Prescribing Exercise for Cancer Survivors: New Guidelines, Evidence, and Future Directions

Prescribing Exercise as Cancer Treatment: Landmark Guidance Redefines Survivorship Care

Recent advancements in exercise oncology have revolutionized our understanding of what it means to live with and beyond cancer. Once, rest and inactivity were the standard advice for cancer survivors; today, experts urge quite the opposite—a proactive approach where tailored exercise becomes a critical component of treatment and long-term care. In October 2019, an expert panel convened by the American College of Sports Medicine (ACSM), co-chaired by Dr. Kathryn Schmitz, released transformative guidelines underscoring the scientific consensus around exercise’s ability to improve cancer-related health outcomes. This article synthesizes the core concepts, evidence, and recommendations behind this cultural and clinical shift.

How Exercise Oncology Evolved: From Rest to Prescribing Activity

For decades, clinicians told cancer patients to avoid exertion and rest during treatment. However, research in the 1990s and early 2000s began to challenge this norm. The resulting field—exercise oncology—has since grown rapidly, now supported by more than 1,000 randomized controlled trials and extensive epidemiological studies.¹

Key milestones in the evolution:

• First large studies in the 1990s suggesting physical activity is safe and beneficial during and after cancer treatment.
• The 2010 ACSM roundtable’s landmark declaration: Cancer survivors can safely engage in exercise to improve fitness, restore function, enhance quality of life, and reduce fatigue.⁴
• Explosive growth in research, with ongoing trials on dose-response, cancer recurrence, treatment tolerance, and personalized exercise programs.²

Now, there is broad consensus: Cancer survivors generally benefit from movement, not rest.

What Can Exercise Improve for Cancer Survivors?

The recent ACSM guidelines, supported by systematic evidence review and expert consensus, identify several health outcomes positively impacted by prescribed exercise.

Note: Anxiety and depression are not improved by resistance training alone, but do improve with a combination of aerobic and resistance (strength) exercise.¹

Exercise and Cancer Survival: The Evidence

Data now show increased survival rates for people who exercise after diagnosis of breast, colon, or prostate cancer. The link between physical activity and survival is strongest for these cancers, but there are general benefits for all survivors, regardless of cancer type.¹

Key findings include:

• Cancer-specific mortality rates are reduced by 31–50% with postdiagnosis physical activity, especially for breast, colon, and prostate cancers.²
• Exercise after diagnosis is associated with longer overall survival for the above cancers.
• All cancer survivors are encouraged to follow standard public health recommendations for activity, even if specific survival benefit is unconfirmed for some diagnoses.

Prescribing Exercise: How Much, How Often, What Types?

Like a medicine, exercise is most effective when prescribed precisely. The ACSM and other organizations now provide detailed recommendations for cancer survivors, during and after treatment.

General Dosage Guidelines

• Aerobic Exercise: At least 2.5 to 5 hours/week of moderate-intensity activity, or 1.25 to 2.5 hours/week of vigorous-intensity activity.
• Resistance (Strength) Training: At least 2 sessions/week (all major muscle groups).
• Combined Programs: Aerobic plus resistance training yields additional benefits, especially for mood and physical function.
• Flexibility (Stretching): Recommended at least twice per week, though evidence is less robust.

Specific Prescriptions During Treatment

• 3 sessions of aerobic exercise weekly, 30 minutes each (can include brisk walking, cycling, swimming).
• 2 sessions of resistance exercise per week (using free weights, resistance bands, or machines).
• Customize to the individual: Tailor the plan based on age, cancer type and stage, side effects from treatment, medical history, pre-existing conditions, and functional ability.^{1 2}

All programs should start at a tolerable level and progress gradually, with input from a healthcare or fitness professional familiar with cancer survivorship.⁴

Safety Considerations: Who Can Exercise, and Are There Risks?

Strong evidence finds that exercise is generally safe for cancer survivors, including during active treatment, provided that individual limitations and risks are considered. Precautions may be needed for:

• Low blood counts (risk of infection or bleeding).
• Severe fatigue, dizziness, or heart or lung issues—medical clearance may be needed.
• Bone metastases or osteoporosis—avoid high-impact activities or those with risk of falls.
• Lymphedema—resistance training is safe if started gradually and monitored.

Supervision by exercise specialists with oncology expertise is recommended for complex cases or those with multiple comorbidities.^{1 4}

Why Isn’t Exercise Routine for All Survivors? Barriers and Solution Paths

Despite the compelling evidence, less than 30% of US cancer survivors report regular exercise. Key barriers include:³

• Lack of awareness among patients, survivors, and some healthcare providers.
• Absence of clear exercise referral systems within oncology care.
• Limited access to trained exercise professionals and programs tailored for cancer survivors.
• Lingering cultural myths about safety or fatigue.

Addressing these gaps is a major focus of initiatives like Moving Through Cancer, led by Dr. Kathryn Schmitz. Their mission: ensure every person living with and beyond cancer is routinely assessed, advised, referred to, and engaged in exercise and rehabilitation support as part of standard cancer care.^{3 6}

Major Initiatives and Research Directions

• Ongoing and future large clinical trials of exercise tailored to cancer type, dose, and treatment context.
• Research on implementation science—how to make evidence-based programs widely accessible and adopted within oncology care.
• Efforts to train more exercise professionals in cancer-specific needs, and to increase patient education.

Practical Tips: Engaging in Exercise During and After Cancer

• Start Slow: Begin with light activity, such as walking 5–10 minutes a day, gradually building duration and intensity as able.
• Mix It Up: Combine aerobic, resistance, and stretching exercises for comprehensive benefits.
• Listen to Your Body: Some fatigue or muscle soreness is normal; stop and consult your care team if you experience pain, dizziness, chest discomfort, or unusual symptoms.
• Seek Help: If possible, work with an exercise professional with cancer expertise, especially at the start.
• Plan for Consistency: Make physical activity part of your weekly routine and set realistic, achievable goals.
• Stay Social: Group classes and peer support can boost motivation and adherence.

The Future: Toward Exercise as a Standard of Cancer Care

Leaders in the field envision a future where exercise is considered as integral as chemotherapy or radiation in the treatment and recovery process. The evidence base continues to grow, with research on optimizing exercise dose, understanding impact on recurrence, and developing effective methods for integrating exercise into every cancer care plan.⁶

Major organizations—including the ACSM, American Cancer Society, and American Society of Clinical Oncology—now endorse structured physical activity programs as a routine aspect of survivorship.

Frequently Asked Questions (FAQs)

Q: Can all cancer survivors exercise?

A: The vast majority of survivors can safely be more active, with appropriate tailoring to their current health, cancer stage, side effects, and history.¹

Q: Will exercise worsen my fatigue?

A: While starting may feel tiring, regular exercise has strong evidence of improving cancer- and treatment-related fatigue over time.^{1 4}

Q: Are there specific exercises to avoid?

A: Activities should be modified in the presence of bone metastases, severe neuropathy, or very low blood counts. Always consult your cancer care team for personalized advice.^{1 4}

Q: How soon after diagnosis or treatment should I start?

A: Many survivors can start gentle activity (even during treatment), unless medically contraindicated. Early engagement is encouraged.¹

Q: What role do healthcare providers play?

A: Providers should assess physical activity levels, advise on benefits and safety, and refer patients to specialized exercise programs as needed.³

Resource Links for Patients and Providers

• Moving Through Cancer: Offers practical resources for survivors, caregivers, clinicians, and exercise professionals, including guidance on program referrals and best practices.
• ACSM Exercise Guidelines: For qualified fitness and health professionals advising cancer survivors.
• National Cancer Institute and American Cancer Society: Provide patient-friendly summaries and evidence reviews.

As research continues and implementation efforts intensify, the paradigm of exercise as medicine promises to transform cancer survivorship worldwide, making hope and health more attainable than ever before.

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medha deb

 

Medha Deb is an editor with a master's degree in Applied Linguistics from the University of Hyderabad. She believes that her qualification has helped her develop a deep understanding of language and its application in various contexts.

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