Should Cancer Doctors Prescribe Exercise? Part II

After a Cancer Diagnosis, Exercise Helps Improve Patient Well-Being
January 19, 2017
By Lada Krilov, PhD, ASCO Staff

ASCO Expert Perspective

“It may be surprising to many, but exercise after a diagnosis of cancer may lead to longer survival. Exercise may have benefits in some cancers that are as good as, or even better than, certain cancer drugs. The exact type and timing of exercise that leads to the greatest benefit requires further study, and numerous trials are underway to answer this question. Discussing exercise and physical activity should be part of the oncologist’s treatment plan and patients may wish to ask their physicians about whether exercise is right for them.”

  • Charles Ryan, MD, ASCO Expert

Cancer and its treatment can profoundly diminish a person’s physical condition and quality of life. The good news is that exercise can help alleviate a whole range of symptoms and improve overall well-being. Perhaps contrary to common belief, exercise is safe for majority of patients and survivors.1 

Exercising During Cancer Treatment Eases Side Effects

During cancer treatment, such as radiation, chemo- or hormone therapy, exercise can reduce fatigue and anxiety, while improving mood, self-esteem and physical functioning.1-3 A variety of physical activities appear to provide benefit, from high-intensity aerobic workouts in the gym to low-intensity walking and even performing household chores. Early research suggests that patients with advanced cancer who are receiving palliative care can benefit from exercise interventions.2

After Treatment, Exercise Can Boost Quality of Life, May Extend Survival

After treatment, exercise interventions have been shown to improve cancer survivors’ overall quality of life, vitality, fitness, fatigue, as well as reduce late-effects of treatment.4 In addition, studies suggest that people who are physically active after a diagnosis of breast or colon cancer have a lower risk of cancer recurrence and death from those diseases than inactive people.5  In the Health Professionals Follow-Up Study, men who engaged in vigorous physical activity three or more hours per week after a prostate cancer diagnosis had a 61% lower risk of dying from prostate cancer than men with less than one hour of vigorous activity per week.6 More research is needed to determine if physical activity may also help people with other types of live longer.

Differences in tumor biology, including its genomic makeup, probably play a role in the effect of physical activity on tumor growth, which explains why exercise seems to benefit people with some types of cancer more than others. For example, regular exercise is associated with a 9% lower risk of dying from hormone-receptor negative breast cancer, but a 50% lower risk of dying from hormone-receptor positive cancers.7

Despite mounting evidence that exercise improves physical function and quality of life, it appears that it is not yet standard practice to prescribe exercise to patients with cancer. Several organizations, including ASCO provide oncologists with exercise guidelines for cancer survivors. ASCO’s Cancer.Net also provides physical activity tips for survivors.

Doctor's Orders: For a Longer, Healthier and Happier Life, Be Active!

Opportunities for exercise seem to be everywhere – from hotel gyms to treadmill desks in offices. If classic jogging is too boring, there are other choices for every personality type, from Zumba and yoga to aqua aerobics.

With modern devices at our fingertips or wrists, we can measure our activity 24/7 – step counts, heart rate and sleep patterns. We can set goals and hold ourselves accountable, if not to our inner self then to the smartphone app of choice.

Yet, only one in five American adults engages in the recommended amount of physical activity, according to the Centers for Disease Control and Prevention (CDC).8 For people 18 years and older, the CDC and the American Cancer Society recommend 150 minutes of moderate-intensity aerobic activity per week and muscle training on two days every week.9

Yes, in our busy lives, carving out over 2 hours for exercise seems unattainable or at least unsustainable on a regular basis. However, this is the equivalent to the amount of time needed to watch a movie on TV (with commercials – sorry, DVR!). While we’re on the subject, did you know that excessive TV watching before and/or after a diagnosis of colorectal cancer diagnosis has been linked to shorter survival?10

 

References:

  1. Speck RM, Courneya KS, Mâsse LC, et al. An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. J Cancer Surviv. 2010 Jun;4(2):87-100.
  2. Eickmeyer SM, Gamble GL, Shahpar S, et al. The role and efficacy of exercise in persons with cancer.PM R. 2012 Nov;4(11):874-81.
  3. Champ CE, Francis L, Klement RJ, Dickerman R, Smith RP. Fortifying the Treatment of Prostate Cancer with Physical Activity. Prostate Cancer. 2016:9462975.
  4. Fong Daniel Y T, Ho Judy W C, Hui Bryant P H, Physical activity for cancer survivors: meta-analysis of randomised controlled trials. BMJ 2012;344:e70
  5. Ballard-Barbash R, Friedenreich CM, Courneya KS, et al. Physical activity, biomarkers, and disease outcomes in cancer survivors: a systematic review. J Natl Cancer Inst. 2012 Jun 6;104(11):815-40
  6. Physical activity and survival after prostate cancer diagnosis in the health professionals follow-up study. Kenfield SA, Stampfer MJ, Giovannucci E, Chan JM. J Clin Oncol. 2011 Feb 20;29(6):726-32.
  7. Holmes MD, Chen WY, Feskanich D, et al. Physical activity and survival after breast cancer diagnosis. JAMA. 2005 May 25;293(20):2479-86.
  8.  http://www.cdc.gov/physicalactivity/data/facts.htm Accessed August 8, 2016.
  9. http://www.cdc.gov/physicalactivity/basics/adults/index.htm  Accessed August 8, 2016.
  10. Arem H, Pfeiffer RM, Engels EA, et al. Pre- and postdiagnosis physical activity, television viewing, and mortality among patients with colorectal cancer in the National Institutes of Health-AARP Diet and Health Study. See comment in PubMed Commons belowJ Clin Oncol. 2015 Jan 10;33(2):180-8.