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therapist. The disciplines involved regularly hold multidisciplinary meetings, and keep track of subjective outcomes and clinimetrics in the trismus file.\u000D5.5.3 Decline in physical endurance and healthy physical activity\u000DHead and neck cancer treatment is often accompanied by loss of muscle mass, which in turn is associated with deterioration of physical functions and activities of daily living (such as lifting, walking performance and the ability to climb stairs) (Jager-Wittenaar 2010, Lonbro, Dalgas et al. 2013).\u000DRadiotherapy in head and neck cancer patients is furthermore associated with fatigue (Rogers, Courneya et al. 2008), which may in part be the result of reduced physical endurance. Although fatigue may be triggered by the disease and its treatment, lifestyle factors appear to contribute to long-term fatigue the most (Al-Majid and McCarthy 2001, Lucia, Earnest et al. 2003). It is highly recommendable to encourage patients to actively resume their lives and improve their physical fitness (IKNL 2007). Fatigue and reduced physical functioning could lead to a downward spiral of reduced physical activity and further loss of physical endurance.\u000DIn two publications, Rogers et al. report on a cross-sectional study into the current and past physical activity in 59 head and neck cancer survivors (18 \u00B1 50,9 months since diagnosis) (Rogers, Courneya et al. 2006, Rogers, Courneya et al. 2008). Only a small part of the studied population was found to perform moderate to vigorous activity. 44% reported a decline in physical activity after diagnosis. Before the diagnosis 30,5% of respondents met current health guidelines for physical activity. Of these respondents, 72% had lost this ability after diagnosis and treatment. Participants reported fatigue (2.2 \u00B1 1.4 on a scale of 1 to 4), as well as depression. The mean score on the CED-D was 18.7 points. Significant associations were found between the number of minutes of physical activity and the varying quality-of-life outcomes, even though effect sizes were modest (0.3). Associations between activity and depression scores could not be found.\u000DFurthermore, no significant association could be found between enjoyment of physical activity, symptom index, alcohol use, self-efficacy, perceived barriers, and comorbidity. These variables \u2013 excepting comorbidity and alcohol use \u2013 can be expected to be positively affected by a rehabilitation programme.\u000DA cross-sectional study by Rogers et al. into head and neck cancer survivors\u0027 preferences for physical activity and rehabilitation shows that the majority of respondents were definitely (33%) or possibly (42%) interested in an exercise programme tailored to head and neck cancer patients (Rogers, Malone et al. 2009) and thought that they would definitely (51%) or possibly (32%) be able to participate. The majority of patients indicated that they preferred exercise at home or in the outdoors. The results of this US-based study are not necessarily applicable in the Dutch situation and should therefore be interpreted with caution.\u000D5.5.3.1 Detection and evaluation of reduced physical functioning, fatigue and physical activity\u000DDetection of fatigue and reduced physical fitness takes place via the problem list of the Distress Thermometer and a VAS score for fatigue. To set goals in terms of activity and participation level, upon inclusion in the head and neck rehabilitation programme, the patient specific complaints (PSC) questionnaire is used (Beurskens, Koke et al. 1999, Stevens, Beurskens et al. 2013).\u000D125\u000D