Okay, okay. I know that I have written about this multiple times in the past, but there is an ongoing flood of information about the value of exercise for cancer patients/survivors. All of us are committed to doing anything we can do to maximize our chances of continuing good health. There is, unfortunately, little that has been proven to help us. Certainly, we begin by taking whatever therapy our doctors suggest. Then, we can pay attention to weight and various life-style factors. All of the literature about those tricky life-style factors is vague, and there is really no evidence that eating broccoli helps. It does seem to matter that we exercise. Since I force myself to the gym every morning (going immediately after I awaken, before I have time to think better of it), I rather like these articles--they help me justify the lost sleep and time with the newspaper.
Here is a summary from the NCI:
Guidelines Urge Exercise for Cancer Patients, Survivors
A panel of 13 researchers with expertise in cancer, fitness, obesity,
and exercise training is spreading what they believe to be one of
the most important messages for cancer patients and survivors:
The panel was convened last year by the American College of
Sports Medicine 1 (ACSM) to develop guidelines 2 on exercise
and physical activity in patients who are undergoing active
treatment for cancer or who have completed treatment.
In addition to promoting the benefits of exercise and physical
activity in this group, the panel had another goal in formulating
the guidelines, said lead author Dr. Kathryn Schmitz of the
University of Pennsylvania's Abramson Cancer Center. "Our hope is that there will be more
conversations about the need for formalized exercise programs for patients during and right
after treatment—programs that will be the cancer equivalent to cardiac rehab," she said.
The benefits of exercise are well documented in a number of cancers, Dr. Schmitz continued,
namely in areas such as fatigue and physical functioning, both of which directly influence
quality of life 3. While survival is the ultimate outcome measure 4, with an estimated 12
million cancer survivors and growing in the United States, the importance of improving
quality of life has grown exponentially.
The evidence linking physical activity with improved quality of life in those undergoing
active treatment and those who have completed it "is incredibly strong," said Dr. Rachel
Ballard-Barbash of NCI's Division of Cancer Control and Population Sciences 5.
The most robust evidence is for people who have completed active cancer treatment, noted
Dr. Kerry Courneya from the University of Alberta, who has led a number of clinical trials of
physical activity in cancer patients. But, he continued, because of differences in study design
and other factors, it's difficult to compare findings involving patients under active treatment
with findings involving patients who have completed treatment.
Overall, said Dr. Courneya during an education session on exercise and cancer at the recent
ASCO annual meeting 6, "We're finding that patients can do a lot more than we originally
thought they could do, even when they're on chemotherapy or radiation therapy."
And that's critical, stressed Dr. Ballard-Barbash. "Even a modest amount of exercise, like
Adapt, but Be Realistic
Patients with different cancer types receive different treatments. So the new ACSM guidelines identify
considerations that patients/survivors and the fitness professionals working with them should take into
In men who have undergone androgen deprivation therapy for prostate cancer, for example, trainers need to be aware of fracture risk and adjust the exercises accordingly. And many women with breast cancer
will have had surgery "that can really debilitate the shoulder," said McAllister, so the guidelines encourage the use of exercises to stabilize and strengthen the surrounding muscles.
Dr. Schmitz noted that although the benefits of exercise are clear, "sometimes people are just
too sick to exercise," particularly during active treatment. Dr. Ballard- Barbash concurred. "If a
patient is finding it difficult to tolerate exercise," she said, "he or she may need to decrease activity for a while, or wait a few days before starting again." brief walks, is beneficial, and we see gains versus doing nothing at all."
Developing the Guidelines
The guidelines, published in the July 2010 Medicine & Science in Sports & Exercise, follow the 2008 release of HHS' Physical Activity Guidelines for Americans 8. But the panel suggested adaptations forexercise in people with different cancer types based on factors such as common adverse effects of treatment, for example, increased risk of bone fractures and cardiac side effects. Specific recommendatio—including the objectives and goals of a prescription for exercise training—and
contraindications for exercise are, however, available only for patients with breast, prostate, colon, gynecologic, and hematologic cancers, since they are the cancers for which
the panel felt there was sufficient evidence for such recommendations.
Two of the primary goals of exercise highlighted in the guidelines are improved body image 9 and body composition. In the case of the former, many cancer patients undergo extensive surgery or receive treatments that can alter their physical appearance and radically alter
feelings about things such as sexual attractiveness, said Dr. Schmitz. "There's good evidence in the literature that physical activity can improve body image, and that may be one mechanism through which exercise can improve quality of life," she explained. Body composition changes are common in many cancer patients, but the reasons can vary by cancer site. Some cancers, such as gastrointestinal and head and neck cancers, are typically associated with body wasting (loss of weight and muscle mass), so much so that it can be difficult for some patients to get up out of a chair. In this group, exercises that help build lean muscle are important.
But in breast cancer, where the bulk of the studies on physical activity have been performed, the systemic treatments patients often receive can lead to significant weight gain. In those patients, exercise "that is more useful for controlling body weight and losing fat, getting back to a healthy BMI," will be more important, Dr. Schmitz said.
The guidelines also make note of the suggestive evidence 10—but by no means definitive
evidence—in breast and colorectal cancer that regular exercise after treatment improves
progression-free and overall survival. As the data continue to emerge in this area, a
prescription for exercise could be "an adjunct to curative care," said Dr. Schmitz.
But Dr. Courneya acknowledged that the jury is still out on survival, calling the data "exciting" but "still experimental."
Putting Exercise into Action
There are numerous issues to address before physical activity becomes proactively integrated
into treatment or survivorship plans, including insurance coverage of exercise training;
educating oncologists, other clinicians, and patients about the benefits of exercise; and
expanding the ranks of fitness professionals who understand the issues and needs faced by
cancer patients and survivors.
From her perspective, said Marilyn McAllister, a trainer from Boise, ID, who often works
with breast cancer survivors in her own studio and at a local hospital, the environment
around exercise and cancer is improving, but more progress needs to be made. In her
experience, physicians often are "too swamped" dealing with day-to-day patient care issues
to learn about or discuss exercise with their patients. "And patients, when they first start
treatment, are just overwhelmed with information, so handing them a piece of paper with
information about yoga or strength training isn't very helpful."
Several initiatives are under way to expand the supply of fitness professionals with cancer-
specific training. ACSM and the American Cancer Society (ACS) have a certification
program 11 for trainers who want to work with cancer patients and survivors, and Dr.
Schmitz helped ACSM develop a new, six-session cancer exercise trainer certification
Webinar 12. In addition, the Lance Armstrong Foundation has partnered with the YMCA 13
to help train fitness staff at YMCAs across the country to work with and meet the needs of
Helping any of her clients improve their fitness is gratifying, said McAllister, an
ACSM/ACS-certified cancer trainer, but working with cancer patients and survivors offers
some unique rewards. "Everybody benefits from exercise, but it can be so dramatic in cancer
patients," she said. "It doesn't take much training to produce big results in their lives."