Physical Activity Trends in Cancer Survivors Treated at the 'MOvement and REhabilitation' Clinic

An active lifestyle after a cancer diagnosis can lead to a reduction in many of the most common adverse effects of oncological treatments or to an improvement in certain cancer-related symptoms. The review published in April 2025 by Bai et al. systematically analyzed the results of over 50 systematic reviews and meta-analyses of randomized controlled trials (RCTs), confirming the benefits associated with physical activity, such as a reduction in cancer-related fatigue, improvements in quality of life, mental health, and physical function. Physical activity has also been shown to contribute to reducing cancer-specific mortality. The benefits extend across different types of cancer and various stages of the disease, making physical activity a cornerstone of integrated oncological care. However, the majority of cancer survivors do not achieve the levels of aerobic physical activity (PA) recommended by the World Health Organization, namely ≥150 minutes per week of moderate activity or ≥75 minutes of vigorous activity.

The most common barriers include persistent treatment-related side effects (such as fatigue, pain, neuropathy), lack of time, low motivation, limited access to facilities, and insufficient guidance on physical activity from healthcare professionals. In particular, among cancer survivors living with pain, fear of worsening symptoms, lack of personalized recommendations, and low self-efficacy represent significant obstacles to adopting an active lifestyle. Despite these challenges, several key facilitators promoting regular physical activity have been identified. These include the perception of improved physical and mental health, a sense of control, social support (from peers or professionals), and the availability of adaptable programs.

Therefore, to support patients in recognizing that participation in exercise programs is not only valuable but feasible, interaction with healthcare professionals must include not only a recommendation for physical activity but also the exploration of patient-specific barriers and guidance on how to overcome them. Indeed, studies have suggested that patient advice is more likely to be effective if healthcare professionals are trained in behavioral change strategies and can use these skills to provide personalized motivational support Individual preferences are central in choosing the type of physical activity: many patients prefer low-impact activities such as walking, home exercises, and personalized consultations, highlighting the importance of a flexible and adaptable approach. Actively engaging patients in exercise programs improves behavioral outcomes. Patient engagement, understood as informed and shared participation in care decisions, promotes self-efficacy, intrinsic motivation, and the sustainability of healthy behaviors. The Transtheoretical Model of Change (TTM) by Prochaska and DiClemente represents a useful theoretical tool to guide personalized interventions, adapted to different stages of behavioral change-from intention to action and maintenance. According to the TTM, the patient's readiness to change can be assessed by the healthcare professional, facilitating a personalized approach and support for engagement. Depending on whether the patient is in a stage of pre-contemplation, contemplation, determination, or action, the professional's advice or support will differ.

Finally, the importance of personalization in physical activity programs has been widely emphasized in the literature.

Given the incidence and prevalence of cancer, together with increased survival due to improved oncological care, promoting an active lifestyle is increasingly important to help individuals with a history of cancer regain a good quality of life, return to daily activities, and contribute to the prevention of other diseases (e.g., cardiovascular disease) and recurrence.

Like a medication, physical activity must be dosed in terms of intensity, frequency, duration, and tailored to the individual's needs and preferences, as recommended by the ACSM.

For this reason, in August 2022, the MOvement and REhabilitation (MO.RE.) clinic was opened by the MFR unit with the support of the Lodini Association (SENOnALTRO and Amiche del CO.RE. projects), dedicated to people with a history of cancer, at any stage of the care pathway, with the mission of providing consultations with an experienced physiotherapist to personalize a physical activity program based on the individual's characteristics, needs, and ongoing or completed therapies.

• Overall physical activity level [Time frame: baseline, 3 months, 6 months]
• Patient engagement [Time frame: baseline]
• Number of session completed [Time frame: 3 months, 6 months]
• Exercise-related adverse events [Time frame: Baseline to 6 months]
• Change in Pain Intensity [Time frame: 3 months, 6 months]
• Barriers to performing physical activity [Time frame: 3 months, 6 months]
• Perceived barriers to physical activity assessed by patient-reported items [Time frame: 3 months, 6 months]