Exercise-based multimodal programming : A treatment gap for older adults with advanced cancer [Commentary]

[Extract] Approximately 60% of new cancer diagnoses occur in patients aged 65 years and older.1 Normal aging is associated with a decline in health and physical function.2 A cancer diagnosis and subsequent treatment can accelerate this age-related physical decline, increasing the risk of adverse health events and mortality.1 Aerobic and resistance exercise is an effective therapy to improve physical fitness and quality of life and to reduce cancer-related fatigue in individuals diagnosed with cancer, including advanced cancer.3 The American College of Sports Medicine guidelines recommend maintenance of physical activity during active cancer treatment,3 but guidelines specific to advanced cancer or elderly populations are lacking. Older patients with cancer are vastly underrepresented in clinical trials, including exercise-based trials,4 due in part to the challenges introduced by the observed heterogeneity among older adults with respect to comorbid conditions, functional status, motivation, and safety-related concerns of the treating health care professionals.4 Older adults are more likely to fear physical activity due to potential injury and to lack of guidance regarding how to start exercising.5,6