The Role of Physical Activity for Patients with Advanced Cancer

Abstract

Abstract The aim of this thesis was to explore the role of physical activity for people living with advanced stages of cancer. The use of both a quantitative and qualitative elements in this thesis enabled a thorough examination of the outcomes associated with exercise interventions in advanced cancer, while also allowing an exploration of the perceptions of patients and healthcare professionals towards physical activity. A narrative review examining exercise prescription to patients with bone metastases found that exercise interventions for patients with bone metastases are associated with positive physical and self-reported outcomes. Studies reporting adverse events did not find a high fracture incidence with exercise in comparison with control participants, or an association between exercise and fracture risk; however, the need to individualize exercise prescription and adapt exercises to patient ability were reinforced in all papers reviewed. A systematic review of exercise trials involving patients with advanced cancer found that recruitment (mean 49% (SD = 17; range 15-74%), adherence (range 44-95%) and attrition rates (mean 24% (SD = 8; range 10-42%) varied widely among the studies reviewed. Concentrated efforts are needed to increase the numbers of patients with advanced disease, including those with metastatic disease, recruited to exercise programmes and to ensure patients recruited are representative of clinical practice. Further studies in this thesis concluded that clinicians and physiotherapists feel that physical activity is safe and important in the advanced cancer patient cohort. However, both groups demonstrated a need for further education in the area of physical activity and advanced cancer. Similarly, patients expressed a need for further information regarding physical activity following diagnosis. Many patients reported a decrease in physical activity levels following a diagnosis of advanced cancer and did not identify common ?cues to action? post-diagnosis that prompted them to maintain or increase their physical activity level, such as written information about physical activity or referral for exercise consultations. Educational efforts targeting fears and misconceptions about the prescription of physical activity for patients with advanced disease may help to improve physiotherapists? and clinicians confidence in recommending physical activity to this population. The ExPeCT Randomised Controlled Trial introduced a six month individualised exercise programme for patients with metastatic prostate cancer. This trial demonstrated that a progressive aerobic exercise programme can be introduced to patients living with metastatic prostate cancer in a multicentre setting. Although the results of the programme did not result in significant changes in psycho-social self-report measures, the exercise intervention was well tolerated by participants and did not result in any adverse events, laying the foundation for further trials in this population.