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FOTO Rehab Outcomes Blog

Safety of Exercise for Patients who Have Advanced Cancer

This topic brings many memories to the forefront and is difficult for me. Years ago, I found a study by Andrea Cheville, MD highlighting the importance of exercise for these individuals. The study included a home exercise program. As I analyzed the program, it was quite apparent that the exercises were not strenuous.

Over the course of the last 2 years, I have had more and more patients who have cancer. For me is difficult to use FOTO with these individuals because they typically do not meet the predicted goals. The reason they do not meet the prediction is because they are outliers. They are outliers because the likelihood of attaining full, predicted function is not realistic. (Okay, I have nothing to substantiate this except what I have reflected on as I treat these individuals.) They are undergoing chemotherapy and infusions... they have bouts of hospitalization... they are experiencing side effects of their treatments...  they have periods where they are not able to physically attend. FOTO can track their change in function nicely - it tends to take longer for change to happen. Often their function reaches a plateau. 

Now, FOTO does have something of high value to help capture something that is really, really important for these individuals: fatigue level. Most of my patients are seeking an increase in strength so they can go up and down stairs normally and enough endurance so they can walk in the grocery store to get their groceries. They complain of severe fatigue. What I tend to use in FOTO as an optional survey is the Facit Fatigue Scale Version 4.  Often times, within 4-6 weeks of initiating services with me, the Facit Fatigue Scale has a substantial change.

I agree with the below study that we really do need more studies to assist us in designing exercise programs that are of the appropriate intensity for these individuals. For now, if you are lucky enough to use FOTO, you can track how they are changing.

Below you will find a quick view of the abstract.


Safety and feasibility of exercise interventions in patients with advanced cancer: a systematic review.




The beneficial effects of exercise in cancer patients are reasonably well-established, although research in this field has predominantly investigated cancer patients in the earlier stages of disease. However, the most recent evidence surrounding exercise interventions in advanced cancer populations has yet to be systematically evaluated. This review critically analyses the safety and feasibility of exercise interventions in patients with advanced cancer.


All randomised, non-randomised and prospective observational trials of exercise training interventions in patients with advanced cancer were included. 'Safety' was defined as the number and severity of reported adverse events during exercise training. 'Feasibility' was determined by participant adherence, attendance and/or study completion rates.


A total of 25 studies involving 1088 patients were included: 16 randomised controlled and nine prospective observational cohort trials. Seven studies included advanced lung cancer patients exclusively, while eight involved patients with various cancer diagnoses. Aerobic exercise was investigated in five studies, resistance training in two studies and combination training (aerobic and resistance) in 14 studies. Six minor adverse events were reported due to exercise. All of these were musculoskeletal in nature, resulting in two participants' withdrawal from the study. Exercise adherence ranged from 65 to 89% but was only described in nine studies. Attendance at each exercise session was described in a further nine studies, ranging from 59 to 100%.


Implementation of exercise interventions appears to be safe and feasible in advanced cancer clinical practice, although targeted studies are required to determine the optimal exercise dose for specific cancer diagnoses.

 2017 Jul 25. doi: 10.1007/s00520-017-3827-0. [Epub ahead of print]