Articulo ejercicio físico y cancer

SPECIAL COMMUNICATIONS
Roundtable Consensus Statement

American College of Sports Medicine Roundtable on Exercise Guidelines for Cancer Survivors
EXPERT PANEL
Kathryn H. Schmitz, PhD, MPH, FACSM Kerry S. Courneya, PhD Charles Matthews, PhD, FACSM Wendy Demark-Wahnefried, PhD ˜ Daniel A. Galvao, PhD Bernardine M. Pinto, PhD Melinda L. Irwin, PhD, FACSM Kathleen Y. Wolin, ScD, FACSM Roanne J.Segal, MD, FRCP Alejandro Lucia, MD, PhD Carole M. Schneider, PhD, FACSM Vivian E. von Gruenigen, MD Anna L. Schwartz, PhD, FAAN
to physical functioning and quality of life are sufficient for the recommendation that cancer survivors follow the 2008 Physical Activity Guidelines for Americans, with specific exercise programming adaptations based on disease and treatment-related adverse effects. Theadvice to ‘‘avoid inactivity,’’ even in cancer patients with existing disease or undergoing difficult treatments, is likely helpful.

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Early detection and improved treatments for cancer have resulted in roughly 12 million survivors alive in the United States today. This growing population faces unique challenges from their disease and treatments, including risk for recurrent cancer, otherchronic diseases, and persistent adverse effects on physical functioning and quality of life. Historically, clinicians advised cancer patients to rest and to avoid activity; however, emerging research on exercise has challenged this recommendation. To this end, a roundtable was convened by American College of Sports Medicine to distill the literature on the safety and efficacy of exercise trainingduring and after adjuvant cancer therapy and to provide guidelines. The roundtable concluded that exercise training is safe during and after cancer treatments and results in improvements in physical functioning, quality of life, and cancer-related fatigue in several cancer survivor groups. Implications for disease outcomes and survival are still unknown. Nevertheless, the benefits0195-9131/10/4207-1409/0 MEDICINE & SCIENCE IN SPORTS & EXERCISEÒ Copyright Ó 2010 by the American College of Sports Medicine. DOI: 10.1249/MSS.0b013e3181e0c112

n 2009, the American Cancer Society (ACS) estimated that there were nearly 1.5 million new cases of cancer diagnosed in the United States and just more than 500,000 people who died from the disease (76). Currently, there are close to 12 millioncancer survivors in the United States, and this number grows each year (66,70,122). Improved prognosis on the basis of earlier detection and newer treatments has created a welcomed new challenge of addressing the unique needs of cancer survivors, which include the sequelae of the disease, its treatment, and conditions predating diagnosis. Cancer is a disease largely associated with aging: mostsurvivors are older than 65 yr (112). Nearly half are survivors of breast or prostate cancer (66). Colon, hematological, and endometrial cancers each account for approximately 10% of survivors (66). In the last two decades, it has become clear that exercise plays a vital role in cancer prevention and control (25,140). Courneya and Friedenreich (26) proposed a Physical Activity and Cancer ControlFramework that highlights specific phases along the cancer continuum where exercise has a logical role (Fig. 1) and identifies two distinct periods before diagnosis and four periods after diagnosis with objectives for exercise programs in each phase. There is a growing body of evidence suggesting that exercise decreases the risk of many of cancers (107,140), and data to support the premise that exercisemay extend survival for breast and colon cancer survivors are emerging (68,73,91,92). Our focus here is on the influence of regular exercise on the health,

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Copyright © 2010 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.

FIGURE 1—Physical activity and cancer control framework. (Reprinted from Courneya KS, Friedenreich CM....