**8. Conclusion**

120 Topics in Cancer Survivorship

Courneya and colleagues also completed a similar trial of aerobic exercise vs usual care in breast cancer survivors who had completed adjuvant treatment, and observed similar favorable effects of exercise on fitness and overall quality of life (Courneya et al., 2003). Overall, these, and other, studies have demonstrated that exercise is safe in cancer survivors and produces beneficial effects on quality of life and cancer-related symptoms with no

A long-term concern in breast-cancer survivors starting an exercise program is lymphoedema. The few studies that have assessed this issue clearly showed that upper body exercise does not induce or exacerbate lymphoedema, and on the contrary, it would

**7.2.3 Physician should know and understand the influence of their beliefs on physical** 

General practitioners (GP) are cited as the primary source of information influencing healthy lifestyle decisions, but few studies have evaluated whether GPs' perceived barriers towards physical activity affect physical activity uptake in their patients. In type 2 diabetes patients, Duclos et al. (2011) have assessed the associations between GPs' perceived barriers to prescribing physical activity and type 2 diabetes patients' perceived barriers to adopting physical activity. Their findings showed that GPs' physical activity and GPs' perceived barriers, are associated with type 2 diabetes patients' physical activity. An effect of GPs barriers on patients' ones towards physical activity was depicted since the higher the GP's barriers score, the higher the type 2 diabetes patient's barriers score. Examining the nature of perceived barriers to physical activity in both type 2 diabetic patients (regarding physical activity practice) and their GPs (regarding physical activity prescription), common barriers emerged with a high score: "A low fitness level", "The fear of being tired", "Their actual physical health status, excluding diabetes", "The fear of suffering a heart attack". These common barriers are inconsistent with evidence-based medicine (Haskell et al., 2007). These results are consistent with the hypothesis that the beliefs of GPs might influence the beliefs of their type 2 diabetes patients. Finally, GPs' physical activity was positively correlated

It has been shown that endorsement of physical activity is more credible coming from a professional who practices physical activity (Abramson et al., 2000). GPs should practise physical activity themselves, not only for their own benefit, but also as a stimulus for

It remain to determine if this proves to be the case in cancer survivors. However this suggests that identifying and working on GPs' barriers but also promoting physical activity

As in other clinical and non-clinical populations, cancer survivors should obtain clearance from their physician or oncologist program. This clearance is especially important in cancer survivors who are at high risk for late-occurring toxic effects secondary to treatment that can increase their risk of cardiovascular disease. Thus, appropriate screening procedures for cardiac and cardiovascular disease are recommended before an exercise program is started. The prerequisite is that patients have obtained the prior agreement of their cancer specialist and that patients should be screened for osteoporosis, bone metastasis, cardiac toxicities,

adverse side effects.

seem that a suitable AP allow to limit this risk.

with their patients' physical activity.

**7.2.4 Recommendations for physicians** 

and lymphedema.

physical activity of their patients (Duclos et al., 2011).

in GPs may improve the uptake of physical activity in their patients.

**activity on the beliefs and physical activity of their patients** 

There is a large body of evidence that physical activity has an important role in prevention and management of cancer: physical activity reduces risk of breast and colon cancer, during and after cancer treatment physical activity ameliorate symptom experience, ameliorate treatment side effects, improve quality of life and reduce mortality and morbidity. As such, regular physical activity should be encouraged in all populations (general population, subjects at high risk of cancer, survivors of cancer… and in physicians) throughout all life. Now, the question is not: "why should I prescribe physical activity in my patients?" but "How initiating and maintaining physical activity in patients?". Initiating exercise is important; however, maintaining an exercise regimen long term is a significant challenge. Behavioural interventions are complex and involve multidisciplinary approach (patients, physicians, scientists, government, urbanists…). Whatever, it's time to get moving and it is never too late to get moving!
