A central and daily question regarding therapeutic exercising with oncological patients is: When to start with the exercise program? In the clinical setting, the trend is to involve exercise therapy as early as possible. The aim here is prevention and stabilization. The loss of power, for example, resulting from the long hospital stay and inactivity can be hampered. Thus, exercise therapy not only has rehabilitative aims but also includes preventive aspect, since a major (health) problem is also the lack of exercise. Exercise therapy should therefore start as early as possible, i.e., already during the medical treatment of cancer .
The aim of therapeutic exercises in the curative and palliative phase: Prevention of negative physical and psychological consequences and psychosocial stabilization.
Exercise therapy continues within the rehabilitation center and is then carried on within a rehabilitation sports program in a cancer sports group. In case the participation in a sports group is not possible or not wanted, patients are recommended to exercise individually in order to stay active all their life.
Ideally, patients in the rehabilitation center receive exercise-related diagnostics to determine whether moderate or more intensive physical activities are feasible. Furthermore, the obtained data enables the determination of the exercise therapy’s intensity and volume. Yet, the entire medical history, current medication, but also the sporting experiences must be considered, as well as the patient’s personal preferences. In order to ensure a targeted-oriented therapy, unsettled questions must be answered at an early stage. A patient will only continue to exercise individually at home, if he/she enjoys his/her activity and feels safe.
The aim of therapeutic exercises in the rehabilitation phase: Regeneration of physical and mental components and psychosocial stabilization or improvement.
Physical activities in the rehabilitative sports group
The ambulatory rehabilitative cancer sports groups in Germany are open for all oncological patients within a curative and palliative treatment concept. In 1981, the first cancer sports group was setup at the German Sport University in Cologne. By now almost 1,000 groups exist in Germany. Since 2001, the statutory health insurance companies (§44 SGB IX, §43 SGB V) are obliged to pay for this exercise offer . The aim is for patients to experience that physical activity is fun and joyful and can improve the overall fitness. In fact, the cancer sport group involves a certain self-help character; yet not to be mistaken with that of a support group. During exercising the cancer disease is “secondary”. By means of the rehabilitative sports groups, patients are to be motivated to stay physically active and mobile during their entire lifetime. The range of exercises includes endurance, resistance, and coordination exercises, as well as relaxation techniques. In addition, the groups typically offer further group activities such as hiking, cycling, and cross-country skiing. Despite 30 years of experience and the increasing and improving care structure nationwide, the evidence of the effectiveness of these cancer sports groups is still poor. In fact, only few studies have evaluated the rehabilitation sports in the oncological after-care and therefore only very few scientific experiences with therapeutic exercise interventions within this setting exist. Especially data concerning the implementation, risk factors, and the effects of this therapy concept are still missing .
Physical activities within home-based programs
There are different ways to motivate oncological patients to become physically active at their place of residence. In “home-based programs”, patients receive a training program and exercise independently without therapeutic support. Studies show that “home-based programs” are not as effective as supervised therapy concepts [12, 13]. Furthermore, investigations show that unsupervised exercises bring about more adverse events or unwanted complications . However, implementing “home-based programs” is reasonable, because the psychosocial influence of a therapist can be excluded, which enables the evaluation of physical activity exclusively. Also true-to-life concepts can be evaluated and implemented.