gms | German Medical Science

Objective: This presentation aims to describe the outpatient cancer rehabilitation concept of the outpatient clinic for oncologic rehabilitation of the Department of PM&R (Medical University of Vienna), and to give exercise prescriptions.

Material/Methods: The outpatient rehabilitation concept is presented, including own experiences in exercise interventions and exercise prescription principles.

Results: Individual tailored rehabilitation plans include medical exercise programs, neuromuscular electrical stimulation (as an passive option to exercise), nutrition, lymph massage, breathing therapy, physiotherapy, occupational therapy, breathing therapy, different forms of massage, electrotherapy, and other physical modalities, but also biofeedback and drug treatment for pain. Since 2011, we discuss challenging and complex cases of cancer patients within the worldwide first official tumour board for cancer rehabilitation in an acute hospital.

One of the most important functional deficits of cancer patients is decreased physical performance (endurance capacity, muscular strength) with impaired activities and participation. Physical activity and regular exercise have been shown to increase physical performance and quality of life of cancer patients. Furthermore, regular moderate physical activity has been described to be preventive against cancer – but also to increase cancer-specific and overall survival in some cancer types.

In our outpatient clinic, patients suffering from metastatic bone disease perform aerobic exercise and reach excellent endurance capacities up to 150%. Furthermore, cancer patients suffering from metastatic brain disease and “multimorbid” cancer patients with peripheral vascular diseases with amputations and after several myocardial infarctions (who normally are not allowed to exercise) are exercising under supervision. Patients during very effective (but very cardio toxic) oncologic treatment modalities are also able to reach excellent endurance capacities. Furthermore, many cancer patients are performing active exercise to increase muscular strength, also those with metastatic bone disease. It has to be mentioned, that all are exercising under supervision of specialized physicians, but also with the “back-up” of a central hospital (Department of Emergency Medicine). This setting seems to be very important in cases of high-risk patients! In all cases of patients who are included in exercise programs, it is very important to have up-to-date knowledge about cancer, cancer treatment, and cancer complications – and of co-morbidities (such as cardiovascular diseases) and of medication of these patients, and an interdisciplinary (oncologist, cardiologist, dietologist,…) approach is very important. Medical history and clinical examination, different laboratory parameters, ECG, echocardiograph findings, exercise testing, spirometry, radiographic findings and bone scans are needed for planning individual exercise programs.

For those patients who are not able or not allowed to perform active exercise neuromuscular electrical stimulation to prevent loss of muscle mass and/or to increase endurance capacity is presented.

Conclusion: Regular physical activity and exercise improve functional health of cancer patients by influencing structures, activities, and participation. Nevertheless, the setting in which it is performed determines the inclusion or exclusion criteria in exercise programs for cancer patients.