Why exercise is medicine for cancer care

Exercise is one of the intervention methods that have been studied and are proving to be effective on patients undergoing treatment. The American College of Sports Medicine (ACSM) organized a Webinar supported by Technogym entitled: "Exercise as Medicine for Cancer". The webinar provided continuous education credit and was conceived to let the attendees able to:
- Appreciate the effects of exercise as medicine to treat different oncological conditions.
- Deepen the understanding of the interaction of exercise with radiation and chemotherapy.

During the webinar, Prof. Robert Newton presented his line of research and the design of an ongoing study on prostate cancer patients who train with a program based on overloaded eccentric contractions, made possible by the new machines of the Biostrength line.

This event follows the series of webinars organized in collaboration with ACSM where Technogym invites high-level scientists, among them Prof. Marco Narici and Prof. Jonathan Myers. Since 2010, ACSM and Technogym have joined forces in the global health initiative, Exercise is Medicine (EIM), to encourage health professionals to include exercise in their patients' treatment. Both Technogym and ACSM are actively engaged in promoting physical activity as an integral part of the prevention and treatment of chronic diseases.

Recently Technogym has allowed to undertake innovative studies on the effectiveness of exercise in the different phases of treatment: before the start of treatment, in combination with chemotherapy, at the end of the treatment protocol.

Among the numerous solutions for combining exercise with cancer treatment, Biocircuit is particularly suitable because, thanks to digital technology, it allows each user to perform exactly the type of exercise prescribed. With Biocircuit, the clinician can dose both the mode and intensity of the load extremely precisely thanks to a load generation system called Biodrive.

Biocircuit Med offers personalized training programs thanks to clinically tested exercise protocols, thus obtaining the EEC 93/42 medical conformity certification. The format has undergone all the verifications required for certification and the electronic card has been redesigned to meet current regulations on electromagnetic emissions for healthcare facilities.

Robert Newton and Silvano Zanuso, Head of Scientific Research at Technogym, identify several reasons we must consider exercise as a very promising form of intervention to fight cancer and offer some good tips a for a proper exercise therapy.

Exercise, why not

It is not unusual when we feel unwell to want to rest and certainly allowing our body to fight the illness is important especially when it comes to getting enough sleep. This certainly applies when you have an acute infection such as the flu. However, this “rest strategy” does not apply when trying to manage a chronic and complex disease such as cancer.

The overwhelming research and clinical evidence indicate that cancer patients should exercise most if not every day of the week regardless of their cancer type, stage of disease or even when undergoing difficult treatments.

Cancer related fatigue

This really seems counterintuitive because cancer and some of the therapies cause an overwhelming level of fatigue and so it is reasonable to assume that you should rest to recover. However, cancer related fatigue is different to tiredness resulting from physical and mental exertion but rather is caused by the impact of the disease in treatments on heart and lung function as well as the structure and capacity of the muscles.

This does not mean a large amount of fatiguing exercise as this may exacerbate the fatigue. The exercise needs to be of relatively high intensity but low volume or dosage so that it facilitates the cardiovascular and muscular systems without overwhelming the body.

Exercise will not worsen the clinical picture

This has been a common misconception for many decades and unfortunately persists even today among patients and even clinicians. It was thought that exercising would increase metabolism and blood flow delivering more nutrients and oxygen to the cancer helping to grow faster and that the exercise would cause it to metastasise (spread to other tissues in the body). In fact, the reverse is true. There are now many research studies demonstrating that exercise suppresses tumour growth and inhibits the processes that cause the cancer cells to change and metastasise.

Exercise is not dangerous for patients

There are now literally hundreds of clinical trials of various types of exercise interventions in people with cancer including those with advanced disease and none of them report serious adverse events. Across the world there are tens if not hundreds of thousands of people with cancer exercising regularly and again there are no reports of the exercise is causing serious injury or illness. Yes, there are minor injuries occurring such as strains and sprains, but the incidence is no higher in cancer patients than anyone else exercising including apparently healthy adults.

Time to start exercising

A cancer diagnosis is a life changing event, but it is also an opportunity to greatly improve your lifestyle to be healthier and to beat the disease. The current recommendation is that anyone with cancer should try and maintain the current physical activity if they are active but if they are currently sedentary then they need to take up an exercise program as soon as possible. Being sedentary greatly diminishes your ability to overcome the disease and to tolerate the treatments.

Exercise is now being applied as a medicine at all phases of cancer management. It is very important as a therapy to prepare you for any surgery as it is important to be as resilient as possible so that outcomes from the surgery are improved and to recover more quickly. In the same manner, exercises being prescribed in the weeks leading to the commencement of chemotherapy or radiation therapy. Again, this is to make the patient more resilient so that they tolerate these therapies better and have less side effects.

Over the course of chemotherapy or radiation therapy it is important to be physically active and here at this phase targeted exercise medicine has an important role as it has been demonstrated to reduce the side effects of these therapies in particular fatigue and there is early evidence that exercising over the course of therapy may even increase effectiveness of chemotherapy and radiation therapy. In fact, there are many clinical trials around the world testing the safety and efficacy of patients exercising immediately before, during and after receiving a chemotherapy infusion and other studies are applying an exercise program immediately before the patient goes in for radiation therapy.

After surgery or completing chemotherapy or radiation therapy, exercise has an important role to rehabilitate the patient to help build muscle and reduce the risk of fat gain as well as increase cardiorespiratory capacity.  In the longer term, maintaining the recommended level of physical activity is very important to reduce the risk of recurrence or the development of other chronic diseases such as type II diabetes and cardiovascular disease.

Exercise and worries about lymphoedema

Lymphoedema is a condition which affects cancer patients whereby surgery or radiation therapy damages the lymph vessels and nodes which drain fluid from the limbs. It is a particularly debilitating condition and many patients are very fearful that exercise may cause lymphoedema or make it worse. The research evidence does not support this fear and in fact appropriate exercise is likely to reduce the risk of lymphoedema, ameliorate existing lymphoedema, and help to maintain function of the affected limb.

Exercise Types for cancer treatment

For most people with cancer in particular those who have completed treatment in a relatively well the current recommendation is to complete both aerobic exercise (for example walking, jogging, swimming, cycling et cetera) as well as resistance training (lifting weights or working again some other resistance). However, for patients with specific cancer and treatment related health issues the exercise prescription should be tailored to address those problems which are causing the greatest morbidity and mortality risk for the patient.

For example, loss of muscle mass (sarcopenia) is a major problem for people with cancer if they are receiving chemotherapy or hormone therapies. Low muscle mass has been implicated as a factor in lower chemotherapy tolerance and greater side-effects as well as compromising function and quality of life. The only way to maintain or increase muscle mass is resistance training and a large volume of aerobic exercise such as walking may be contraindicated. The more severe the health issues facing the patient the more important it is to seek the advice of a qualified exercise professional for a targeted exercise prescription.

Times and occurrences of exercise

For cancer patients and survivors who are relatively well the recommendation is to accumulate between 75 and 150 minutes per week of vigorous to moderate aerobic exercise AND at least two resistance training sessions. As outlined above, patients with specific health issues need a more targeted exercise prescription designed to address priority morbidity and mortality risks. The most important message is, if you are sedentary then start moving ASAP. Even a little bit of exercise each week is better than none.

What is particularly exciting about exercise medicine is the increasing research examining the mechanisms by which exercise influences tumour biology slowing rate of growth, helping the body to destroy cancer cells, reducing the risk of metastasis and increasing chances of survival. As exercise is recognised as a medicine it is better to take a smaller amount of this medicine throughout the week and even if possible, spread across the day.

Spreading the exercise dosage is particularly relevant for patients struggling with fatigue, nausea, functional impairment and other cancer related issues. For example, to achieve 30 minutes of exercise in a day it may be easier to do three x 10-minute sessions. It is likely that performing 20 minutes of vigorous aerobic exercise four days a week and two days where you do resistance training will be more effective than trying to do all your exercise in two days over the weekend.

A Starting point for working out

If nothing else is available than just get out and walk. A very effective resistance training can be done at home without any equipment. However, the most effective exercise programs are supervised by exercise professionals and are generally in a fitness centre or exercise clinic. It has also been demonstrated that exercising with other people with cancer is much more effective in terms of adherence and enjoyment.

Across the world there are many cancer groups that offer exercise classes and other physical activities. Again, we reiterate that everyone should avoid being physically inactive. A sedentary lifestyle will only result in less effectiveness of cancer surgery and therapies, more severe and numerous side effects, accelerated comorbidities such as diabetes and heart disease, and ultimately reduced chances of survival.