Survivors may soon get their very own exercise prescription, following new guidelines presented recently at the American Society of Clinical Oncology’s annual meeting.

Prior guidelines aren’t specific enough, said Kathryn Schmitz, PhD, of the University of Pennsylvania School of Medicine, during a session on physical activity in cancer survivors. Plus, scientific evidence about cancer and exercise has grown greatly in the past few decades, as has the number of cancer survivors, which has jumped from two million to 12 million since the 1970s. Considering the increasing number of exercise programs for patients and survivors that are popping up all around the world, Schmitz said better guidance was needed not only for fitness instructors but also for physicians who need to get past the idea that patients shouldn’t push themselves during treatment.

Schmitz headed up a panel of experts brought together by the American College of Sports Medicine to develop new recommendations for exercise during and after cancer treatment. Published studies in five cancer types–breast, prostate, hematologic, colon, and gynecologic–were used to develop the recommendations.

Although Schmitz noted there are circumstances in which a patient or survivor should receive a medical assessment before starting an exercise program, she said it shouldn’t be the norm. In fact, the panel concluded that in order to reduce barriers to starting an exercise program, requiring medical assessment for all survivors is not recommended. “We chose to do this because we felt that the small risk in a small body of patients was probably less than the amount of risk that is induced by telling people that they shouldn’t exercise until they’re cleared,” she said during the session, adding that the risk of inactivity for the large majority of patients at low risk for problems is probably greater than the small risk of putting someone in harm’s way.

The first and most important exercise guidelines for cancer survivors, Schmitz said, is that they must avoid inactivity. They must continue their normal activities during and after treatment, and resume daily life as soon as possible after surgery. Other specific recommendations include:

• Over the course of one month, it’s safe to build sedentary patients up to 150 minutes of moderate-intensity aerobic exercise per week
• It’s safe for patients undergoing stem cell transplant to exercise every day, but these patients should reduce intensity and progression of intensity because of the effects on the immune system
• For patients suffering from weight loss, resistance training can help build strength
• For those with prostate, hematologic, and colon cancers, twice-weekly resistance training is recommended: one exercise for each major muscle group for eight to 10 repetitions, and one to three sets per exercise
• Women with breast and gynecologic cancers should start with a supervised resistance training program given the risk for lymphedema
• Given side effects such as incontinence and sexual dysfunction, floor exercises should be added to an exercise routine for men with prostate cancer
• Colon cancer patients with an ostomy should avoid excessive intra-abdominal pressures

The full guidelines will be published in the July 1 issue of the journal Medicine and Science in Sports and Exercise, and are expected to be made available on the ACSM website at www.acsm.org.

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