cancer have been well documented and have led to exercise being recommended by oncology societies for all people with a cancer diagnosis. However, these recommendations are derived from research typically involving cohorts with more common cancers and relatively good prognosis, such as breast and prostate. Evidence from these cancers may not apply to women with recurrent ovarian cancer. Therefore, the primary objective of this trial is to evaluate the feasibility and safety of a home-based, telephone-delivered exercise intervention for women undergoing chemotherapy for recurrent ovarian cancer. METHODS AND ANALYSIS: The Exercise During Chemotherapy for Recurrent Ovarian Cancer (ECHO-R) trial is a single-arm, phase II, pre/postintervention trial of a 6-month, telephone-delivered exercise intervention (consistent with recommended exercise oncology prescription). The target sample size is 80 women who are currently undergoing (or are scheduled to receive) chemotherapy for recurrent ovarian cancer. Recruitment is through participating hospital sites in Queensland, Australia, or via self-referral. The exercise intervention comprises 12 telephone sessions over a 6-month period delivered by trial-trained exercise professionals and supplemented (where feasible) by five sessions face to face. Exercise prescription is individualised and works towards an overall goal of achieving a weekly target of 150 min of moderate-intensity, mixed-mode exercise. Assessments via self-administered survey and physical fitness and function tests occur at baseline and then at 6 and 9 months postbaseline. Data to inform feasibility and safety are recorded as case notes by the exercise professional during each session. ETHICS AND DISSEMINATION: Ethics approval for the ECHO-R trial was granted by the Metro North Human Research Ethics Committee (HREC/2020/QRBW/67223) on 6 November 2020. Findings from the trial are planned to be disseminated via peer-reviewed publications and both national and international exercise and oncology conferences. TRIAL REGISTRATION NUMBER: ACTRN12621000042842.
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Neoplasias Ovarianas , Qualidade de Vida , Feminino , Humanos , Masculino , Carcinoma Epitelial do Ovário , Terapia por Exercício/efeitos adversos , Estudos de Viabilidade , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/etiologia , TelefoneRESUMO
PURPOSE: The aim of this analysis was to compare the cost-consequences of a 12 week exercise intervention when delivered under high- versus low-level supervision conditions by an Exercise Professional (ExP) to women with breast cancer. METHODS: 60 women (50 ± 9 years) with stage II + breast cancer, who were insufficiently active, and reported ≥ 1 comorbidities or persistent treatment-related side-effects, were randomized to the high- or low-supervision group. The high-supervision group received 20 supervised sessions with an ExP over a 12 week period (reflecting a typical research model), whereas the low-supervision group received five sessions over the same period (replicating what is publicly funded within Australia). Health outcomes including health-related quality of life, and physical and psychosocial outcomes were assessed at baseline and post-intervention. To assess intervention consequences, composite effectiveness scores were created by calculating mean z-scores from raw data for all outcomes per participant. Total program costs were calculated including program development, staff training, program implementation, and equipment. RESULTS: 79.3% of the high- and 63.0% of the low-supervision group showed clinically relevant health improvements. Cost per improver was $1,814 for 23 improvers and $1,571 for 17 improvers in the high- and low-supervision groups, respectively. CONCLUSION: The SAFE exercise intervention, when delivered via high- or low-supervised conditions, represents good value with over 60% of women in both groups reporting health improvements. High-supervision levels resulted in a greater proportion of women experiencing health benefits, but future research will need to determine the longer term health impacts of these group differences.
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Neoplasias da Mama , Humanos , Feminino , Qualidade de Vida , Exercício Físico , Terapia por Exercício/métodos , Análise Custo-BenefícioRESUMO
The aim of this systematic rapid review was to explore barriers, facilitators, perceptions and preferences of physical activity for people diagnosed with cancer, by cancer type and treatment stage. The search strategy, implemented through four databases, included terms relating to cancer, physical activity, barriers, facilitators, perceptions and preferences, and relevant study designs. Studies reporting the outcomes of interests for adults diagnosed with cancer and living in Western countries were included and grouped according to the Social-Ecological Model and the Health Belief Model, and pragmatically. A total of 118 studies, involving 15 cancers were included. Outcomes were most commonly explored within samples involving mixed cancers (32 studies) and breast cancer (31 studies), and at the post-treatment phase (52 studies). Across all cancers and during- and post-treatment, treatment- and disease-related side-effects were the most commonly identified barrier, social support and guidance was the most commonly identified facilitator, and promoting health and recovery was the most commonly identified perception of benefit of physical activity. Notable differences were identified in barriers, facilitators and perceptions across cancer types and treatment stages, with specific examples including: comorbidities were inconsistently reported as a barrier across cancers; time pressure was more commonly reported as a barrier post-treatment; and women with breast cancer reported inaccessibility of appropriate services more commonly during-treatment than post-treatment. Preference findings varied widely across cancer types and treatment phases. These findings can be used to aid efforts to improve physical activity levels post-cancer by providing healthcare professionals with information to facilitate individualised advice and services.
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INTRODUCTION: High rates of disease- and treatment-related symptoms, such as bone lesions, in people with multiple myeloma (MM) create uncertainty on the safety and feasibility of exercise. This study determined the safety, feasibility, and acceptability of an individualized exercise medicine program for people with MM at any disease stage. METHODS: A multisite, randomized waitlist-controlled trial was conducted of an individualized, high-intensity aerobic, resistance, and impact-loading exercise program. The exercise sessions were supervised twice weekly by accredited exercise physiologists, with one additional unsupervised session per week, for 12 wk. Safety was determined by number of adverse and serious adverse events. Feasibility outcome measures were study eligibility, recruitment, adherence, and attrition. Acceptability was determined by qualitative interviews and subjective levels of enjoyment. RESULTS: Of 203 people with MM screened, 88% were eligible, with 34% accepting participation (60 people) and 20% attrition for the between-group analysis, meeting a priori criteria (≥25% and <25%, respectively). No adverse or serious adverse events attributed to testing and/or exercise training were reported. Attendance at supervised exercise sessions was 98%, with 45% completion of the home-based exercise sessions. Adherence rates were 35%, 63%, and 34% for the aerobic, resistance, and impact-loading protocols, with 55%, 80%, and 37% of participants meeting a priori criteria (75% of protocol). Acceptability of the exercise program was high (mean, 82%; 95% confidence interval, 78%-87%) and highly supported by qualitative responses. CONCLUSIONS: An individualized, high-intensity aerobic, resistance, and impact-loading exercise medicine program is safe and acceptable, and feasible by some measures for people with MM. Adherence to the prescribed exercise protocols was limited by comorbidities and disease symptoms. Strategies to improve unsupervised exercise completion are warranted in this population.
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Mieloma Múltiplo , Humanos , Mieloma Múltiplo/terapia , Estudos de Viabilidade , Exercício Físico , Terapia por Exercício/métodos , ComorbidadeRESUMO
PURPOSE: To determine the safety, feasibility, and potential effect of an 18-week exercise intervention for adults with primary brain cancer. MATERIALS AND METHODS: Eligible patients were 12-26-weeks post-radiotherapy for brain cancer. The individually-prescribed weekly exercise was ≥150-minutes of moderate-intensity exercise, including two resistance-training sessions. The intervention was deemed "safe" if exercise-related, serious adverse events (SAE) were experienced by <10% of participants, and feasible if recruitment, retention, and adherence rates were ≥75%, and ≥75% compliance rates were achieved in ≥75% of weeks. Patient-reported and objectively-measured outcomes were assessed at baseline, mid-intervention, end-intervention, and 6-month follow-up, using generalized estimating equations. RESULTS: Twelve participants enrolled (51 ± 19.5 years, 5 females). There were no exercise-related SAEs. The intervention was feasible (recruitment:80%, retention:92%, adherence:83%). Participants completed a median of 172.8 (min:77.5, max:560.8) minutes of physical activity per week. 17% met the compliance outcome threshold for ≥75% of the intervention. Improvements in quality of life (mean change (95% CI): 7.9 units (1.9, 13.8)), functional well-being (4.3 units (1.4, 7.2)), depression (-2.0 units (-3.8, -0.2)), activity (112.8 min (42.1, 183.4)), fitness (56.4 meters (20.4, 92.5)), balance (4.9 s (0.9, 9.0)), and lower-body strength (15.2 kg (9.3, 21.1)) were observed end-intervention. CONCLUSION: Preliminary evidence support that exercise is safe and beneficial to the quality of life and functional outcomes for people with brain cancer.Registration: ACTRN12617001577303.
The BRAin Cancer and Exercise (BRACE) study highlights the need for regular monitoring of disease- and treatment-related side effects which may present as barriers to exercise.Exercise prescription should be modified according to the presence and severity of disease- and treatment-related barriers.Adverse events observed, such as dizziness, highlight the importance of supervised exercise for people with brain cancer.If supervision is not possible, then exercise modes with low risk of harm from falls are recommended (e.g., walking, machine-based resistance training).
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The volume of high-quality evidence supporting exercise as beneficial to cancer survivors has grown exponentially; however, the potential harms of exercise remain understudied. Consequently, the trade-off between desirable and undesirable outcomes of engaging in exercise remains unclear to clinicians and people with cancer. Practical guidance on collecting and reporting harms in exercise oncology is lacking. We present a harms reporting protocol developed and refined through exercise oncology trials since 2015.Development of the Exercise Harms Reporting Method (ExHaRM) was informed by national and international guidelines for harms reporting in clinical trials involving therapeutic goods or medical devices, with adaptations to enhance applicability to exercise. The protocol has been adjusted via an iterative process of implementation and adjustment through use in multiple exercise oncology trials involving varied cancer diagnoses (types: breast, brain, gynaecological; stages at diagnosis I-IV; primary/recurrent), and heterogeneous exercise intervention characteristics (face to face/telehealth delivery; supervised/unsupervised exercise). It has also involved the development of terms (such as, adverse outcomes, which capture all undesirable physical, psychological, social and economic outcomes) that facilitate the harms assessment process in exercise.ExHaRM involves: step 1: Monitor occurrence of adverse outcomes through systematic and non-systematic surveillance; step 2: Assess and record adverse outcomes, including severity, causality, impact on intervention and type; step 3: Review of causality by harms panel (and revise as necessary); and step 4: Analyse and report frequencies, rates and clinically meaningful details of all-cause and exercise-related adverse outcomes.ExHaRM provides guidance to improve the quality of harms assessment and reporting immediately, while concurrently providing a framework for future refinement. Future directions include, but are not limited to, standardising exercise-specific nomenclature and methods of assessing causality.
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Exercício Físico , Neoplasias , Humanos , Neoplasias/terapia , MamaRESUMO
The aim of this comparative, effectiveness trial was to evaluate the safety, feasibility and effect of an exercise intervention delivered via low-level versus high-level supervision. The target population were women who were diagnosed with ≥stage II breast cancer, had ≥ one comorbidity and/or persistent treatment-related side-effects, and were insufficiently physically active. Sixty women (50 ± 9 years) were randomized to the low-supervision group (n = 30) or high-supervision group (n = 30). The low-supervision group participated in a 12-week, individually-tailored exercise intervention supported by five supervised sessions with an exercise professional. The high-supervision group participated in the same exercise intervention but received 20 supervised sessions across the 12-week period. The target weekly dosage of 600 metabolic equivalent minutes of exercise per week (MET-mins/wk) and the session content, such as safety and behaviour change topics, were standardized between the groups. The primary outcomes were intervention safety, defined as the number, type, and severity of exercise-related adverse events (e.g., musculoskeletal injury or exacerbated treatment-related side effects), and feasibility, which was defined as compliance to target exercise dosage. The effect of the intervention on quality of life, physical activity, self-efficacy, fitness, and strength was also assessed (pre- and post-intervention, and at 12-week follow-up). The intervention was safe, with no exercise-related adverse events of grade 3 or above in either group. Both groups reported high compliance to the target exercise dosage (median MET-mins/wk: High = 817; Low = 663), suggesting the exercise intervention was feasible, irrespective of supervision level. Improvements in quality of life, physical activity and fitness were observed post-intervention and maintained at follow-up for both groups (p < 0.05). Only the high-supervision group showed clinically-relevant improvements in strength and self-efficacy at post-intervention (p < 0.05). Individually-targeted exercise delivered under high- or low-levels of supervision is safe, feasible and beneficial for women with stage II+ breast cancer. Future research needs to assess whether the greater gains observed in the group who received higher supervision may contribute to longer term maintenance of physical activity levels and overall health benefits. Australian and New Zealand Clinical Trials Registry: ACTRN12616000547448.
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OBJECTIVES: The SAFE-Maintain study sought to evaluate the effect and acceptability of a physical activity counselling (PAC) session, versus a PAC session plus provision of a Fitbit (Charge HR®; PAC+F), on maintenance of physical activity levels 12 weeks following participation in a supervised exercise intervention. DESIGN: Fifty-two women with stage II+breast cancer who had recently (within the previous 7 days) completed a 12-week supervised exercise program were randomised to the PAC or PAC+F group. METHODS: Physical activity levels, including weekly minutes of total physical activity (min/week), daily step count (steps/day), and weekly minutes of moderate to vigorous physical activity (MVPA, min/week), were assessed using the Active Australia survey and Actigraph® GT3X+ accelerometers. Self-reported outcomes were assessed at baseline and 12-week follow-up, while objectively-measured outcomes were only available at 12-week follow-up. RESULTS: Compared with the PAC group, the PAC+F group had higher self-reported MVPA and self-reported total activity (between-group mean difference: 78.2 [95% CI=-8.3, 164.9] min/week, p<0.01, and 171.9 [95% CI=46.1, 297.8] min/week, p<0.01, respectively) at 12-week follow-up. Higher objectively-assessed MVPA (p=0.03) and steps/day (p=0.07) at 12-week follow-up was also observed in the PAC+F group compared with the PAC group. Most (>80%) of the PAC+F group reported high levels of Fitbit use and considered the device to be beneficial for physical activity maintenance. CONCLUSIONS: Findings suggest that activity trackers show promise as an effective, feasible and acceptable approach to support physical activity maintenance following completion of a supervised exercise intervention. TRIAL REGISTRATION: Prospectively registered on the Australian and New Zealand Clinical Trials Registry (ANZCTR, Trial registration number: ACTRN12616000954426).
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Neoplasias da Mama/terapia , Exercício Físico , Monitores de Aptidão Física , Promoção da Saúde/métodos , Actigrafia , Adulto , Austrália , Aconselhamento , Estudos de Viabilidade , Feminino , Humanos , Pessoa de Meia-Idade , AutorrelatoRESUMO
OBJECTIVE: The purpose of this commentary is to summarize the evidence of the feasibility and benefits of exercise for cancer patients with complex health profiles. Case studies are used to describe the therapeutic approach taken by exercise professionals. The information presented will assist the cancer care team in understanding their role in supporting these patients to move more. DATA SOURCES: Professional organizations, peer-reviewed manuscripts, and expert clinical opinion. CONCLUSION: Individually-tailored exercise is safe and feasible in the presence of complex health profiles, and all patients can benefit through exercise, regardless of individual circumstance or disease burden. However, to ensure patients benefit through physical activity, including exercise, a multidisciplinary approach, whereby all members of the health care team promote and encourage physical activity is needed. IMPLICATIONS FOR NURSING PRACTICE: There is a clear need for collaboration between the oncology team and exercise professionals, particularly when dealing with patients with complex health profiles. These patients are more likely to engage in exercise when they are advised and supported by their oncology team to do so. As such, promotion of physical activity and, when relevant, referral to an exercise professional is the responsibility of all members of the cancer team.
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Terapia por Exercício/métodos , Oncologia/organização & administração , Neoplasias/terapia , Idoso , Terapia Combinada , Terapia por Exercício/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente/organização & administração , Guias de Prática Clínica como Assunto , Qualidade de VidaRESUMO
Studies show conflicting results on whether exercise interventions to improve outcomes for women with breast cancer are cost-effective. We modelled the long-term cost-effectiveness of the Exercise for Health intervention compared with usual care. A lifetime Markov cohort model for women with early breast cancer was constructed taking a societal perspective. Data were obtained from trial, epidemiological, quality of life, and healthcare cost reports. Outcomes were calculated from 5000 Monte Carlo simulations, and one-way and probabilistic sensitivity analyses. Over the cohort's remaining life, the incremental cost for the exercise versus usual care groups were $7409 and quality-adjusted life years (QALYs) gained were 0.35 resulting in an incremental cost per QALY ratio of AU$21,247 (95% Uncertainty Interval (UI): Dominant, AU$31,398). The likelihood that the exercise intervention was cost-effective at acceptable levels was 93.0%. The incremental cost per life year gained was AU$8894 (95% UI Dominant, AU$11,769) with a 99.4% probability of being cost effective. Findings were most sensitive to the probability of recurrence in the exercise and usual care groups, followed by the costs of out-of-pocket expenses and the model starting age. This exercise intervention for women after early-stage breast cancer is cost-effective and would be a sound investment of healthcare resources.
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Neoplasias da Mama , Análise Custo-Benefício , Terapia por Exercício , Neoplasias da Mama/terapia , Terapia por Exercício/economia , Terapia por Exercício/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Cadeias de Markov , Recidiva Local de Neoplasia , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de VidaRESUMO
OBJECTIVES: This report describes why there is a need for cancer-specific physical activity and exercise prescription guidelines, how the recommendations in the guidelines were derived, and how these guidelines can be used and by whom, to reduce cancer-related burden. DATA SOURCE: Professional organizations and peer-reviewed papers. RESULTS: Higher physical activity levels post-cancer diagnosis has been consistently associated with improved morbidity and/or survival outcomes for all cancers studied to date. As such, although physical activity recommendations for those post-cancer are largely generic and tend to replicate physical activity guidelines endorsed for healthy adults, the cancer-specific epidemiological evidence-base suggest this to be appropriate. These guidelines should be endorsed and promoted by all members of the cancer care team, across all phases of cancer survivorship. Cancer-specific exercise prescription guidelines are supported by a clinical trial evidence-base and enable targeted exercise prescription for the benefit of the individual patient. Any member of the cancer care team can refer patients at any time to exercise professionals, who will use these exercise guidelines to direct their provision of exercise as medicine. CONCLUSION: The prevention of physical activity declines and small increases in physical activity levels during and following cancer treatment is appropriate for the majority. Further, physical activity promotion, alongside incorporation of planned, purposeful, targeted and individualized exercise, has significant potential for reducing morbidity and mortality of cancer worldwide. IMPLICATIONS FOR NURSING PRACTICE: Nurses are well-placed to regularly encourage patients to participate in physical activity, and to refer patients to exercise professionals, during and following their cancer treatment.
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Terapia por Exercício/métodos , Neoplasias/terapia , Sobrevivência , Exercício Físico , Humanos , Guias de Prática Clínica como AssuntoRESUMO
OBJECTIVES: Since Exercise and Sports Science Australia (ESSA) first published its position statement on exercise guidelines for people with cancer, there has been exponential growth in research evaluating the role of exercise pre-, during and post-cancer treatment. DESIGN AND METHODS: The purpose of this report is to use the current scientific evidence, alongside clinical experience and exercise science principles to update ESSA's position statement on cancer-specific exercise prescription. RESULTS: Reported in this position statement is a summary of the benefits accrued through exercise following a cancer diagnosis and the strengths and limitations of this evidence-base. An exercise prescription framework is then proposed to enable the application of cancer-specific considerations for individualisation, specificity, safety, feasibility and progression of exercise for all patients. Additional specific exercise prescription considerations are provided for the presence of haematological, musculoskeletal, systemic, cardiovascular, lymphatic, gastrointestinal, genitourinary and neurological disease- and treatment-related concerns, as well as presence of co-morbid chronic disease. Further, we also identify and discuss cancer-specific pragmatic issues and barriers requiring consideration for exercise prescription. CONCLUSIONS: While for the majority, multimodal, moderate to high intensity exercise will be appropriate, there is no set prescription and total weekly dosage that would be considered evidence-based for all cancer patients. Targeted exercise prescription, which includes the provision of behaviour change advice and support, is needed to ensure greatest benefit (as defined by the patient) in the short and longer term, with low risk of harm.
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Terapia por Exercício , Neoplasias/terapia , Austrália , Doença Crônica , Comorbidade , Humanos , Guias de Prática Clínica como Assunto , Sociedades CientíficasRESUMO
Resumen Desde la primera publicación de la declaración de consenso sobre pautas de ejercicio para personas con cáncer, de la asociación Ejercicio y Ciencias del Deporte - Australia (ESSA, Exercise and Sports Science Australia), ha ocurrido un crecimiento exponencial en las investigaciones que evalúan el papel del ejercicio antes, durante y después del tratamiento del cáncer. El propósito de este reporte es utilizar la evidencia científica actual, junto a la experiencia clínica y los principios de las ciencias del ejercicio, para poner al día la declaración de consenso de ESSA sobre la prescripción de ejercicio específica para el cáncer. En esta declaración de consenso se reporta un resumen de los beneficios alcanzados mediante el ejercicio luego de un diagnóstico de cáncer, así como las fortalezas y limitaciones de la evidencia acumulada. Se propone, entonces, un marco de prescripción del ejercicio para permitir la aplicación de consideraciones específicas para el cáncer en la individualización, especificidad, seguridad, factibilidad y progresión del ejercicio para toda clase de pacientes. Se ofrecen consideraciones adicionales específicas para la prescripción del ejercicio cuando hay presencia de enfermedades hematológicas, osteomusculares, sistémicas, cardiovasculares, linfáticas, gastrointestinales, genitourinarias y neurológicas y preocupaciones relacionadas con su tratamiento, así como la presencia crónica de comorbilidades. Además, se identifican y comentan temas prácticos específicos y barreras que deben tomarse en cuenta para la prescripción del ejercicio. Si bien es cierto que el ejercicio multimodal de intensidad moderada a intensa será apropiado para la mayoría, no hay una prescripción establecida ni una dosificación semanal, que se puedan considerar basadas en la evidencia, para todos los pacientes de cáncer. Es necesaria una prescripción del ejercicio dirigida específicamente a esta población, que asegure el mayor beneficio (conforme lo defina cada paciente) a corto y largo plazo, con un bajo riesgo de perjuicio.
Abstract Objectives: Since Exercise and Sports Science Australia (ESSA) first published its position statement on exercise guidelines for people with cancer, there has been exponential growth in research evaluating the role of exercise pre-, during and post-cancer treatment. Design and Methods: The purpose of this report is to use the current scientific evidence, alongside clinical experience and exercise science principles to update ESSA's position statement on cancer-specific exercise prescription. Results: Reported in this position statement is a summary of the benefits accrued through exercise following a cancer diagnosis and the strengths and limitations of this evidence-base. An exercise prescription framework is then proposed to enable the application of cancer-specific considerations for individualisation, specificity, safety, feasibility and progression of exercise for all patients. Additional specific exercise prescription considerations are provided for the presence of haematological, musculoskeletal, systemic, cardiovascular, lymphatic, gastrointestinal, genitourinary and neurological disease- and treatment-related concerns, as well as presence of co-morbid chronic disease. Further, we also identify and discuss cancer-specific pragmatic issues and barriers requiring consideration for exercise prescription. Conclusions: While for the majority, multimodal, moderate to high intensity exercise will be appropriate, there is no set prescription and total weekly dosage that would be considered evidence-based for all cancer patients. Targeted exercise prescription, which includes the provision of behaviour change advice and support, is needed to ensure greatest benefit (as defined by the patient) in the short and longer term, with low risk of harm.
Resumo Desde a primeira publicação da declaração de consenso da Organização de Ciências do Exercício e do Esporte - Austrália ((ESSA, Exercise and Sports Science Australia) sobre diretrizes de exercícios para pessoas com câncer, tem ocorrido um crescimento exponencial nas pesquisas que avaliam o papel dos exercícios antes, durante e depois do tratamento do câncer. O objetivo deste relatório é usar as evidências científicas atuais com a experiência clínica e os princípios da ciência do exercício, para atualizar a declaração de consenso da ESSA sobre a prescrição de exercícios específica para o câncer. Esta declaração de consenso relata um resumo dos benefícios obtidos por meio de exercícios após o diagnóstico de câncer, bem como os pontos fortes e as limitações da evidência acumulada. Assim, propõe-se uma estrutura de prescrição de exercícios para permitir a aplicação de considerações específicas para o câncer na individualização, especificidade, segurança, viabilidade e progressão do exercício para todas as classes de pacientes. Considerações adicionais específicas para a prescrição de exercícios são fornecidas quando há doenças hematológicas, osteomusculares, sistêmicas, cardiovasculares, linfáticas, gastrointestinais, geniturinárias, neurológicas e preocupações relacionadas ao seu tratamento, bem como a presença crônica de comorbidades. Além disso, questões práticas específicas e barreiras à prescrição de exercícios são identificadas e discutidas. Embora seja verdade que o exercício multimodal de intensidade moderada a vigorosa seja apropriado para a maioria, não há uma prescrição definida ou dosagem semanal que possa ser considerada baseada em evidências para todos os pacientes com câncer. Há uma necessidade de prescrição de exercícios especificamente direcionada a essa população, garantindo o maior benefício (conforme definido pelo paciente individual) em curto e longo prazos, com baixo risco de danos.
Assuntos
Humanos , Exercício Físico , Terapia por Exercício , Neoplasias/terapiaRESUMO
BACKGROUND: Colorectal cancer (CRC) diagnosis and the ensuing treatments can have a substantial impact on the physical and psychological health of survivors. As the number of CRC survivors increases, so too does the need to develop viable rehabilitation programs to help these survivors return to good health as quickly as possible. Exercise has the potential to address many of the adverse effects of CRC treatment; however, to date, the role of exercise in the rehabilitation of cancer patients immediately after the completion of treatment has received limited research attention. This paper presents the design of a randomised controlled trial which will evaluate the feasibility and efficacy of a 12-week supervised aerobic exercise program (ImPACT Program) on the physiological and psychological markers of rehabilitation, in addition to biomarkers of standard haematological outcomes and the IGF axis. METHODS/DESIGN: Forty CRC patients will be recruited through oncology clinics and randomised to an exercise group or a usual care control group. Baseline assessment will take place within 4 weeks of the patient completing adjuvant chemotherapy treatment. The exercise program for patients in the intervention group will commence a week after the baseline assessment. The program consists of three supervised moderate-intensity aerobic exercise sessions per week for 12 weeks. All participants will have assessments at baseline (0 wks), mid-intervention (6 wks), post-intervention (12 wks) and at a 6-week follow-up (18 wks). Outcome measures include cardio-respiratory fitness, biomarkers associated with health and survival, and indices of fatigue and quality of life. Process measures are participants' acceptability of, adherence to, and compliance with the exercise program, in addition to the safety of the program. DISCUSSION: The results of this study will provide valuable insight into the role of supervised exercise in improving life after CRC. Additionally, process analyses will inform the feasibility of implementing the program in a population of CRC patients immediately after completing chemotherapy. TRIAL REGISTRATION: ACTRN012606000395538.
Assuntos
Neoplasias Colorretais/reabilitação , Terapia por Exercício , Exercício Físico/fisiologia , Sobreviventes , Adolescente , Adulto , Idoso , Antineoplásicos/uso terapêutico , Neoplasias Colorretais/tratamento farmacológico , Exercício Físico/psicologia , Feminino , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Motivação , Avaliação de Resultados em Cuidados de Saúde , Qualidade de VidaAssuntos
Exercício Físico , Neoplasias , Terapia por Exercício , Estudos de Viabilidade , Humanos , Neoplasias/terapiaRESUMO
INTRODUCTION: Cancer is increasingly being viewed as a chronic illness requiring long-term management, and there is a growing need for evidence-based rehabilitation interventions for cancer survivors. Previous reviews have evaluated the benefits of exercise interventions for patients undergoing cancer treatment and long-term survivors, but none have investigated the role of exercise during cancer rehabilitation, the period immediately following cancer treatment completion. This systematic review summarises the literature on the health effects of exercise during cancer rehabilitation and evaluates the methodological rigour of studies in this area to date. METHODS: Relevant studies were identified through a systematic search of PubMed and Embase to April 2009. Data on study design, recruitment strategy, participants, exercise intervention, adherence rates, and outcomes were extracted. Methodological rigour was assessed using a structured rating system. RESULTS: Ten studies were included. Breast cancer patients were the predominate patient group represented. Most interventions were aerobic or resistance-training exercise programmes, and exercise type, frequency, duration and intensity varied across studies. Improvements in physical functioning, strength, physical activity levels, quality of life, fatigue, immune function, haemoglobin concentrations, potential markers of recurrence, and body composition were reported. However, all studies were limited by incomplete reporting and methodological limitations. CONCLUSIONS: Although the methodological limitations of studies in this new field must be acknowledged, initial evidence indicates that exercise is feasible and may provide physiological and psychological benefits for cancer survivors during the rehabilitation period. Future studies with rigorous study designs are now required to advance the field.