Article

Alternative exercise traditions (AETs) such as Pilates, yoga,
Tai Chi Chuan,
Qigong, and various forms of dance offer the potential to improve diverse
outcomes among cancer survivors by reducing adverse symptoms and mood disorders,
and by enhancing function. Additionally AETs have emerged as a potential means to
address deficits in current disease-focused care delivery models which are marked
by prevalent under-treatment of symptoms and physical impairments. Relative to
therapeutic exercise in allopathic models, many AETs are comparatively affordable
and accessible. AETs have the further potential to simultaneously address needs
spanning multiple domains including social, physical, and psycho-emotional. AETs
additionally offer the salient benefits of promoting integrated whole body
movement and concurrently enhancing strength, coordination, balance, posture,
flexibility, and kinesthetic awareness. Despite AETs' benefits, compelling
concerns leave many clinicians ambivalent and reluctant to endorse or even
discuss them. One issue is the extensive heterogeneity across and even within
specific AETs. An additional concern is that the one-size-fits-many nature of AET
group classes undermines an instructor's capacity to individualize dose, type,
frequency, and intensity, which are cornerstones of effective therapeutic
exercise. Inconsistencies in AET practitioner expertise and certification, as
well as the extent of practitioner familiarity with vulnerabilities unique to
cancer populations, may also be problematic. At this juncture, an extensive
literature of inconsistent quality that spans diverse cancer populations
frustrates efforts to precisely determine the effect size of any specific AET in
improving a specific outcome; Although systematic reviews and meta-analyses have
concluded that AETs have beneficial effects, they consistently identify a high
risk of bias in a majority of trials related to a lack of blinding, poor
allocation concealment, small sample sizes, and incomplete outcome data.
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