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| # | Item | Delphi round on which consensus was achieved |
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| | Recommending exercise to prevent cancer and improve survival rates and wellbeing of cancer patients and survivors | |
| 1 | Sedentary lifestyle was observed to be associated with several common types of cancer. | 2 |
| 2 | Evidence from various epidemiological studies demonstrated that exercise reduced the risks of at least 13 types of cancer including endometrial, colorectal, breast, and lung cancers. | 2 |
| 3 | Evidence from various epidemiological studies demonstrated that exercise reduced recurrence of colon, prostate, and breast cancer. | 1 |
| 4 | A growing body of research has demonstrated that exercise improved survival in patients who have developed certain types of cancer. | 2 |
| 5 | Evidence from various animal studies demonstrated that exercise reduced incidence, growth, and metastasis of tumors. | 1 |
| 6 | A growing body of research has demonstrated that exercise improved objective physiologic measures related to physical function, body composition, and cardiopulmonary fitness of cancer patients and survivors. | 1 |
| 7 | A growing body of research has demonstrated that exercise improved reported outcomes related to sleep, fatigue, life satisfaction, and quality of life of cancer patients and survivors. | 1 |
| 8 | Cancer care providers should know that engaging cancer patients and survivors in exercise might promote their adherence to health life style like healthy diet and quitting smoking. | 1 |
| 9 | Evidence from various cancer animal models demonstrated that exercise controlled progression of cancer, regulated tumor growth, alleviated side effects of treatment, and improved therapy outcomes. | 1 |
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| | The effects of exercise on metastasis of cancer | |
| 1 | Cancer care providers should know that exercise has the potential to reduce the rate of tumor growth. | 1 |
| 2 | Cancer care providers should know that exercise induced molecular factors that might be capable of interfering with tumor formation. | 1 |
| 3 | Cancer care providers should know that exercise stimulated the release of catecholamines that activate the Hippo and YAP signaling pathway which is implicated in tumor formation. | 2 |
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| | The effects of exercise on metabolism within tumors | |
| 1 | Cancer care providers should know that tumors favored aerobic glycolysis to support high energy demands within rapidly proliferative environments of the tumor. | 1 |
| 2 | Cancer care providers should know that tumors were susceptible to increased energy stress during exercise. | 1 |
| 3 | Cancer care providers should know that exercise regulated metabolism within tumors probably through inhibiting the phosphatidylinositol-3-kinase (PI3K)/protein kinase B (PKB (Akt))/mammalian target of rapamycin (mTOR) (PI3K-Akt-mTOR) signaling pathway. | 2 |
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| | The effects of exercise on the functions of immune system and exposure to carcinogens | |
| 1 | Cancer care providers should know that exercise increased the number of natural killer cell and their cytotoxic activity. | 1 |
| 2 | Cancer care providers should know that exercise increased monocytes and macrophages in number and function. This included increasing their antitumor cytotoxic activity and their ability to produce cytokines that suppressed cancerous cells. | 1 |
| 3 | Cancer care providers should know that exercise decreased the number and function of proinflammatory monocytes and proinflammatory cytokines. | 1 |
| 4 | Cancer care providers should know that exercise enhanced T-cell priming and antigen presenting by increasing expression of dendritic cells, interleukin (IL-4), and interferon (IFN-γ) expressing T-cells. | 1 |
| 5 | Cancer care providers should know that exercise improved adaptive immunity by increasing the number of naïve CD8+ T-cells, decreasing the number of senescent/exhausted CD4+ and CD8+ T-cells. | 2 |
| 6 | Cancer care providers should know that exercise mobilized and redistributed cytotoxic immune cells. | 1 |
| 7 | Cancer care providers should know that exercise increased the levels of chemokines attracting immune cells, natural killer cell-activating receptor ligands, and ligands that reduce blockade check-points of immune cells. | 1 |
| 8 | Cancer care providers should know that exercise increased the number of neutrophils and their production of antitumor peroxides and free radicals. | 1 |
| 9 | Cancer care providers should know that exercise increased interferon levels and cytotoxic natural killer and T-cells infiltration of tumors. | 1 |
| 10 | Cancer care providers should know that exercise decreased levels of lactate resulted from high aerobic glycolysis and thus, reduced suppressive effects of lactate on the functions of cytotoxic immune cells like T-cells. | 2 |
| 11 | Cancer care providers should know that exercise increased mobilization of cytotoxic immune cells through different mechanisms that involved shear stress induced by blood flow and adrenergic signaling. These immobilized cytotoxic immune cells might identify and eradicate cancerous cells. | 2 |
| 12 | Cancer care providers should know that habitual exercise might induce hyperthermia which can regulate and delay growth of tumors and increase infiltration of tumors by natural killer cells by increasing the diameter of blood vessels within the tumor. | 1 |
| 13 | Cancer care providers should know that exercise increased body temperature which in turn induced interleukin (IL-6) trans-signaling and subsequently made blood vessels within the tumor more permissible to cytotoxic cells. | 1 |
| 14 | Cancer care providers should know that exercise speeded up the passage of food through the large intestine and thus reduced exposure of the colon to carcinogens. | 1 |
| 15 | Cancer care providers should know that exercise altered fecal pH and modified the intestinal flora and thus reduced formation of carcinogens. | 1 |
| 16 | Cancer care providers should know that exercise might reduce the conversion of steroids to more potent carcinogens. | 1 |
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| | The role of myokines release induced by exercise | |
| 1 | Cancer care providers should know that exercise stimulated skeletal muscles to release myokines. Released myokines like Oncostatin M, Irisin, and SPARC have the potential to inhibit cancer cells in vitro. | 2 |
| 2 | Cancer care providers should know that myokines released during exercise stimulated the release of cytokines, which in turn induced the release of interleukins. Interleukins (for example IL-6) were known to promote proliferation, differentiation, and maturation of natural killer and T-cells. | 2 |
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| | The effects of exercise on anticancer therapies | |
| 1 | Cancer care providers should know that exercise had the potential to reduce tumor-induced muscle mass loss. | 2 |
| 2 | Cancer care providers should know that exercise might help reduce intramuscular protein degradation associated with chemotherapeutic agents. | 2 |
| 3 | Cancer care providers should know that exercise might induce the hormone ghrelin which induced appetite and reduced anorexia. | 2 |
| 4 | Cancer care providers should know that exercise had the potential to stimulate the release of anti-inflammatory cytokines and reduce the levels of proinflammatory factors in cancer states. | 1 |
| 5 | Cancer care providers should know that exercise have the potential to reduce body fats and cardiovascular risk factors in cancer states. | 1 |
| 6 | Cancer care providers should know that exercise had the potential to reduce the symptoms of anxiety, depression, and cognitive problems associated with cancer itself and anticancer therapies. Symptoms of depression were seen when kynurenine, which is a metabolite of tryptophan, crossed the blood-brain barrier. During exercise, PGC-1α transcription factor was upregulated which subsequently increased metabolism of kynurenine into kynurenic acid that cannot cross the blood-brain barrier. | 2 |
| 7 | Cancer care providers should know that exercise improved muscle strength which was a powerful predictor of patient survival after surgery for cancers. | 1 |
| 8 | Cancer care providers should know that exercise had the potential to improve the potency and efficacy of anticancer drugs. | 2 |
| 9 | Cancer care providers should know that exercise had the potential to reduce the toxicity of anticancer drugs. | 2 |
| 10 | Cancer care providers should know that exercise improved blood flow; this might improve delivery of adequate concentrations of anticancer agents to tumors. | 1 |
| 11 | Cancer care providers should know that exercise improved recovery and reduced postoperative complications in patients undergoing surgery for solid tumors. | 1 |
| 12 | Cancer care providers should know that exercise could protect patients with and survivors of cancer from comorbidities. | 1 |
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