ExerciseforCancerPatients:

EvidenceandBenefits

Preparedby:
DanielSantaMina,PhD(Cand);CEP/CES

Whendothebenefitsstart?

Now!
Extensiveresearchhasshownthatexerciseatany
pointduringthecancerjourneyisbeneficial

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ResearchatAllLevelsofLife

QOL
Emotional

Physical
Cellular

CancerandAssociatedTreatments
CanCause:

Weightgain
Fatigue
Boneloss
MuscleLoss
AppetiteLoss
Depression
Anxiety
Poorsleep
Pain
Stiffness
Confusion
ReducedQualityofLife

ExerciseCanHelp!

ExerciseforPrevention/PreDiagnosis

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PhysicalActivityCanHelpPreventSome
Cancers

ColonCancer
BreastCancer
EndometrialCancer
ProstateCancer
LungCancer
OvarianCancer

(2025%riskreduction)
(25%riskreduction)
(2030%riskreduction)
(1020%riskreduction)
(2040%riskreduction)
(20%riskreduction)

(Friedenreich,
Friedenreich, 2010; 2002)

Howexercisecanprotectusfrom
cancer
Exercisecanimprove:
Immunesystemfunction
Bodyfat%
Hormoneregulations(e.g.insulin,testosterone,
estrogen)
Overallhealthierlifestyle(quitsmoking,betterdiet,
cancerscreening)

ExerciseBeforeCancerTreatment

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PreparingforTreatment
Exercisecanhelpyouprepareforyourtreatment
byimprovingyourfitnesslevels,soyoucan:
Tolerateyourtreatmentbetter
Proceedwithdifficulttreatments
Reducetreatmentcomplications
Reducehospitalizationduration
Maintainminimumlevelsofstrength,evenafter
longperiodsofbedrest
Keepyoucalm
Recovermorequickly

ExerciseDuringTreatment

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ExerciseDuringTreatmentIS possible!
Exercisecanbesafelydoneduring:
Radiation
Chemotherapy
Hormonetherapy
Beforesurgery(andafterrecovery)
Bonemarrow/Stemcelltransplant
Immunotherapy
ForstageIIVcancers
(Young-McCaughan & Arzola, 2007)

WhatExerciseDoesNOTDo

ExerciseDoesNOT:
Worsentreatmentordiseaserelatedsymptoms
Compromisetreatmenteffectiveness

ExerciseDuringTreatment:
TheBenefits
Improvesfatigue
Improvesphysical
function
Decreasesweightand
bodyfat
Improvesimmune
systemfunction
Improvescardio
pulmonaryfunction
Improvesupper
extremitylymphedema

Improvesqualityoflife
Reducesdepression&
anxiety
Regulatesbowelmovements
Improvesappetite
Improvessleep
Preservesbonehealth
Reduceshospitalization
duration

(Systematic Reviews: Galvao & Newton, 2005; Schmitz et al, 2005; Knols et al, 2008)

Fatigue
Fatigueisthemostcommonsideeffectofcancerandits
treatment,affecting70100%ofpatients
(Mock et al, 2001, Cancer Practice)

Fatigueisthemost distressingtreatmentrelated
symptom
94%ofoncologiststreatpain;only5%treatfatigue
(National Cancer Institute, 2007)

Maycausepatientstodiscontinue/reducetreatment

CancerRelatedFatigue(CRF):

Tumour
Decreased

Treatment

Functional &
Fitness

CRF
Anxiety/

Sleep

Depression

Disturbance
Other
illnesses

FatigueCycle
Manyresearchstudieshaveshownthatexerciseimproves
cancerrelatedfatigue
Sedentary

Exercise

Fatigue

Behaviour

Reduced functional capacity/

Better Sleep
& Functional Capacity

Physical
Deconditioning
RECONDITIONING

FatandCancer
Maybelifestyleortreatmentinduced
Obesityincreasesriskforseveralcancers:
Colon,breast(postmenopausal),
endometrial,kidney,esophageal
Obesitynegativelyaffects:
Cancerprogression(byhormonechanges)
Otherillnesses(cardiovasculardisease,diabetes,etc.)
Jointpain/dysfunction
Treatments(e.g.surgicalrisk)
Mortality

CancerRelatedOsteopenia &Osteoporosis
Bonelossduringcancerandtreatmentcanbedueto:
Thetumour itself(osteosarcoma,metastatic lesions)
Chemotherapy
Radiation
Steroids
Surgery
Hormonetherapy
ReducedcalciumandVitaminDabsorbance
Resultantsedentarylifestylefromfatigue&malaise

ExerciseandBoneDensityinCancer
Onlyafew(8)studieshaveassessedtheeffectof
exerciseonbonehealthforcancerpatients
Researchshowsthatexercisecanhelpmaintainbone
health
Waltman , 2010

Exercisemayaddtothebenefitsofbonemaintaining
medications(bisphosphonates)
Resistancetrainingandpossiblyhighimpactexercise
maybebestforstimulatingbonedevelopment
Newton et al , 2010, ACPCRA Conference

Lymphedema
Lymphedemaisanaccumulationoflymphatic
fluid,oftenintheextremities.
Itcancause:
Swelling
Pain
LossofFunction
IncreasedRiskofInfection
Hardening/Thickeningoftheskin
Ulcers

ExerciseandLymphedema
Researchshowsthatexercisedoesnotworsenupper
extremitylymphedema;butmayactuallyhelpit
Personswithlymphedemashouldexercisewith
caution(consultwithyourdoctor,aphysiotherapist,
ortrainedWellspringCancerExerciseleader)
Therelationshipbetweenlowerlimblymphedema
andexerciseisnotwellunderstood
(Schmitz, 2010, NEJM, Harris, 2000, J Surg Onc; McKenzie & Kalda,
2003, JCO, Ahmed et al, 2006, JCO; Lacomba, 2010, BMJ; Katz, 2010)

ExerciseCanImproveEmotionaland
CognitiveWellbeing
Inmanycancers,exercisehasshowntoimprove:
QualityofLife
Confusion/MentalFunction
Mooddisturbance
Anger/Hostility
BodyImage
WeightConcerns
SexualAttractiveness
SelfEsteem

ExercisePostTreatment

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PhysicalActivityPostTreatment...
ContinuedBenefits
Fromsystematicreviews
Cardiovascular&
musculoskeletalfitness
Vigor
MentalClarity
Lymphedema
Physicalfunctioning
Fatigue
Bonemineraldensity
Bodycomposition

Jointmobility
Immunefactors
QualityofLife
ReducedRiskofcomorbidities
Reducedchronictreatment
relatedsideeffects
Improvedbodyimageand
selfesteem
Survival

(Schmitz et al, 2005, Ca Epi, Bio, Prev; Galvao et al, 2006, JCO)

ExerciseandPostTreatmentPain
Concernthatexercisewillcausepain
Highlysensitivetochangesinpain
Exercisehasbeenassociatedwithreducedpain
incancerpatients

(Alfano et al, 2007; J of Cancer Survivorship; McNeely, 2004, Head & Neck)

ExerciseandSurvivalAfterCancer
Newresearchisdemonstratingthatsurvivalcanbe
improvedwithexercisefor
BreastCancer
ColorectalCancer
ProstateCancer
Benefitsincludecancerandnoncancersurvival
improvement
Holmes, 2005, JAMA; Meyerhardt, 2006, JCO; Kenfield, 2011, JCO)

PhysicalActivityPostTreatment/Palliation
Inlatestagecancer,Exerciseisassociatedwith:
Improvedtoleranceofsymptoms
Improvedmobility
Improvedcoping
Maintenanceofphysicalfunction
Maintenanceofqualityoflife
andisgenerallywelltolerated

(Courneya & Friedenreich, 2007, Seminars in Nursing Oncology;

AgainWhendothebenefitsstart?

Now!
Exerciseisbeneficialduringeveryphaseofcancer:

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Exercise Guidelines

GoalsofExerciseProgramsforCancer
Survivors
1.
2.
3.
4.
5.
6.
7.
8.

Regainandimprovephysicalfunction
Improvebodyimageandqualityoflife
Improvebodycomposition
Improvecardiorespiratory,hormone,neurological,
muscular,cognitiveandpsychosocialoutcomes
Reduceordelayrecurrenceorsecondprimarycancer
Improvecopingwithrecurrence/asecondprimary
Reduce/preventlongterm&lateeffectsoftreatment
Improvetolerancetocurrent&futuretreatments

(Schmitz et al, 2010 MSSE, ACSM Roundtable)

CarefulConsiderationBeforeStartingAn
ExerciseProgram
Consultwithyourfamilydoctororoncologistortrained
WellspringCancerExerciseleaderbeforestartinganexercise
program.
Becautiouswhenexercisingifyouhave:
Recentlycompletedsurgery(upto8weeksaftersurgery)
Extremefatigueoranemia
Lowbloodcountsofimmunecellsorplatelets
Anylocalrestrictions(e.g.lymphedema,scarring,skin
sensitivity)
Drains(e.g.JPdrains,ostomy,catheters)
Highfracturerisk
(Schmitz et al, 2010 MSSE, ACSM Roundtable)

ExerciseGuidelinesforCancer
Survivors
GeneralStatement:
Avoidinactivity
Returntodailyactivitiesasquicklyaspossibleafter
surgery
Continuenormaldailyactivitiesasmuchaspossible
duringandafternonsurgicaltreatments
Individualswithcardiacconditionsmayrequire
modifications&greatersupervision

3060mins ofmoderatetovigorousPA,
>5d/wk
(Schmitz et al, 2010 MSSE, ACSM Roundtable)

CancerandExerciseGuidelines:
FITTPrinciple
Frequency
Thenumberofdaysperweekthatyouparticipateina
certainactivity

Intensity
Theamountofeffortyouputintotheexercise
Thelevelofdifficultyoftheexercise

Time
Thedurationoftheactivity

Type
Thespecificactivitythatyoutakepartin

GeneralExercisePrescriptionfor
CancerPatients
Modality

Frequency

Intensity

Volume(Time)

Aerobic/Cardio

35

5090%MaxHeartRate 2060mins
47/10Ratingof
(continuousor
PerceivedExertion
intermittent)

Anaerobic/
Resistance

13

Flexibility

23

5080%1Repetition
Maximum;
47/10RPE
?

14setsper
musclegroup
24setsper
musclegroup,
holdfor1030s

Galvao & Newton, 2005, JCO

ExerciseAdherence:
Theextenttowhichindividuals exercisebehaviours
correspondwiththeexerciseprescription

Schmitzetal,CanEpi Bio2005

Exerciseneedstobealongterm
commitment
Only30%ofcancersurvivorsaremeetingphysical
activityrecommendations
(Bellizzi et al, 2007)

Studieshaveshownthatafteranexerciseprogramis
discontinued,negativesideeffectsofcancerand
treatmentreturn

DurationofExercise=DurationofBenefits

(Culos-Reed et al,2007; Courneya & Friedenreich, 1997)

BarrierstoPhysicalActivityinCancer
Survivors

Unawareofexercisebenefits
Emotionalfactors(depression)
Psychosocialfactors(bodyimage,feelingsick)
Fatigue
Nauseaandvomiting
Time(vacation,medicalappointments)
Lackofconfidence/comfort/familiaritywithexercise
Lackofsocialsupport
Lackoftime
Distancefromtheexercisecentre
Lowmotivation
Worryaboutinjuries,diseaseprogression
Travel(SnowBirdEffect)

StrategiestoFacilitateAdherence
Homebasedequipment
PhysicianReferral&
Followup
GroupExercise&
ExerciseSupportGroups
GoalSetting

ExerciseManuals/
EducationalDocuments
Educationalseminars
Qualifiedtrainers
Selfrewards
Problemsolving