Introduction

Exercise has consistently been shown to improve quality of life and psychological well-being of the general population. Despite these well-documented health benefits of regular exercise, more than 50% of the population isn’t regularly active.

This is despite the fact that exercise can help prevent disease. More specifically, there is a growing body of research showing beneficial effects of exercise for cancer patients. In fact, the American Cancer Society and the American College of Sports Medicine have put forth recommendations on regular physical activity for cancer survivors.

Cancer is currently the second leading cause of death for adults, with over 550,000 cases annually. Early detection methods and improvements in treatments and recovery have resulted in a dramatic increase in cancer survivors -- totaling 10.1 million cancer survivors. In addition, the lifespan of cancer survivors is increasing; sixty-two percent of cancer patients have extended the length of their recovery and live more than five years after diagnosis. In fact, in as little as a 9-year period (1983 to 1992), the 5-year survival rate for breast cancer increased from 75% to 97%.

The goal of physical activity during cancer treatment and recovery is to return patients to their normal physical and psychological function, with an emphasis on maintaining strength, function, and endurance.

One published review found that strength, flexibility, fatigue/tiredness, confusion, difficulty sleeping, self-esteem, psychosocial outcomes, body size, vigor and vitality, immune function, and mental health quality of life showed 100% improvement with exercise participation. The authors concluded that physical activity is safe for cancer survivors and is beneficial for physiological and psychosocial measures.

But despite these findings, and the mounting evidence demonstrating a clear benefit for cancer patients to incorporate exercise in their daily regimen, many physicians hesitate to prescribe exercise as part of a patient’s treatment. And patients may be hesitate to start an exercise program without specific recommendations. Many patients are also likely fatigued from the disease and treatments. Therefore, not surprisingly, they are fearful about doing anything that they believe might further negatively affect their bodies and/or symptoms. The reality, however, is that in most cases the benefits of exercise far exceed any risks.

Benefits of Exercise for Cancer Patients

Improved physical and psychological function in patients. Significant improvements in body composition Improved lower-body flexibility Increases in aerobic capacity Improvements in quality of life Reduced fatigue and nausea Preserve muscle mass Improved quality of life

Even low-to moderate-intensity exercise programs can be sufficient stimulus to promote improvements in psychological and physiological parameters in cancer patients.

While the recommendation to rest for alleviation of fatigue appears to make sense it may actually make things worse. Physical inactivity will worsen fatigue because of the resultant muscle atrophy, decreased aerobic capacity, decreased functional capacity, and progressive inability to perform daily activities of living.

Current Recommendations for Exercise for Cancer Patients

The Evidence Report by the Agency for Healthcare Research and Quality, suggests the exercise prescription associated with these positive-outcomes in cancer survivors was generally moderate-to vigorous intensity aerobic activity on 3 or more days per week, for 10-60 minutes per session. The American Cancer Society recommends that cancer survivors perform regular physical activity toward the goal of maintaining a healthy body weight, reducing risk of recurrence, and reducing risk for other common chronic diseases.

Exercise Prescription

It is critical for patients to talk with their personal clinicians before starting any exercise program and for clinicians to discuss specific exercise guidelines with their patients. Currently, there are no guidelines suggesting a specific training dose for cancer patients and how exercise dose may vary from types of cancer, stage of recovery, or particular treatments.

Take Home Points

1. Exercise is recommended for the overall well being of healthy populations.
2. The number of cancer survivors is growing.
3. Exercise is an important adjunct to overall cancer treatment.
4. Studies have suggested exercise may enhance the quality of survivorship.
5. Although there are few studies suggesting the most appropriate mode of activity, research has indicated that both aerobic and resistance training may be beneficial.
6. Exercise is an important positive lifestyle habit that may play a role in cancer prevention.