Journal of Cancer Survivorship

, Volume 6, Issue 2, pp 219–228 | Cite as

Community-based exercise program effectiveness and safety for cancer survivors

  • Emily Jo Rajotte
  • Jean C. Yi
  • K. Scott Baker
  • Lindsey Gregerson
  • Andréa Leiserowitz
  • Karen L. SyrjalaEmail author



Clinical trials have demonstrated the benefits of exercise for cancer survivors. This investigation determined the effectiveness and safety of a disseminated community-based exercise program for cancer survivors who had completed treatment.


Personal trainers from regional YMCAs received training in cancer rehabilitation and supervised twice-a-week, 12-week group exercise sessions for survivors. At baseline and post-program, validated measures assessed patient-reported outcomes (PRO) and physiologic measurements.


Data were collected from 221 survivors from 13 YMCA sites and 36 separate classes. All participants had data available at one time point, while matched baseline and post-program PRO and physiologic data were available for 85% (N = 187). Participants with matched data were largely female (82%), with mean age of 58 (range, 28–91 years). Time since diagnosis ranged from 1 to 48 (mean, 5.6 years), and mean time since last treatment was 3.0 (range, 1–33 years). Physiological improvements were significant in systolic (P < 0.001) and diastolic (P = 0.035) blood pressure, upper and lower body strength, the 6-min walk test (P = 0.004), and flexibility (P < 0.001). Participants reported improvements in overall health-related quality of life (P < 0.001), social support (P = 0.019), body pain (P = 0.016), fatigue (P < 0.001), insomnia (P < 0.001), and overall musculoskeletal symptoms (P = <0.001). Few injuries or lymphedema events occurred during classes.


Community-based exercise groups for cancer survivors of mixed diagnoses and ages, who have completed active treatment, have physiologic and psychosocial benefits, and are safe.

Implications for cancer survivors

Survivors may expect significant benefit from participating in a community-based exercise program tailored to meet their individual needs as a survivor.


Cancer survivors Exercise Physical activity Community YMCA 



Support for this research was provided by the LIVESTRONG Foundation and the Amgen Foundation of Washington State. We thank the survivors participating in this study and each of the Exercise and Thrive personal trainers and sites participating in this project, including:

Northshore YMCA, Bothell, WA

Bellevue Family YMCA, Bellevue, WA

West Seattle Family YMCA, Seattle, WA

Downtown Seattle YMCA, Seattle, WA

Dale Turner Family YMCA, Shoreline, WA

Meredith Mathews-East Madison YMCA, Seattle, WA

Auburn Valley YMCA, Auburn, WA

Gig Harbor Family YMCA, Gig Harbor, WA

Marysville Family YMCA, Marysville, WA

University Family YMCA, Seattle, WA

Briggs Community YMCA, Olympia, WA

Olympia Downtown YMCA, Olympia, WA

Clallam County Family YMCA, Port Angeles, WA


  1. 1.
    Altekruse SF, Kosary CL, Krapcho M, Neyman N, Aminou R, Waldron W et al. SEER Cancer Statistics Review, 1975-2008, National Cancer Institute. Bethesda, MD, Accessed 14 Nov 2011.
  2. 2.
    Howlader N, Noone AM, Krapcho M, Neyman N, Aminou R, Waldron W et al. SEER Cancer Statistics Review, 1975-2008, National Cancer Institute. Bethesda, MD, Accessed 14 Nov 2011.
  3. 3.
    Horner MJ, Ries LAG, Krapcho M, Neyman N, Aminou R, Howlader N et al. SEER Cancer Statistics Review, 1975-2006, National Cancer Institute. Bethesda, MD, Accessed 14 Nov 2011.
  4. 4.
    Stein KD, Syrjala KL, Andrykowski MA. Physical and psychological long-term and late effects of cancer. Cancer. 2008;112:2577–92.PubMedCrossRefGoogle Scholar
  5. 5.
    Brearley SG, Stamataki Z, Addington-Hall J, Foster C, Hodges L, Jarrett N, et al. The physical and practical problems experienced by cancer survivors: a rapid review and synthesis of the literature. Eur J Oncol Nurs. 2011;15:204–12.PubMedCrossRefGoogle Scholar
  6. 6.
    Servaes P, Verhagen S, Schreuder B, Veth R, Bleijenberg G. Fatigue after treatment for malignant and benign bone and soft tissue tumors. J Pain Symptom Manage. 2003;26:1113–22.PubMedCrossRefGoogle Scholar
  7. 7.
    Hjermstad SD, Fosså SD, Oldervoll L, Holte H, Jacobsen AB, Loge JH. Fatigue in long-term Hodgkin’s disease survivors: a follow-up study. J Clin Oncol. 2005;23:6587–95.PubMedCrossRefGoogle Scholar
  8. 8.
    Bower JE, Ganz PA, Desmond KA, Bernaards C, Rowland JH, Meyerowitz BE, et al. Fatigue in long-term breast carcinoma survivors. A longitudinal investigation. Cancer. 2006;106:751–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Servaes P, Gielissen MFM, Verhagen C, Bleijenberg G. The course of severe fatigue in disease-free breast cancer patients: a longitudinal study. Pycho-Oncol. 2007;16:787–95.CrossRefGoogle Scholar
  10. 10.
    Syrjala K, Yi JC, Artherholt SB, Stover AC, Abrams JR. Measuring musculoskeletal symptoms in cancer survivors who receive hematopoietic cell transplantation. J Cancer Surviv. 2010;4:225–35.PubMedCrossRefGoogle Scholar
  11. 11.
    Yahalom J, Portlock CS. Long-term cardiac and pulmonary complications of cancer therapy. Heart Fail Clin. 2011;7:403–11.PubMedCrossRefGoogle Scholar
  12. 12.
    Abouassaly R, Fossa SD, Giwercman A, Kollmannsberger C, Motzer RJ, Schmoll HJ, et al. Sequelae of treatment in long-term survivors of testis cancer. Eur Urol. 2011;60:516–26.PubMedCrossRefGoogle Scholar
  13. 13.
    Baker KS, Chow E, Steinberger J. Metabolic syndrome and cardiovascular risk in survivors after hematopoietic cell transplantation. Bone Marrow Transplant. 2011. doi: 10.1038/bmt.2011.118.
  14. 14.
    Pliarchopoulou K, Pectasides D. Late complications of chemotherapy in testicular cancer. Cancer Treat Rev. 2010;36:262–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Sharma N, Hansen CH, O'Connor M, Walker J, Kleiboer A, Murray G, et al. Sleep problems in cancer patients: prevalence and association with distress and pain. Psycho-Oncol. 2011. doi: 10.1002/pon.2004.
  16. 16.
    Farquhar-Smith P. Chemotherapy-induced neuropathic pain. Curr Opin Support Palliat Care. 2011;5:1–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Harrington S, Padua D, Battaglini C, Michener LA, Giuliani C, Myers J, et al. Comparison of shoulder flexibility, strength, and function between breast cancer survivors and healthy participants. J Cancer Surviv. 2011;5:167–74.PubMedCrossRefGoogle Scholar
  18. 18.
    Jansen L, Hermann A, Stegmaier C, Singer S, Brenner H, Arndt V. Health-related quality of life during the 10 years after diagnosis of colorectal cancer: a population-based study. J Clin Oncol. 2011;29:3263–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Bencová V, Bella V, Svec J. The dynamics of psychosocial burden development in breast cancer survivors: clinical success with psychosocial consequences. Klin Onkol. 2011;24:203–8.PubMedGoogle Scholar
  20. 20.
    Oerlemans S, Mols F, Nijziel MR, Lybeert M, van de Poll-Franse LV. The impact of treatment, socio-demographic and clinical characteristics on health-related quality of life among Hodgkin's and non-Hodgkin's lymphoma survivors: a systematic review. Ann Hematol. 2011;90:993–1004.PubMedCrossRefGoogle Scholar
  21. 21.
    Ness K, Wall MM, Oakes JM, Robison LL, Gurney JG. Physical performance limitations and participation restrictions among cancer survivors: a population-based study. Ann Epidemiol. 2006;16:197–205.PubMedCrossRefGoogle Scholar
  22. 22.
    Drake D, Falzer P, Xistris D, Robinson G, Roberge M. Physical fitness training: outcomes for adult oncology patients. Clin Nurs Res. 2004;13:245–64.PubMedCrossRefGoogle Scholar
  23. 23.
    Curt GA, Breitbart W, Cella D, Groopman JE, Horning SJ, Itri LM, et al. Impact of cancer-related fatigue on the lives of patients: new findings from the Fatigue Coalition. Oncologist. 2000;5:353–60.PubMedCrossRefGoogle Scholar
  24. 24.
    Pekmezi D, Demark-Wahnefried W. Updated evidence in support of diet and exercise interventions in cancer survivors. Acta Oncol. 2011;50:167–78.PubMedCrossRefGoogle Scholar
  25. 25.
    Demark-Wahnefried W. Cancer survival: time to get moving? Data accumulate suggesting a link between physical activity and cancer survival. J Clin Oncol. 2006;24:3517–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Brown J, Huedo-Medina TB, Pescatello LS, Pescatello SM, Ferrer RA, Johnson BT. Efficacy of exercise interventions in modulating cancer-related fatigue among adult cancer survivors: a meta-analysis. Cancer Epidemiol Biomarkers Prev. 2011;20:123–33.PubMedCrossRefGoogle Scholar
  27. 27.
    Hede K. Supportive care: large studies ease yoga, exercise into mainstream oncology. J Natl Cancer Inst. 2011;103:11–2.PubMedCrossRefGoogle Scholar
  28. 28.
    Kim D, Sim YJ, Jeong HJ, Kim GC. Effect of active resistive exercise on breast cancer-related lymphedema: a randomized controlled trial. Arch Phys Med Rehabil. 2010;91:1844–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Schmitz K, Ahmed R, Troxel A, Cheville A, Smith R, Lewis-Grant L, et al. Weight lifting in women with breast-cancer-related lymphedema. N Engl J Med. 2009;361:664–73.PubMedCrossRefGoogle Scholar
  30. 30.
    Winters-Stone K, Dobek J, Nail L, Bennett JA, Leo MC, Naik A, et al. Strength training stops bone loss and builds muscle in postmenopausal breast cancer survivors: a randomized, controlled trial. Breast Cancer Res Treat. 2011;127:447–56.PubMedCrossRefGoogle Scholar
  31. 31.
    Loprinzi C, Wolf SL, Barton DL, Laack NN. Symptom management in premenopausal patients with breast cancer. Lancet Oncol. 2008;9:993–1000.PubMedCrossRefGoogle Scholar
  32. 32.
    Ferrer R, Huedo-Medina TB, Johnson BT, Ryan S, Pescatello LS. Exercise interventions for cancer survivors: a meta-analysis of quality of life outcomes. Ann Behav Med. 2011;41:32–47.PubMedCrossRefGoogle Scholar
  33. 33.
    Speck R, Courneya KS, Mâsse LC, Duval S, Schmitz KH. An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. J Cancer Surviv. 2010;4:87–100.PubMedCrossRefGoogle Scholar
  34. 34.
    Ibrahim E, Al-Homaidh A. Physical activity and survival after breast cancer diagnosis: meta-analysis of published studies. Med Oncol. 2011;28:753–65.PubMedCrossRefGoogle Scholar
  35. 35.
    Wiggins M, Simonavice EM. Cancer prevention, aerobic capacity, and physical functioning in survivors related to physical activity: a recent review. Cancer Manag Res. 2010;2:157–64.PubMedCrossRefGoogle Scholar
  36. 36.
    Holmes MD, Chen WY, Feskanich D, Kroenke CH, Colditz GA. Physical activity and survival after breast cancer diagnosis. JAMA. 2005;293:2479–86.PubMedCrossRefGoogle Scholar
  37. 37.
    Meyerhardt JA, Giovannucci EL, Holmes MD, Chan AT, Chan JA, Colditz GA, et al. Physical activity and survival after colorectal cancer diagnosis. J Clin Oncol. 2006;24:3527–34.PubMedCrossRefGoogle Scholar
  38. 38.
    Meyerhardt JA, Heseltine D, Niedzwiecki D, Hollis D, Saltz LB, Mayer RJ, et al. Impact of physical activity on cancer recurrence and survival in patients with stage III colon cancer: findings from CALGB 89803. J Clin Oncol. 2006;24:3535–41.PubMedCrossRefGoogle Scholar
  39. 39.
    Irwin ML, McTiernan A, Manson JE, Thomson CA, Sternfeld B, Stefanick ML, et al. Physical activity and survival in postmenopausal women with breast cancer: results from the Women's Health Initiative. Cancer Prev Res. 2011;4:522–9.CrossRefGoogle Scholar
  40. 40.
    Kirkegaard H, Johnsen NF, Christensen J, Frederiksen K, Overvad K, Tjønneland A. Association of adherence to lifestyle recommendations and risk of colorectal cancer: a prospective Danish cohort study. BMJ. 2010. doi: 10.1136/bmj.c5504.
  41. 41.
    Demark-Wahnefried W, Peterson B, McBride C, Lipkus I, Clipp E. Current health behaviors and readiness to pursue life-style changes among men and women diagnosed with early stage prostate and breast carcinomas. Cancer. 2000;88:674–84.PubMedCrossRefGoogle Scholar
  42. 42.
    Irwin ML, McTiernan A, Bernstein L, Gilliland FD, Baumgartner R, Baumgartner K, et al. Physical activity levels among breast cancer survivors. Med Sci Sports Exerc. 2004;36:1484–91.PubMedGoogle Scholar
  43. 43.
    Irwin M, Crumley D, McTiernan A, Bernstein L, Baumgartner R, Gilliland FD, et al. Physical activity levels before and after a diagnosis of breast carcinoma: the Health, Eating, Activity, and Lifestyle (HEAL) study. Cancer. 2003;97:1746–57.PubMedCrossRefGoogle Scholar
  44. 44.
    Jones LW, Courneya KS. Exercise counseling and programming preferences of cancer survivors. Cancer Pract. 2002;10:208–15.PubMedCrossRefGoogle Scholar
  45. 45.
    Fink B, Weiner JG, Jordan TR, Thompson AJ, Salvage TC, Coman M, et al. Early stage breast cancer and its association with diet and exercise-related perceptions and behaviors to prevent recurrence. Breast Cancer. 2010;4:65–72.PubMedGoogle Scholar
  46. 46.
    Haines TP, Sinnamon P, Wetzig NG, Lehman M, Walpole E, Pratt T, et al. Multimodal exercise improves quality of life of women being treated for breast cancer, but at what cost? Randomized trial with economic evaluation. Breast Cancer Res Treat. 2010;124:163–75.PubMedCrossRefGoogle Scholar
  47. 47.
    American Thoracic Society. ATS Statement: Guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166:111–7.Google Scholar
  48. 48.
    Enright PL. The six-minute walk test. Respir Care. 2003;48:783–5.PubMedGoogle Scholar
  49. 49.
    Kraemer WJ, Fry AC. Strength testing: development and evaluation of methodology. In: Maud PJ, Foster C, editors. Physiological assessment of human fitness. Champaign, IL: Human Kinetics; 1995.Google Scholar
  50. 50.
    Shaw CE, McCully KK, Posner JD. Injuries during the one repetition maximum assessment in the elderly. J Cardiopulm Rehabil. 1995;15:283–7.PubMedCrossRefGoogle Scholar
  51. 51.
    Barnard KL, Adams KJ, Swank AM, Mann E, Denny DM. Injuries and muscle soreness during the one repetition maximum assessment in a cardiac rehabilitation population. J Cardiopulm Rehabil. 1999;19:52–8.PubMedCrossRefGoogle Scholar
  52. 52.
    Wells KF, Dillon EK. The sit and reach. A test of back and leg flexibility. Res Q. 1952;23:115–8.Google Scholar
  53. 53.
    Ware JE, Kosinski M, Dewey JE. How to score version 2 of the SF-36 health survey. Lincoln, RI: QualityMetric Incorporated; 2000.Google Scholar
  54. 54.
    Hawthorne G, Osborne RH, Taylor A, Sansoni J. The SF36 version 2: critical analyses of population weights, scoring algorithms and population norms. Qual Life Res. 2007;16:661–73.PubMedCrossRefGoogle Scholar
  55. 55.
    Hann DM, Jacobsen PB, Azzarello LM, Martin SC, Curran SL, Fields KK, et al. Measurement of fatigue in cancer patients: development and validation of the fatigue symptom inventory. Qual Life Res. 1998;7:301–10.PubMedCrossRefGoogle Scholar
  56. 56.
    Hann DM, Denniston MM, Baker F. Measurement of fatigue in cancer patients: further validation of the fatigue symptom inventory. Qual Life Res. 2000;9:847–54.PubMedCrossRefGoogle Scholar
  57. 57.
    ENRICHD Investigators. Enhancing recovery in coronary heart disease (ENRICHD): baseline characteristics. Am J Cardiol. 2001;88:316–22.CrossRefGoogle Scholar
  58. 58.
    Pagoto S, Schneider KL, Oleski JL, Luciani JM, Bodenlos JS, Whited MC. Male inclusion in randomized controlled trials of lifestyle weight loss interventions. Obesity. 2011. doi: 10.1038/oby.2011.140.
  59. 59.
    Adamsen L, Rasmussen JM, Pedersen LS. “Brothers in arms”: how men with cancer experience a sense of comradeship through group intervention which combines physical activity with information relay. J Clin Nurs. 2001;10:528–37.PubMedCrossRefGoogle Scholar
  60. 60.
    Rogerino A, Grant LL, Wilcox H, Schmitz KH. Geographic recruitment of breast cancer survivors into community-based exercise interventions. Med Sci Sports Exerc. 2009;41:1413–20.PubMedCrossRefGoogle Scholar
  61. 61.
    Blaney J, Lowe-Strong A, Rankin J, Campbell A, Allen J, Gracey J. The cancer rehabilitation journey: barriers to and facilitators of exercise among patients with cancer-related fatigue. Phys Ther. 2010;90:1135–47.PubMedCrossRefGoogle Scholar
  62. 62.
    Karvinen K, DuBose KD, Carney B, Allison RR. Promotion of physical activity among oncologists in the United States. J Support Oncol. 2010;8:35–41.PubMedGoogle Scholar
  63. 63.
    Ahmed RL, Thomas W, Yee D, Schmitz K. Weight training does not increase incidence of lymphedema in breast cancer survivors. J Clin Oncol. 2006;24:2765–72.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Emily Jo Rajotte
    • 1
  • Jean C. Yi
    • 1
  • K. Scott Baker
    • 1
  • Lindsey Gregerson
    • 2
  • Andréa Leiserowitz
    • 3
  • Karen L. Syrjala
    • 1
    • 4
    Email author
  1. 1.Clinical Research DivisionFred Hutchinson Cancer Research CenterSeattleUSA
  2. 2.YMCA of Greater SeattleSeattleUSA
  3. 3.Oncology Physical TherapyEugeneUSA
  4. 4.Department of Psychiatry and Behavioral SciencesUniversity of Washington School of MedicineSeattleUSA

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