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Pre‐procedural considerations

Equipment

Ensure people are aware that they will need to be suitably dressed in loose comfortable clothes, such as jogging pants, and good supportive footwear, particularly lace‐up shoes, when carrying out physical activity.

Assessment and recording tools

There are a variety of ways to provide a baseline assessment of physical activity levels including exercise diaries such as that provided by Macmillan Cancer Support ([163]), self‐report or a more validated tool such as the Godin‐Shephard Leisure‐Time Physical Activity Questionnaire (Godin [113]). The decision on what assessment tool to use will depend on the individual patient's situation.

Pharmacological support

Be aware if patient is on any medication that may restrict or preclude exercise.

Procedure guideline 27.20

Supporting physical activity

Table 27.20 Prevention and resolution (Procedure guideline 27.20)

Problem	Cause	Prevention	Action
Lack of motivation.	During treatment: side‐effects of treatment low mood uncertainty about how to be physically active. Long‐term consequences of treatment: long‐term side‐effects low mood unsure about how to be physically active.	Ensure timing of giving information – where possible link to teachable moment.	Consider attending behavioural change training such as motivational interviewing.
Lymphoedema or at risk of lymphoedema.	Removal of lymph nodes leads to risk of lymphoedema.	Inform regarding the benefits of exercise to assist the lymphatic system.	Give advice on slow progression of exercises. Advise to avoid repetitive or sustained exercises.
Bone metastases.	Patient at increased risk of fracture.	Advise to avoid heavy impact exercises.	Refer to specialist services such as physiotherapy.
Concurrent or pre‐existing co‐morbidities, e.g. heart disease.	Precaution/contraindications to exercise		Liaise/refer to relevant medical team.
Identification of new symptoms, e.g. dizziness or red flags.	Physiological changes as a result of increased energy expenditure.	Screen for any physiological changes or red flags through questioning.	Refer for urgent medical review.
Exacerbation of existing symptoms such as pain or fatigue.	Exercising at too intensive a level. Incorrect form of exercise.	Reduce level of intensity. Modify exercise type.	If an ongoing problem, contact medical team for review.
Risk of falls.	Poor balance, exercise too difficult.	Screen for balance problems through questioning. Encourage supportive footwear. Consider advice to be given on types of exercises.	Request medical review. Consider referral to local community falls team.
Lack of resources for onward referral.	No national standard care of exercise provision/resources.		Online resources such as Macmillan Cancer Support or specific cancer charities, e.g. PCUK/Breast Cancer Care.