The Science Nook on Exercising with Cancer

Exercise, from diagnosis into survivorship, can have numerous benefits.  Just as treatment regimens are consistent, an exercise routine should also be just as frequent.  Moving the muscles and building strength can have a profound and beneficial impact throughout the cancer care continuum.

Exercise is associated with a multitude of benefits, including decreased circulating insulin levels, increased functionality and strength, improved immune systems to fight infection, and increased psychological well-being and quality of life.  In addition, it may decrease the risk of certain cancers and help to prevent cancer recurrence while maintaining a healthy body weight.

During treatment, exercise has a beneficial effect on the on the whole body, and may be advantageous on the days where side effects from treatment are severe.  As a result, it may reduce overall treatment time and increase its effectiveness.  Most importantly, exercise provides an opportunity to take control at a time when everything else may seem out of control.

Patients are experiencing even longer lives after cancer due to more effective treatment modalities.  However, longer lives and past exposure to the chemicals during treatment may exacerbate the risk for comorbidities such as type 2 diabetes and cardiovascular disease later in life.  Exercise can help attenuate these chronic diseases [i][ii][iii].

Finally, exercise provides opportunities for reaching personal fitness goals and offers a social activity to engage in with family and friends.  And the science is supporting it.  Here is just a glimpse at what we found:

 

Study 1

Progressive resistance training in head and neck cancer patients undergoing concomitant chemoradiotherapy

 

Journal: Laryngoscope Investigative Otolaryngology

 

Although this study included a small number of participants, there were positive and significant findings in relation to the patients’ quality of life.  The participants expressed large social, physical, and psychological benefits after partaking in the program, stating that it made going through treatment easier. 

In this 12-week pilot study, a group of 12 individuals undergoing concomitant chemoradiotherapy (CCRT) partook in a progressive resistance training program. The exercise sessions were supervised and done on training machines, focusing on the large muscle groups, 3 times per week over the 12-week period.

Functional performance (measured by maximal stair climbing, 30-second chair stand, and 30-second arm curl) did not change during the CCRT, but after treatment ended at week 6 or before, functional performance increased. Strength in 1 maximum repetition in the chest press decreased significantly and strength in leg press did not change during treatment, but increased during the post-treatment period, although non-significantly (iv).

 

For the patient and caregiver

Going through cancer treatment is overwhelming, and adding an exercise program into the mix may seem even more arduous. However, incorporating resistance training into your day while undergoing treatment may provide benefits, both physical and psychological, particularly if you exercise with others going through treatment or those close to you. Talk to your healthcare team about the most appropriate resistance training program for you, and seek out professionals in the field of exercise and cancer that can help you to individualize the process.  The local YMCA as well as seeking a referral to a local physical therapist affiliated with your cancer center may be a good way to start.

 

For the healthcare team

Speaking to your patients about resistance training will provide them with guidance to begin an exercise program. It may allow them to gain increased functionality and strength after treatment, as well as diminish the loss of lean body mass in the long-term, at a time when treatment and the disease may greatly impact the amount of lean body mass that they carry.  Make sure to enhance the results for the patient by focusing on all 8 major muscle groups at least twice per week.  Make a referral to a cancer exercise specialist.

 

Study 2

Molecular mechanisms linking exercise to cancer prevention and treatment

 

Journal: Cell Metabolism

 

Here, the authors explore the molecular mechanisms of exercise and cancer, which is important for clinicians to be able to elucidate the potential benefits at the cellular and physiological level.  Exercise may help slow tumor growth and proliferation by causing release of catecholamines, and increasing blood flow and temperature. These acute effects may result in long term improved blood perfusion, immunogenicity, decreased inflammation, and adjustments in metabolism, leading to the aforementioned slowed tumor growth.  Exercise also helps to improve drug tolerance during treatment, attenuate adverse effects commonly experienced after treatment, and decrease risk of recurrence and comorbidities. There is much to discover, but one thing is for sure, the effects of exercise on cancer are profound [v].

 

For the patient and caregiver

If your cancer treatment side effects are preventing you from engaging in physical activity, talk to your healthcare team, and take a look at these articles to help manage your side effects.  That way, you can begin your journey with an appropriate exercise program specific to you.  Exercise can help manage specific side effects.  It can increase appetite, fight fatigue and promote regular bowel movements just to name a few benefits.

 

For the healthcare team

Recommending an exercise program consisting of both aerobic and resistance training before, during, and after treatment is feasible and beneficial to your patients both physiologically and psychologically. Depending on the side effects experienced by the patient, offering guidance on how to alter exercises will become key. During survivorship, stress the importance of sustaining regular exercise for the long-term benefit of risk reduction and weight management.

 

References
[i] Luo W, Cao Y, Liao C, Gao F (2012). Diabetes mellitus and the incidence and mortality of colorectal cancer: a meta-analysis of 24 cohort studies. Colorectal Dis, 14:1307-12.
[ii] Sandhu MS, Dunger DB, Giovannucci EL (2002). Insulin, insulin-like growth factor-I (IGF-I), IGF binding proteins, their biologic interactions, and colorectal cancer. J Natl Cancer Inst, 94:972-80.
[iii] Tran TT, Medline A, Bruce WR (1996). Insulin promotion of colon tumors in rats. Cancer Epidemiol Biomarkers Prev, 5:1013-5.
[iv] Lonkvist CK, Vinther A, Zerahn B, Rosenbom E, Deshmukh AS, Hojman P, Gehl J (2017). Progressive resistance training in head and neck cancer patients undergoing concomitant chemoradiotherapy. Laryngoscope Investigative Otolaryngology, 2:295-306. doi:10.1002/lio2.88.
[v] Hojman P, Gehl J, Christensen JF, Pederson BK (2017). Molecular mechanisms linking exercise to cancer prevention and treatment. Cell Metabolism, 27. https://doi.org/10.1016/j.cmet.2017.09.015.
Jenna Koroly, MS, RD, CDN

Jenna is a Registered Dietitian and has her Masters in Nutrition and Exercise Physiology from Teachers College, Columbia University. She has a passion for nutrition therapy for oncology patients, and has been a part of the Savor Health team since October, 2016, sharing evidence-based nutrition articles and recipes as Social Media Manager. She gained further clinical knowledge in oncology while performing nutrition assessments at Northern Westchester Hospital and Amsterdam Nursing Home as a Dietetic Intern. Jenna also has a strong interest in sports nutrition and altering body composition through delicious whole foods and exercise. As a graduate student and Dietetic Intern, she worked with collegiate athletes at St. Francis College and Columbia University.

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