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The Prescription or Proscription of Exercise in Colorectal Cancer Care

BROWN, JUSTIN C.; SCHMITZ, KATHRYN H.

Medicine & Science in Sports & Exercise: December 2014 - Volume 46 - Issue 12 - p 2202–2209
doi: 10.1249/MSS.0000000000000355
Clinical Sciences

Purpose Clinical guidelines recommend that oncologists prescribe exercise to their patients with colorectal cancer (CRC). However, 84% of oncologists do not prescribe exercise, citing concerns of safety and feasibility. Data are inadequate regarding the proportion of CRC survivors that could be safely prescribed with the dose of exercise recommended by the American College of Sports Medicine (ACSM), American Cancer Society (ACS), or National Comprehensive Cancer Network (NCCN) in an unsupervised setting.

Methods We reviewed published guidelines for exercise prescription among cancer survivors and extracted health factors that may necessitate referral to trained personnel (physical therapist or exercise professional) for an individualized exercise program or supervision of exercise as recommended by the ACSM/ACS/NCCN. We applied these health factors to a cohort of nonmetastatic CRC survivors 6 months after completing curative care. The primary outcome was the proportion of CRC survivors to whom oncologists could prescribe unsupervised exercise at the dose recommended by the ACSM/ACS/NCCN.

Results Among 351 CRC survivors, 6 months after curative care, 21%–42% of patients could be prescribed with the dose of exercise recommended by the ACSM/ACS/NCCN. Estimates varied as a function of the inclusion or exclusion of several prevalent comorbid health conditions including hypertension, diabetes, arthritis, obesity, and hyperlipidemia.

Conclusions Our data are consistent with the clinical observation that a large proportion of CRC survivors may be unable to participate in unsupervised exercise 6 months after curative care. These data underscore the need for continued research to clarify the safety and feasibility of prescribing exercise to CRC survivors.

Supplemental digital content is available in the text.

Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA

Address for correspondence: Justin C. Brown, M.A., Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, 8th Floor Blockley Hall, 423 Guardian Drive, Philadelphia, PA; E-mail: brownjus@mail.med.upenn.edu.

Submitted for publication September 2013.

Accepted for publication March 2014.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.acsm-msse.org).

© 2014 American College of Sports Medicine