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Structured exercise has the strongest evidence of any recovery intervention, including a randomised survival benefit in colon cancer. In a population survey of blood cancer survivors, 46 per cent met neither the aerobic nor the strength guideline and 22 per cent met both, and meeting both was associated with having been to university.
The evidence for exercise after cancer treatment is covered on the existing exercise records and on the body facet of this front. This record is about the distance between that evidence and what happens.
The measured uptake. In a population-based cross-sectional survey of 606 haematologic cancer survivors in Alberta, with separate assessment of aerobic and strength behaviour, "22% of HCS met the combined exercise guideline, 22% met aerobic-only, 10% met strength-only, and 46% met neither exercise guideline". Strength training is the weaker half: only 32 per cent met the strength guideline at all, in either combination. Survivors were more likely to meet the combined guideline than a single guideline if they had completed university, and more likely if they had no children living at home.
Why the strength half matters here specifically. The things this front describes as recoverable, muscle lost to disuse and treatment, bone lost to endocrine therapy, the physical function that walks somebody up stairs, respond to resistance training specifically. An exercise service that offers only a walking group is not delivering the prescription the trials used.
What is actually offered. Australia's national cancer body states that exercise should be part of standard cancer care rather than general advice, which is the clearest national position of its kind. Whether a person can get a supervised programme depends on local commissioning everywhere we looked, and the supervised element is the part that is hard to fund: the exercise consensus work finds supervised programmes better than unsupervised for mood, while for fatigue the two are similar.
The structural barriers, in the order they bite. Referral: nobody refers if nobody screens for function. Transport and time: a supervised programme twice a week for twelve weeks is a large ask of somebody working, caring or travelling far. Cost: where programmes are not commissioned, they are paid for privately. Confidence: people who have been ill are frightened of exertion and need supervision to start, which is the expensive part. Education, which the Alberta data identify directly, probably stands in for several of these.
What would close it. The measurement is cheap, grip strength and a chair stand cost nothing. The prescription is published. The missing piece is a referral pathway attached to the end of treatment and somebody funded to supervise the first weeks, which is the same missing piece as for rehabilitation.
An intervention that requires sustained behaviour, supervision to begin safely, transport, time and often payment will be taken up in proportion to the resources a person has, regardless of how strong the evidence for it is. Evidence strength and uptake are independent, and nothing about the first fixes the second.
Query for this technology: (TITLE:"Exercise is the best-evidenced thing on this front, and most survivors are not doing it" OR ABSTRACT:"Exercise is the best-evidenced thing on this front, and most survivors are not doing it") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Exercise is the best-evidenced thing on this front, and most survivors are not doing it, not a curated reading list.
Shares Who misses out on recovery care, measured, Knowledge reaches practice too slowly, Late effects and survivorship toxicity, Survivorship and late effects are neglected and the tags rejuvenation, survivorship, measurement, access, equity.
Shares After treatment in Australia: a stated model of survivorship care, Referral to rehabilitation: the service most people who need it never see, Who misses out on recovery care, measured, Not enough oncologists, nurses, pathologists, physicists and the tags rejuvenation, survivorship, measurement, access.
Shares Referral to rehabilitation: the service most people who need it never see, The exercise prescription after cancer: the dose the guidelines state, Late effects and survivorship toxicity, Survivorship and late effects are neglected and the tags rejuvenation, survivorship, measurement, access.
Shares Referral to rehabilitation: the service most people who need it never see, Who misses out on recovery care, measured, Late effects and survivorship toxicity, Survivorship and late effects are neglected and the tags rejuvenation, survivorship, measurement, access.
Shares Walking, gripping and standing up: the tests that take five minutes, Who misses out on recovery care, measured, Late effects and survivorship toxicity, Survivorship and late effects are neglected and the tags rejuvenation, survivorship, measurement, access.
Shares Walking, gripping and standing up: the tests that take five minutes, Structured exercise programmes after curative treatment, The exercise prescription after cancer: the dose the guidelines state, Survivorship and late effects are neglected and the tags rejuvenation, survivorship, measurement.
Shares Walking, gripping and standing up: the tests that take five minutes, Who misses out on recovery care, measured, Cancer-related fatigue (tiredness), Late effects and survivorship toxicity and the tags rejuvenation, survivorship, measurement.
Shares Referral to rehabilitation: the service most people who need it never see, Walking, gripping and standing up: the tests that take five minutes, Sarcopenia, The exercise prescription after cancer: the dose the guidelines state and the tags rejuvenation, survivorship.