Cancer Care Program - Staff and Physicians

Including physical activity and exercise in the treatment plan for those living with and beyond cancer enables them to:

• Better manage their disease
• Better manage treatment-related side effects
• Maintain or improve muscle strength and overall functional fitness
• Reduce feelings of fatigue

Presurgical exercise (prehabilitation) benefits include:

• Optimize physical function and emotional wellbeing prior to surgery
• Faster recovery from surgery
• Reduced surgical complications

Additional benefits include:

• Improved quality of life
• Improved mental wellbeing
• Improved response to treatment
• Reduced risk of recurrence
• Reduced risk of other chronic health conditions

Although there are possible contraindications, research shows that physical activity is safe for most people living with and beyond cancer with appropriate precautions and modifications, as needed. 

Our vision is to make physical activity and exercise a part of standard cancer care. 

Our mission is to optimize the use of physical activity and exercise in cancer management and recovery.

Physical activity has been shown to have positive effects on physical, social and mental outcomes for those living with and beyond cancer. 

The Physical Activity and Cancer Lab (PAC Lab) is a research lab dedicated to improving quality of life, well-being and activity of daily living through physical activity for those living with and beyond cancer. The PAC Lab is interested in patient, provider and system-level changes to promote physical activity as part of the standard of care for those living with and beyond cancer in Nova Scotia. The PAC Lab is led by Dalhousie University faculty with Nova Scotia Health affiliation. 

Referrals to the PAC Lab: 

• Health care providers can use the referral form to refer people to the PAC Lab.
• The PAC Lab team will follow up with referred individuals directly to: 
  • Discuss the program in more detail
  • Conduct a risk assessment
  • Support them in getting set up to participate
• Those living with and beyond cancer can also contact the program directly to learn more. 

What is being done:

Nova Scotia Health Cancer Care Program has supported the creation of an action framework that details the current state of exercise programming for individuals living with cancer in Nova Scotia. The action plan also provides recommendations regarding best practices and how to achieve them.

Dr. Stefan Heinze, a post-doctoral fellow funded by a Health System Impact Fellowship (CIHR), led this work, which was co-hosted by:

• The Cancer Care Program
• Nova Scotia Health’s Research, Innovation, and Discovery team
• Dalhousie University

Dr. Heinze’s research investigated:

• How exercise programs in Nova Scotia positively impact the lives of people living with a cancer diagnosis
• How such programs might positively impact the health care system
• How the Cancer Care Program can best identify who will benefit the most from these programs through the use of frailty screening tools

The action framework, endorsed by the Cancer Care Program in August 2024, reflects Dr. Heinze's research along with:

• Results from available research-based exercise programs, including ACCESS and EXCEL
• Consultations with program department leads, experts in the field, and patient and family advisors 

The action framework includes a series of recommendations and best-practice guidelines. It now serves as a guiding document for integrating exercise programming as a standard of care for people living with and beyond a cancer diagnosis in Nova Scotia.

Why it matters:

Exercise programming in oncology care settings has the potential to positively impact patients and the healthcare system, although there is limited knowledge of how to integrate the evidence into practice as a standard of care. Translating knowledge and evidence into health system practice is complex.

Current guidelines state that oncology healthcare providers should recommend aerobic and resistance exercise programming for individuals living with a cancer diagnosis. Evidence supporting this recommendation continues to emerge, suggesting that exercise or physical activity programming can improve:

• cancer-related fatigue levels
• quality of life
• physical functioning
• anxiety
• depression  

Exercise is also associated with improvements in therapy-related adverse-event risk, including during chemotherapy or when preformed prior to surgery.

The action framework provides a roadmap that considers the evidence and the complexity of our systems. It recommends an embedded model of exercise program delivery that will support cancer patients and the health system in Nova Scotia. Research in this field continues to expand, with current efforts focusing on:

• The types and doses of exercise that are best for specific cancers
• When exercise programming is most effective
• Which individuals would see the most benefit

These questions must be answered to realize the maximum potential of exercise programming as a standard of care in a cancer care setting. The action framework provides a solid starting point for program development and delivery. Program evaluation and continued partnership with the Physical Activity and Cancer (PAC) research lab will inform these areas and support continued quality improvement in program delivery.

(Ligibel et al., 2022)