title: Unsupervised exercise in survivors of human papillomavirus related head and neck cancer: how many can go it alone?
abstract: OBJECTIVE
  Patients with human papillomavirus (HPV)-related head and neck cancer (HNC) have a better prognosis relative to other types of HNC, making survivorship an emerging and critical issue. Exercise is a core component of survivorship care, but little is known about how many survivors of HPV-related HNC can safely be advised to start exercising on their own, as opposed to needing further evaluation or supervised exercise.
  
  
  METHODS
  We utilized guidelines to identify health issues that would indicate value of further evaluation prior to being safely prescribed unsupervised exercise. We performed a retrospective chart review of 150 patients with HPV-related HNC to assess health issues 6 months after completing definitive therapy. Patients with at least one health issue were deemed appropriate to receive further evaluation prior to prescription for unsupervised exercise. We utilized logistic regression to identify clinical and demographic factors associated with the need for further evaluation, likely performed by outpatient rehabilitation clinicians.
  
  
  RESULTS
  In this cohort of patients, 39.3% could safely be prescribed unsupervised exercise 6 months after completing definitive therapy. On multivariable regression, older age, BMI >30, and receipt of radiation were associated with an increased likelihood for requiring further evaluation or supervised exercise.
  
  
  CONCLUSIONS
  Over half of patients with HPV-related HNC would benefit from referral to physical therapy or an exercise professional for further evaluation to determine the most appropriate level of exercise supervision, based upon current guidelines.
  
  
  CONCLUSIONS
  Development of such referral systems will be essential to enhance survivorship outcomes for patients who have completed treatment.
authors.affiliation: Perelman Center for Advanced Medicine, Perelman School of Medicine at the University of Pennsylvania, South Pavilion, Floor 10, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA. joshua.bauml@uphs.upenn.edu.
authors.forename: Joshua
authors.initials: J
authors.lastname: Bauml
authors.affiliation: Perelman Center for Advanced Medicine, Perelman School of Medicine at the University of Pennsylvania, South Pavilion, Floor 10, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA.
authors.forename: Jiyoung
authors.initials: J
authors.lastname: Kim
authors.affiliation: Penn State College of Medicine, Hershey, PA, USA.
authors.forename: Xiaochen
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Perelman Center for Advanced Medicine, Perelman School of Medicine at the University of Pennsylvania, South Pavilion, Floor 10, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA.
authors.forename: Charu
authors.initials: C
authors.lastname: Aggarwal
authors.affiliation: Perelman Center for Advanced Medicine, Perelman School of Medicine at the University of Pennsylvania, South Pavilion, Floor 10, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA.
authors.forename: Roger B
authors.initials: RB
authors.lastname: Cohen
authors.affiliation: Penn State College of Medicine, Hershey, PA, USA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Schmitz
mesh_terms: D000328:Adult; D000368:Aged; D015444:Exercise / Q000502:physiology*; D005260:Female; D006258:Head and Neck Neoplasms / Q000628:therapy* / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D027383:Papillomaviridae / Q000472:pathogenicity*; D011379:Prognosis; D012189:Retrospective Studies; D017741:Survivors / Q000523:psychology*
keywords: Exercise; HPV; Head and neck cancer; Human papillomavirus; Survivorship