The development of evidence-based exercise guidelines for people with cancer


Exercise is a safe, cost-effective means to prevent and manage secondary health complications and enhance quality of life (QoL) among cancer survivors (CS). Published exercise recommendations for CS have been based on literature reviews and roundtable consensus and were not underpinned by a robust, standardized guideline development process using rigorous methodology (e.g., a systematic review of research evidence, extensive peer review). The objective of this study was to systematically develop evidence-informed exercise guidelines to improve aerobic and muscular fitness, and increase QOL, among CS. The Appraisal of Guidelines, Research and Evaluation II guideline development protocol was used as a methodological strategy. The evidence base for the guideline development process consisted of a systematic review and quality appraisal of research examining the effects of exercise on aerobic and muscular fitness and QoL among adults with cancer. A multidisciplinary working group reflected on the evidence and generated the guidelines. The guidelines underwent a four-stage review process in which they were reviewed by 12 internal content experts, three guideline methodology experts, five external content experts, and 69 potential end-users, with refinements made at each stage. The guidelines contain recommendations regarding the duration, frequency, and intensity of aerobic and resistance-training sessions. The guideline also includes considerations for safety, delivery methods, and long-term maintenance of exercise behaviour. More research is necessary to generate more exact exercise programs for specific cancer types. Oncologists, primary care providers, and other members of the healthcare team (e.g., rehabilitation therapists, kinesiologists, psychologists) are encouraged to adopt these rigorously developed guidelines.

Acknowledgments: Systematic review and guideline development supported by the Psychosocial Oncology Program at Cancer Care Ontario.