Exercise Strategy for Cancer Survivors

(ACCESS Trial)

Overseen By Scott Grandy, MD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Nova Scotia Health Authority

Disqualifiers: Less than 18 years

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 30

Duration: 12 weeks

100 Participants Needed

Trial Summary

What is the purpose of this trial?

Cancer continues to have the dubious honor of being the leading cause of premature mortality in Canada. The good news is, advances in early detection and cancer treatments are extending the lives of those diagnosed with the disease. However, as more people are living longer, the impact of the therapies used to treat the disease are becoming increasingly apparent. Ranging from the physiological to psychological, cancer survivors are often confronted with substantial, disabling, and life-threatening consequences. The benefits of physical activity (all movement) and exercise more specifically have long been established as a means of prevention and treatment of chronic disease. Several recent reviews and meta-analyses have demonstrated that exercise is a safe and effective means of preventing and improving a multitude of physical and psychological treatment and disease-related sequelae across the cancer trajectory. For example, we know that cancer survivors who exercise not only have a reduced risk of disease recurrence and cancer mortality, but also have reduced acute/late effects of their cancer and/or its treatment such as anxiety, depression, and cancer-related pain. Regrettably, despite our substantial knowledge base, the majority of cancer survivors are not sufficiently active to realize these benefits over the long-term. Moreover, even with the development of evidence-based guidelines, exercise has not yet been widely implemented as a standard of care in the oncology setting largely due to a lack of resources, exercise expertise, and awareness of benefits. Continuing to provide cancer care with little guidance and understanding of the benefits of exercise places cancer survivors at an increased risk for recurrence, late effects, and/or onset of additional co-morbidities, and premature mortality. Therefore, it is important to consider best practices that will optimize and improve quality of survival. Building on the ongoing work of our Alberta-based colleagues and the Alberta Cancer Exercise (ACE) Program (an evidence-based clinic-to-community cancer exercise model), Activating Cancer Communities through an Exercise Strategy for Survivors (ACCESS) is designed to bridge the gap between research and practice and in doing so, lessen the impact of a cancer diagnosis and its treatment(s) on the physical and psychological well-being of cancer survivors.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of the treatment Exercise, Physical Activity, Workout, Fitness Training for cancer survivors?

Research shows that exercise can help cancer survivors cope with and recover from treatment, improve their health, and potentially extend their survival. It is considered a safe and beneficial addition to cancer care, helping to reduce treatment-related side effects. ^{1 2 3 4 5}

Is exercise safe for cancer survivors?

Exercise is generally safe for most cancer survivors and offers many benefits, such as improved physical function and quality of life. The American College of Sports Medicine recommends 150 minutes of moderate or 75 minutes of vigorous aerobic activity per week, along with resistance training. However, survivors with specific conditions like lymphedema or peripheral neuropathy should follow special precautions. ^{6 7 8 9 10}

How is the treatment of exercise unique for cancer survivors?

Exercise is unique for cancer survivors because it not only helps them cope with and recover from treatment, but also improves their overall health and extends survival. Unlike traditional treatments, exercise can enhance physical, mental, and social well-being, and it is tailored to individual needs to maximize benefits. ^{1 2 6 7 11}

Eligibility Criteria

This trial is for adults over 18 who have been diagnosed with cancer, whether they're about to start treatment, currently in treatment, or finished within the last 5 years. Participants should be able to do light exercise and commit to a 12-week program in Halifax.

Inclusion Criteria

I have been diagnosed with cancer.

Be willing to attend a 12-week exercise program in Halifax

Be able to provide informed written consent in English

Exclusion Criteria

I am under 18 years old.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

1 visit (in-person)

Baseline Assessment

Baseline physical fitness testing and cancer-specific screening measures are conducted to determine appropriateness for hospital or community-based physical activity participation

1 week

1 visit (in-person)

Treatment

Participants engage in a 12-week exercise program including aerobic, resistance, balance, and flexibility exercises delivered in a circuit-type class setting or group/individual personal training format

12 weeks

24 visits (in-person, twice weekly)

Follow-up

Participants are monitored for safety and effectiveness after treatment, with assessments at baseline, post-intervention, 6 and 12 month follow-up

12 months

4 visits (in-person)

Treatment Details

Interventions

• Exercise

Trial Overview The ACCESS program aims to integrate exercise as part of cancer care. It tests how effective a structured 12-week exercise regimen can be in improving physical and psychological health outcomes for cancer survivors.

Participant Groups

Group I: ACCESS Experimental Treatment 1 Intervention

Individuals that consent to the study will be assigned to a 12-week exercise program (ACCESS)

Who Is Running the Clinical Trial?

Nova Scotia Health Authority

Lead Sponsor

Trials

302

Recruited

95,300+

Findings from Research

Physical activity has been shown to significantly improve both patient-reported outcomes and physiological health in cancer survivors during and after treatment, highlighting its importance in recovery.

The review discusses ongoing phase III trials that are investigating the impact of physical activity on clinical disease endpoints, suggesting a strong focus on integrating exercise into cancer care to enhance patient outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Putting Exercise Into Oncology Practice: State-of-the-Science, Innovation, and Future Directions. Brown, JC., Ligibel, JA.[2023]

Regular physical exercise is associated with a reduced risk of developing colorectal and breast cancer, and may also lower the risk for prostate, endometrial, and lung cancers, based on a review of recent literature.

Exercise is beneficial for cancer survivors, aiding in recovery from treatment and potentially extending survival, although specific guidelines on the optimal amount, type, and intensity of exercise are still being developed.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercise in cancer. Rajarajeswaran, P., Vishnupriya, R.[2021]

Among cancer survivors, exercising in the afternoon (PM) led to significant improvements in fitness and lower-body muscular endurance, while morning (AM) or mixed exercise times did not show these benefits.

Mixed exercise timing was associated with less favorable outcomes, including increases in waist circumference, body weight, and BMI, suggesting that consistent AM or PM exercise may be better for weight management and overall health in cancer survivors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The association between time-of-day of habitual exercise training and changes in relevant cancer health outcomes among cancer survivors. Coletta, AM., Playdon, MC., Baron, KG., et al.[2023]

Exercise training is a safe and well-tolerated adjunct therapy for cancer patients, showing potential to reduce treatment-related side effects during and after adjuvant therapy.

Current evidence suggests that incorporating exercise into the care plan for cancer survivors may enhance their overall management, although further research is needed to fully understand its benefits across different stages of cancer survivorship.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercise therapy in the management of solid tumors. Jones, LW., Peppercom, J., Scott, JM., et al.[2021]

Adding behavioral counseling to a 4-week supervised physical activity program for kidney cancer survivors showed feasibility and a potential increase in physical activity levels, although the increase was not statistically significant.

Participants receiving behavioral counseling improved their 6-minute walk distance significantly more than those receiving standard exercise counseling, suggesting that behavioral strategies may enhance fitness outcomes in cancer survivors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Feasibility and preliminary efficacy of adding behavioral counseling to supervised physical activity in kidney cancer survivors: a randomized controlled trial. Trinh, L., Plotnikoff, RC., Rhodes, RE., et al.[2014]

Exercise has been shown to improve key physical health markers in breast cancer survivors, such as peak oxygen consumption, muscle strength, and cardiovascular health, which are linked to better overall health outcomes.

The review will provide recommendations for exercise interventions tailored to breast cancer survivors, highlighting the importance of physical activity in reducing risks of disability and chronic diseases.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinically Relevant Physical Benefits of Exercise Interventions in Breast Cancer Survivors. Kirkham, AA., Bland, KA., Sayyari, S., et al.[2018]

Exercise is an effective rehabilitative intervention for cancer survivors, as it helps maintain body weight and bone mass, particularly in a high-risk population like breast cancer survivors, based on findings from 25 randomized controlled trials.

While most trials showed no significant weight change, some indicated reductions in fat mass and increases in lean mass, highlighting the need for further research to optimize exercise interventions for improving quality of life in cancer survivors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercise and cancer. Knobf, MT., Winters-Stone, K.[2014]

Regular exercise significantly reduces the recurrence and mortality rates of several common cancers, and can improve quality of life and physical function in cancer survivors, with moderate activity like walking 30 minutes a day being effective.

The American College of Sports Medicine recommends 150 minutes of moderate or 75 minutes of vigorous aerobic activity per week for cancer survivors, emphasizing that exercise is generally safe and should be encouraged, while also noting the need for specific precautions for those with certain medical conditions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Initiating Exercise Interventions to Promote Wellness in Cancer Patients and Survivors. Schwartz, AL., de Heer, HD., Bea, JW.[2022]

Exercise is deemed safe and beneficial for cancer survivors, leading to improvements in physical function, strength, fatigue, quality of life, and potentially reducing recurrence and improving survival rates.

The guidelines developed by the American College of Sports Medicine provide a framework for oncology care providers to effectively collaborate with exercise and physical therapy professionals to implement these exercise recommendations in clinical practice.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Implementing the exercise guidelines for cancer survivors. Wolin, KY., Schwartz, AL., Matthews, CE., et al.[2023]

Physical activity is linked to a lower risk of developing breast cancer and recurrence, as well as improved survival rates, based on observational studies.

Engaging in physical activity can alleviate treatment-related side effects, such as fatigue from chemotherapy and musculoskeletal issues from aromatase inhibitors, highlighting its importance in breast cancer survivorship.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Physical Activity and Breast Cancer: an Opportunity to Improve Outcomes. Peterson, LL., Ligibel, JA.[2019]

Regular moderate exercise significantly enhances physical, mental, and social well-being in breast cancer survivors after treatment, promoting overall recovery and quality of life.

A supportive environment and positive mindset towards exercise are crucial for encouraging breast cancer survivors to adopt and maintain an active lifestyle, which can improve their physical strength and endurance post-therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Maximizing exercise in breast cancer survivors. Adkins, BW.[2009]

References

1. United States pubmed.ncbi.nlm.nih.gov

Putting Exercise Into Oncology Practice: State-of-the-Science, Innovation, and Future Directions. [2023]

2. Germany pubmed.ncbi.nlm.nih.gov

Exercise in cancer. [2021]

3. United States pubmed.ncbi.nlm.nih.gov

The association between time-of-day of habitual exercise training and changes in relevant cancer health outcomes among cancer survivors. [2023]

4. United States pubmed.ncbi.nlm.nih.gov

Exercise therapy in the management of solid tumors. [2021]

5. United States pubmed.ncbi.nlm.nih.gov

Feasibility and preliminary efficacy of adding behavioral counseling to supervised physical activity in kidney cancer survivors: a randomized controlled trial. [2014]

6. United States pubmed.ncbi.nlm.nih.gov

Clinically Relevant Physical Benefits of Exercise Interventions in Breast Cancer Survivors. [2018]

7. United States pubmed.ncbi.nlm.nih.gov

Exercise and cancer. [2014]

8. United States pubmed.ncbi.nlm.nih.gov

Initiating Exercise Interventions to Promote Wellness in Cancer Patients and Survivors. [2022]

9. United States pubmed.ncbi.nlm.nih.gov

Implementing the exercise guidelines for cancer survivors. [2023]

10. United States pubmed.ncbi.nlm.nih.gov

Physical Activity and Breast Cancer: an Opportunity to Improve Outcomes. [2019]

11. United States pubmed.ncbi.nlm.nih.gov

Maximizing exercise in breast cancer survivors. [2009]