EXERCISE & CANCER

that cancer patients are able to modify the frequency, intensity, or duration of their exercise depending on their response to treatment. High intensity exercise should be avoided during cancer treat- ment because of the potential immuno- suppressive effects but is not contraindi- cated in cancer survivors. From a duration perspective, it is likely that many cancer patients will not be able to perform 30 minutes of continuous exercise at the start of their treatments, especially if they were previously sedentary.

Many researchers have used intermittent or interval training (ie. alternating short bouts of exercise and rest) for patients dur- ing chemotherapy treatment, or immedi- ately following bone marrow transplanta- tion, as a way of accumulating the 30 min- utes. This approach is recommended for older deconditioned persons with chronic diseases (9) and may also be optimal for cancer patients who have been sedentary or are receiving palliative care. Guidelines for prescribing exercise to cancer patients and survivors are summarized in table 3.

It is also important to recognize that can- cer patients exercise as much for psycho- logical benefit as for physical health (11). Consequently, it is important to take psy- chological benefits into account when pre- scribing exercise for cancer patients. As a general guideline, physicians should pre- scribe exercise that is enjoyable, builds confidence, develops new skills, incorpo- rates social interaction, and takes place in an environment that engages the mind and spirit.

Summary Good evidence exists for promoting exer- cise to enhance QOL following cancer diagnosis. Currently, there are 36 studies that have addressed this issue using pri- marily intervention designs. Despite limi- tations in the studies, the evidence sug- gests that exercise will improve various QOL parameters both during and following cancer treatment. Nevertheless, there are important precautions that should be heeded when conducting exercise tests and prescribing exercise programs for can- cer patients and survivors. General guide- lines for exercise prescription include moderate intensity exercise performed three to five times per week for 30-60 minutes in an environment that optimizes psychosocial health.

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7. Winningham ML. Walking program for people with cancer: Getting started. Cancer Nursing 1991;14:270-276 8. American College of Sports Medicine (1998). Position Stand on: Exercise and physical

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