Current Treatment Options in Oncology

, Volume 9, Issue 2–3, pp 135–146

Exercise in Prevention and Management of Cancer

Complementary and Alternative Therapies in Oncology

Opinion statement

Regular and vigorous physical exercise has been scientifically established as providing strong preventative medicine against cancer with the potential to reduce incidence by 40%. The effect is strongest for breast and colorectal cancer; however, evidence is accumulating for the protective influence on prostate cancer, although predominantly for more advanced disease and in older men. Following cancer diagnosis, exercise prescription can have very positive benefits for improving surgical outcomes, reducing symptom experience, managing side effects of radiation and chemotherapy, improving psychological health, maintaining physical function, and reducing fat gain and muscle and bone loss. There is now irrefutable evidence from large prospective studies that regular exercise postdiagnosis will actually increase survivorship by 50%–60% with the strongest evidence currently for breast and colorectal cancers. In our work with prostate cancer patients, we have found that exercise can limit or even reverse some of the androgen deprivation therapy (ADT) adverse effects by increasing muscle mass, functional performance, and cardiorespiratory fitness without elevating testosterone levels. Hormone therapies for breast and prostate cancer can result in alarmingly increased risk of cardiovascular disease, obesity, type 2 diabetes, osteoporosis, and sarcopenia. Increasingly, patients are questioning the benefit of some cancer treatments as the risk of morbidity and mortality from other chronic diseases begins to outweigh the initial cancer diagnosis. Over three decades of research in exercise science and many hundreds of RCTs demonstrate the efficacy of appropriate physical activity for preventing and managing these secondary diseases. Based on this evidence it is now clear to us that exercise is a critical adjuvant therapy in the management of many cancers and will greatly enhance the therapeutic effects of traditional radiation and pharmaceutical treatments by increasing tolerance, reducing side effects, and lowering risk of chronic diseases, even those not aggravated by cancer treatment. While patients and their clinicians deal with their cancer, other chronic disease mechanisms continue unabated. Anxiety, depression, poor nutritional choices, and a counterproductive rest strategy will accelerate these processes, while a well-designed exercise program adhered to by the patient and supported by the medical and exercise professionals will effectively control and even reverse these diseases and disabilities. In the wide range of cancer populations that we work with, both young and old and with curative and palliative intent, our overwhelming experience is that exercise is first well tolerated, and benefits the patient

psychologically and physically. While some of our patients are on individual, home-based programs, we find that small group exercise sessions with close supervision by Exercise Physiologists (EP) provides a more motivating setting and the social interaction is critical for adherence and retention as well as greater psychological benefits such as reduced anxiety and depression and enhanced social connectedness. While managing many hundreds of cancer patients over the last 6 years, our clinic has not experienced any instances of the exercise hindering patient recovery or treatment purpose, nor have any significant injuries occurred. However, it is critical that the exercise prescription and management be tailored to the individual patient and that they are monitored by appropriately trained and professionally accredited exercise specialists. For those patients at low exercise risk and without significant musculoskeletal issues, community-based physical activity is of excellent benefit where the emphasis should be on adherence, affordability, convenience, and enjoyment.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. 1.••
    Booth FW, Chakravarthy MV, Spangenburg EE. Exercise and gene expression: physiological regulation of the human genome through physical activity. J Physiol. 2002;543(Pt 2):399–411. doi:10.1113/jphysiol.2002.019265.CrossRefPubMedGoogle Scholar
  2. 2.
    Yach D, Hawkes C, Gould CL, Hofman KJ. The global burden of chronic diseases: overcoming impediments to prevention, control. JAMA. 2004;291(21):2616–2622. doi:10.1001/jama.291.21.2616.CrossRefPubMedGoogle Scholar
  3. 3.
    Bernstein L, Patel AV, Ursin G, Sullivan-Halley J, Press MF, Deapen D, et al. Lifetime recreational exercise activity and breast cancer risk among black women and white women. J Natl Cancer Inst. 2005;97(22):1671–1679.PubMedCrossRefGoogle Scholar
  4. 4.
    Howard RA, Freedman DM, Park Y, Hollenbeck A, Schatzkin A, Leitzmann MF: Physical activity, sedentary behavior, and the risk of colon and rectal cancer in the NIH-AARP Diet and Health Study. Cancer Causes Control 2008, April 25, 2008 [Epub ahead of print] doi:10.1007/s10552-008-9159-0
  5. 5.
    Giovannucci EL, Liu Y, Leitzmann MF, Stampfer MJ, Willett WC A prospective study of physical activity and incident and fatal prostate cancer. Arch Intern Med. 2005;165:1005–1010. doi:10.1001/archinte.165.9.1005.CrossRefPubMedGoogle Scholar
  6. 6.
    Braga-Basaria M, Dobs AS, Muller DC, Carducci MA, John M, Egan J, et al. Metabolic syndrome in men with prostate cancer undergoing long-term androgen-deprivation therapy. J Clin Oncol. 2006;24(24):3979–3983. doi:10.1200/JCO.2006.05.9741.CrossRefPubMedGoogle Scholar
  7. 7.••
    Galvão DA, Newton RU, Taaffe DR, Spry N. Can exercise ameliorate the increased risk of cardiovascular disease and diabetes associated with ADT? Nat Clin Pract Urol. 2008;5(6):306–307. doi:10.1038/ncpgasthep1141.PubMedGoogle Scholar
  8. 8.
    Taaffe DR Sarcopenia. Exercise as a treatment strategy. Aust Fam Physician. 2006;35(3):130–134.PubMedGoogle Scholar
  9. 9.
    Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007;39(8):1423–1434. doi:10.1249/mss.0b013e3180616b27.CrossRefPubMedGoogle Scholar
  10. 10.••
    Nelson ME, Rejeski WJ, Blair SN, Duncan PW, Judge JO, King AC, et al. Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007;39(8):1435–1445. doi:10.1249/mss.0b013e3180616aa2.CrossRefPubMedGoogle Scholar
  11. 11.••
    Galvão DA, Newton RU Review of exercise intervention studies in cancer patients. J Clin Oncol. 2005;23(4):899–909. doi:10.1200/JCO.2005.06.085.CrossRefPubMedGoogle Scholar
  12. 12.
    Harriss DJ, Cable NT, George K, Reilly T, Renehan AG, Haboubi N Physical activity before and after diagnosis of colorectal cancer: disease risk, clinical outcomes, response pathways and biomarkers. Sports Med. 2007;37(11):947–960. doi:10.2165/00007256-200737110-00003.CrossRefPubMedGoogle Scholar
  13. 13.
    Samad AK, Taylor RS, Marshall T, Chapman MA A meta-analysis of the association of physical activity with reduced risk of colorectal cancer. Colorectal Dis. 2005;7(3):204–213. doi:10.1111/j.1463-1318.2005.00747.x.CrossRefPubMedGoogle Scholar
  14. 14.
    Lee KJ, Inoue M, Otani T, Iwasaki M, Sasazuki S, Tsugane S Physical activity and risk of colorectal cancer in Japanese men and women: the Japan Public Health Center-based prospective study. Cancer Causes Control. 2007;18(2):199–209. doi:10.1007/s10552-006-0098-3.CrossRefPubMedGoogle Scholar
  15. 15.
    Friedenreich CM, Cust AE: Physical activity and breast cancer risk: impact of timing, type and dose of activity and population sub-group effects. Br J Sports Med 2008, May 6 2008 [Epub ahead of print] doi: 10.1136/bjsm.2006.029132
  16. 16.
    Giovannucci E, Leitzmann M, Spiegelman D A prospective study of physical activity and prostate cancer in male health professionals. Cancer Res. 1998;58:5117–5122.PubMedGoogle Scholar
  17. 17.
    Patel AV, Rodriguez C, Jacobs EJ, Solomon L, Thun MJ, Calle EE Recreational physical activity and risk of prostate cancer in a large cohort of U.S. men. Cancer Epidemiol Biomarkers Prev. 2005;14(1):275–279.PubMedGoogle Scholar
  18. 18.
    Nilsen TIL, Romundstad PR, Vatten LJ Recreational physical activity and risk of prostate cancer: a prospective population-based study in Norway (the HUNT study). Int J Cancer. 2006;119:2943–2947. doi:10.1002/ijc.22184.CrossRefPubMedGoogle Scholar
  19. 19.
    Häkkinen K, Kraemer WJ, Pakarinen A, Triplett-McBride T, McBride JM, Häkkinen A, et al. Effects of heavy resistance/power training on maximal strength, muscle morphology, and hormonal response patterns in 60–65-year-old men and women. Can J Appl Physiol. 2002;27(3):213–231.PubMedGoogle Scholar
  20. 20.
    Barnard RJ, Leung PS, Aronson WJ, Cohen P, Golding LA A mechanism to explain how regular exercise might reduce the risk for clinical prostate cancer. Eur J Cancer Prev. 2007;16(5):415–421.CrossRefPubMedGoogle Scholar
  21. 21.
    Jones LW, Peddle CJ, Eves ND, Haykowsky MJ, Courneya KS, Mackey JR, et al. Effects of presurgical exercise training on cardiorespiratory fitness among patients undergoing thoracic surgery for malignant lung lesions. Cancer. 2007;110(3):590–598. doi:10.1002/cncr.22830.CrossRefPubMedGoogle Scholar
  22. 22.
    Benumof JL Obesity, sleep apnea, the airway and anesthesia. Curr Opin Anaesthesiol. 2004;17(1):21–30. doi:10.1097/00001503-200402000-00005.CrossRefPubMedGoogle Scholar
  23. 23.
    Hope PAJ, Newton RU, Sacco P, Kristjanson L, Spry N: Fatigue and associated changes in activity and fitness during adjuvant breast radiotherapy. Second Annual Chicago Supportive Oncology Conference; 2006 September 28–30; Chicago, Illinois; 2006: 429Google Scholar
  24. 24.
    Singh NA, Stavrinos TM, Scarbek Y, Galambos G, Liber C, Fiatarone Singh MA A randomized controlled trial of high versus low intensity weight training versus general practitioner care for clinical depression in older adults. J Gerontol A Biol Sci Med Sci. 2005;60(6):768–776.PubMedGoogle Scholar
  25. 25.
    Holmes MD, Chen WY, Feskanich D, Kroenke CH, Colditz GA Physical activity and survival after breast cancer diagnosis. JAMA. 2005;293(20):2479–2486. doi:10.1001/jama.293.20.2479.CrossRefPubMedGoogle Scholar
  26. 26.••
    Demark-Wahnefried W Cancer survival: time to get moving? Data accumulate suggesting a link between physical activity and cancer survival. J Clin Oncol. 2006;24(22):3517–3518. doi:10.1200/JCO.2006.06.6548.CrossRefPubMedGoogle Scholar
  27. 27.
    Meyerhardt JA, Giovannucci EL, Holmes MD, Chan AT, Chan JA, Colditz GA, et al. Physical activity and survival after colorectal cancer diagnosis. J Clin Oncol. 2006;24(22 (Electronic)): 3527–3534.CrossRefPubMedGoogle Scholar
  28. 28.
    Meyerhardt JA, Heseltine D, Niedzwiecki D, Hollis D, Saltz LB, Mayer RJ, et al. Impact of physical activity on cancer recurrence and survival in patients with stage III colon cancer: findings from CALGB 89803. J Clin Oncol. 2006;24(22 (Electronic)):3535–3541.CrossRefPubMedGoogle Scholar
  29. 29.
    Smith MR, Finkelstein JS, McGovern FJ, Zietman AL, Fallon MA, Schoenfeld DA, et al. Changes in body composition during androgen deprivation therapy for prostate cancer. J Clin Endocrinol Metab. 2002;87(2):599–603. doi:10.1210/jc.87.2.599.CrossRefPubMedGoogle Scholar
  30. 30.
    Galvão DA, Spry NA, Taaffe DR, Newton RU, Stanley J, Shannon T, et al.: Changes in muscle, fat and bone mass after 36 weeks of maximal androgen blockade for prostate cancer. BJU Int 2008, 102(1):44–47Google Scholar
  31. 31.
    Galvão DA, Taaffe DR, Spry N, Newton RU Exercise can prevent and even reverse adverse effects of androgen suppression treatment in men with prostate cancer. Prostate Cancer Prostatic Dis. 2007;10(4):340–346. doi:10.1038/sj.pcan.4500975.CrossRefPubMedGoogle Scholar
  32. 32.
    Braga-Basaria M, Muller DC, Carducci MA, Dobs AS, Basaria S: Lipoprotein profile in men with prostate cancer undergoing androgen deprivation therapy. Int J Impot Res 2006, 18(5):494–498Google Scholar
  33. 33.
    Sharifi N, Gulley JL, Dahut WL Androgen deprivation therapy for prostate cancer. JAMA. 2005;294(2):238–244. doi:10.1001/jama.294.2.238.CrossRefPubMedGoogle Scholar
  34. 34.
    Shahinian VB, Kuo YF, Freeman JL, Goodwin JS Risk of fracture after androgen deprivation for prostate cancer. N Engl J Med. 2005;352(2):154–164. doi:10.1056/NEJMoa041943.CrossRefPubMedGoogle Scholar
  35. 35.
    Smith MR, Lee WC, Brandman J, Wang Q, Botteman M, Pashos CL Gonadotropin-releasing hormone agonists and fracture risk: a claims-based cohort study of men with nonmetastatic prostate cancer. J Clin Oncol. 2005;23(31):7897–7903. doi:10.1200/JCO.2004.00.6908.CrossRefPubMedGoogle Scholar
  36. 36.
    Greenspan SL, Coates P, Sereika SM, Nelson JB, Trump DL, Resnick NM Bone loss after initiation of androgen deprivation therapy in patients with prostate cancer. J Clin Endocrinol Metab. 2005;90(12):6410–6417. doi:10.1210/jc.2005-0183.CrossRefPubMedGoogle Scholar
  37. 37.
    Petrella JK, Kim JS, Tuggle SC, Hall SR, Bamman MM Age differences in knee extension power, contractile velocity, and fatigability. J Appl Physiol. 2005;98(1):211–220. doi:10.1152/japplphysiol.00294.2004.CrossRefPubMedGoogle Scholar
  38. 38.
    Segal RJ, Reid RD, Courneya KS, Malone SC, Parliament MB, Scott CG, et al. Resistance exercise in men receiving androgen deprivation therapy for prostate cancer. J Clin Oncol. 2003;21(9):1653–1659. doi:10.1200/JCO.2003.09.534.CrossRefPubMedGoogle Scholar
  39. 39.
    Spry NA, Kristjanson L, Hooton B, Hayden L, Neerhut G, Gurney H, et al. Adverse effects to quality of life arising from treatment can recover with intermittent androgen suppression in men with prostate cancer. Eur J Cancer. 2006;42(8):1083–1092. doi:10.1016/j.ejca.2006.01.029.CrossRefPubMedGoogle Scholar
  40. 40.
    Herr HW Quality of life in prostate cancer patients. CA Cancer J Clin. 1997;47(4):207–217. doi:10.3322/canjclin.47.4.207.CrossRefPubMedGoogle Scholar
  41. 41.
    Galvão DA, Nosaka K, Taaffe DR, Spry N, Kristjanson LJ, McGuigan MR, et al. Resistance training and reduction of treatment side effects in prostate cancer patients. Med Sci Sports Exerc. 2006;38(12):2045–2052. doi:10.1249/01.mss.0000233803.48691.8b.CrossRefPubMedGoogle Scholar
  42. 42.
    Galvão DA, Newton RU, Taaffe DR Anabolic responses to resistance training in older men and women: a brief review. J Aging Phys Act. 2005;13(3):343–358.PubMedGoogle Scholar
  43. 43.
    Windsor PM, Nicol KF, Potter J A randomized, controlled trial of aerobic exercise for treatment-related fatigue in men receiving radical external beam radiotherapy for localized prostate carcinoma. Cancer. 2004;101(3):550–557. doi:10.1002/cncr.20378.CrossRefPubMedGoogle Scholar
  44. 44.
    Galvão DA, Nosaka K, Taaffe DR, Peake J, Spry N, Suzuki K, et al. Endocrine and immune responses to resistance training in prostate cancer patients. Prostate Cancer Prostatic Dis. 2008;11(2):160–165. doi:10.1038/sj.pcan.4500991.CrossRefPubMedGoogle Scholar
  45. 45.
    Moyad MA Promoting general health during androgen deprivation therapy (ADT): a rapid 10-step review for your patients. Urol Oncol. 2005;23(1):56–64. doi:10.1016/j.urolonc.2005.03.018.PubMedGoogle Scholar

Copyright information

© Current Medicine Group LLC 2008

Authors and Affiliations

  1. 1.Vario Health InstituteEdith Cowan UniversityJoondalupAustralia

Personalised recommendations