There is one prescription that is applicable to almost everyone, healthy or not: Exercise. “Use it or lose it,” we say. “Movement is life,” we hear.
Although in the past cancer patients were advised to rest and remain inactive, that changed in 2010 when guidelines advising the opposite were drawn up by experts in exercise and oncology. At that time, the American College of Sports Medicine (ACSM) met with oncology specialists and concluded that studies of survivors of breast and prostate cancers showed clear benefit from participating in exercise programs. These experts found that such programs improved survivors’ physical functioning and fitness, helped with their cancer-related fatigue, and generally enhanced their quality of life. Those preliminary recommendations have been updated by subsequent research; since then, results of more than 2500 randomized controlled trials on the importance of exercise have been published.
Exercise is especially helpful to cancer survivors — a population that is happily ever increasing. There are now more than 15.5 million cancer survivors in this country, and that number continues to rise.1 However, although the benefits of exercise are becoming increasingly clear, actually putting it into practice can be difficult for someone who is fatigued, older, or returning to work while continuing to cope with their disease as well as comorbidities.
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The 2018 ACSM International Multidisciplinary Roundtable on Physical Activity and Cancer Prevention and Control convened international exercise and rehabilitation professionals to update current evidence-based recommendations. Forty representatives from 20 worldwide organizations were in attendance. Their goals were to cover: 1) the role of exercise in cancer prevention and control; 2) the efficacy of exercise to improve cancer-related health outcomes (acute, late, and long-term effects); and 3) the translation of evidence into clinical and community settings. Attendees provided new evidence-based prescriptions for exercise testing and training using the acronym FITT — frequency, intensity, time, type.
The program included safety precautions and other considerations specifically for cancer survivors. The guidelines based each exercise prescription on research that identified the optimal type, intensity, or frequency of exercise, and classified FITT prescriptions based on whether the supporting evidence was strong, moderate, or insufficient.
Strong Evidence of Benefit
Anxiety The exercise prescription for reducing anxiety in cancer survivors is moderate-intensity aerobics 3 times per week for 12 weeks or twice a week for 6 to 12 weeks if resistance training is added. Resistance training by itself does not reduce anxiety.
Depressive symptomatology This effect is significantly reduced with the same prescription of moderate-intensity aerobics 3 times a week for at least 12 weeks or twice a week for 6 to 12 weeks if resistance training is added. Resistance training by itself does not reduce depressive symptoms.
Cancer-related fatigue Moderate-intensity aerobics 3 times a week for at least 12 weeks can significantly reduce cancer-related fatigue both during and after cancer treatment. Adding resistance training can be effective, particularly for patients with prostate cancer.
Health-related quality of life (HRQOL) Moderate-intensity aerobics combined with resistance exercise 2 to 3 times a week for at least 12 weeks can lead to improved HRQOL during and after treatment.
Lymphedema A progressive resistance program focused on large muscle groups 2 to 3 times a week with the caveat of “start low, progress slow” is safe; importantly, the Roundtable stresses that a fitness professional supervise these sessions. There is not enough evidence supporting aerobic exercise in lymphedema to draw conclusions.
Physical function Self-reported physical function can improve with moderate intensity aerobics, resistance training, or both modalities combined 3 times a week for 8 to 12 weeks. Again, supervised exercise is the most effective.
Moderate Evidence of Benefit
Bone health, sleep Exercise may improve bone health and sleep in some situations. However, results of recent research in cancer survivors concluded that evidence of exercise improving bone health and sleep has been inconsistent.
Insufficient Evidence of Benefit
Evidence on the benefits of exercise for several conditions is insufficient. The researchers stress that further research is needed to determine the benefits of exercise on cardiotoxicity, chemotherapy-induced peripheral neuropathy (CIPN), cognitive function, falls, nausea, pain, sexual function, and treatment tolerance.
Moving Through Cancer: Recommendations
The ACSM initiated the “Moving Through Cancer” program to help clinicians worldwide recommend and incorporate exercise into their patients’ prevention and treatment plans. The new recommendations include:
- Exercise is important for all adults for the prevention of cancer, and specifically lowers risk of 7 common types of cancer: colon, breast, endometrial, kidney, bladder, esophagus, and stomach;
- Cancer survivors should incorporate exercise into their day-to-day routine to help improve survival after a diagnosis of breast, colon, or prostate cancer;
- Exercising during and after cancer treatment improves fatigue, anxiety, depression, physical function, and quality of life, and does not exacerbate lymphedema.
- Research that will drive the integration of exercise into the standard of care for cancer needs to continue;
- The increasingly robust evidence base on the positive effects of exercise for cancer patients should be translated into practice.
Bette Weinstein Kaplan is a medical writer based in Tenafly, New Jersey.
Reference
1. Campbell KL, Winters-Stone KM, Wiskemann J, et al. Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable. Med Sci Sports Exerc. 2019 Nov;51(11):2375-2390.
This article originally appeared on Oncology Nurse Advisor
