Prescribing Exercise for Cancer Treatment

The Alberta Cancer Exercise program adds physical activity into cancer patients’ treatment plans to improve their quality of life and chance of recovery

Dr. Nicole Culos-Reed.
Photograph by Jared Sych.

In the spring of 2017, Candace Cook, a 46-year-old Edmontonian living with metastatic breast cancer, was looking for a way to bolster her spirits and her energy. “I was feeling low, weak and tired,” she says.

She decided to give a new program called Alberta Cancer Exercise (ACE) a try, and the results were dramatic.

“[By the end of the program] I felt fantastic and optimistic,” Cook says. “After one year of progression on three different lines of treatment, my cancer was stable. And I had found a supportive community, as well.”

For Dr. Margaret McNeely and Dr. Nicole Culos-Reed, co-leads of the ACE study, results like Cook’s are no surprise.

Culos-Reed, a professor in the Faculty of Kinesiology at the University of Calgary, and McNeely, an associate professor in the Department of Physical Therapy, Faculty of Rehabilitation Medicine at the University of Alberta, both believe that a cancer diagnosis shouldn’t just mean a focus on treatment. It should also mean a focus on exercise and wellness. That’s why they are leading the ACE program.

ACE is a free, 12-week community exercise program and five-year study, funded by Alberta Innovates Health Solutions’ Cancer Prevention Research Opportunity. It began in January 2017 and was created for cancer survivors and cancer “thrivers” (individuals who are still undergoing treatment). For participants, ACE is about learning how to properly incorporate exercise into a weekly routine after a cancer diagnosis. The co-leads who developed the program, meanwhile, are examining its execution.

“We’re studying how to best implement ACE into clinical care for cancer patients, but we are also studying ACE’s effectiveness,” explains McNeely. “We’re tracking ACE participants to make sure we are actually making a change to their physical fitness and behaviour.”

Dr. Margaret McNeely. Photograph by Bluefish Studios.

McNeely and Culos-Reed are hands-on with ACE, doing everything from managing the database of participants’ results, which tracks fitness progress, to supervising the training of new exercise specialists and helping implement the programs.

According to both ACE co-leads, exercise is a healthy way to manage symptoms that accompany cancer treatment, like cancer-related fatigue. Also, exercise slows down the usual decline in fitness and strength that happens during cancer treatment, meaning exercise helps patients recover sooner or more easily. That’s why McNeely and Culos-Reed’s long-term goal is to implement the ACE program across the province on a permanent basis and make exercise a priority in individuals’ post-cancer recovery.

“Patients today are counselled right from the point of diagnosis regarding how their cancer will be treated,” says McNeely. “With ACE, they are also counselled on the lifestyle changes they can make to improve the overall outcomes of treatment.”

Right now, there is no province-wide exercise program like ACE running anywhere else in Canada. That it’s offered in community health facilities, such as Wellspring and city-run recreation centres, is also unique.

“Instead of delivering the exercise program in cancer centres or in research labs, we wanted to deliver ACE at different community locations so participants then have the skills and the confidence to go into a community exercise class. We want them to become lifelong exercisers,” says Culos-Reed.

Currently, ACE runs out of various community fitness facilities in Edmonton, Calgary, Red Deer and Medicine Hat. ACE will also be offered in Grand Prairie starting this September and in Lethbridge by January 2019. All exercise specialists working on the program undergo ACE training prepared by Culos-Reed and her partner, Dr. Lauren Capozzi, in order to acquire cancer-specific knowledge.
That training includes a 16-hour online module as well as a practical session with ACE-certified exercise physiologists.

At all sites across the province, the 12-week program is offered three times per year; intake is in September, January and April. Additionally, ACE was designed so that many people can qualify to participate. Regardless of their type of cancer, any adult can register as long as they are currently receiving cancer treatment, are within three years of having completed treatment, or are experiencing ongoing issues related to their cancer.

ACE begins with a baseline fitness assessment. Then, ACE participants join in either circuit training or weight training sessions twice a week with up to 14 others. During the post-program assessment, participants get tested to see how their fitness, balance, flexibility and muscular strength have improved. The co-leads say many participants then choose to register and pay for the ACE maintenance program, which costs an average of $150 for each subsequent 12-week session and allows those individuals to keep up the exercise routine they’ve begun.

Well over 700 participants have enrolled in ACE across Alberta so far. And many of them, including Candace Cook, have already become firm supporters. Now in the ACE maintenance program, Cook believes ACE is as crucial to her well-being as her medication.

“ACE changed my life,” she says. “It’s given me a healthier, stronger body, but it’s also given me a healthier, stronger mind.”

ACE-Recommended Exercises
ACE incorporates exercises that target different elements of fitness, including cardiovascular endurance, muscular strength, balance and flexibility. Exercises in the 12-week ACE program include resistance band exercises, light free weights, treadmill walking, stationary cycling and stretching.


For more information on the program, visit

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