Exercise and Cancer

Exercise is developing significant evidence for its benefits in preventing chronic illnesses including cancer but is also proving to be a major benefit during cancer treatment with improved results and managing side effects as well as improving long term outcomes and reducing reoccurance rates. The many physical and mental benefits of exercise make it a vital part of treatment but there are important things that need to be considered when planning the type volume and intensity of exercise and how the program needs to be modified as treatment progresses. This is the role of exercise professionals like Physio’s and Exercise Physiologists.   General Benefits of Exercise

• improve physical function
• strengthen muscle and bones
• improve circulation
• helps to maintain or achieve a healthy weight
• boosts energy levels
• improves mobility and balance
• enhances self-esteem
• helps you to cope with stress, anxiety and depression.
• offers a way to socialise and meet people
• reduces the risk of high blood pressure, heart disease, stroke, diabetes, osteoporosis and cancer.

The Clinical Oncology Society of Australia (COSA) position statement on exercise in cancer care: Exercise should be prescribed to all cancer patients as a standard part of their cancer care to help manage the effects of cancer and it’s treatment. 

Activity Guidelines Recommendations for an average healthy adult is 150 minutes of moderate intensity exercise or 75 minutes of high intensity exercise per week. Unless you are already very active you should not expect to achieve this at the start. Start slow, with small increments of exercise and regular rest periods, gradually progressing exercise as your energy levels and endurance increase.

• Increase general activity and sit less
• Be active each day
• 2.5-5 hours of moderate intensity or 1.25-2.5 hours of vigorous exercise or a combination each week.
• 2-3 strength training sessions/week

After Diagnosis:

After being diagnosed, rather than resting, exercise should be used to manage many of the common side effects of the disease and its treatment. Being active has been shown to speed recovery, improve quality of life and for some cancers, exercise can improve how you respond to treatment and reduce the likelihood of it coming back. Recently it was reported in the media that due to the overwhelming evidence that if exercise were a pill, it would be prescribed to every cancer patient in the world. There has been continued publicity of the undeniable benefits of exercise but it is a matter of changing the culture within medicine to treat exercise as medicine as the referrals have not followed the evidence. The important thing to consider is how your diagnosis effects the exercise you should do, what level to start at and how it should be progressed or modified in relation to your treatment and disease.  

Common Side Effects of Cancer Treatment and How Exercise Can Help

Fatigue

Fatigue is the most commonly reported side effect of cancer treatment. This can be related to the disease itself, from therapies involved in treatment that effect the red blood cell levels and bone marrow and from the loss of previous fitness as a result of resting or reduced normal activity. Fatigue levels can be severe enough that simply eating or standing is exhausting which significantly restricts the volume of exercise that can be done and needs to be considered in program planning. This situation often means the doctors need to get involved with transfusions which can make a huge difference. From an exercise point of view, staging and planning activity is important when fatigued to avoid making the situation worse but generally exercise helps to increase fitness and reduce fatigue when medically stable.

Anaemia

Low Red Blood Cell or Haemoglobin levels are a common side effect contributing to fatigue. Activity needs to be modified to appropriate levels until fatigue improves or medical treatment takes effect and the effects on red cell production ease.

Quality of Life

Exercise has been shown to have many benefits in addition to simply improving your fitness. These are just as important, if not more so, when dealing with chronic health issues which can be isolating, painful and when presented with an uncertain future can test your mental health. These benefits include: sleep regulation and quality, pain reduction, reduction in anxiety and depression, improved self-esteem, sexuality and ability to be socially active.

Mood Changes

The release of endorphins and the control of stress hormones from exercise have a strong influxes on anxiety and depression which can otherwise lead to mood changes and a negative situation in terms of mental health. A positive attitude towards recovery is usually seen as being helpful and exercise can help to make that possible.

Loss of muscle strength

This can be related to reduced activity or treatments including hormones and steroids. Exercise helps to reverse these changes.

Heart Problems

Radiotherapy to the chest, chemotherapy and other targeted therapies can effect the heart leading to long term cardiovascular disease. Activity that improves heart function such as aerobic exercise can help to reduce the risk of long term cardiovascular problems.

Loss of bone strength

Cancers effecting the bone, either as the primary cancer or secondary metastatic tumours and the treatments including hormone therapy and targeted radiotherapy can effect bone strength. This can be general osteoporosis or more focused to a particular site. Weight bearing exercise will have the effect of strengthening the bone but care needs to be taken with levels of impact and contact sports due to the risk of pathological fracture with relative trivial forces.

Safety Tips for Exercising with Cancer:

There are a few symptoms that are warning signs: if you experienced chest pain or pressure, severe shortness of breath, faint or dizziness, nausea or rapid heart beat. If you notice any of these cease exercise immediately and speak medical assistance. Take extra care with:

• Bone metastasis – reduces bone strength.Avoid contact sports or those involving high impact
• Low White Cells – Increased risk of infection. Avoid sharing water bottles, close contact with other people and risk of contact with sports that may lead to scratches and grazes and infection from playing surfaces
• Low platelets – Increased bleeding and bruising.Avoid contact and high impact sports.

 

Getting Started

Firstly, it’s important to remember that any exercise is better than none at all and if you’re starting new exercises, ease into it, take regular breaks and increase activity slowly and progressively. Depending on your situation having 2 difference exercise programs prepared to give you options for good days and days when you are not feeling well. Also, have options for getting outside to exercise in the sun and fresh air but have options for when the weather isn’t ideal, to exercise inside and reduce the risk of skipping sessions. As with any new program it isn’t uncommon to develop Delayed Onset of Muscle Soreness (DOMS) which typically last a few days and is often worse on the second day before starting to improve. This may be more severe if you are starting from a very fatigued and weaken position. If this does persists notify your Physio or Exercise Physiologist to allow adjustments and slower progression of your program. Before starting a program it is a good idea to talk to your doctor to ensure you are medical stable and to request any records or referrals to assist with planning and funding. From that point your EP and Physio will be in contact with the medical team to coordinate your exercise with all other aspects of your treatment.  

Structuring Exercise Sessions

Ideally, each session will involve a warm up, the main body of the session and a cool down. Warm up: aimed to prime the body, warm up the muscles and slowly raise the heart rate to preparing the body for exercise. This can including 5-10 minutes of low intensity aerobic work and light dynamic stretching.  E.g walking. Training: this can involve various type of exercise depending on the session goals including aerobic exercise, resistance training, circuit training, mobility and stability training. Each of these will be modified in terms of volume, duration, frequency and intensity depending on you current situation. Cool down: performed post training session to slowly lower heart rate, cool down the body and stretch the muscles used during the training sessions to reduce muscles soreness. Keep in mind that initially a small ‘warm up’ will be all you do. That’s ok! Over time you will improve and the sessions will get bigger and you will incorporate these different components.  

Type of Exercise

Aerobic exercise:

Exercise that increases the heart rate for a significant length of time to improve fitness of the heart and lunges. This involves using the larger muscle groups, creating demand for oxygen and challenging the heart and lungs to deliver it. This can be a light walk, cycling on a stationary bike, running up a hill or anywhere in between.

Strength training:

This consists of using weights or other forms of resistance to increase the strength of muscles, connective tissue and bone. This can include body weight, free weights, machines or resistance bands. If you have not performed any strength training before it is ideal that you seek advice from and exercise professional such as an exercise physiologist to begin an individualised program.

Flexibility exercise:

This involves stretching or slow controlled movements taking the muscles and joints through full ranges of movement to reduce the stiffness that results from inactivity and from the effects of treatment.  Learn more about Stretching  

Highlights of recent research:

Early Intervention

Recent studies involving breast and colon cancer demonstrated that individuals who performed regular exercise had a reduced risk of cancer reoccurrence.

Mental Health

Exercise stimulates the brain to produce chemicals such as serotonin which boost mood and balance stress hormones such as adrenaline and cortisol. This is an important finding for the general population with exercise being important in the management of mental health but with the effects on people’s self esteem, physical abilities, pain and uncertainty about the future, few things more challenging to mental health than chronic illness and exercise can help.

Blood Flow

Increased circulation through the body as a result of exercise results in improved supply of nutrients to the healthy cells of the body and delivers immune cells and cancer medications to areas of disease.

Hormones and Circulation

Reduction of stress hormones and increased circulation can also have an impact on reducing inflammation within the body. This potential reduction in inflammation may reduce the uncontrolled division of abnormal cells and thus reduce cancer cell growth. Studies are still ongoing in explaining this process.

Reduction in Secondary Diseases

Structured and supervised high and lower intensity exercise programs have demonstrated a reduction in the risk of other diseases, improves endurance, reducing fatigue levels and symptoms enhancing immunity and quality of life. Other benefits also include maintaining and healthy weights, improvements in lean body mass and strength. https://www.bmj.com/content/339/bmj.b3410.full

Fatigue

Exercise manages and reduces fatigue in cancer sufferers. In a study to determine the effects of exercise on fatigue levels in women undergoing breast cancer treatment, women were randomly assigned to a control group consisting of normal care and an intervention group, receiving a home-based moderate intensity walking exercise program. The women in the moderate intensity exercise group reported less serve fatigue symptoms.

HIIT and Chemotherapy

A study consisting of 866 men with metastatic castrate- resistant prostate cancer, demonstrated that high intensity supervised strength exercise improved survival rates compared to self-directed exercise over a 2 year period.

• Exercise has the potential to reduce progression of disease and improve survival.
• Exercise as a combined therapy can improve cancer patient outcomes.

https://bmjopen.bmj.com/content/8/5/e022899

Increased Levels of Function

A UK study looked at a 5 week cancer prehabilitation program for individuals awaiting surgery. This consisted of twice weekly exercise sessions and well-being classes. Of those who attended the sessions demonstrated an average 25m increases in 6 minute walk assessment, average 5 rep increase in sit to stand test and a 0.7kg increase in hand grip strength.     https://www.csp.org.uk/frontline/article/cancer-prehab-fit-surgery https://www.cancercouncil.com.au/cancer-information/exercise-cancer/getting-started/ https://www.runnersworld.com/news/a26801030/hiit-cancer-cell-growth/ https://www.csp.org.uk/news/2019-07-24-prehab-improves-cancer-outcomes-and-physio-key-service-delivery https://australian.physio/inmotion/oncology-exercise-group-fills-gap