Safety, feasibility, and effectiveness of implementing supervised exercise into the clinical care of individuals with advanced cancer

Abstract

Objective To evaluate the safety, feasibility, and preliminary effectiveness of implementing supervised exercise programming into the clinical care of individuals with advanced cancer. Design Single group implementation feasibility study using a pre–posttest design. Setting Exercise Oncology Unit of the Spanish Cancer Association (a cancer-specific community facility outside the hospital setting). Participants Adult individuals with advanced cancer profile involving advanced local cancer or distant metastases. Intervention A 12-week, twice-weekly, supervised, clinic-based multi-component exercise program. Main Measure Paired t-tests were used to assess pre–post changes and analyses of covariance were used to compare effects based on selected participant characteristics. Results Eighty-four individuals with advanced cancer completed the baseline assessment, with six participants withdrawing prior to the start of the program. Of the 78 participants, 17 dropped out, thus, a total of 61 completed the final assessment. Mean adherence was 82.5%. No serious adverse events occurred. Exercise significantly improved VO2max by 5.2 mL·kg·min ( p < 0.001), chest strength ( p < 0.001), leg strength ( p < 0.001), lean body mass ( p = 0.003), skeletal muscle mass ( p < 0.002), % body fat ( p = 0.02), quality of life by 5.3 points ( p = 0.009), fatigue by 3.2 points ( p = 0.012), and physical activity by 1680 METs/week ( p < 0.001). Conclusions Our clinically supervised and tailored exercise program involving moderate to vigorous intensity exercise was found to be feasible, safe, and effective for individuals with advanced cancer. Implications for Cancer Survivors With proper screening and supervision, individuals with advanced cancer can benefit from tailored exercise oncology support as part of an overall therapeutic care plan.

Dropout from exercise trials among cancer survivors—An individual patient data meta‐analysis from the POLARIS study

“…Other roles and responsibilities and lack of time have previously been reported by cancer survivors as barriers to physical activity participation 34 . In contrast to our findings, lower BMI has previously been associated with more dropout from exercise programs performed during cancer treatment 37 . However, it is likely that this association was related to the frailty of the participants, more advanced cancer, and possibly cancer cachexia 37 …”

“…34 In contrast to our findings, lower BMI has previously been associated with more dropout from exercise programs performed during cancer treatment. 37 However, it is likely that this association was related to the frailty of the participants, more advanced cancer, and possibly cancer cachexia. 37 It is concerning that the reporting of adverse events in exercise oncology trials is poor and possibly subject to publication bias.…”

“…37 However, it is likely that this association was related to the frailty of the participants, more advanced cancer, and possibly cancer cachexia. 37 It is concerning that the reporting of adverse events in exercise oncology trials is poor and possibly subject to publication bias. 8 Adverse events caused by the exercise may impact study dropout and should be reported to inform future interventions and the need for tailored programs.…”

A Feasibility Study Investigating an Exercise Program in Metastatic Cancer Based on the Patient-Preferred Delivery Mode

“…Compared to our study, a prior investigation found a positive impact of exercise on strength. 14 Specifically, a 12-week intervention combining aerobic and strength training was able to significantly improve upper and lower limb strength, both, in patients with advanced cancer. A possible explanation could be related to the strength protocol; whereas such a study used strength training based on isotonic machines, we have preferred to deliver a program based on exercises performed using body weight or elastic bands.…”

“…Nevertheless, most available evidence derives from early-stage settings, whereas minor attention has been dedicated to the metastatic context. Few investigations have been conducted on patients affected by a metastatic disease 6-14 ; most of them tested combined aerobic and resistance training delivered through a supervision-based approach 7 , 8 , 10 , 12 , 14 or with a home-based program, 6 , 9 , 11 whereas just one explored the impact of aerobic training. 13 Preliminary evidence deriving from these researches reported mixed findings regarding benefits in physical fitness and quality of life, which are the most studied outcomes.…”