Accelerometer Determined Lifestyle Behaviors Over Time—Letter

We read with interest the recent report by Sabiston and colleagues (1) whose data show that despite compelling evidence for the health benefits of exercise for cancer survivors (2), a majority remain sedentary (78% of their day) and engage in little exercise [<2% of their day in moderate-to-vigorous physical activity (MVPA)]. Their findings were dismaying. Indeed, we had hoped that in the almost decade since our review, “Riding the Crest of the Teachable Moment (3),” in which we made a plea to the oncology care community to actively endorse not only exercise, but also the consumption of healthier diets and maintenance of optimal weight among individuals diagnosed with cancer, that more survivors would be standing and walking, rather than sitting.

To understand why teachable moments have not been used to promote MVPA, we must recognize that integration of exercise promotion in cancer follow-up care (with a few exceptions: ref. 4) has failed to occur; nor has there been noticeable uptake of community-based programs such as LIVESTRONG at the YMCA. On top of the usual barriers that stop many of us from exercising (too busy, bad weather, family responsibilities, etc.), cancer survivors encounter additional barriers to MVPA as a function of the sequelae of their cancer treatments such as fatigue, neuropathy, incontinence, and weight gain. To surmount these, much more needs to be done by healthcare providers to promote healthy lifestyles. This includes providing brief, tailored advice that can and should be repeated to encourage and support survivors. At a minimum, reducing sedentary behavior may be a viable new strategy to improve recovery and health outcomes of cancer survivors (5). Furthermore, reducing sedentary behavior may be much more feasible for subgroups of cancer survivors, many of whom are older and have other comorbid health conditions. Referrals to evidence-based programs as part of survivorship care offer another opportunity to support survivors' becoming physically active. Importantly, it should be recognized that the teachable moment of cancer extends far beyond the initial diagnosis and can and should be leveraged repeatedly to promote and reinforce healthful behavior change.

Thus, we repeat our call for providers, caregivers, family members, community-based organizations, and researchers to provide survivors with the “surf” boards needed to help them ride the crest of the teachable moments that surviving cancer affords and maintain a physically active lifestyle.