To date the most effective principles on which to base exercise delivery are under researched. The model below is most commonly used.
The practical tips below from the Exercise and Sports Science Australia (ESSA) position statement1 provide valuable guidance and should be considered for all exercise prescription in prehabilitation.
- The exercise prescription that works best for whom and when will be determined by patient assessment, identification and consideration of general and cancer-specific health issues and their contribution to risk of morbidity and/or mortality, and subsequent patient-driven goals.
- While for the majority, multimodal, moderate to high intensity exercise will be appropriate, there is no set prescription and total weekly dosage that would be considered evidence-based for all cancer patients.
- Targeted exercise prescription, which includes the provision of behaviour change advice and support, is needed to ensure greatest benefit (as defined by the patient) is achieved in the short and longer term, with very low risk of harm.
Summary model of exercise prescription
Timing of intervention
The ideal timing for exercise prehabilitation before cancer treatment remains undetermined. Often, the duration of prehabilitation is associated with the work up time before cancer treatment2. The brief period between cancer diagnosis and treatment is commonly seen as a hindrance to implementing prehabilitation3,4. Nevertheless, recent findings indicate that engaging in exercise prehabilitation for two weeks or longer is generally recommended. Even durations of less than two weeks before cancer treatment may still contribute to enhanced postoperative recovery5.
Frequency of intervention
This is dependent on the assessment but twice per week is most commonly used, the setting is also variable but supervision is important, either by video conferencing, web based delivery or face to face. For individuals assessed as needing specialist care, face to face may be a safer environment for delivery of exercise.
Which clinicians provide targeted and specialist exercise intervention
Clinicians providing targeted and specialist intervention should be physiotherapists or exercise physiologists and should be familiar with the following position statements to help guide exercise prescription in the oncology population:
- Exercise recommendation for people with bone metastases: Expert consensus for health care providers and exercise professionals (2022)
- Cancer exercise toolkit is also a valuable clinician resource to support skill training.