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PRIORITY ISSUES.
EXERCISE PRESCRIPTION.

Guided programs

Figure 1.

Exercise Medicine

Screenings and Guidlines 

Screening tools and guidelines, such as the ESSA Adult Pre-Exercise Screening tool, Physical Activity Readiness Questionnaire, or the American College of Sports Medicine (ACSM) guidelines for exercise testing and prescription are useful for developing an initial health and risk profile for an individual. However, these tools are not designed to collect the necessary additional information required to enable safe and feasible exercise prescription for cancer patients. Instead, information needs to be collected on all issues specified in point 1 above, most of which can be sourced directly from the patient. However, patient-derived information, particularly with respect to risk of developing acute, persistent or late treatment-related side effects, needs to be supplemented with information derived from reputable sources. The Australian Government online resource of cancer treatment protocols (https://www.eviq.org.au) may be useful in this regard. This information (point 1 above) could be supplemented with questionnaires typically used in cancer research and clinical management to measure and track changes in patient-reported outcomes including quality of life (e.g., Functional Assessment of Cancer Therapy (FACT) – General, Patient-reported Outcomes Measurement Information System (PROMIS)), treatment-related side effects (e.g., PROMIS, FACT-Breast) and exercise self-efficacy. The initial assessment could also include a battery of physical/functional tests including assessments (or surrogate measures) of cardiorespiratory fitness, function, strength, balance, body composition and bone health.

Citation:

Hayes SC, Newton RU, Spence RR, Galvão DA. The Exercise and Sports Science Australia position statement: Exercise medicine in cancer management. J Sci Med Sport. 2019 Nov;22(11):1175-1199. doi: 10.1016/j.jsams.2019.05.003. Epub 2019 May 10. PMID: 31277921.

Recommended process for targeted, exercise prescription for cancer patients

 Fig. 1, represents a recommended process that can guide individualised, evidence-based assessment, exercise prescription and follow-up to cancer patients (defined from herein as a person who has been diagnosed with cancer). It incorporates cancer-specific considerations to all aspects of patient care, including assessment and initial exercise prescription, as well as exercise principles of progressive overload, periodisation and autoregulation. Further, it incorporates the use of behaviour change strategies, education and monitoring, to ensure a patient-centred approach to the provision of care (specificity), while enabling patients to develop the necessary skills to ensure exercise can benefit their health in the longer term. The process is as follows:

  • 1) Patient assessment, including patient and family health history (presence of comorbidities/additional chronic disease and related treatment); cancer diagnosis (previous and current); cancer treatment (previous, current and planned); risk, presence and severity of treatment-related toxicities (acute, persistent and late side effects); and physical activity and exercise history.

 

  • 2) Determine health issues and prioritise contribution of these to risk of morbidity and/or mortality. Exercise prescription following cancer diagnosis typically seeks to influence any one or more of a range of outcomes, including but not limited to prevention or management of disease- and treatment-related toxicities. The exercise prescription must be focussed on ameliorating issues with greatest impact on health and survival.

 

  • 3) Identify patient capacity and intervention suitability determined by considering economic, psychosocial and physiological constraints (including contraindications), accessibility, preferences, self-efficacy, barriers and facilitators to exercise, and potential benefit.

 

  • 4) Prescribe exercise according to patient-driven exercise-related goals.

 

  • 5) Reassessment and prescription modification by following points 1–4.
Resistance Band

RESISTANCE TRAINING

Resistance training reduces disability in PCS on ADT and has become a highly recommended part of your treatment plan.

Impact Training_Jump

IMPACT TRAINING

Impact training is an important component to the program as it has proven to increase the effectiveness of resistance training alone in increasing BMD.

Aerobic Exercise

Every journey starts with a single step. Depending on your prescription, aerobic exercise needs to be implemented in a strategic way into your program.

Train

The Workout

OVERVIEW

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JUSTIN FASSIO

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Personal Trainer & Physical Therapist

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