FEATURE: EXERCISE ONCOLOGY EXERCISE IS MEDICINE FOR CANCER – THE EVOLUTION AND ROLE OF EXERCISE ONCOLOGY Table 1. Modular multi-modal exercise program for patients with bone metastases Metastases Resistance Aerobic Flexibility site Upper Trunk Lower WB NWB Static Pelvis √ √ √** √ √ Lumbar √ √ √ √*** spine However, the overarching Thoracic √* √ √ √ √*** spine/ribs message remains that for Provimal √ √ √** √ √ most patients, doing femur All regions √* √** √ √*** “some exercise is better √, target exercise region; *, exclusion of shoulder flexion/extension/abduction/adduction – inclusion of elbow flexion/extension;than no exercise” and xx, exclusion of hip extension/flexion – inclusion of knee extension/flexion; ***, exclusion of spine/flexion/extension/rotation; NWB, nonweight bearing (eg.cycling); WB, weight bearing (e.g. walking). Reproduced from: Nart NH, Galväo DA, Newton RU. (2017). Exercise Medicine for Advanced Prostate Cancer. Curr Opin support Palliat Care, 11: 247–257 generally “more exercise is better than less”. exercise (varied between high-intensity continues to balloon, another critical benefit to chronic disease patients, interval training, HIIT; and moderate- focus is the role of implementation and is a step in the right direction, intensity continuous training, MICT) science; that is, understanding how it does not appropriately facilitate entry and resistance exercise (targeting large to develop pathways to ensure that into exercise for cancer patients. As the muscle groups across the whole body) evidence-based, best clinical practice evidence demonstrating the benefits and impact exercise (if appropriate and identified through research, are routinely of exercise continues to mount, it is feasible) to target the cardiorespiratory implemented into patient care. Much critical to engage government, public and musculoskeletal systems, of the cancer-related research focuses and private funding sources in order respectively, and to promote various on “what to do”, while implementation to create a financial structure that biochemical, hormonal and immune science focuses on “how to do it”. This adequately supports meaningful responses to disparate modalities. represents a critical gap in the literature, access and engagement in exercise Patients with bone metastases require as highlighted in a recent editorial by for people with cancer. modified programs for their safety. Prof. Robert Newton (Curr Oncol. 2018; This highlights the value of ensuring 25(2): 117-118), noting: “most cancer In addition to financial constraints, all cancer patients, regardless of their patients or survivors are not aware of there are several other barriers to stage of disease, are referred to an or not able to access exercise-related access, including lack of clinician AEP for a needs assessment, exercise services and support”. training and engagement, poor prescription, and ongoing clinical organisational support and geography management in collaboration with the Financial constraints represent a major (patient proximity to suitable exercise patient’s team of medical professionals barrier to patients accessing exercise clinics or facilities). Understanding (oncologists, general practitioner, other and are a key focus for this work. these barriers and creating systems specialists). You can locate an AEP Presently, Australia’s Medicare system to overcome them are critical for the for you (or your patient) by visiting: offers a Chronic Disease Management successful implementation of exercise https://www.essa.org.au/find-aep/, Plan (CDMP) to anyone with a chronic oncology. We have commenced this through which the search engine disease, including people with cancer. important work in Perth, and also includes a sub-speciality field for those This provides five (5) fully subsidised nationally, in partnership with Genesis experienced in exercise and cancer. consults with allied health professionals Cancer Care, led by our PhD candidate during a calendar year; however, these Mary Kennedy, with a strong interest IMPLEMENTATION five appointments are shared among in translating the evidence we have, all allied health services (e.g. dietetics, to patients at large. As exercise oncology develops, and the psychology) and are not dedicated to popularity of exercise for cancer patients AEPs. While the CDMP is of considerable 10 VOLUME 36 • ISSUE 2 2018