Download PDF
Int J Sports Med 2014; 35(14): e1-e9
DOI: 10.1055/s-0034-1389972
Clinical Sciences
© Georg Thieme Verlag KG Stuttgart · New York

Exercise Intensity Guidelines for Cancer Survivors: a Comparison with Reference Values

E. Gil-Rey
3   University of the Basque Country, Faculty of Physical Activity and Sport Sciences, Physical Education and Sport, Vitoria-Gasteiz, Spain
,
K. Quevedo-Jerez
1   Gabinete Médico Deportivo, Ayuntamiento de Miranda de Ebro, Spain
2   Grupo de Investigación en Actividad Física y Salud (GIAFyS), Medical, Miranda de Ebro, Spain
,
S. Maldonado-Martin
3   University of the Basque Country, Faculty of Physical Activity and Sport Sciences, Physical Education and Sport, Vitoria-Gasteiz, Spain
,
F. Herrero-Román
1   Gabinete Médico Deportivo, Ayuntamiento de Miranda de Ebro, Spain
2   Grupo de Investigación en Actividad Física y Salud (GIAFyS), Medical, Miranda de Ebro, Spain
› Author Affiliations
Further Information

Publication History



accepted after revision 06 August 2014

Publication Date:
27 November 2014 (online)

Also available at
    Permissions and Reprints

Abstract

The optimal dose of physical activity (PA) in cancer survivors (CS) is unknown due to the large variety of types of cancer, illness stages and treatments, low cardiorespiratory fitness, and physical inactivity. It is recommended that CS follow current PA guidelines for healthy population. There are no specific exercise prescription guidelines for CS. To know the cardiorespiratory parameters of CS in order to create exercise prescription guidelines for this population, 152 inactive CS were recruited to perform a cardiopulmonary exercise test. Peak oxygen uptake (VO2peak), ventilatory threshold (VT) and respiratory compensation point (RCP) determined 3 exercise intensity zones to create exercise intensity classification guidelines for CS. VO2peak (18.7±4.6 mL·kg−1·min−1) and peak heart rate (HRpeak) (145.1±17.9 bpm) were lower than the estimated values (p<0.001). Moderate intensity zone for CS was different from the current PA guidelines for healthy population: 41–64% VO2max, 55–70% HRmax, 23–48% HRres, 2.5–4 METs and 8–14 points on RPE scale. Intensities in PA guidelines for healthy population are not adapted to the characteristics of CS. For individual exercise prescription in CS specific PA guidelines should be used in order to maximize the benefits obtained by the use of aerobic exercise training.

Key words

exercise prescription - survivorship - physical activity - quality of life
 

  • References

  • 1 American College of Sports Medicine . ACSM’s Guidelines for exercise testing and prescription. 9th ed. Philadelphia (PA): Lippincott Williams & Wilkins; 2013
    Google Scholar
  • 2 Burnett D, Kluding P, Porter C, Fabian C, Klemp J. Cardiorespiratory fitness in breast cancer survivors. Springerplus 2013; 2: 68
    CrossrefPubMedGoogle Scholar
  • 3 Carvalho VO, Mezzani A. Aerobic exercise training intensity in patients with chronic heart failure: principles of assessment and prescription. Eur J Cardiovasc Prev Rehabil 2011; 18: 5-14
    CrossrefPubMedGoogle Scholar
  • 4 Cheema BS, Gaul CA. Full-body exercise training improves fitness and quality of life in survivors of breast cancer. J Strength Cond Res 2006; 20: 14-21
    PubMedGoogle Scholar
  • 5 Courneya KS. Exercise in cancer survivors: an overview of research. Med Sci Sports Exerc 2003; 35: 1846-1852
    CrossrefPubMedGoogle Scholar
  • 6 Courneya KS, Mackey JR, Bell GJ, Jones LW, Field CJ, Fairey AS. Randomized controlled trial of exercise training in postmenopausal breast cancer survivors: cardiopulmonary and quality of life outcomes. J Clin Oncol 2013; 21: 1660-1668
    PubMedGoogle Scholar
  • 7 Courneya KS, Segal RJ, Mackey JR, Gelmon K, Reid RD, Friedenreich CM, Ladha AB, Proulx C, Vallance JK, Lane K, Yasui Y, McKenzie DC. Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. J Clin Oncol 2007; 25: 4396-4404
    CrossrefPubMedGoogle Scholar
  • 8 Esteve-Lanao J, Foster C, Seiler S, Luci A. Impact of training intensity distribution on performance in endurance athletes. J Strength Cond Res 2007; 21: 943-949
    PubMedGoogle Scholar
  • 9 Fong DY, Ho JW, Hui BP, Lee AM, Macfarlane DJ, Leung SS, Cerin E, Chan WY, Leung IP, Lam SH, Taylor AJ, Cheng KK. Physical activity for cancer survivors: meta-analysis of randomized controlled trials. BMJ 2012; 344-370
    PubMedGoogle Scholar
  • 10 Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, Nieman DC, Swain DP. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc 2011; 43: 1334-1359
    CrossrefPubMedGoogle Scholar
  • 11 Gellish RL, Goslin BR, Olson RE, McDonald A, Russi GD, Moudgil VK. Longitudinal modeling of the relationship between age and maximal heart rate. Med Sci Sports Exerc. 2007; 39: 822-829
    PubMedGoogle Scholar
  • 12 Harriss DJ, Atkinson G. Ethical Standards in Sport and Exercise Science Research: 2014 Update. Int J Sports Med 2013; 34: 1025-1028
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Hayes SC, Spence RR, Galvão DA, Newton RU. Australian Association for Exercise and Sport Science position stand: optimizing cancer outcomes through exercise. J Sci Med Sport 2009; 12: 428-434
    CrossrefPubMedGoogle Scholar
  • 14 Herrero F, San Juan AF, Fleck SJ, Balmer J, Pérez M, Cañete S, Earnest CP, Foster C, Lucía A. Combined aerobic and resistance training in breast cancer survivors: a randomized, controlled pilot trial. Int J Sports Med 2005; 27: 573-580
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Herrero F, Balmer J, San Juan AF, Foster C, Fleck SJ, Pérez M, Cañete S, Earnest CP, Lucía A. Is cardiorespiratory fitness related to quality of life in survivors of breast cancer?. J Strength Cond Res 2006; 20: 535-540
    PubMedGoogle Scholar
  • 16 Herrero F, Pérez M. Actividad física y cáncer. In: Casajús JA, Vicente- Rodriguez G (eds.). Ejercicio físico y salud en poblaciones especiales. Exernet Madrid: Colección ICD, 58:2011; 387–410
    PubMed
  • 17 Humpel N, Iverson DC. Review and critique of the quality of exercise recommendations for cancer patients and survivors. Support Care Cancer 2005; 13: 493-502
    CrossrefPubMedGoogle Scholar
  • 18 Irwin ML. ACSM’s guide to exercise and cancer survivorship. USA: ACSM; 2012
    Google Scholar
  • 19 Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin 2011; 61: 69-90
    CrossrefPubMedGoogle Scholar
  • 20 Jones LW, Douglas PS, Eves ND, Marcom PK, Kraus WE, Herndon 2nd JE, Inman BA, Allen JD, Peppercorn J. Rationale and design of the Exercise Intensity Trial (EXCITE): A randomized trial comparing the effects of moderate versus moderate to high-intensity aerobic training in women with operable breast cancer. BMC Cancer 2010; 10: 531-540
    CrossrefPubMedGoogle Scholar
  • 21 Jones LW, Liang Y, Pituskin EN, Battaglini CL, Scott JM, Hornsby WE, Haykowsky M. Effect of exercise training on peak oxygen consumption in patients with cancer: a meta-analysis. Oncologist 2011; 16: 112-120
    CrossrefPubMedGoogle Scholar
  • 22 Karavirta L, Häkkinen K, Kauhanen A, Arija-Blázquez A, Sillanpää E, Rinkinen N, Häkkinen A. Individual responses to combined endurance and strength training in older adults. Med Sci Sports Exerc 2011; 43: 484-490
    PubMedGoogle Scholar
  • 23 Kirkham AA, Campbell KL, McKenzie DC. Comparison of aerobic exercise intensity prescription methods in breast cancer. Med Sci Sports Exerc 2013; 45: 1443-1450
    CrossrefPubMedGoogle Scholar
  • 24 Kodama S, Saito K, Tanaka S, Maki M, Yachi Y, Asumi M, Sugawara A, Totsuka K, Shimano H, Ohashi Y, Yamada N, Sone H. Cardiorespiratory fitness as a quantitative predictor of all-cause moratility and cardiovascular events in healthy men and women: A meta-analysis. JAMA 2009; 301: 2014-2035
    PubMedGoogle Scholar
  • 25 Lucia A. Earnest Perez M. Cancer-related fatigue: can exercise physiology assist oncologists?. Lancet Oncol 2003; 4: 616-625
    CrossrefPubMedGoogle Scholar
  • 26 Mann T, Lamberts RP, Lambert MI. Methods of Prescribing Relative Exercise Intensity: Physiological and Practical Considerations. Sports Med 2012; 43: 613-625
    PubMedGoogle Scholar
  • 27 Meyer T, Lucia A, Earnest CP, Kindermann W. A conceptual framework for performance diagnosis and training prescription from submaximal gas exchange parameters-theory and application. Int J Sports Med 2005; 26 S1 S38-S48
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Mezzani A, Hamm LF, Jones AM, McBride PE, Moholdt T, Stone JA, Urhausen A, Williams MA. European Association for Cardiovascular Prevention and Rehabilitation; American Association of Cardiovascular and Pulmonary Rehabilitation; Canadian Association of Cardiac Rehabilitation . Aerobic exercise intensity assessment and prescription in cardiac rehabilitation: a joint position statement of the European Association for Cardiovascular Prevention and Rehabilitation, the American Association of Cardiovascular and Pulmonary Rehabilitation, and the Canadian Association of Cardiac Rehabilitation. Eur J Prev Cardiol 2013; 20: 442-467
    CrossrefPubMedGoogle Scholar
  • 29 Mishra SI, Scherer RW, Snyder C, Geigle PM, Berlanstein DR, Topaloglu O. Exercise interventions on health-related quality of life for people with cancer during active treatment. Cochrane Database Syst Rev 2012; 15: 8 Review
    PubMedGoogle Scholar
  • 30 Norton K, Norton L, Sadgrove D. Position statement on physical activity and exercise intensity terminology. J Sci Med Sport 2010; 13: 496-502
    CrossrefPubMedGoogle Scholar
  • 31 Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS, Schwartz AL, Bandera EV, Hamilton KK, Grant B, McCullough M, Byers T, Gansler T. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin 2012; 62: 243-274
    PubMedGoogle Scholar
  • 32 Ruiz-Casado A, Verdugo AS, Solano MJ, Aldazabal IP, Fiuza-Luces C, Alejo LB, del Hierro JR, Palomo I, Aguado-Arroyo O, Garatachea N, Cebolla H, Lucia A. Objectively assessed physical activity levels in Spanish cancer survivors. Oncol Nurs Forum 2014; 41: E12-E20
    CrossrefPubMedGoogle Scholar
  • 33 Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvão DA, Pinto BM, Irwin ML, Wolin KY, Segal RJ, Lucia A, Schneider CM, von Gruenigen VE, Schwartz AL. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc 2010; 42: 1409-1426
    CrossrefPubMedGoogle Scholar
  • 34 Speck RM, Courneya KS, Masse LC, Duval S, Schmitz KH. An update of controlled physical activity trials in cancer survivors: a systematic review and metha-analysis. J Cancer Surviv 2010; 4: 87-100
    CrossrefPubMedGoogle Scholar
  • 35 Steins Bisschop CN, Velthuis MJ, Wittink H, Kuiper K, Takken T, van derMeulen WJ, Lindeman E, Peeters PH, May AM. Cardiopulmonary exercise testing in cancer rehabilitation: a systematic review. Sports Med 2012; 42: 367-379
    CrossrefPubMedGoogle Scholar
  • 36 Swain D, Leutholtz B, King M, Haas L, Branch J. Relationship between % heart rate reserve and %VO2reserve in treadmill exercise. Med Sci Sports Exerc 1998; 30: 318-321
    CrossrefPubMedGoogle Scholar
  • 37 Wolin KY, Schwartz AL, Matthews CE, Courneya KS, Schmitz KH. Implementing the exercise guidelines for cancer survivors. J Support Oncol 2012; 10: 171-177
    CrossrefPubMedGoogle Scholar