The Clinical Oncology Society of Australia (COSA) recommends that exercise therapy be embedded as part of standard practice in cancer care. Exercise acts as an adjunct to traditional treatment by improving survival outcomes through decreasing mortality rate and cancer recurrence. Participating in exercise while undergoing active cancer treatment decreases fatigue, decreases physical deconditioning, decreases psychological distress and improves quality of life. Exercise also increases treatment efficacy, boosts the immune response, normalises the tumour microenvironment, decreases circulating tumor cells and regulates metabolic markers. Resistance exercises are particularly beneficial as they maintain and/or improve muscle mass, which has been shown to improve prognosis. Participation in resistance exercise also creates a 90% higher likelihood that an increase in dose and intensity will be tolerated.
This research has led to Orange Hospital funding 2 Exercise Physiologists (EPs) for a 12 month pilot program in oncology. Staff underwent training at Chris O’Brien Lifehouse to gain valuable insight on how best to implement a service for cancer patients. Participants can access individualised exercise programs either at home and/or in a group class held at an external gym. Selection criteria for participation includes; undergoing active cancer treatment; neoadjuvant treatment; adjuvant treatment; presence of metastatic cancer; and/or palliative. Outcome measures are re-assessed at the 12-week follow-up for a combination of; skeletal muscle mass (SMM%); generic strength testing; Edmonton Symptom Assessment System (ESAS); and patient feedback.
Thirty-seven participants have completed the program thus far. Statistically significant improvements have been obtained in lower limb strength (30s sit to stand: -2.97 (95%CI: -4.34, -1.60)), lower limb strength (30s wall push up: -4.1 (95%CI: -5.57, -2.61)) and sleep (1.09, 95% CI: 0.00, 2.18). Reductions in symptoms of depression (0.75, 95%CI -0.12, 1.62; P=0.09), anxiety (0.81, 95%CI -0.15, 1.78, P=0.096) and distress (0.65, 95%CI: -0.08, 1.39) were also observed, however these were not statistically significant. Outcome measures that have been maintained include SMM%, fatigue, pain, nausea, drowsiness, and shortness of breath.
Current research shows that positive exercise behaviours come from having a university trained exercise professional supervise group classes and tailor exercise programs for the individual. This is demonstrated by 12% of people undergoing supervised exercises requiring a dose reduction, compared to 34% for usual care/home program only. Exercise Physiologists should be a part of routine care in the oncology space as the programs they provide has a positive influence on participant’s mental health, physical health and overall wellbeing.