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Evidence‐based approaches

  • The Department of Health (DH) has set guidelines of 30 minutes of moderate physical activity five times a week for adults aged 19–64 as well as specific strengthening exercises twice a week. The total of 150 minutes of exercise in a week can also be broken down into 10‐minute episodes of exercise (DH [78]). Although this is not cancer specific, it is what people should be working towards following their primary cancer treatment (Campbell et al. [35]).
  • The American College of Sports Medicine (Schmitz et al. [249]) also looked at the evidence regarding physical activity for people with cancer and concluded that overall the benefits to quality of life outweighed any potential disadvantages. After taking into consideration any precautions regarding exercise, they recommended following the Guidelines on Physical Activity for Americans (U.S. Department of Health and Human Services [276]) which are consistent with the recommendations given by the Department of Health.
  • The World Health Organization (WHO 2010) Global Recommendations on Physical Activity for Health also set out guidance in line with the Department of Health advice. Again this is not cancer specific.

Rationale

Physical activity can assist physiological changes by increasing muscle bulk and strength and also increasing joint mobility through stretches. It is also important to increase cardiovascular fitness at all stages to help overcome some of the related side‐effects such as cancer fatigue. Physical activity has been proven to help with these physiological changes and also to improve mood. Research has highlighted numerous positive effects for the inclusion of physical activity interventions following any cancer diagnosis including minimizing biological processes associated with tumour growth (Betof et al. [14]). It also helps to improve psychosocial factors during and after cancer.

Indications

Physical activity is relevant to all people with cancer at any stage of their disease or treatment. Tailoring physical activity advice and intervention to the individual ensures that it is meaningful to them (Bourke et al. [25]). There is also evidence to support that making a healthy lifestyle change is often triggered at the time of cancer diagnosis (Saxton and Daley [247]). This is referred to as the teachable moment and relates to the time when people with cancer are more receptive to making beneficial lifestyle changes (Demark‐Wahnefried et al. [69]). Nurses are in an ideal position to help support and advise people with cancer to be more active both during and after treatment (Hall‐Alston [121]). People at risk of osteoporosis due to cancer treatment may benefit from moderate intensity aerobic exercises, including some weight‐bearing exercises, to assist bone health (Winters‐Stone et al. [289]).

Contraindications

At any stage:
  • if the person feels unwell with, for example, dizziness/breathlessness
  • red flags – unexplained weight loss or pain, night pain, constant pain, suspected metastatic spinal cord compression (MSCC; see Chapter c26), new unexplained symptoms and signs of cauda equina syndrome (a neurological condition in which there is damage to the cauda equina).
Pre‐treatment:
  • any co‐morbidity, such as arthritis, that may restrict patients from participating in all types of exercise.
During treatment:
  • on the day of chemotherapy
  • excessive diarrhoea or vomiting
  • haematology – check with the medical team
  • low white blood cell count
  • low haemoglobin – if the patient is anaemic
  • insufficient nutritional intake.
After treatment:
  • If the patient has osteoporosis or bone metastases they need to avoid exercises such as heavy weights that will put excessive stress on the bones.
People with cancer should check with their medical team before commencing any new physical activity or exercise initiatives.
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