Exercise

Despite many doctors feeling less than confident in prescribing holistic and natural practises in relation to our cancer treatments it seems that almost all of them would prescribe exercise of some kind.  

Cancer diagnosis has detrimental physical as well as psychological effects – both short-term and long-term – e.g. muscle atrophy, fatigue, reduced quality of life, loss of bone mass density and reduced muscular strength. As cancer treatment has improved so has the number of survivors and with that the increased importance to seek to improve the quality of life of these survivors.   Lack of activity has been shown to lead to a reduced ability of the heart and lungs to get oxygen to the muscles, making you feel more tired. This can lead to a drastically lower quality of life that has been linked frequently to an increased mortality rate. Also, the increase in the incidence of obesity in society has led to an increase in obesity induced diseases – particularly cancers – and also to poorer prognosis. 

Research has shown the positive effect exercise can have on individuals both during and after treatment and therefore suggests that increasing exercise levels (particularly resistance training) can influence recovery and recurrence. 

Exercise is good for you – even when you have or have had cancer. Research shows that physical activity can help counteract depression, anxiety, fatigue, weight gain, loss of strength, and many other side effects experienced by cancer patients both during and after treatment.  

It seems to be harder to engage men in post-cancer rehab.  For example   ADT, the most common form of treatment for men suffering from prostate cancer, is used across all stages of the carcinoma.  ADT slows the growth of the tumour by suppressing the release of testosterone (Basal Serum testosterone is a hormone that is key in maintaining muscle mass and reducing the risk of muscle atrophy). This can cause an increase in fat mass resulting in severe levels of fatigue and an increased risk of cardiovascular diseases.  Essentially ADT increases fat mass and decreases muscle mass so exercise can help by reversing these effects (decreasing fat mass and increasing muscle mass respectively).¹

In Denmark research was carried out on men who had been treated for prostate cancer.  They were encouraged to play football. The findings indicated that participants regarded football as a welcome opportunity to regain control and acquire a sense of responsibility for their own health without assuming the patient role, and football training legitimized and promoted mutual caring behaviour in a male‐oriented context. They could discuss their problems with each other during warm ups, in the changing room or after the game without feeling as if they were under the spotlight.²

It is not just after treatment has finished that exercise is seen to be helpful but also during treatment.  Exercise physiologist and researcher Dr Prue Cormie is very clear in her press statement:-

“If we could turn the benefits of exercise into a pill it would be demanded by patients, prescribed by every cancer specialist and subsidized by government. It would be seen as a major breakthrough in cancer treatment.”

Dr. Cormie states: “the level of evidence is really indisputable and withholding exercise from patients is probably harmful.”

There are hundreds of studies showing real, tangible benefits of exercise for patients with a variety of different cancers and at different stages.

Loosely quoting from Dr Monique Tello’s article in the Harvard Health Blog ³ she says that exercise as an additional therapy for patients undergoing cancer treatment has been well-studied and associated with many benefits. In one analysis of 61 clinical trials of women with all stages of breast cancer, those who underwent an exercise program during treatment had significantly improved quality of life, fitness, energy, and strength, as well as significantly less anxiety, depression, and lower body mass index and waist circumference compared with the regular care groups. In another major analysis of 28 trials involving over 1,000 participants with advanced cancers (including leukaemia, lymphoma, multiple myeloma, lung, breast, GI, and prostate), an exercise program during treatment was associated with significantly improved physical function, energy levels, weight/BMI, psychosocial function, sleep quality, and overall quality of life.

The Clinical Oncology Society of Australia (COSA) advises that people with cancer should:-

Avoid inactivity and be as physically active as they are able, with the goal of:

  • at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic exercise (e.g. walking, jogging, cycling, swimming) each week; and
  • two to three resistance exercise (e.g., lifting weights) sessions each week involving moderate- to vigorous-intensity exercises targeting the major muscle groups.

Their care team should:

  • tailor exercise recommendations to the individual’s abilities, anticipated disease trajectory, and health status
  • consult with accredited exercise physiologists and physical therapists as the most appropriate health professionals to prescribe and deliver exercise programs to people with cancer
  • promote these recommendations throughout treatment;

For now, COSA’s exercise prescription translates to about 21 minutes per day of exercise, plus a couple of muscle-building sessions per week.

There has been research to show the Importance of Resistance Training Post-treatment.  4 

This experiment was carried out with regards to post-treatment prostate cancer sufferers, the most commonly diagnosed cancer in men in the western world (although the findings can be applicable to a multitude of different cancers).

Experiment:

Designed to assess how resistance training affects certain activities (e.g. number of times someone can go from sitting to standing) and EQ5D scores over a twelve-week period of resistance exercise. 

Why use the 30 second sit to stand test?

The sit to stand test is a safe and effective test to evaluate functional performance in an older adult and an important tool to assess strength (particularly lower body strength). An increase in performance in the sit to stand test also correlates with a reduction in falls and hip fractures in the elderly population.

Why use the EuroQol 5-D?

The EuroQol 5-D is used to measure health outcomes such as mobility, self-care, pain and discomfort, ability to complete usual activities, anxiety and depression alongside a self-perceived score of their health. It helps to show the quality of life of patients.

Results: 

There were significant differences between the 30 second sit to stand scores before and after the 12-week resistance exercise period (80% improved on their scores – the other 20% remained the same). The EQ5D scores (used to measure the generic health status – i.e. an indication of their all-round wellbeing) also showed significant improvements after the 12 weeks (65% showed improvement). 

Conclusion:

Resistance training helps in performance of daily tasks in those who have undergone treatment (and are suffering from side effects of this treatment) of prostate cancer. It not only helps to increase physical functioning; it also improves quality of life and reduces side effects of treatment, with specific improvements in mobility, self-care and ability to complete usual activities.

What is resistance training

Resistance training is a technique used to progressively help improve muscular technique and it can be done with weights or simply by using your own bodyweight.

What does resistance training do?

  • Helps to increase anaerobic endurance and muscular strength
  • It increases skeletal muscle mass, improves muscle mass, bone density (increases strength)
  • It helps with functionality, mobility and muscle efficiency (helps you move more easily)
  • reduces the risk of injury and improves cardiac function (improves general health)
  • It reduces muscle atrophy (muscles wasting away due to lack of activity) and by doing this it improves energy levels and reduces cancer-related fatigue 
  • If done two to three times a week, results show an increase in functional capacity

We all probably know that cancer and the treatments for cancer change our bodies in a number of ways.  Here are just some of the changes:-

Cachexia – severe weight loss linked to various cancers due to a reduced appetite, changes in metabolic rate, excess catabolism and increased inflammation 

Cytokines – cancer patients have more of these inflammatory markers that act on a skeletal myocyte (ie type of white blood cell) which cause muscle atrophy. 

Chemotherapy – increases in pulmonary, gastrointestinal and cardiac toxicity and induces muscle atrophy by increasing certain hormones, which have been found to cause atrophy. Although various studies have been carried out on mice to show how chemotherapy influences muscle wastage, more extensive research is needed to conclusively establish the different effects of various forms. 

Effect strength training has on physical function in older adults

After the age of 50 muscle mass naturally starts to decrease and the reduction in muscle mass is heavily linked to mortality rate and physical disability in older adults. 

How can exercise help

  • Lean body tissue, which strength training promotes has various important functions including insulin management, cardiac output and respiratory function and most notably drug metabolism
  • Muscle strength has been determined as an important factor in functional impairments in older adults

BBC News recently reported on a new trial taking place in the UK.  Cancer patients are being offered one-to-one exercise sessions before, during and after treatment as part of a two-year pilot scheme in North Yorkshire.    Active Against Cancer is being trialled in Harrogate and, if successful, could be rolled out across the UK. 5 

The scheme, funded by Yorkshire Cancer Research, comes after research found physical activity is linked to better outcomes for several types of cancer.

It offers sessions with specialist trainers to everyone with a diagnosis.  Since it launched in July, more than 170 patients have been referred and that number is expected to reach 1,200 over the two-year period.

Rest and recuperation were traditionally seen as best, but now experts say exercise helps overcome the effects of the illness and its treatment.

When I was going through chemotherapy for lymphoma I remained fully active and was advised to add “green exercise” to my routine, such as  “forest bathing” (which simply means walking in the woods!).  Being outside in natural surroundings when exercising provides additional benefits such as fresh air, sunshine (not so common in the UK!) and the general meditative contentment we commonly get when we are close to nature.  

If you are being treated for cancer, the exercise recommendations can sound overwhelming, but it’s important to remember the idea is to individualize the activity plan.  The idea is for patients to do whatever they can manage, as they will reap the benefits, from strength conditioning to emotional well-being to relapse prevention.  6 7 

1 Isaac Oppong physiotherapist at Tottenham Hotspur Foundation

2 “All boys and men can play football”: A qualitative investigation of recreational football in prostate cancer patients

D. M. Bruun P. Krustrup T. Hornstrup J. Uth K. Brasso M. Rørth J. F. Christensen J. Midtgaard

3 https://www.health.harvard.edu/blog/exercise-as-part-of-cancer-treatment-2018061314035

4 Isaac Oppong, physiotherapist at the Tottenham Hotspur Foundation

5 https://www.bbc.co.uk/news/uk-england-york-north-yorkshire-49639276#

6 https://www.ncbi.nlm.nih.gov/pubmed/29730319

7 https://www.ncbi.nlm.nih.gov/pubmed/29738745