Published: 10 Sep 2011 Full version

Exercise and cancer

What is cancer?
The term cancer describes a disease in which abnormal cells multiply without control. While there are more than 100 different types of cancer, prostate cancer, bowel cancer (colon and rectal cancers), breast cancer, melanoma of the skin, and lung cancer account for more than half of all cancers diagnosed in Australia. More than 110 000 new cases of cancer are diagnosed yearly, and one in two men and one in three women will be diagnosed with cancer by the age of 85 years. Survival after cancer varies and is influenced by the type of cancer and the stage of the cancer at diagnosis. For many cancers, including melanoma and prostate and breast cancers, current survival rates exceed 90% or are progressively improving. People diagnosed with cancer may be at greater risk of dying from other causes such as cardiovascular disease. Currently, about 710 000 Australians have survived cancer (1). While surgical removal of cancer remains the primary treatment for most cancers, radiation therapy, chemotherapy and other drug treatments are also used frequently as primary or adjunct treatments. Advances in treatment have led to more effective therapies. However, treatment-related side effects are still common and may persist for long-term survivors. Common side effects of treatment include fatigue, pain, impaired immune function, negative changes in bodyweight and composition (an increased percentage of fat), worsened bone health, fluid build-up that causes swelling in various body parts (lymphoedema), and gastrointestinal (bowel) changes.

Why is exercise important for cancer survivors?

Exercise is widely accepted as important for maintaining good health, reducing the risk of chronic disease, and aiding rehabilitation from disease. Cancer survivors face unique challenges related to the risk of cancer recurrence and the development of other chronic diseases. In addition, treatment and disease-related physical and psychological side effects are common. The potential benefits of exercise during and after treatment (2) are outlined in the table below. Also, a growing body of evidence indicates that exercise after diagnosis may improve survival rates, at least in breast and colon cancer (3).
Preservations or improvements Muscle strength, mass and power Physical functioning Range of motion Immune function Chemotherapy completion rates Body image, mood and self esteem Reductions Duration of hospitalisation Psychological and emotional stress Depression and anxiety Number and severity of symptoms and side effects reported (eg pain, fatigue, nausea)

Is exercise safe for cancer survivors?

Exercise is considered safe when commenced at an appropriate level and progressed gradually. Standard guidelines (eg those of the American College of Sports Medicine) (4) should be followed, particularly for people who have heart and lung problems. Exercise physiologists need to remember that cancer survivors often have a higher risk of heart attack or other cardiovascular events than the general population. Extra care is also needed in choosing activities for certain survivors, such as people with increased fracture risk (eg people receiving particular hormonal treatments or people whose cancer has spread to the bones). Also, some exercise locations are not appropriate for survivors with suppressed immune systems (eg public exercise environments that may increase the chance of infections). The American College of Sports Medicine (ACSM) exercise guidelines for cancer
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survivors (5) provide an in-depth discussion of specific contraindications and reasons to stop during a given exercise session. Importantly, studies on exercise in survivors have typically involved people likely to be younger, healthier and with a history of exercising, compared with the wider population of cancer survivors. Therefore, the decision to participate in specific forms of exercise such as organised sports should be made on an individual basis. Extra caution and supervision are required for people experiencing fluctuating treatment-related side effects and new side effects, and for those who have little or no history of exercising.

What type of exercise is best for cancer survivors?

A specific exercise program should be tailored to each cancer survivors past and current fitness level; previous and planned treatment; disease and treatment-related risk factors; and the presence and severity of symptoms. The overall aim is to meet the physical activity guidelines recommended for the general population. That is, 150 minutes of moderateintensity aerobic-based exercise weekly, or an equivalent amount of weekly exercise that includes high-intensity exercise and 23 sessions of resistance-based exercise (eg weights training) for the major muscle groups. For some people, particularly immediately after surgery or during other associated treatment, these guidelines may be unrealistic. In these cases, people should be encouraged to maintain or return to activities of daily life, and then gradually introduce structured, planned exercise. Importantly, some exercise is better than no exercise, and more is generally better than less. A comprehensive overview of specific exercise programs can be found in the ACSMs exercise guidelines for cancer survivors (5) and the position stand of Exercise & Sports Science Australia (ESSA), Optimising cancer outcomes through exercise (2).

How can I help cancer survivors to become and remain active?

Encourage: emphasise the importance of avoiding inactivity and progressing gradually. Educate: o help survivors to understand why being active is important, and provide information about the benefits of exercise during and after cancer treatment o teach survivors how to overcome barriers to exercise; examples of common barriers and possible solutions can be found in the ESSA factsheets for specific cancers, and further suggestions can be found in the ESSA position stand (2). Equip: help survivors become independent exercisers; work together to set short-term and long-term goals that are specific, measurable, achievable, realistic and timely.

Related information and references

Exercise & Sports Science Australia www.essa.org.au Australian Cancer Council http://www.cancer.org.au/home.htm

1. Australian Institute of Health and Welfare (AIHW). (2010). Cancer in Australia 2010: An overview. Cancer series no. 60. Cat. no. CAN 56. Canberra: AIHW. 2. Hayes SC, Spence RR, Galvo DA, Newton RU. Australian Association for Exercise and Sport Science position stand: optimising cancer outcomes through exercise. J Sci Med Sport 2009; 12(4): 428-34. Epub 9 May 2009. 3. World Cancer Research Fund & American Institute for Cancer Research. Food, nutrition, and physical activity, and the prevention of cancer: A global perspective. Washington, DC: WCRF/AICR. 4. American College of Sports Medicine. (2010). ACSMs guidelines for exercise testing and prescription. 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. 5. Schmitz KH, Courneya KS, Matthews C, et al. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exer 2010; 42(7): 1409-26.

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