Most Canadians know that being physically active is important for overall health. But did you know that physical activity may be particularly important for young people diagnosed with cancer?

Children, adolescents, and young adults diagnosed with cancer experience many negative effects, like fatigue and pain, and are at greater risk for chronic health conditions and early mortality (Armenian et coll., 2020; Chao et coll., 2020; Hallquist Viale, 2016; Phillips et coll., 2015). Researchers have found that physical activity is a safe way to decrease some of the negative effects young people diagnosed with cancer experience.

Physical activity can also improve physical fitness (for example, strength and flexibility) and mental health (for example, feelings of anxiety or stress; Beulertz et coll., 2016; Kim et Park, 2019; Munsie et coll., 2022; Rabin et coll., 2016). There is also evidence to suggest that physical activity might help young people diagnosed with cancer think and remember better (Riggs et coll., 2017; Wurz, Ayson, et coll., 2021). This evidence has been summarized in reviews (Munsie et coll., 2019; Wurz, McLaughlin, Lategan, Ellis, et coll., 2021), which collectively suggest that it is time for young people diagnosed with cancer to “move more.”

Unfortunately, starting or increasing physical activity is challenging, even without a cancer diagnosis. We know that many young people diagnosed with cancer are not active enough to receive health benefits (Götte et coll., 2022; Rabin, 2011).

Below, we outline steps that exercise professionals, physical activity programmers, or coaches can take to support physical activity among young people diagnosed with cancer.

1) Prioritize safety

It is always important to ensure your participant is ready to start or maintain physical activity. You may be aware of helpful screening tools, like the Get Active Questionnaire. However, when working with young people diagnosed with cancer, it is important do further screening. Even if you have qualifications to screen for participation in physical activity, we recommend collecting additional information covering treatment, other medical issues, current symptoms that could impact physical activity or exercise, and physical restrictions (Wurz, McLaughlin, Lategan, Chamorro Viña, et coll., 2021). If feasible, we also suggest you try connecting with your participant’s healthcare team to gain further information and confirmation of readiness to engage in exercise (Wurz, McLaughlin, Lategan, Chamorro Viña, et coll., 2021). From there, you can continue prioritizing safety by following the tips below:

Start low and progress slow. This means going back to basics and choosing activities that are easy for your participant to complete. Choose modified versions of exercises, see how they feel and then build up difficulty over time. For example, if you are working on lower body strength with a young adult, you could have them start with a seated leg extension. If that is feeling okay, you could then have them progress to a sit to stand. From there they could try a body weight squat. It is important to meet the participant where they are at, and only progress as they feel comfortable.

Check-in during physical activity. Ask your participant to reflect on how hard they are working. We like using a Rating of Perceived Exertion/Effort (RPE) scale ranging from 0 (no effort) to 10 (the hardest exercise you could imagine or have experienced). Another easy way to check-in on intensity is by using the Talk Test. These tools can be helpful to ensure you start low and progress slow.

Set up for safety. Many young people diagnosed with cancer experience trouble with balance and peripheral neuropathy (weakness, numbness, pain in the hands and feet). Make sure you clear some space, keep equipment off to the side, and consider appropriate footwear. It can also be helpful to have a chair or wall nearby for additional support that they can use for certain exercises or to hold on to for balance.

2) Make it fun

As exercise professionals, physical activity programmers, or coaches you might be focused on the exercise prescription specifics, but we know that making it fun is important, especially for young people. You can increase the fun factor by asking what physical activity your participant already likes to do, re-naming exercises using favourite books or movies as an inspiration or coming up with themed workouts.

For example, if you have a participant who loves animals and the zoo, you could create an animal themed workout where you and the child act out various animals (for example, standing like a flamingo to work on balance, flapping bird wings to open through the chest). You can also switch things up and try new activities or try integrating elements of (or practicing) your participant’s favourite sport. Researchers have found that sport-based interventions can improve quality of life and fatigue among young people affected by cancer (Götte et coll., 2014).

3) Make it a family (and friends) affair

Moving with family and friends is also a great way to up the fun factor, and it can provide additional support to help young people get their physical activity minutes in. Parents are often key physical activity supporters, so including them in the session can be a useful strategy for exercise professionals or coaches. Many young people may also have siblings. Consider offering sibling sessions, which may help ease the burden for parents to fit in everyone’s extracurricular activities. Or, you may consider having your participant invite their friends to try new activities or sports with them. Including family and friends can help improve feelings of confidence for physical activity, which can help support long-term physical activity behaviour (Gilliam et coll., 2012).

If you are feeling ready to help young people diagnosed with cancer start or maintain physical activity, here are some additional, evidence-based resources that may be of interest to you.

Recommended resources

• International Pediatric Oncology Exercise Guidelines – this article provides guidance and recommendations to help children and adolescents affected by cancer move more.
• International Pediatric Oncology Exercise Guidelines Toolkit – this toolkit includes free, downloadable resources that you can give to your participants to encourage them to move more.
• The Pediatric Oncology Exercise Manual – this free, downloadable manual provides detailed evidence-based information and resources that you can use to support your participants’ physical activity.
• Pediatric and Young Adult Cancer et Exercise Training – these online training modules seek to equip exercise professionals, such as yourself, with knowledge about cancer types, common treatments and side effects, the evidence for physical activity, and practical tips to promote physical activity.
• IMplementation of Physical Activity for Children and adolescents on Treatment – this ongoing study is testing the effects of an individually tailored, 1:1 physical activity intervention delivered by an exercise professional over Zoom 2-3 times per week for 12 weeks. Any child or adolescent between 5-18 years who has been diagnosed with cancer or blood disease in Alberta and who is currently receiving, scheduled to receive, or has completed treatment within the past three months is eligible to participate.
• Yoga for Young Adults: This is an ongoing study testing the effects of a group-based yoga intervention delivered over Zoom 2 times per week for 12 weeks. Any young adult living in Canada who has been diagnosed with cancer between the ages of 18-39 years is eligible to participate.

We hope you will use these resources in your efforts to help more young people diagnosed with cancer “move more” to receive the benefits physical activity can offer. If you want to learn more about any of this information or the resources listed, please contact us at wellnesslab@ucalgary.ca.

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About the Author(s)

Amanda Wurz, Ph.D., ACSM-CPT, is an Assistant Professor in the School of Kinesiology at the University of the Fraser Valley. Her research explores physical activity as a strategy to promote wellness and quality of life among young people diagnosed with cancer. She has expertise in behaviour change, physical activity promotion, and intervention implementation.

Emma McLaughlin, MSc, is a PhD student working with Dr. Culos-Reed and the Health & Wellness Lab within the Faculty of Kinesiology at the University of Calgary. Her program of research is focused on resource development and program implementation to support children, adolescents, and young adults affected by cancer to move more.

Nicole Culos Reed, Ph.D., is a Professor and the Director of the Health & Wellness Lab within the Faculty of Kinesiology at the University of Calgary. She is a behaviour change researcher with expertise in implementation research and development of sustainable community resources to enhance wellness in cancer survivorship.

References

Armenian, S. H., Xu, L., Cannavale, K. L., Wong, F. L., Bhatia, S., et Chao, C. (2020). Cause-specific mortality in survivors of adolescent and young adult cancer. Cancer, 126(10), 2305-2316. https://doi.org/10.1002/cncr.32775

Beulertz, J., Prokop, A., Rustler, V., Bloch, W., Felsch, M., et Baumann, F. T. (2016). Effects of a 6-month, group-based, therapeutic exercise program for childhood cancer outpatients on motor performance, level of activity, and quality of life. Pediatric Blood et Cancer, 63(1), 127-132. https://doi.org/10.1002/pbc.25640

Chao, C., Bhatia, S., Xu, L., Cannavale, K. L., Wong, F. L., Huang, P. S., Cooper, R., et Armenian, S. H. (2020). Chronic comorbidities among survivors of adolescent and young adult cancer. Journal of the American Society of Clinical Oncolog, 38(27), 3161-3174. https://doi.org/10.1200/JCO.20.00722

Gilliam, M. B., Madan-Swain, A., Whelan, K., Tucker, D. C., Demark-Wahnefried, W., et Schwebel, D. C. (2012). Social, demographic, and medical influences on physical activity in child and adolescent cancer survivors. Journal Pediatric Psychology, 37(2), 198-208. https://doi.org/10.1093/jpepsy/jsr085

Götte, M., Basteck, S., Beller, R., Gauss, G., Schmidt, S., Burchartz, A., Kolb, S., Grydeland, M., et Reinhardt, D. (2022). Physical activity in 9-15 year-old pediatric cancer survivors compared to a nationwide sample. Journal of Cancer Research and Clinical Oncology. https://doi.org/10.1007/s00432-022-04392-5

Götte, M., Taraks, S., et Boos, J. (2014). Sports in pediatric oncology: the role(s) of physical activity for children with cancer. Journal of Pediatric Hematology/Oncology, 36(2), 85-90. https://doi.org/10.1097/MPH.0000000000000101

Hallquist Viale, P. (2016). Late effects: focus on adolescent and young adult cancer survivors. J Journal of Advanced Practitioner in Oncology, 7(1), 15-16. https://doi.org/10.6004/jadpro.2016.7.1.1

Kim, Y., et Park, S. (2019). Feasibility and benefits of a combined programme of exercise and play for paediatric cancer survivors: A pilot study. European Journal of Cancer Care, 28(5), e13111. https://doi.org/10.1111/ecc.13111

Munsie, C., Ebert, J., Joske, D., et Ackland, T. (2019). The benefit of physical activity in adolescent and young adult cancer patients during and after treatment: a systematic review. Journal of Adolescent and Young Adult Oncology, 8(5), 512-524. https://doi.org/10.1089/jayao.2019.0013

Munsie, C., Ebert, J., Joske, D., et Ackland, T. (2022). A randomised controlled trial investigating the ability for supervised exercise to reduce treatment-related decline in adolescent and young adult cancer patients. Supportive Care in Cancer, 30(10), 8159-8171. https://doi.org/10.1007/s00520-022-07217-w

Phillips, S. M., Padgett, L. S., Leisenring, W. M., Stratton, K. K., Bishop, K., Krull, K. R., Alfano, C. M., Gibson, T. M., de Moor, J. S., Hartigan, D. B., Armstrong, G. T., Robison, L. L., Rowland, J. H., Oeffinger, K. C., et Mariotto, A. B. (2015). Survivors of childhood cancer in the United States: prevalence and burden of morbidity. Cancer Epidemiolology, Biomarkers et Prevention, 24(4), 653-663. https://doi.org/10.1158/1055-9965.EPI-14-1418

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Rabin, C., Pinto, B., et Fava, J. (2016). Randomized trial of a physical activity and meditation intervention for young adult cancer survivors. Journal for Adolescent and Young Adult Oncology, 5(1), 41-47. https://doi.org/10.1089/jayao.2015.0033

Riggs, L., Piscione, J., Laughlin, S., Cunningham, T., Timmons, B. W., Courneya, K. S., Bartels, U., Skocic, J., de Medeiros, C., Liu, F., Persadie, N., Scheinemann, K., Scantlebury, N., Szulc, K. U., Bouffet, E., et Mabbott, D. J. (2017). Exercise training for neural recovery in a restricted sample of pediatric brain tumor survivors: a controlled clinical trial with crossover of training versus no training. Neuro-Oncology, 19(3), 440-450. https://doi.org/10.1093/neuonc/now177

Wurz, A., Ayson, G., Smith, A. M., et Brunet, J. (2021). A proof-of-concept sub-study exploring feasibility and preliminary evidence for the role of physical activity on neural activity during executive functioning tasks among young adults after cancer treatment. BMC Neurology, 21(1), 300. https://doi.org/10.1186/s12883-021-02280-y

Wurz, A., McLaughlin, E., Lategan, C., Chamorro Viña, C., Grimshaw, S. L., Hamari, L., Götte, M., Kesting, S., Rossi, F., van der Torre, P., Guilcher, G. M. T., McIntyre, K., et Culos-Reed, S. N. (2021). The international Pediatric Oncology Exercise Guidelines (iPOEG). Translational Behavioral Medicine, 11(10), 1915-1922. https://doi.org/10.1093/tbm/ibab028

Wurz, A., McLaughlin, E., Lategan, C., Ellis, K., et Culos-Reed, S. N. (2021). Synthesizing the literature on physical activity among children and adolescents affected by cancer: evidence for the international Pediatric Oncology Exercise Guidelines (iPOEG). Translational Behavioral Medicine, 11(3), 699-708. https://doi.org/10.1093/tbm/ibaa136

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