Exercise for the Management of Cancer

On Saturday the 11th of November, both Ross and I took part in a professional development course called ‘Exercise for the Management of Cancer’, ran by Kyle Smith from the Exercise Medicine Research Institute at Edith Cowan University (ECU), Western Australia. With the prevalence of cancer now affecting 1 in 2 males, and 1 in 3 females worldwide, being able to help cancer sufferers with carefully guided exercise to improve vitality and quality of life is something that we are all excited to pursue further at Restart. The current research, much of which is being done by ECU’s team of Professors and Doctors, states that exercise is beneficial for all cancer sufferers, interestingly even for those suffering with bone metastases.

 

The Research

 

Prostate Cancer

Men who performed >3 hours per week of vigorous activity after prostate cancer diagnosis had a:

– 49% lower risk of all-cause mortality,

– 61% lower risk of prostate cancer mortality (1).


Breast Cancer

Evidence from observational studies suggests a reduced risk of breast cancer death of:

– 20-50% if physically active, and a

– reduced risk of breast cancer recurrence of 17-43% if physically active (2).

 

People affected by cancer often have other comorbidities, therefore it is very important for these individuals to avoid being physically inactive. However, ~62% of people with cancer are insufficiently active or sedentary (3).

 

Resistance Exercise and Cancer

Resistance exercise was associated with a 33% lower risk of all-cause mortality (4).

 

Exercise is Medicine

Exercise is still viewed as an ‘optional extra’ despite benefits across disease spectrum in cancer patients. Exercise should be ‘standard of care’ for all patients.

 

Adjuvant Medicine

Exercise can be provided concurrently with primary therapies to help increase tolerance and reduce, prevent or reverse side-effects associated with treatment.

Synergistic Medicine

Exercise can be provided with primary therapies to increase effectiveness (potency) of treatments.

Targeted Medicine

Exercise can directly exert anti-cancer effects on human tumours (established using animal models only) to change tumour biology and suppress tumour growth.

 

Adjuvant Benefits of Exercise:

– Increased muscle mass and strength,

– Maintenance of bone mass and strength,

– Decrease adipose and visceral fat,

– Improved physical function,

– Decreased anxiety and distress,

– Improved sleep quality,

– Decreased depression,

– Decreased risk of developing other cancers,

– Improved quality of life.

 

Restart Exercise Physiology and the benefits of exercise on cancer management.

Known benefits of exercise on cancer management.

 

Current Exercise Recommendations

 

Exercise Therapy

Combine with primary therapies during ‘active treatment’:

– Pre and post-surgery,

– Radiotherapy,

– Chemotherapy,

– Hormone therapy,

– Immunotherapy.

 

Current ACSM Exercise Recommendations for Cancer Patients

– Engage in regular physical activity,

– Avoid inactivity and be as physically active as abilities and conditions allow,

– Aim to achieve at least:

– 150 minutes of moderate intensity aerobic exercise, or

– 75 minutes of vigorous intensity aerobic exercise per week.

– Include resistance exercise 2-3 days per week.

 

As Exercise Physiologists, we have the knowledge and prescription skills to individualise all exercise relevant to patient presentation.

 

Bone Metastases

A 2011 Western Australian study on the efficacy and safety of exercise in prostate cancer patients with bone metastases reported no major adverse events or bone pain in relation to the intervention (exercise). The study concluded that exercise improved self-reported physical function compared to controls (5).

Patients with bone metastases can and should exercise, however must always be supervised. Current recommendations are to avoid loading the areas of bones with lesions, but this may change in the near future once further research is done to establish safe load limits.

 

Client success story – Rachel, aged 34

“I believe that exercise helped in reducing my fatigue levels during chemotherapy, however I would still have to take it easy. Interestingly, I noticed that people that were not engaging in regular exercises appeared to be more fatigued than I was during the course of the treatment. When it came to tolerating chemoy, a lot of people undergoing treatment at the same time as me would miss treatment sessions due to low blood cell counts and thus have their dosage altered. I managed to get through the whole bout of chemo without missing any sessions or changing any chemo doses.

Additionally, during chemo I did get a lot of muscle soreness, and stretching with my Exercise Physiologist helped reduce these symptoms, especially lower back pain. These benefits helped solidify my reasoning behind making the effort to regularly get to the gym and see an Exercise Physiologist.”

 

At Restart, we are looking to link up more effectively with local Oncologists, Urologists and Cancer Treatment Centres to increase our exposure to cancer patients. Currently, we accept:

– Chronic Disease Management (CDM) Medicare referrals for cancer patients,

– Private GP referrals, both with and without patient Private Health Insurance (HICAPS terminal on-site at each Restart practice),

– Referrals for 12-week Group Exercise class. This class is modelled on Edith Cowan University’s Life Now program.

 

References

1) Kenfield et al, Physical activity and survival after prostate cancer diagnosis in the health professionals follow-up study. Journal of Clinical Oncology, 2011.

2) Holmes, M.D., Chen, W.Y., Feskanich, D., Kroneke, C.H. & Colditz, G.A. (2005). Physical activity and survival after breast cancer diagnosis. 293(20). 2479-2486. doi:10.1001/jama.293.20.2479.

3) Ogle K.S., Swanson, G.M., Woods, N., Azzouz, F. (2000) Cancer and Comorbidity: redefining chronic diseases 88 (3) 653-63. Retrieved May 15, 2012 from http;//www.ncbi.nlm.nih.giv/pubmed/10649261

4) Hardee et al. The effect of resistance exercise on all-cause mortality in cancer survivors, Mayo Clin Proc. 2014;89(8):1108-1115

5) Galvao et al. Efficacy and safety of a modular multi-modal exercise program in prostate cancer patients with bone metastases: a randomised controlled trial. BMC Cancer 2011; unpublished data.

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