Fitness
What an Oncology APP Should Know About Exercise in Cancer Care | Oncology Nursing News
Oncology advanced practice providers (APPs) should be aware of the transformative potential of exercise in cancer care and how to get patients started with a feasible exercise plan, said Daniel Glidden, MS, PA-C.
Ahead of his presentation at JADPRO Live 2025 on evidence-based diet and exercise tactics for patients with cancer, Glidden spoke with Oncology Nursing News about the key evidence APPs should be aware of, as well as actionable changes that can be made to incorporate exercise in patients’ care plans.
What data supports exercise as an essential part of cancer care?
For the longest time, we’ve had observational data that associates exercise and proper nutrition with improved survival, but it’s always been observational data. Now we have the first randomized, controlled trial—the
This was a phase 3 randomized controlled trial that randomized patients into either receiving health education materials alone or receiving health education materials plus a structured exercise program where they would go in for a supervised exercise and also have either in-person or virtual visits to talk about behavioral change to increase their exercise. What they found, of course, was that people in that exercise group had increased physical fitness in terms of their VO2 max and their 6-minute walk test and so on, but also that their disease-free survival was significantly improved. Around the 8-year mark, there was a [7%] improvement in disease-free survival in the patients in the intervention group. There was also an overall survival benefit.
Do the CHALLENGE data set a standard for all types of cancer care?
This is the first randomized control trial to show the true survival benefit that exercise can confer, at least in this patient population. We can’t extrapolate those data to all different cancers, but we have some good observational data that tells us that that there’s improved survival in many different cancers with exercise. As more of these studies come out, we’ll see more that exercise truly can be helpful for survival in cancer.
What level of exercise should patients with cancer be told to follow?
The general guidelines for people with cancer to start seeing health benefits from exercise are to get between 150 and 300 minutes of moderate-intensity aerobic exercise per week. Moderate-intensity aerobic exercise is a brisk walk where, if you’re walking with a friend, you can have a good conversation with them, but if you tried to sing a song, you’d get out of breath. That’s a good “talk test” for moderate intensity exercise. We recommend that [routine], plus 2 to 3 days per week, getting resistance training of the major muscle groups for about a half hour at a time.
How can exercise plans be personalized for each patient?
The first step is finding out what people are doing. Are they exercising regularly? Are they exercising somewhat or completely sedentary? If they’re completely sedentary, I wouldn’t tell them to just go right off and exercise to those guidelines. We would want to start off slow and do a stepwise approach. …For many of our patients, cancer is not their only chronic condition, and there may be other safety issues like their neuropathy or bone [metastases] or poor bone health in general that we must take into consideration when we’re creating an exercise prescription.
What should all oncology APPs know about exercise in cancer care?
Exercise counseling is something that [oncology APPs] can integrate into their clinical visits. I want them to know that the true benefit of exercise is not just something that we can do, it’s something that we should be doing, all of us. If exercise was a medicine in a pill form, it would be something that we would all be lining up around the corner at our doctor’s offices to get a prescription for. Really, exercise truly is medicine.
What is integrative oncology, and what made you choose this field?
Integrative oncology is a patient-centered approach to cancer care that looks at the whole patient and combines their conventional cancer care with other treatment modalities like exercise; nutrition; stress management; and mind-body therapies like yoga, tai chi, and meditation to take care of the whole person.
I started off my career working first in emergency medicine, then in medical oncology. While I was working in medical oncology, I saw that we were doing a great job treating the cancer. We were winning the battle more and more, but there’s still a person there who needs to be taken care of, and that person was undoubtedly cared for by their cancer team. But there is certainly more that can be done.
I made the transition into integrative oncology at Dana-Farber so I could spend my entire clinical practice emphasizing and optimizing health, wellness, and quality of life. I will see people for consults and people come to me for different reasons. Sometimes it’s for treatment-related adverse effects. In those cases, we talk about how can acupuncture be helpful? For hot flashes, joint pains, or neuropathy, how can exercise, proper nutrition, and stress management be helpful?
This transcript has been edited for clarity and conciseness.
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Physical activity saves lives, but now it turns out there’s a “precise dosage” at which it becomes especially effective in preventing heart disease.
Exercising is key to longevity; it’s been associated with everything from improved cardiovascular health to increased strength to a longer life. But there’s one exercise, in particular, that a doctor says women over 50 should add to their routine.
Meet the expert: Steven Bowers, D.O., board-certified family physician and author of Secrets of the World’s Healthiest People
Daily strength workouts may help boost all aspects of life, Steven Bowers, D.O., board-certified family physician and author of Secrets of the World’s Healthiest People, previously told Prevention. Physical fitness makes functional tasks like carrying grocery bags from the car, opening jars, and lifting heavy items easier.
There are plenty of moves to try, but Dr. Bowers says the one that should get top billing in your routine is the plank.
While planks challenge your whole body, they’re particularly great for strengthening your core. “Core muscle fibers tend to shrink and become less supple as we age, which can put more strain on your back,” he previously said. Having a strong core is important for balance and stability, and it can help you go about your day with more ease.
Wondering how long to hold a plank, and the proper form? First, place your forearms on the floor. Your elbows should be right below your shoulders, and your arms should be parallel—not turning in or out. Your feet should also be shoulder-width apart. Press your hands and toes into a mat on the ground, lifting your body, squeezing your glutes and quads for support. Your body should create one straight line from head to toe. Don’t lock your knees or arch your back, and keep your neck straight by looking slightly in front of you.
Hold this position for 20 seconds. “As you get more comfortable and your core gets stronger, hold the plank for as long as possible without sacrificing form or breath,” Dr. Bowers noted. It’s that simple! Whether you’re a pro or want to test your plank skills, adding the simple move to your routine may be what your core has been waiting for.
Shin splints are one of those nagging aches and pains most runners encounter at some point in their training—but that doesn’t mean you should just grin and bear it.
“We see it all the time in the clinic,” osteopath and clinical lead at The Livewell Clinic, Danny Sayandan tells Fit&Well.
Common themes, he says, are runners in worn-out shoes, heel striking instead of landing midfoot, or overstriding.
“It’s often linked to the least stretched muscle in the body—your calves—and most neglected muscle—the tibialis anterior—found on the front of the shin,” says Sayandan.
When they’re tight or undertrained, the impact of every footstrike gets pushed straight into the shins, triggering a dull ache down the front or inside of your shins.
The solution? Add these five exercises from Sayandan to your weekly workouts to stretch and strengthen these often overlooked muscles.
5 exercises to try if you get shin pain when running
1. Toe raise
Toe Raises – Ask Doctor Jo – YouTube
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Sets: 2 Reps: 12-15 each side
Why: Lifting your toes strengthens the front of your shin.
How:
- Stand with your feet hip-width apart.
- Lift your toes.
- Hold for two seconds.
- Lower your toes to the start.
2. Calf raise
Sets: 2 Reps: 12-15
Why: Build strength and endurance in the lower legs.
How:
- Stand with your feet together.
- Lift your heels to rise onto your toes and the balls of your feet.
- Pause, then lower slowly.
You can also perform these with your heels off a step (as in the video above), lowering your heels below the step to add a stretch to your calves.
As you get stronger, progress to single-leg calf raises, then begin to add weight with a dumbbell or kettlebell held in one hand.
3. Soleus wall hold
Sets: 2 Reps: 12-15 / Time: 30sec
Why: This bent-knee heel raise targets the deep-lying soleus muscle in your calves.
How:
- Stand with your feet hip-width apart, holding a bannister or other sturdy anchor point for support (an alternative is to rest your back on a wall, as in the video above).
- Bend your knees and push your hips back to lower into a squat, with your knees bent at 90˚.
- Hold this position and either perform 12-15 calf raises (see above), or rise up onto the balls of your feet and hold for 30 seconds.
4. Tibialis stretch
Anterior Tibialis Stretch Kneeling – Ask Doctor Jo – YouTube
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Sets: 2 Reps: 8-10
Why: This is a gentle stretch for the muscles in the front of the shin.
How:
- Kneel with your feet together, sitting on your heels with your hands or forearms on the floor to help control the load through your ankles.
- Push through your hands or forearms and carefully lift your knees to increase the stretch in the front of your shins.
- Hold for a few seconds, then lower.
Rather than an exercise, try to practice this continuously—and certainly as you move from exercise to exercise in this workout. Concentrate on landing softly through your midfoot to retrain your gait and reduce impact through your heel, ankle, calves and shins.
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