15 Apr The role of Exercise Physiologists in the treatment of cancer
Exercise will probably be the last thing on your mind after a cancer diagnosis… but it shouldn’t be. Research continues to establish exercise as a medicine for people living with cancer. People with cancer who exercise regularly experience fewer and less severe treatment related side effects as well as improved quality of life.
So how much exercise is safe, and where can you get advice? We asked a range of exercise oncology experts for their advice. Here’s what they said…
“Accredited Exercise Physiologists (AEP) in your cancer care team can help you improve your physical and mental health and well-being before, during and after your cancer treatment.”
WHY SHOULD I EXERCISE WHEN I HAVE CANCER?
Research shows exercise is an effective medicine for people with cancer. People with cancer who exercise regularly have fewer and milder side effects from their treatments. This includes feeling less tired and distressed, being better able to continue normal activities and feeling better about their quality of life. Research suggests exercise may help lower the chances of cancer coming back and may help you live longer.
WHAT ARE THE EXERCISE RECOMMENDATIONS FOR PEOPLE WITH CANCER?
The evidence-based guidelines recommend all people with cancer to:
a. avoid being inactive and be as physically active as their doctor or AEP advise their current condition allows
b. progress towards and maintain participation in regular moderate to vigorous intensity aerobic exercise (e.g. brisk walking, jogging, cycling, swimming) and resistance exercise (e.g. lifting weights using the major muscle groups)
c. receive an exercise prescription that meets the person’s needs and abilities.
Changes to the prescription may be needed due to the type and stage of cancer they have, what treatments they receive, any side effects of those treatments and their overall health.
If you’re not exercising regularly, you’re not alone. Most people with cancer are not meeting these recommendations. Seeking the advice of a health professional will help you build up to or maintain the recommended level of exercise. AEPs are health professionals who are skilled in providing exercise to patients with health concerns.
WHAT DO EXERCISE PHYSIOLOGISTS DO?
AEPs complete a minimum 4 years of study at university. They specialise in prescribing and supervising exercise for people who have complex health conditions. As exercise specialists, AEPs have the knowledge and skills to design, deliver and evaluate safe exercise programs. When you see an AEP who has experience working with people with cancer, you can be confident that they:
- understand cancer diagnosis, staging and treatments,
- understand the phases of cancer care from being first diagnosed through until end of life,
- know the symptoms and side effects of cancer and cancer treatments,
- understand how cancer and its treatment may influence your ability to exercise,»» use clinical skills to review your health status before starting exercise,
- understand cancer-specific issues that need to be considered to ensure exercise is safe and suitable,
- use evidence-based practice to develop targeted exercise prescriptions which have been individualised to you,
- use appropriately selected types of exercise, intensities (i.e. how hard) and volumes (i.e. how much) throughout your treatment and recovery,
- maximise the safety and benefits of exercise even if you are going through difficult treatments or suffering serious side effects,
- provide cancer-specific exercise education, advice and support to help improve your overall health and well-beingthrough regular exercise.
HOW WILL AN EXERCISE PHYSIOLOGIST HELP ME?
AEPs provide advice, support and resources that are specific to each patient. This is the same as how your doctor provides care that is best for you because no two people have the same response to cancer. An AEP will be able to prescribe and monitor an individualised exercise program that helps you through:
- improved fitness and strength,
- improved physical function to help you do everyday activities,
- reduced tiredness and fatigue,
- reduced distress, depression and anxiety,
- improved wellbeing that helps increase quality of life,
- helps maintain bone health, build muscle and stop or reduce increases in fat,
- may help to lower the chance of cancer returning and help patient’s live longer (for some types of cancer especially breast, prostate and bowel cancer),
- reduce the chance of developing new cancers and other diseases such as cardiovascular disease, diabetes and osteoporosis.
HOW DO EXERCISE PHYSIOLOGISTS DELIVER THEIR SERVICES?
AEPs use a variety of ways to deliver exercise to people with cancer. These services always meet your individual abilities, needs, goals and preferences. AEPs can deliver their services through:
- individual appointments that involve talking to and assessing patients to help develop a program just for you,
- supervising one-on-one and group-based exercise sessions (involving instruction and monitoring on the correct exercise technique and required modifications to the exercise prescription according to any symptoms you may be experiencing),
- supporting you to exercise independently by checking in on the phone or contacting you online,
- contacting and referring to other members of your health care team to support your overall care,
- making services available to you in hospitals, cancer treatment facilities and community-based facilities (e.g. fitness centre, gym, exercise clinic).
HOW MUCH DOES AN EXERCISE PHYSIOLOGIST COST?
The costs of AEP services do vary between providers. Financial support is available for people with cancer which allow for these services to be accessed at a relatively low cost, or in some cases, at no cost. Financial support may be available through:
- A Medicare Chronic Disease Management (CDM) Plan prepared by your GP can provide rebates for up to 5 sessions peryear (10 for an Aboriginal and/or Torres Strait Islander person).
- Department of Veterans’ Affairs provides various subsidies for entitled clients through appropriate referral by your GP (requires a valid D904 referral form)
- Private Health Insurance providers offer various subsidies for individual and group-based AEP services which vary depending on your insurer and level of coverage.
- Other financial subsidies may be available to people with cancer through local government funded initiatives, research programs, private companies, life insurers, cancer organisations and the National Disability Insurance Scheme.
HOW CAN I FIND AN EXERCISE PHYSIOLOGIST?
Your cancer care team will be able to recommend AEPs who specialise in cancer. A referral from a health professional is not needed to see an AEP, but you may be referred by a member of your cancer care team or your GP. Any person with cancer, their family or friends can directly contact an AEP to make an appointment.
There are over 5,000 AEPs throughout Australia. To find one near you, click here.
**This information has been taken from a consensus statement, developed in consultation with Accredited Exercise Physiologists with expertise in cancer care and oncology specialists representing disciplines involved with the multidisciplinary cancer care team. Access to the full consensus statement, including authors and scientific references, is available here.
AUTHORS: Jane Turner, Michael Marthick, Andrew Murnane, Morgan Atkinson, Louise Czosnek, Alex Lawrence, Janette Vardy, Mei Krishnasamy, Jon Emery and Prue Cormie.