How do practitioners prescribe exercise to patients with breast cancer? Professional perspectives on the implementation of aerobic exercise guidelines for patients with breast cancer undergoing chemotherapy.

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Abstract
Purpose: The benefits of exercise for cancer are well established. However, how experienced accredited exercise physiologists (AEPs) and medical professionals implement exercise guidelines when prescribing/recommending aerobic exercise to patients with breast cancer undergoing chemotherapy remains unknown. Methods: A four round, two phase, survey was conducted. Four cancer-specific AEPs, four oncologists, and one breast cancer surgeon (median 13-yr breast-cancer-specific experience) completed phase one. Eighty-four AEPs (median 5-yr experience) completed phase two. Phase one participants answered open- and close-ended questions regarding how they implement cancer-specific aerobic exercise guidelines for patients with breast cancer patients undergoing chemotherapy, and what information they believe should be collected to guide exercise prescription. All questions agreed upon in phase one (>70% rating 7-9 on a 0-9 Likert Scale) were rated by AEPs in phase two. Results: Subjective questioning by AEPs should consider the stage, type, and location of breast cancer, treatments, side effects, and exercise preferences and expectations. Objective assessment should include upper-arm circumference, strength, and range of motion. Separating aerobic exercise into 5-to-9-minute bouts was considered appropriate and exercising to exhaustion should be avoided. Exercise intensity and duration should be adjusted throughout chemotherapy to improve tolerance and adherence. Conclusion: This study identifies how professionals approach exercise assessment and prescription in patients with breast cancer undergoing chemotherapy. These findings can help guide practice and inform future guidelines. Implications for Cancer Survivors: This research helps exercise professionals make better decisions when prescribing exercise to patients with breast cancer undergoing chemotherapy, improving the quality of care for this population.

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