Stepping stones to implement exercise as integral part of cancer care

Exercise provides a myriad of health benefits to cancer survivors by reducing fatigue, anxiety and depressive symptoms, and improving physical fitness and quality of life. Although, international, evidence-based exercise guidelines exist for cancer survivors to improve cancer- and treatment related side effects, exercise programs have not yet been implemented as integral part of cancer care. As such, there is a growing need to bridge the gap between evidence and practice in order to increase engagement in physical activity among cancer survivors and make exercise referral the standard of cancer care. To promote implementation of exercise in daily clinical practice, the current knowledge should be expanded beyond the general effects of exercise in cancer survivors.
The focus of this thesis is to expand our current knowledge. In part I, we aimed to identify relevant patient characteristics that might explain adherence to exercise guidelines and participation in exercise interventions. Insight into these characteristics enables us to optimize adherence to exercise guidelines and programs. In part II, we investigated the long-term effects of exercise in cancer survivors. Although exercise effects in cancer survivors have been investigated extensively, the long-term effects remain understudied. Furthermore, the majority of randomized controlled exercise trials is conducted in breast and prostate cancer survivors, hampering generalizability of results to understudied cancer populations. Therefore, we investigated the effects of exercise in patients with esophageal cancer. In part III, we expanded our current knowledge on mechanisms that underlie cancer- and treatment-induced side effects and the potential working mechanisms of exercise.