New Exercise Guidelines Tailored for Older Cancer Survivors

While regular exercise is often recommended for cancer survivors of all ages, specific guidelines for patients aged 65 and older have historically been lacking. Older adults frequently face unique physiological, functional, and psychosocial barriers to exercise, such as fear of injury, chronic pain, and underlying health conditions, making tailored recommendations essential.

Expert Panel Addresses the Gap

To bridge this crucial gap, an expert panel, led by Dr. Jose Garcia, professor of Gerontology and Geriatric Medicine, was convened. The panel developed evidence-based recommendations for safe, accessible, and effective exercise programs tailored for older cancer survivors. Their comprehensive work incorporated insights from a community advisory board of older cancer survivors and caregivers, as well as existing data and professional guidelines. The panel successfully reached a consensus on 11 key recommendations.

These findings were published in the journal Cancer, in a paper titled “Exercise recommendations for older adults living with and beyond cancer: A consensus statement by the Advancing Capacity to Integrate Exercise Into the Care of Older Cancer Survivors expert panel.”

Key Recommendations for Professionals

These new guidelines are specifically designed to assist medical and exercise professionals in prescribing exercise as a vital component of cancer survivorship care for older patients. They provide clear guidance across various stages of exercise delivery:

Medical Evaluation

Professionals should follow existing American College of Sports Medicine (ACSM) and National Comprehensive Cancer Network (NCCN) guidelines. Typically, no additional medical evaluation is required beyond these established protocols.

Exercise Testing

To ensure comprehensive assessment, supplement ACSM fitness assessments with functional assessments tailored for older adults. These include:

• Timed Up and Go
• Short Physical Performance Battery
• Tests for static and dynamic balance

Exercise Prescription

When prescribing exercise routines, two critical components must be incorporated:

• Incorporate balance training: This should include 1-2 sets of 4-10 exercises, performed 3 or more days per week.
• Add flexibility training or stretches: Each stretch should be held for 30-60 seconds, performed 2-7 days per week.

Exercise Tolerance and Safety

Safety is paramount, especially for older survivors. Professionals must:

• Monitor symptoms such as fatigue, pain, dizziness, weakness, shortness of breath, and movement incontinence during exercise sessions.
• Assess the exercise environment for potential fall hazards, provide clear instructions, and demonstrate exercises effectively.

Implementing Prescriptions in Practice

Successful implementation requires a survivor-centered approach:

• Deliver survivor-centered exercises with empathy and patience.
• Begin with low intensity and slow progression, actively addressing any barriers and engaging caregivers where appropriate. Utilize behavioral techniques to foster adherence.
• For survivors with mobility deficits, prioritize building strength, balance, and flexibility before introducing aerobic exercise.
• Adjust group size and supervision levels based on the individual's age, cognitive abilities, and comorbidities.
• Modify exercises or involve caregivers, family, or friends if unsupervised exercise poses safety risks.

Enhancing Survivorship Care

These comprehensive guidelines are expected to significantly improve survivorship care by expanding access to appropriate exercise and reducing common barriers for older cancer survivors. Properly prescribed exercise is viewed as crucial for enhancing survivors' health, quality of life, and independence as they age.