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**9** 

Karen Y. Wonders

*United States of America* 

**The Role of Exercise in Cancer Survivorship** 

At the turn of the 20th century, the outlook was bleak for individuals diagnosed with cancer. The pathophysiology of cancer was not well understood, and the associated treatments were as dire as the disease itself. In 1971, President Nixon declared "war" on cancer (Haran & DeVita, 2005). Since then we have seen dramatic improvements in cancer prognoses. At present, more than 11.7 million men and women are living as cancer survivors in the US, primarily due to early detection and advances in treatment options (Centers for Disease Control, 2007). However, such treatments often result in long-term physical and psychological toxicities, which negatively impact the cancer survivor's quality of life (QOL). These sequelae include, but are not limited to, decreased muscle strength, reduced cardiorespiratory fitness, reduced lean body mass, bone loss, fatigue (Pihkala et al., 1995; Lucia et al., 2003), depression, emotional distress, and anxiety (Jones et al., 2010). Thus, cancer research has shifted from its initial focus on prevention, to one that is centered on controlling or eliminating treatmentrelated toxicities with pharmacologic, physical, or social interventions. Now more than ever, healthy behavior choices are being promoted in attempt to limit this disease. In 2006, 42% of NIH-funded research projects contained an intervention component designed to improve the psychosocial well-being, physical status, and/or health behaviors of cancer survivors (National Institutes of Health, 2011). One such intervention, exercise rehabilitation, has been widely reported in the literature to benefit cancer patients. With more than two decades of literature examining this topic, research continues to support a link between a physically active lifestyle and improvements in mental and physical QOL in cancer survivors (Douglas, 2005; Wiggins & Simonavice, 2009).Thus, the primary aim of this chapter will be to explore the

Cancer survivors often have disease or treatment-specific limitations that affect the exercise response. The specific effects of cancer on the exercise response are determined by the tissues affected and their level of involvement. Treatment-specific limitations arise from the type and duration of anticancer therapy employed. Surgery, chemotherapy, and radiation are the most common forms of cancer treatment, and all are associated with both acute and chronic effects that may negatively impact the exercise response. Table 1 briefly lists some of the more common treatment-related effects. In addition, most people are treated with a combination of surgery, radiation, and chemotherapy, which may cause a host of treatmentrelated problems. Pain, lymphedema, risk of infection, shortness of breath, neural deficits,

**1. Introduction** 

role of physical activity and exercise in cancer recovery.

**2. Precautions during exercise** 

*Wright State University, Maple Tree Cancer Alliance, Dayton,* 

