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Exercise and the gut microbiome: implications for supportive care in cancer

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Abstract

Purpose

Growing recognition of the gut microbiome as an influential modulator of cancer treatment efficacy and toxicity has led to the emergence of clinical interventions targeting the microbiome to enhance cancer and health outcomes. The highly modifiable nature of microbiota to endogenous, exogenous, and environmental inputs enables interventions to promote resilience of the gut microbiome that have rapid effects on host health, or response to cancer treatment. While diet, probiotics, and faecal microbiota transplant are primary avenues of therapy focused on restoring or protecting gut function in people undergoing cancer treatment, the role of physical activity and exercise has scarcely been examined in this population.

Methods

A narrative review was conducted to explore the nexus between cancer care and the gut microbiome in the context of physical activity and exercise as a widely available and clinically effective supportive care strategy used by cancer survivors.

Results

Exercise can facilitate a more diverse gut microbiome and functional metabolome in humans; however, most physical activity and exercise studies have been conducted in healthy or athletic populations, primarily using aerobic exercise modalities. A scarcity of exercise and microbiome studies in cancer exists.

Conclusions

Exercise remains an attractive avenue to promote microbiome health in cancer survivors. Future research should elucidate the various influences of exercise modalities, intensities, frequencies, durations, and volumes to explore dose-response relationships between exercise and the gut microbiome among cancer survivors, as well as multifaceted approaches (such as diet and probiotics), and examine the influences of exercise on the gut microbiome and associated symptom burden prior to, during, and following cancer treatment.

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Acknowledgements

NHH is MASCC Founding Chair of Exercise Oncology and MASCC Chair of Fatigue, HRW is MASCC Vice-Chair of Mucositis, and RJC is MASCC Chair of Survivorship for the Multinational Association of Supportive Care in Cancer. NHH is a MASCC Terry Langbaum Survivorship Fellow. DH is a MASCC Cognition Fellow.

Funding

NHH and RJC receive salary support from the National Health and Medical Research Council as investigator fellows (APP2018070 and APP1194051). HRW receives salary support from the Hospital Research Foundation Group as a research fellow.

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Authors and Affiliations

  1. Human Performance Research Centre, INSIGHT Research Institute, University of Technology Sydney (UTS), Moore Park, NSW, 2030, Australia

    Nicolas H. Hart, Morgan J. Farley, Darren Haywood & Tina L. Skinner

  2. Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia

    Nicolas H. Hart, Matthew P. Wallen, Ria Joseph & Raymond J. Chan

  3. Cancer and Palliative Care Outcomes Centre, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia

    Nicolas H. Hart & Raymond J. Chan

  4. Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia

    Nicolas H. Hart

  5. Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia

    Nicolas H. Hart

  6. Institute for Health and Wellbeing, Federation University, Ballarat, VIC, Australia

    Matthew P. Wallen

  7. School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia, QLD, Australia

    Morgan J. Farley, Alexander N. Boytar & Tina L. Skinner

  8. Mental Health Division, St Vincent’s Hospital Melbourne, Melbourne, VIC, Australia

    Darren Haywood

  9. Department of Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia

    Darren Haywood

  10. The University of Queensland Diamantina Institute, Faculty of Medicine, The University of Queensland, St. Lucia, QLD, Australia

    Kate Secombe

  11. Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia

    Kate Secombe

  12. Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands

    Marlou-Floor Kenkhuis & Laurien M. Buffart

  13. School of Biomedicine, University of Adelaide, Adelaide, SA, Australia

    Hannah R. Wardill

  14. Supportive Oncology Research Group, Precision Cancer Medicine, South Australian Health and Medical Research Institute, Adelaide, SA, Australia

    Hannah R. Wardill

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Contributions

NHH, MPW, RJC, and HRW conceptualised the review topic, scope, and content. All authors contributed significantly to the preparation, drafting, revision, and completion of the manuscript at multiple stages throughout the process. All authors reviewed the final version of the manuscript.

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Correspondence to Nicolas H. Hart.

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NHH is an associate editor for the Supportive Care in Cancer journal.

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Nicolas H. Hart and Matthew P. Wallen are co-first authors.

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Hart, N.H., Wallen, M.P., Farley, M.J. et al. Exercise and the gut microbiome: implications for supportive care in cancer. Support Care Cancer 31, 724 (2023). https://doi.org/10.1007/s00520-023-08183-7

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