Keeping Patients With Cancer Exercising in the Age of COVID-19

Abstract

The novel 2019 coronavirus disease (COVID-19) pandemic is a global public health emergency. To date, physical distancing and good personal hygiene have been the only effective measures to limit spread. The pandemic has altered routine cancer care, including allied health and supportive care interventions. Clinicians must adapt and find ways to continue to deliver optimal patient care at this time. The prescription of exercise to people with cancer has been demonstrated to have meaningful benefits for both physical and mental health and quality of life, and may even enhance survival. Such exercise interventions provide the largest benefit to patients when delivered in a supervised, group, clinic-based setting. In the age of COVID-19, group-based exercise in communal facilities presents risks for both aerosol and surface transmission of the virus among people exercising, necessitating a pivot from the usual methods of exercise delivery to home-based exercise programs. In this article, we discuss the challenges that need to be overcome in moving to a home-based program for patients with cancer while maintaining the benefits of targeted and high-fidelity exercise medicine. We provide practical recommendations for how home-based exercise can be supported and nurtured by qualified exercise professionals who treat people living with cancer, as well as pointing to resources that are available online to assist practitioners. Despite the challenges faced during this pandemic, we believe that it is important for people to continue to benefit from exercise in a safe environment with the support of exercise specialists.

Fig 1.

Triage pathway of patients with cancer and survivors from diagnosis to referral to a qualified exercise professional (QEP), risk stratification, and prescription of a tailored exercise program. Setting of exercise program depends on patient risk profile, with digital exercise medicine providing support in each environment, as appropriate. Patients may migrate between settings as health and risk profile change. Modified from Santa Mina et al CPET, cardiopulmonary exercise test.

Fig 2.

Appropriate setting and supervision intersect with patient risk and relative contraindications as well as cancer-specific complexities, for example, bone metastases. Because of COVID-19, setting may be limited to park or home, requiring much higher fidelity telehealth support to manage risk and optimize effectiveness. QEP, qualified exercise professional.