Kendra Zadravec, MSc, PhD candidate / MPT student
Rehabilitation Sciences Graduate Program, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
The KT committee is introducing a new format for Knowledge Translation articles with an emphasis on how current research may impact practitioners. This month’s article is written by Kendra Zadravec (MSc, PhD Candidate, MPT Student).
- Exercise can help people living with advanced cancer improve quality of life and physical function, as well as reduce some negative effects of cancer therapy (e.g., fatigue).
- When working with people living with advanced cancer, exercise professionals should collaborate and communicate with the individual and their healthcare team to prescribe and monitor exercise.
- Previous standards of care for people living with advanced cancer involved minimizing exercise because of potential risk of bone health issues (e.g., fracture) due to bone metastases.
- Although this risk is important, it should be considered along with the potential benefits of exercise on physical function, quality of life, and cancer therapy side effects. The benefits of exercise for people living with advanced cancer may outweigh the risk of bone health issues.
- The International Bone Metastases Exercise Working Group (IBMEWG) was formed to develop best practice recommendations based on current research, clinical experience, and expert opinion. The IBMEWG involved an international team of physicians, physiotherapists, clinical exercise physiologists, and researchers.
How the study was done
This research involved five steps:
- Surveyed physicians and nurse practitioners about their current attitudes and beliefs about exercise for people living with advanced cancer.
- A systematic review of current research about the safety, feasibility, and benefit of exercise for people living with advanced cancer.
- Surveyed physiotherapists, clinical exercise physiologists, physicians, and researchers, using what is called a Delphi process, that aimed to find a consensus about key considerations when prescribing and monitoring an exercise program for people living with advanced cancer.
- In-person meeting of the IBMEWG to discuss findings from steps 1 to 3 and develop recommendations.
- Stakeholder engagement with patients and clinicians to finalize recommendations.
What the researchers found
The IBMEWG suggested FIVE recommendations to help people living with advanced cancer exercise safely:
- Before beginning exercise, assess the risk of potential bone health issues from exercise (e.g., fracture).
- Consult and communicate with the individual’s healthcare team when conducting the initial assessment and throughout exercise training.
- Refer to physiotherapists and/or exercise physiologists (i.e., CSEP-CEP) with cancer-specific training/experience.
- Limit and/or modify any necessary exercise testing.
- Follow the International Exercise Guidelines for Cancer Survivors (November 2019), with a focus on controlled movement, appropriate postural alignment, and proper technique. For all movements, consider the location of bone metastases.
- Exercise can improve physical function and quality of life among people living with advanced cancer, as well as reduce some negative effects of cancer therapy. The potential benefits may outweigh the potential risk of bone health issues related to exercise.
- When prescribing and monitoring exercise for people living with advanced cancer, exercise professionals should maintain ongoing collaboration and communication with the individual and their healthcare team.
- These recommendations are an initial framework for healthcare and exercise professionals to prescribe and monitor exercise for people living with advanced cancer and will likely change as more research becomes available.
Campbell KL, Cormie P, Weller S, Alibhai SMH, Bolam KA, Campbell A, Cheville AL, Dalzell MA, Hart NH, Higano CS, Lane K, Mansfield S, McNeely ML, Newton RU, Quist M, Rauw J, Rosenberger F, Santa Mina D, Schmitz KH, Winters-Stone KM, Wiskemann J, Goulart J. Exercise Recommendation for People With Bone Metastases: Expert Consensus for Health Care Providers and Exercise Professionals. JCO Oncol Pract. doi: 10.1200/OP.21.00454.
This article is a summary of an article published in Applied Physiology, Nutrition & Metabolism. If you intend to cite any information in this article, please consult the original article and cite that source. This summary was written for the Canadian Society for Exercise Physiology and it has been reviewed by the CSEP Knowledge Translation Committee.