can be increased, but initially duration should be considered. The general recommendation is to increase the duration of the exercise by 5 to 10 minutes per week. After progressing the duration, frequency is the next component to increase. Intensity is the last component that should be increased to be progressed. Any progression should be gradual, and possible setbacks should be anticipated. Patients may have many motivations for participating in an exercise program during cancer treatment. It can help them feel “normal,” help them to cope with the treatment, give them control over their life, reduce stress, help them feel better, improve immune function, and improve their energy level. However, barriers such as fatigue, nausea, vomiting, lack of time, pain, medical procedures, chemotherapy sessions, diarrhea, and visitors may prevent patients from participating in exercise programs during treatment. Similar motivations and barriers exist in the survivorship phase. The motives include recovering from the treatment, reduced risk of recurrence, improved strength, improved fitness level, reduced stress, improved weight control, and feeling better. Barriers include lack to time, fatigue, deconditioning, poor health, poor weather, lack of motivation, joint pain, lack of equipment, or recurrence of cancer. The structure of the exercise program should contain the following components: Warm-up for 5 to 10 minutes, stretching for 5 to 10 minutes, conditioning (variable time), and a cool down for 5 to 10 minutes. Recommendations for physical activity and exercise for cancer survivors are 30 to 60 minutes per day of moderate to vigorous activity at least 5 days per week (American College of Sports Medicine, 2019). Table 7: CDC Recommendations – Greater Health Benefits Intensity Aerobic Strengthening Moderate 300 min/week. ≥ 2 days/week large muscle groups. Vigorous 150 min/week. ≥ 2 days/week large muscle groups. Combination (aerobic + strengthening) 100 mod & 100 vigorous. 150 mod & 75 vigorous. ≥ 2 days/week large muscle groups. The CDC recommends weight training, working with resistance bands, and body weight exercises for strength training (i.e., pushups, pullups, sit-ups). Some daily activities may also qualify as strengthening exercises such as heavy gardening and digging with a shovel. They advise strengthening of the large muscle groups of the legs, hips, back, chest, abdomen, shoulders, and arms.
Table 5: American College of Sports Medicine Intensity Comparison Intensity % VO 2 Peak % HRmax RPE Very light < 20 < 35 < 10 Light 20-39 35-54 10-11 Moderate 40-59 55-69 12-13 Hard 60-84 70-89 14-16 Very hard ≥85 ≥90 17-19 Maximal 100 100 20 Time, or duration, is the total amount of time spent exercising or the total caloric expenditure. Shorter exercise periods require a larger number of sessions, or increased frequency. When progressing the program, time should be increased before frequency. Type, or mode, is the type of exercise that is performed. This may depend on what equipment or facilities are available. Patient preference is another consideration, since they are more likely to be compliant with the program if they enjoy the activity. Exercise safety is also an important consideration when choosing the mode. The types of exercises could include aerobic, strength training, stretching, and core stabilization activities. One of the key benefits of using the FITT model is using the metrics of frequency, intensity, time, and type to determine progression of the program. Frequency, intensity, and time
The Centers for Disease Control and Prevention recommendations The Centers for Disease Control and Prevention (CDC) defines moderate-intensity exercise as sufficient to raise the heart rate and allow someone to talk, but not sing, while performing the activity (Centers for Disease Control & Prevention, 2020). Walking fast, water aerobics, pushing a lawn mower, and riding a bike are acceptable exercises for this purpose. The CDC describes vigorous exercise as breathing hard and fast with a marked increase in heart rate. The patient should not be able to speak more than a few words without breathing. Jogging, running, playing singles tennis, playing basketball, and riding a bike fast would qualify as vigorous exercises. Tables 6 and 7 below detail the CDC’s recommendations on
various levels of exertion to receive health benefits. Table 6: CDC Recommendations – Health Benefits Intensity Aerobic Strengthening Moderate 150 min/week. 2 days/week large muscle groups. Vigorous 75 min/week. 2 days/week large muscle groups. Combination (aerobic + strengthening) 50 mod & 50 vigorous. 90 mod & 30 vigorous. 2 days/week large muscle groups.
The American College of Sports Medicine recommendations The American College of Sports Medicine (ACSM) offers its own recommendations similar to the CDC, outlined in Tables 8 and 9 below. The ACSM states that light to moderate exercise may be beneficial for deconditioned patients. They recommend a daily step count of at least 7,000 steps at a moderate intensity and expending more than 2,000 kcal per week (American College of Sports Medicine, 2019). Exercise volume below these levels may still be beneficial if a patient is unwilling or unable to achieve the recommended exercise volume. The ACSM recommends a gradual progression
of exercise volume by increasing duration, frequency, and/or intensity until the goals are reached. The ACSM recommends that cancer survivors avoid inactivity and return to normal daily activities as soon as possible after surgery (American College of Sports Medicine, 2020). They should be evaluated for peripheral neuropathies and musculoskeletal dysfunctions that could result from cancer treatment. Patients should continue with their normal daily activities and exercise as often as possible. If there is known metastatic bone cancer, exercise should be modified to avoid fractures. The presence of cardiac conditions may also require
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