Naveed Saleh, MD, MS, for MDLinx | December 09, 2019
Once upon a time, patients with cancer were advised to rest and relax, especially after cancer treatment such as chemotherapy, so as not to strain themselves. This isn’t so much the case today, when exercise is encouraged for this patient population—and even dosed into treatment regimens.
In the 1990s and 2000s, evidence cropped up that contraindicated previous beliefs that exercise was bad for patients with cancer. In turn, these studies laid the foundation for the burgeoning field of exercise oncology. Today, there are more than 1,000 randomized, controlled trials on the topic.
In October 2019, the American College of Sports Medicine (ACSM) convened an expert panel to report recently updated guidelines regarding the role of exercise in cancer survivorship. Let’s take their results from the top, and focus on the role of exercise as a cancer treatment.
“The ACSM panel found evidence that providing specific exercise prescriptions for a number of cancer-related health outcomes benefitted people living with or beyond cancer,” said former ACSM president and panel co-chair Kathryn Schmitz, PhD, MPH, professor, Departments of Public Health Sciences and Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, PA. “As an example, we saw strong evidence that an exercise program consisting of a half hour of aerobic exercise three times weekly was sufficient to improve anxiety, depression, fatigue, quality of life, and physical function in cancer survivors.”
Concerns about lymphedema secondary to twice-weekly resistance training have been raised, but the panel found this type of exercise did not increase the risk of disease and even offered some health benefits. However, compared with resistance training alone, symptoms of depression and anxiety have only been shown to improve with resistance training combined with aerobic training.
It remains to be elucidated whether exercise also improves other cancer-related outcomes—including cardiotoxicity, peripheral neuropathy, pain, cognitive function, or chemotherapy completion rate—as well as whether exercise boosts treatment tolerance.
In terms of survivorship, exercise prescribed to patients with colon, breast, or prostate cancers has been linked to lengthened survival. However, not enough evidence exists regarding potential survival benefit in those with other types of cancer. On a related note, the ACSM recommends that all cancer survivors heed to general public health recommendations for physical activity, which is either 2.5 to 5.0 hours per week of moderate-intensity activity or 1.25 to 2.5 hours per week of vigorous activity.
Years ago, it was unclear to most that exercise is good for the heart, and now everybody knows this thanks to a paradigm shift. Similarly, the ACSM hopes for a paradigm shift in how providers, caregivers, and patients with cancer view exercise as beneficial and necessary in treatment.
“ACSM has just started a new initiative called Moving Through Cancer,” said Dr. Schmitz, “which focuses on increasing awareness of the value of exercise for cancer survivors, along with educating the cancer clinician workforce to refer, coordinate, and prescribe exercise; expanding opportunities to exercise; and shifting policy so that, by 2029, exercise is standard practice for all patients living with and beyond cancer.”
Importantly, any exercise regimen needs to be personalized to patient preference and functional status. Factors including age, cancer type/stage, adverse effects of treatment, and comorbidities should be taken into consideration.
Lots of people with cancer don’t exercise. These patients should be advised to try some type of physical activity as a means to improve their health. Simply going from no exercise to some exercise is a great improvement. The ACSM recommends that all physicians ask their patients with cancer about physical activity, and if inadequate, recommend more.
“Even if that is all providers have time to do, it demonstrates to patients that physical activity is an important part of managing their health and lays out the expectation that being physically active is healthier than being sedentary,” said Dr. Schmitz. “This is true even for patients with advanced disease and those experiencing limitations, although those cancer patients will need a medically supervised program.”
Physicians are busy professionals. Unpacking the benefit of exercise for your patients will take precious minutes. However, many patients with cancer enjoy exercise programs greatly, and appreciate the guidance in retrospect. Focusing on exercise can be a productive and empowering portion of the clinical encounter.
In interested in learning more, the Moving Through Cancer initiative’s website provides ample information on high-quality exercise programs and answers to frequently asked questions. Keep in mind that physicians need to refer patients to exercise programs, with most exercise programs requiring physician approval.