This article was co-authored by Chad Rethorst, Ph.D.
When we care for patients with cancer, they’re sometimes surprised when we recommend exercise as part of their treatment plan. However, research in recent years has shown that moderate, low-intensity exercise is the gold-standard of prevention and care for patients with a variety of conditions, from heart disease to various types of cancer.
If exercise was a pill, doctors would prescribe it for every patient. And according to a 2018 announcement, more doctors should! The Clinical Oncology Society of Australia (COSA) released the first worldwide position statement on cancer and exercise in May 2018. COSA calls for exercise to be an essential part of any cancer treatment protocol and also suggests that withholding such a recommendation from patients could even harm their health.
Although most research on cancer and exercise has examined the benefits for patients with breast or colon cancer, there is mounting evidence to suggest that exercise can have positive effects against other types of cancer as well. This is exciting because the benefits of exercise are far from subtle for many patients.
How does exercise benefit patients with cancer?
Studies show that exercise can reduce cancer-related side effects and improve patient outcomes. For example, an August 2013 study suggests a link between physical activity and a lower risk of breast cancer recurrence. In the short-term, exercise can help patients overcome treatment-related side effects such as mild to moderate fatigue due to chemotherapy. Patients who exercise regularly might find that they can recover their energy quicker on treatment days than those who don’t.
Exercise also can help reduce depression and anxiety, which can arise at any point of a patient’s cancer journey. A 2012 meta-analysis found that cancer patients who completed treatment and participated in aerobic exercise, resistance training, or strength training were more likely to experience improvement in psychological outcomes and quality of life than those who were sedentary.
Patients who exercise during treatment also are more likely to make exercise a habit after treatment. According to a March 2018 study, those with breast or colon cancer who participated in an exercise program for 18 weeks during chemotherapy treatment were more likely to have continued exercising four years later than people who didn’t participate in the program.
If exercise was a pill, doctors would prescribe it for every patient. And according to a 2018 announcement, more doctors should!
How can patients with cancer safely start exercising?
Talk to the doctor
The first step is for patients to discuss with a doctor how cancer and treatment affect their daily life, particularly regarding activity levels and how well they’re responding to treatment. A tool we often use to gauge these factors is the Eastern Cooperative Oncology Group (ECOG) performance scale. For example, an ECOG grade 1 means a patient is able to go for a walk or do some light cleaning but cannot do strenuous activity, while a patient with an ECOG grade 3 is more limited and likely to rest for more than 50 percent of a day. The ECOG scale can help us determine whether patients can incorporate more physical activity into their day and, if so, how to achieve that goal.
Doctors also can help patients find workarounds for barriers or alleviate anxiety about working out. For example, one concern many patients share is the fear of coming into contact with others in public places during treatment if immunity is lowered. Also, when patients are busy with doctor visits, treatments, and other stressors, exercise can go on the backburner. Doctors can help with strategies to reduce the risk of infection and also refer patients to licensed clinical social workers or cancer support groups to help find ways to fit in exercise and otherwise, in general, persevere.
Choose the right program
The best exercise program is one that a patient can look forward to and will want to do on a regular basis. The program doesn’t have to take place at a gym. Walking around the neighborhood or mall or enjoying low-impact activities such as swimming, bike riding, gardening, yoga, and strength training can be effective for patients with cancer.
Feelings of isolation, anxiety, and depression are common for cancer patients, and fatigue often goes hand in hand with low mood. If patients feel sluggish, they’re less likely to be active. It can be a vicious cycle. Finding ways to be engaged with the community and be physically active can help. Many YMCAs in North Texas offer LIVESTRONG, a wellness program for cancer support, cardiovascular conditioning, strength training, balance, and flexibility exercises, along with assessments for fitness and quality of life.
UT Southwestern, in collaboration with the Cancer Prevention Research Institute of Texas, is working on the Promoting Activity in Cancer Survivors (PACES) trial in an effort to test and identify potential interventions that are effective and affordable for patients with breast cancer.
It’s important for patients to strive for daily activity during every stage of the cancer journey. Talk to a doctor about starting a regular exercise program to reduce muscle loss and improve emotional side effects.