Should head and neck cancer survivors be considered a distinct special population within the context of exercise prescription?

Exercise is now widely accepted as a safe, cost-efficient, and effective intervention for cancer survivors and exercise guidelines for cancer survivors have been published. Currently there are no specific guidelines for different cancers despite apparent cancer-specific differences in the physical manifestations of the disease and the outcomes following treatment. One group of cancers where this appears to be particularly relevant is head and neck cancer (HANC). Common issues reported by HANC survivors include shoulder and neck dysfunction, head and neck lymphoedema, speech dysfunction, dysphagia, xerostomia, malnutrition, disfigurement, social isolation, and major depression. These issues have important implications for exercise prescription and supervision in terms of the safety and efficacy of the exercise, as well as patient uptake and adherence. HANC-specific issues should be considered when prescribing exercise within the framework of the general cancer exercise guidelines. Also, individual patient factors such as current fitness level, disease and treatment status, exercise preferences, and perceived barriers to exercise need to be considered. HANC survivors have many unique challenges and should be considered a distinct population within the context of exercise prescription. There has been a lack of research investigating exercise as an intervention in HANC survivors and much more research is required before robust evidence-based guidelines can be established. The purpose of this article is to provide a summary of salient factors to consider when optimising exercise prescription following HANC.