Cancer and Exercise — A new relationship in modern medicine

Andrew Awad
Accredited Exercise Physiologist

The incidence of cancer in Australia is increasing and it is estimated that 138,321 new cases will be diagnosed in 2018 (74,644 males and 63,676 females) with the most common types of cancer being breast 41.6%, prostate 23.1%, colorectal 12.4%, melanoma 10.4% and lung 9.3%.1 The most common of these cancers which lead to death are those of the lungs, bowels and prostate.

These are the facts.

The good news is the survival rate is increasing, with emerging research into treatment, exercise, better understanding of nutrition and early interventions.

Exercise has a significant effect on the mortality rate from cancer.

A study conducted on 661,137 subjects demonstrated that abiding by the recommended exercise guidelines (75 vigorous-intensity or 150 moderate-intensity minutes per week) provided the minimum benefit threshold in reducing the rate of mortality from cancer.

This study also demonstrated that those who are very active (those who performed more than ten times the recommended minimum volume of exercise each week) had a 31% reduced risk of cancer mortality in comparison to sedentary individuals.2

The benefits are evident on either end of the spectrum, not to mention a reduction in mortality from cardiovascular disease.

Exercise lowers risk of cancer

Further research investigated the association of physical activity with the risk of 26 different types of cancer.

This study demonstrated that very active lifestyles are associated with a lowered risk of 13 different types of cancer (oesophageal adenocarcinoma, liver, lung, kidney, myeloid leukaemia, myeloma, colon, head and neck, rectal, bladder and breast).3

The exercise guidelines that demonstrated these outcomes are based on 150 minutes of moderate-intensity activity per week.

Cancer-related fatigue (CRF) is the most common side effect of cancer and cancer treatment.

A meta-analysis of 113 studies found that exercise during and post cancer treatment significantly reduced cancer-related fatigue to a greater magnitude in comparison to pharmacological interventions.4

Incorporating exercise will improve quality of life and maintain psychological state, whilst managing all the energy consuming factors related to fighting off cancer.

Exercise improves immune function

Exercise has also shown to improve immune function, specifically by decreasing the age-associated decline in immune function referred to as immunosenescence.

A study investigating T Cell Immunosenescence demonstrated that aerobic exercise training could indeed prevent, limit or delay immunosenescence.5

This response was evident in subjects who exceeded more than 150 minutes of moderate intensity exercise or 75 minutes of vigorous-intensity activity on a weekly basis.

This immune response will also benefit patients undergoing cancer treatment.

Benefits of exercise

Exercise must be recommended for individuals diagnosed with cancer, but more importantly as a proactive approach. The benefits of incorporating exercise include:

• reduced risk factors associated with cancer (overweight, obesity, sedentary behaviour, diabetes, hyperlipidaemia)
• maintain and improve cardiovascular function
• strengthen and protect bones
• improved mood and psychological wellbeing (drug-free relief while undergoing treatment)
• improved appetite
• improved symptoms of nausea and vomiting (side effect from chemotherapy)
• improved immune function (stimulating lymphokines)
• improved completion rates with chemotherapy
• reduced cancer-related fatigue
• increase individual’s will to live
• improve Health Related Quality of Life (HRQOL)
• enhanced pre-diagnosis, active treatment and post-treatment patient reaction to treatment.

Prescribing exercise during cancer treatment

The recipe for the correct type, duration and frequency of exercise for cancer is very interdependent.

Several factors may affect your ability to exercise which may include: the type of cancer, stage of treatment, systematic effects, previous exercise history, fatigue periods during treatment and the volume of medications being induced.

The guidelines for exercise are:

• 20–60 mins per session
• 3–5 days per week
• moderate-intensity exercise (50% to 75% Maximal Heart Rate)
• Include aerobic, resistance and flexibility components to obtain a holistic benefit from your program.
• Encourage exercise to be conducted in a supportive and social environment.
• If the individual is feeling unwell or sick, advise to rest as required.
• If the individual is undertaking radiation therapy, advise to avoid frequent use of swimming pools as exposure to bacteria may cause infections and chlorinated pools may irritate the skin.

Evidence shows that exercise has an integral role in the treatment, management and prevention of cancer.

It is strongly advised that your patient/s be prescribed with an appropriate exercise program according to their individuals needs in consultation with their Exercise Physiologist and medical team.

References

1. Cancer Australia [Internet]. Australia: Australian Government; 2018. Cancer in Australia. Available from: https://canceraustralia.gov.au/affected-cancer/what-cancer/cancer-australia-statistics
2. Arem H, Moore S, Patel A, Hartge P, Berrington de Gonzalez A, Visvanathan K et al. Leisure time physical activity and mortality: a detailed pooled analysis of the dose-response relationship ; 175(6):959–67.
3. Moore S, Lee I, Weiderpass E, Campbell P, Sampson J, Kitahara C et al. Association of Leisure-Time Physical Activity with Risk of 26 Types of Cancer in 1.44 Million Adults. PubMed ; 176(6):816–25.
4. Mustian K, Peppone L, Palesh O, Janelsins M, Mohile S, Purnell J et al. Exercise and Cancer-related Fatigue. National Institute of Health. 2009;5(2):20–23.
5. Turner J, Brum P. Does Regular Exercise Counter T Cell Immunosenescence Reducing the Risk of Developing Cancer and Promoting Successful Treatment of Malignancies? Oxidative Medicine and Cellular Longevity. 2017;2017:1–18.