Cancer Exercise Programs: Personalized Plans for Your Diagnosis & Treatment

•Reducing cancer-related fatigue (the #1 non-pharmacologic intervention)

•Improving sleep quality

•Reducing anxiety and depression

•Positively affecting body composition

•Enhancing physical function

•Improving bone health

•Managing breast cancer-related lymphedema (a chronic condition caused by a blockage in the lymphatic system, leading to a buildup of lymph fluid and swelling) What is the scientific data evaluating the link between exercise and disease outcomes in patients with cancer, including potential benefits?

•Over 3,000 randomized controlled trials in PubMed validate these benefits.

•Organizations like the American Society of Clinical Oncology (ASCO), The American College of Sports Medicine (ACSM), and the American Cancer Society (ACS) recommend exercise during active cancer treatment.

•There has been an exponential increase in randomized controlled trials since the 1980s, showing exercise's positive effects.

•Ongoing clinical trials include " THRIVE-65," which explores the impact of exercise on chemotherapy completion in older breast cancer patients.

•The CHALLENGE trial demonstrated a significant improvement in disease-free and overall survival for Stage 2 and 3 colon cancer patients who engaged in exercise after treatment.

•The Moving Through Cancer Task Force's goal is to make exercise a standard of care in oncology by 2029. While exercise is beneficial for cancer patients, only 15% report being referred to exercise programs by their oncologists.

•Brisk walking is associated with improved physical quality of life in women with ovarian cancer (Women's Activity and Lifestyle Study in Connecticut (WALC) ). What is the general advice on exercise for cancer patients?

•Sit less and move more; any movement is beneficial - even small amounts of activity can help, even moving while sitting – the goal is to avoid being completely sedentary and to gradually increase activity as tolerated. The biggest benefit comes from going from doing nothing to doing something, so even small steps are valuable.

•Tailor exercise to your individual capabilities, including your condition, treatment stage, energy level, and health goals

•Aim for up to 90 minutes per week of moderate-intensity aerobic exercise during treatment

•Do resistance training twice weekly

•For general wellness and reducing recurrence, increase to 115 minutes of aerobic exercise weekly

•Complement exercise with adequate protein intake How can you personalize your exercise based on currently available scientific evidence?

•Triage: Use validated tools (like EXCEEDS) to assess your individual needs, considering factors like age, comorbidities, and current physical condition

•Goal-setting: Tailor your exercise program to your specific goals, such as managing fatigue, maintaining muscle mass, and improving overall wellness

•Progression: Start with small amounts of movement (even seated exercises), gradually increase intensity and duration

•Professional advice : Consult with an exercise professional who can create a personalized program based on your specific health condition and goals What are some specific recommendations to optimize your exercise?

•If you are experiencing muscle loss, e.g., from hormone deprivation therapy, consider intensive resistance (weight) training 2-3 times per week with progressive weight increases with adequate protein intake (1.2 grams per kilogram of body weight daily).

•If you are doing extreme amounts of exercise, it might negatively affect your immune system, leading to increased cancer risk.

•If you are struggling to find time for exercise during your cancer treatment, do whatever minimal movement is possible, then titrate up as your energy increases. What software tools or medical devices can help with your exercise program?

•To monitor your heart rate, consider devices like Fitbit, Garmin, Apple Watch, or Polar

•To monitor your body composition/muscle mass, consider tools like InBody

•To monitor your energy levels and fatigue and titrate exercise, consider the "Cancer Exercise app” How can you learn more about exercise and cancer?

•Contact Katie Schmitz at schmitzk@upmc.edu.

•Review previous Cancer Patient Lab conversations on exercise and cancer, including:

•Adding Exercise for Everyday Life and Developing a Medical Device to Personalize Cancer Treatment

•“Exercise as a Countermeasure to Hormone Deprivation Therapy Side Effects and for Bone and Mental Health”

•The information and opinions expressed on this website or platform, or during discussions and presentations (both verbal and written) are not intended as health care recommendations or medical advice by Cancer Patient Lab, its principals, presenters, participants, or representatives for any medical treatment, product, or course of action. You should always consult a doctor about your specific situation before pursuing any health care program, treatment, product or other course of action that might affect your health. Meeting Notes KEYWORDS Exercise oncology, cancer patients, physical therapy, American College of Sports Medicine, moving through cancer, randomized controlled trials, exercise benefits, fatigue, sleep quality, muscle mass, resistance training, clinical trials, patient support, exercise guidelines. SPEAKERS Kathryn Schmitz (74%), Rick Davis (7%), Brad Power (5%), Matthew DeAngellis (4%), Cindy Ness (3%), Helen Connelly (3%), Roger Royse (2%), Alexander Lalov (1%) CHAT CONTRIBUTORS Allen Morris, Siva, Helen Connelly, Roger Royse, Kathryn Schmitz, David Young, Rick Davis, Russ Hollyer, Vic Paglisotti, Jeff Dwyer, Robb Owen, Shailesh Chavan, Heather Mikels (Messerly) SUMMARY Kathryn Schmitz, a leader in exercise oncology, discussed the benefits of exercise for cancer patients, citing a 281% increase in randomized controlled trials since 2010. The ACSM guidelines recommend 90 minutes of moderate aerobic exercise and twice-weekly resistance training for symptom management. The Challenge trial showed a 28% improvement in disease- free survival and a 37% improvement in overall survival for stage II and III colon cancer patients. Only 15% of cancer patients are referred to exercise programs. Schmitz emphasized the need for personalized exercise programs and the development of AI and tech solutions to support patients. OUTLINE Kathryn Schmitz's Background and Initiatives

•Katie Schmitz is Interim Director of the UPMC Hillman Cancer Center and past president of the American College of Sports Medicine.

•The "Moving Through Cancer" initiative aims to make exercise a standard of care in oncology.

•A historical overview of exercise oncology includes early clinical trials and reviews from the 1980s and 1990s.

•There is a significant increase in randomized controlled trials in the field since the first ACSM guidelines in 2010. Benefits and Outcomes of Exercise in Cancer

•The American College of Sports Medicine guidelines concluded that exercise benefits cancer-related fatigue, sleep quality, anxiety, depression, body composition, physical function, and bone health.

•Research is ongoing in areas like cardiotoxicity, chemotherapy-induced peripheral neuropathy, cognitive function, and treatment tolerance.

•The National Cancer Institute's Exercise and Nutrition Interventions to Improve Cancer Treatment-Related Outcomes (ENICTO) consortium aims to improve cancer treatment outcomes through exercise and nutrition interventions. (The consortium funds clinical trials that examine how exercise and nutrition can help patients complete treatment, manage side effects, and improve their physical function and overall well-being.)

•The THRIVE-65 trial examines the impact of exercise on older breast cancer patients' ability to complete chemotherapy. Guidelines and Recommendations

•The 2018 American College of Sports Medicine guidelines and the 2022 American Cancer Society guidelines recommend exercise during active cancer treatment.

•ASCO guidelines suggest that medical oncologists refer patients to exercise programming to address symptoms and side effects.

•There is a lack of evidence for dietary interventions during active cancer treatment, except for specific cases like a method of drug or nutrient administration that bypasses the digestive system, typically by injection or infusion into the bloodstream, muscle, or under the skin. Challenges and Opportunities in Exercise Oncology

•The Challenge trial showed significant improvements in disease-free and overall survival for stage II and III colon cancer patients.

•Only 15% of cancer patients are referred to exercise programs by their oncologists, despite the evidence supporting exercise.

•The Moving Through Cancer Task Force aims to make exercise standard of care by 2029, with a focus on stakeholder awareness and policy changes.

•A multicolored brochure and a Spanish translation promote the benefits of movement for cancer patients. Patient Experiences and Questions

•Roger Royse raised concerns about a study linking long-distance running to colon cancer, which Katie discussed in terms of the immune system's response to exercise.

•Matthew DeAngelis asked about the opportunity cost of exercising during cancer treatment, and Katie recommended the "Cancer Exercise" app for monitoring fatigue and energy levels.

•Helen asked about maintaining muscle mass during treatment, and Katie suggested focusing on resistance training and rebalancing body composition. Technology and Future Directions

•There is ongoing research into using tech to support exercise programs.

•Cindy Ness asked about measuring zone two training, and Katie recommends Polar heart rate monitors for accurate tracking.

•Katie emphasized the importance of triage in exercise programs to tailor recommendations to individual patients' needs and goals.

•She concluded by encouraging participants to advocate for exercise programs with their oncology clinicians and to move more throughout their day.