Expert panel releases evidence‑based exercise guidance for older cancer survivors

Exercise for older cancer survivors

Regular exercise is commonly recommended as part of cancer survivorship care for patients of all ages, but there is little consensus on guidance for patients 65 and older. 

While even modest amounts of exercise can improve cancer related health outcomes, many older adults struggle to get enough physical activity, and inactivity often increases with age.
Older adults have a variety of physiological, functional and psychosocial needs and may face barriers to exercise, such as fear of injury, chronic pain, underlying health conditions and social and environmental factors. 

“Older adults now represent the majority of cancer survivors, yet most exercise guidelines were not developed with their unique needs in mind,” said Dr. Jose Garcia, professor (Gerontology and Geriatric Medicine). 

Expert panel review

An expert panel, consisting of Garcia and other leaders in the field, was convened to address these needs and develop credible, evidence-based recommendations for delivering safe, accessible and effective exercise programming for older cancer survivors.

Their recommendations were informed by a community advisory board of older cancer survivors and caregivers as well as insights from data sources and relevant professional guidelines. The panel reached consensus on 11 recommendations aimed at helping older cancer survivors incorporate exercise into their lives while keeping barriers and risks low.

The panel reported their findings in “Exercise recommendations for older adults living with and beyond cancer: A consensus statement by the Advancing Capacity to Integrate Exercise Into the Care of Older Cancer Survivors expert panel,” recently published in Cancer.

Recommendations

The panel’s recommendations are meant to guide medical and exercise professionals seeking to prescribe exercise as part of cancer survivorship care for older patients. 

The recommendations cover several domains throughout the delivery process including medical evaluation/clearance for exercise, pre‐exercise assessment, exercise prescription, exercise tolerance and safety, exercise delivery, and behavioral support.

“These consensus recommendations provide practical, evidence informed guidance to help clinicians and exercise professionals safely integrate exercise into routine cancer care for older adults-emphasizing function, balance, and accessibility rather than unnecessary barriers,” Garcia said. 

Medical evaluation

• Follow the American College of Sports Medicine (ACSM) and the National Comprehensive Cancer Network (NCCN) guidelines to prescribe an appropriate exercise program (no additional medical evaluation is required)

Exercise testing

• Add functional assessments to ACSM fitness assessments (Timed Up and Go, Short Physical Performance Battery, and tests of static and dynamic balance)

Exercise prescription

• Add balance training (1-2 sets of 4-10 exercises, 3 days or more per week)
• Add flexibility training or stretches (30-60 seconds per stretches, 2-7 days per week)

Exercise tolerance and safety

• Monitor any symptoms during exercise (fatigue, pain, dizziness, weakness, shortness of breath and movement incontinence)
• Assess the environment for fall hazards, use clear instructions and demonstrate exercises

Implementing prescriptions in practice

• Deliver survivor-centered exercises with empathy and patience 
• Start low and slow, address barriers, engage caregivers, use behavioral techniques
• Build strength, balance and flexibility before adding aerobic exercise for survivors with mobility deficit
• Tailor group size and supervision based on age, cognition, and comorbidities
• Modify exercises or involve caregivers, family or friends if unsupervised exercise is unsafe

An essential part of survivorship care

These guidelines are designed to better meet the needs of older cancer survivors by expanding access to exercise and reducing barriers. Appropriately prescribed exercise plays a key role in survivorship care and helps improve survivors’ health, quality of life and independence as they age.

Garcia emphasized, “Our goal is to make exercise a realistic and essential part of survivorship care for this rapidly growing population.”