title: Tailoring exercise interventions to comorbidities and treatment-induced adverse effects in patients with early stage breast cancer undergoing chemotherapy: a framework to support clinical decisions.
abstract: OBJECTIVE
  Delivery of exercise interventions to patients with early-stage breast cancer undergoing chemotherapy requires complex clinical decisions. The purpose of this study was to develop a framework to support clinical decisions for tailoring exercise interventions to common comorbidities and cancer treatment-induced adverse effects.
  
  
  METHODS
  Tailored exercise prescriptions were developed in four steps, following the i3-S strategy. All steps were based on current best available evidence, complemented with expert opinions. First, common comorbidities and treatment-induced adverse effects were identified. In the subsequent steps, contra-indications and restrictions for exercise were described, along with possible exercise adaptations. In the final step, the obtained information was synthesized into a framework.
  
  
  RESULTS
  Prevalent comorbidities were hypertension, heart disease, diabetes mellitus, (osteo)arthritis, chronic obstructive pulmonary disease, and obesity. Adverse effects included conditions induced by pretreatment (e.g., lymphedema as a result of surgery) or by chemotherapy (e.g., reduced blood cell counts). Adaptations to the recommended exercise program were related to exercise tolerance, safety, and hygiene. A framework was proposed to guide clinical decisions during the exercise intervention.
  
  
  CONCLUSIONS
  Comorbidities and adverse effects of breast cancer treatment require exercise adaptations. The proposed framework provides guidance on tailored exercise prescriptions in patients with breast cancer undergoing chemotherapy. Implications for Rehabilitation Exercise is recommended for patients with breast cancer undergoing chemotherapy, but requires complex clinical decisions of the health professional. We identified the most important comorbidities and adverse effects of breast cancer treatment, and the resultant contra-indications and restrictions to exercise. We incorporated these findings into a clinical decision framework that provides suggestions for exercise adaptations in patients with breast cancer undergoing chemotherapy.
authors.affiliation: a Department of Rehabilitation Medicine , VU University Medical Center , Amsterdam , The Netherlands.|b Reade , Amsterdam Rehabilitation Research Centre , Amsterdam , The Netherlands.
authors.forename: Marike
authors.initials: M
authors.lastname: van der Leeden
authors.affiliation: a Department of Rehabilitation Medicine , VU University Medical Center , Amsterdam , The Netherlands.
authors.forename: Rosalie J
authors.initials: RJ
authors.lastname: Huijsmans
authors.affiliation: a Department of Rehabilitation Medicine , VU University Medical Center , Amsterdam , The Netherlands.
authors.forename: Edwin
authors.initials: E
authors.lastname: Geleijn
authors.affiliation: b Reade , Amsterdam Rehabilitation Research Centre , Amsterdam , The Netherlands.
authors.forename: Mariëtte
authors.initials: M
authors.lastname: de Rooij
authors.affiliation: c Department of Medical Oncology , VU University Medical Center-Cancer Center Amsterdam , Amsterdam , The Netherlands.
authors.forename: Inge R
authors.initials: IR
authors.lastname: Konings
authors.affiliation: c Department of Medical Oncology , VU University Medical Center-Cancer Center Amsterdam , Amsterdam , The Netherlands.|d Department of Epidemiology and Biostatistics , VU University Medical Center , Amsterdam , The Netherlands.
authors.forename: Laurien M
authors.initials: LM
authors.lastname: Buffart
authors.affiliation: a Department of Rehabilitation Medicine , VU University Medical Center , Amsterdam , The Netherlands.
authors.forename: Joost
authors.initials: J
authors.lastname: Dekker
authors.affiliation: e Department of Physiotherapy , Netherlands Cancer Institute , Amsterdam , The Netherlands.
authors.forename: Martijn M
authors.initials: MM
authors.lastname: Stuiver
mesh_terms: D000368:Aged; D000740:Anemia / Q000150:complications; D001943:Breast Neoplasms / Q000628:therapy*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D000066491:Clinical Decision-Making; D015897:Comorbidity; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D007970:Leukopenia / Q000150:complications; D008875:Middle Aged; D013921:Thrombocytopenia / Q000150:complications
keywords: Exercise; adverse effects; breast cancer; chemotherapy; clinical decisions; comorbidity