Presenting the Brazilian physical activity during cancer treatment guidelines: adaptations and challenges in a low- and middle-income context

The purpose of this article is to present the Brazilian Physical Activity (PA) During Cancer Treatment Guidelines(PA) during cancer treatment, and discuss the adaptations made to align the recommendations with the Brazilian context and its distinctive peculiarities. The development of Brazilian Guidelines for recommending PA during cancer treatment consisted of identifying international guidelines and positions and adapting their recommendations and statements for the Brazilian context. For this, an expert working group including scientists, exercise specialists, and oncologists revised the international guidelines, selected outcomes, and created recommendations based on PA safety and efficacy on the selected adverse effects of cancer treatment and the regional context. After review of 14 PA oncology guidelines, two were selected. Drawing from the selected guidelines, the working group formulated the recommendations considering the scientific evidence extracted from the documents and the Brazilian contextualization. Although the guidelines were based on international recommendations, the expert working group introduced adaptations to better reflect the Brazilian context. These adaptations included translating the content into Portuguese and simplifying the language to improve accessibility for healthcare professionals. Safety information and contraindications were added, and recommendations were adjusted not only in terms of intensity, mode, and frequency but also to promote accessibility, motivation, and long-term adherence. Additionally, the guidelines took into consideration professional regulations, access to qualified staff, the structure of the health system, and regional sociocultural and economic disparities, particularly in underserved and rural areas. There is a clear need for context-specific exercise oncology research and policies that reflect the low and middle-income countries’ social, economic, and cultural characteristics. This Brazilian guideline represents a first and essential step toward aligning Brazil with the international agenda for establishing PA standards in oncology.