Cancer Rehabilitation Through Industry Collaboration: Implementing Tiered Rehabilitation and Promoting Lifelong Recovery Awareness

Cancer has nearly become the leading killer threatening human health.

According to the “2018 Global Cancer Statistics” recently released by People’s Daily, there were 18.1 million new cancer cases and 9.6 million cancer deaths worldwide in 2018.

Asia has once again become a region frequently affected by cancer. Among all cases, 48.4% of new diagnoses and 57.3% of deaths originate from Asia. It is estimated that,In 2018, there were 3.804 million new cancer cases and 2.296 million cancer-related deaths in China. This means that more than 10,000 people are diagnosed with cancer every day in the country, with an average of seven new diagnoses per minute.

Cancer patients often undergo treatments such as surgery and pharmacotherapy during their care. For patients with advanced-stage cancer, chemotherapy is commonly employed; however, this approach may lead to cancer-related fatigue and compromised immune function, significantly impairing the patients' quality of life.

Medical interventions such as surgery and pharmacotherapy have certain limitations. It has become an urgent issue to identify non-medical approaches, beyond conventional treatments, that can assist cancer patients and improve their quality of life.Western countries provided the answer in the last century: exercise prescription.

This approach was initially intended to promote exercise as a measure for enhancing physical fitness. However, subsequent studies have demonstrated its positive impact on patients. Through comprehensive medical examinations, exercise risk assessments, and health-related physical fitness evaluations, and by taking into account the patient’s living environment and personal preferences, healthcare providers can issue individualized exercise prescriptions. These prescriptions specify the type, duration, intensity, and frequency of exercise, which patients are then guided to follow. Adherence to such prescribed regimens can ultimately improve patients’ physical constitution, boost immune function, prevent and manage chronic diseases, and enhance their quality of life. Cancer patients are no exception.

Research institutions worldwide have conducted nearly a century of exploration into the role of exercise prescriptions.

From the outset, the exploration of exercise prescriptions has not been confined solely to academic research but has aimed to apply them in clinical settings to address practical problems.As early as the 1950s in the United States, exercise prescriptions for coronary heart disease gained public acceptance as an effective therapeutic approach.

In 1954, the Hollmann Institute in Germany successively released research findings on exercise prescriptions and developed a series of such prescriptions for populations with conditions such as diabetes and myocardial infarction. Established in 1970, the Cooper Center Longitudinal Study (CCLS) is the world’s earliest database and tracking research center dedicated to exercise and health. Aerobic exercise, popularized globally by Kenneth Cooper, continues to influence and transform the world. In Japan, the Sports Science Center was founded in 1970, followed by the establishment of the “Exercise Prescription Research Committee” in 1971 under the leadership of Professor Michio Inokai, marking the beginning of exercise prescription initiatives in Japan.

In the early 1990s, the United Kingdom established Exercise Referral Schemes (ERSs), which are analogous to the concept of exercise prescriptions, aiming to bridge healthcare gaps through clinical exercise interventions in non-clinical settings such as leisure centers and gyms. These schemes primarily targeted non-communicable diseases (NCDs), including diabetes, cancer, cardiovascular diseases, respiratory diseases, and neuropsychiatric disorders. Exercise prescriptions have also proven effective for patients with chronic cancer.

In fact,Research on the association between exercise prescriptions and cancer is ongoing. Based on epidemiological and clinical evidence from studies on various cancers and physical activity levels, increasing physical activity and reducing sedentary behavior confer health benefits in the prevention, treatment, and rehabilitation of multiple types of cancer.

The “EPIC” collaborative research project under the European Cancer Plan, initiated in the 1990s, conducted a seven-year follow-up study on 500,000 volunteers aged 35 to 70 from ten developed European countries, including France. The results showed thatFor colorectal cancer and breast cancer, which account for the highest number of new cancer cases among men and women respectively, engaging in regular exercise and physical activity can significantly reduce the risk of developing these two types of cancer.

Another prospective study on post-diagnosis physical activity and cancer-specific mortality pointed out:Studies of patients with breast, colorectal, and prostate cancer have found that those who engage in regular physical activity have a 37% lower risk of cancer-specific mortality compared to those who do not exercise.The risk of cancer recurrence or death due to cancer recurrence was also reduced.Multiple studies have demonstrated that exercise yields significant benefits in mitigating the toxic side effects of radiotherapy and chemotherapy in cancer patients, optimizing the efficacy of pharmacological treatments, and alleviating common comorbidities such as cardiopulmonary diseases, diabetes, osteoporosis, and arthritis.

Treating cancer as a special type of chronic disease and implementing long-term, targeted, and standardized management of the rehabilitation process is a trend in many developed countries. The expert panel on exercise guidelines for adult cancer patients from the American College of Sports Medicine (ACSM) reported that,There is ample evidence demonstrating that exercise is safe for patients with all types of cancer (such as breast, prostate, colon, hematologic, and gynecologic malignancies) both during and after treatment., the FITT principle for patient exercise—frequency, intensity, type, and time—should be adjusted according to the condition of malignant tumors to develop individualized exercise prescriptions and clarify the level of medical supervision required during exercise.

Kaiser Permanente hospitals and the Mayo Clinic (now known as Mayo Clinic) in the United States, along with cancer rehabilitation hospitals in Australia, Canada, and other countries, have incorporated exercise prescriptions into strategies for cancer patient rehabilitation and recurrence prevention. Many hospitals and professional institutions in Europe and the United States have established medical fitness centers that offer services including cancer patient rehabilitation.

andIn today’s digital era, an increasing number of enterprises are attempting to deliver exercise prescriptions through online channels.For instance, Apple’s partner Physitrack integrates healthcare professionals through drchrono, a mobile EHR (electronic health record) manufacturer, to provide exercise prescription services for users of Apple iPad, iPhone, and Apple Watch.

Meanwhile, the UK-based Active8lives platform provides clinically validated Aseptika digital rehabilitation management tools for patients recovering from cardiovascular disease, lung disease, and cancer through its Active+me protocol (physical exercise, self-care, and monitoring). “Living With,” the most frequently used medical app in the UK, offers NHS-approved, affordable, and intelligent remote monitoring features for patients with pelvic health conditions, rheumatoid arthritis, and esophageal cancer.

By integrating clinical evidence-based research with digital intelligence technologies, the dose-response relationship between exercise and cancer rehabilitation can now be digitally visualized.Driven by the rigid demand for cancer rehabilitation and advancements in digital health technology, the application of exercise prescriptions in China’s cancer rehabilitation sector is merely a matter of time.

The emphasis on health has led China to adopt new developments in the field of exercise prescription from abroad at an early stage. Early research on sports medicine in China mainly focused on individuals in the sports community, asHealthy China: "Integration of Sports and Medicine"With the emergence of such perspectives, an increasing number of clinicians have initiated explorations—shifting from initially introducing and disseminating international advances in the field of exercise prescriptions to examining their impact on patient diagnosis and treatment. The scope of research has also gradually aligned with international trends, extending to investigations into the beneficial effects of exercise prescriptions on cancer.

In fact, domestic enterprises have long applied exercise prescriptions in the field of rehabilitation therapy. Aomei Health, which began exploring exercise prescriptions in the early 21st century, has leveraged nearly two decades of accumulated expertise to achieve new advancements in this area by expanding into cancer rehabilitation. Currently, Jiangsu Province is implementing a province-wide project for rehabilitation guidance and follow-up management for cancer patients.Aomei Health has partnered with Jiangsu Cancer Hospital to integrate exercise prescriptions into the rehabilitation guidance and follow-up management program for cancer patients in Jiangsu Province, serving as a practical example of the implementation of cancer rehabilitation initiatives.

In 2019, the State Council’s “Opinions on Implementing the Healthy China Action” stated that the overall five-year cancer survival rate should reach no less than 43.3% by 2022 and 46.6% by 2030. To further improve cancer patient survival rates, under government guidance, Jiangsu Cancer Hospital (Jiangsu Provincial Cancer Center) aims to enhance patients’ awareness of rehabilitation and increase the five-year survival rate for cancer patients through follow-up and rehabilitation guidance for 65,000 cancer cases.

In traditional medical services, physicians often overrely on clinical interventions while placing insufficient emphasis on rehabilitation.Even when precautions are advised for patients, they are often limited to nutritional aspects. Internationally, comprehensive management involving surgery and rehabilitation has long been implemented, with non-medical interventions such as exercise prescriptions gradually improving survival rates among cancer patients.

The Jiangsu Cancer Prevention and Health Management Platform features multiple sections, including cancer prevention education, cancer screening examinations, and rehabilitation guidance.Aomei Health leverages its 18 years of expertise in the field of exercise prescriptions to launch an online training camp for cancer exercise prescriptions via its platform, providing professional knowledge training for doctors, nurses, rehabilitation therapists, and health managers.Through physician-led education, cancer patients are encouraged to engage with the corresponding content to facilitate learning and achieve rehabilitation.

As exercise prescriptions require clinicians to conduct a series of offline assessments, provide exercise guidance, and offer medical supervision,Aomei Health Plan will next leverage the Jiangsu Provincial Cancer Prevention and Control Network to launch offline collaborations, establishing a cancer rehabilitation center in Nanjing., and pilot programs were conducted in two to three hospitals in Jiangsu Province in 2021.

During the development of the cancer patient rehabilitation management and follow-up program in Jiangsu Province, physicians’ misconceptions regarding exercise-based rehabilitation highlighted to Aomei Health the critical importance of cultivating rehabilitation professionals.In addition to launching an 18-day online training camp on exercise prescriptions for cancer prevention and treatment tailored to this project, Aomei Health has also partnered with the Chinese Academy of Sports Rehabilitation Education to strengthen the cultivation of professionals in sports rehabilitation for cancer patients.

Established in August 2020 and affiliated with the Chinese Medical Association, the Chinese Academy of Sports Rehabilitation Education was founded under the leadership of its inaugural dean, Professor Li Guoping. Professor Li is the former director of the Institute of Sports Medicine of the General Administration of Sport of China and the founding chairman of the Sports Medicine Branch of the Chinese Medical Association. Leveraging the professional background, academic and expert resources, and continuing education platforms of the Chinese Medical Association, the Academy will continue to advance the development of standards for exercise prescriptions and sports rehabilitation, as well as provide training and certification, continuing education, academic promotion, and public science education.

Currently, it is also collaborating with two leading international authoritative institutions, namely the American College of Sports Medicine (ACSM) for Exercise Physiologist/Clinical Exercise Physiologist (EP/CEP) exercise prescription training, and Germany’s MTT (Medical Training Therapy) vocational skills training in sports rehabilitation.Through standardized training and certification, Aomei Health, in partnership with the Chinese Sports Rehabilitation Education Institute, is supplying the industry with professionals capable of prescribing exercise regimens for patients with various chronic diseases.

The treatment and recovery of cancer patients can be divided into three stages:

Phase I is the tertiary rehabilitation period, which generally covers the preoperative phase, the perioperative period of surgical treatment, and the first three months postoperatively for cancer patients.At this stage, the primary goals are to help cancer patients reduce surgical complications, alleviate psychological burden, improve treatment efficacy, and minimize drug-related toxic side effects.Since patients are basically at the surgical hospital during this stage,Aomei Health Plan collaborates with provincial and municipal Grade A tertiary hospitals to jointly implement exercise therapy for cancer patients., formulate and implement targeted exercise prescriptions based on patients' clinical and physical fitness assessment indicators, and provide individualized plans for nutrition, psychology, physiotherapy, and traditional Chinese medicine, helping patients prolong their lives and achieve a tumor-free state.

The second stage is the Level II rehabilitation period, which typically occurs within 2–3 years after postoperative rehabilitation.The primary aim is to help cancer patients prevent metastasis and recurrence, alleviate symptoms, and restore function.At this stage, cancer patients often return to the community, soAomei Health has also designated community medical institutions or health management organizations as its partners for this phase.Cancer patients can enhance their immune function and resistance by adopting healthy lifestyles and adhering to tailored rehabilitation programs, including exercise, nutrition, psychological support, and physical therapy. Furthermore, the recovery of cancer patients often serves as an inspiration for other individuals with chronic diseases within community healthcare settings, thereby creating a positive feedback loop.

Phase III is the Level 1 rehabilitation period, also known as the health management and prevention period, referring to the stage after returning from the community to the home.At this stage, cancer patients have already cultivated a correct awareness of rehabilitation and know how to manage themselves using scientific methods. They can receive care at home through remote management systems (such as mini-programs and mobile applications).Implement further rehabilitation training to help patients eliminate high-risk factors and restore health.

In reality, the rehabilitation process for cancer patients requires not only the specialized intervention of Aomei Health in the field of exercise prescription but also the involvement of all stakeholders across the industry chain.The patient recovery process involves nutrition, exercise, sleep, digestion, psychology, traditional Chinese medicine, physical therapy, and may also include insurance claims processing.

Xu Junhua, founder of Aomei Health, stated thatWe hope to collaborate with more local institutions in this process to build a rehabilitation care chain that better aligns with the psychological profiles and dietary habits of Chinese patients; we also hope to see greater participation from physicians and medical institutions in the rehabilitation of cancer patients; and we further hope to attract more capital investment into the establishment and implementation of cancer rehabilitation centers.For cancer patients, the participation of various stakeholders in the industry will ultimately benefit individual patients and their families.

Although the field of cancer survivorship still faces certain obstacles, we are also witnessing emerging trends that will further transform the current landscape.

1、The Cancer Exercise Rehabilitation Group of the Chinese Sports Rehabilitation Education Institute is about to be established.Professional societies have begun to mobilize resources to train relevant personnel, which helps enhance physicians’ awareness of rehabilitation and strengthen the clinical skills of healthcare providers, ultimately benefiting patients and reshaping societal perceptions of cancer rehabilitation.

2、The "Outline of the Healthy China 2030 Plan" points out that it is necessary to further strengthen the integration of sports and medicine, as well as non-medical health interventions.“Promote the formation of a disease management and health service model that integrates sports and medicine, and leverage the positive role of nationwide scientific fitness in health promotion, chronic disease prevention, and rehabilitation.” Policy-driven integration of sports and medicine will further facilitate the combination of exercise prescriptions with clinical practice, thereby promoting the application and development of exercise prescriptions.

3. With the further development of academic research in China,Domestic and international research on exercise prescriptions is gradually converging and developing in tandem.. Domestic research has begun to develop exercise prescriptions tailored to the specific conditions of the Chinese population, which has also driven the development of the entire field of exercise prescription.

In fact, standards in the field of exercise prescription in China still need to be established. This undoubtedly presents new opportunities for companies that have long been dedicated to this field, such as Aomei Health.