Exercise and Cancer – What is the Evidence Telling Us?

In Australia, 33% of men and 25% of women will experience cancer before age 75. It is projected that in 2020 there will be 150,000 people diagnosed with cancer (Cancer Council Australia, 2020).

Is Exercise Safe?

High quality research currently recommends exercise provided by clinical healthcare professionals as being safe and effective in patients with various types of cancer, whether they are pre-treatment, during their cancer treatment, or post (Cormie et al., 2018; Segal et al., 2017). Whether treatment is palliative or curative, the treatment and cancer itself can negatively impact patients’ health and function, with symptoms presenting both during and long after treatment is undertaken (Hayes, Spence, Galvão & Newton, 2009).

These symptoms can include

• fatigue,
• deconditioning,
• reduced quality of life,
• decreased function and
• changes to mental health.

Therefore, best practice states that cancer care should include a referral to a Physiotherapist or Exercise Physiologist experienced in cancer rehabilitation to assist with these effects (Cormie et al., 2018; Segal et al., 2017).

Definition of Exercise

Exercise, as per the American College of Sports Medicine, is defined as planned or structured physical activity which increases energy expenditure (Segal et al., 2017). Current oncology clinical practice guidelines recommend a program tailored to the individual which develops strength, conditioning and endurance. Guidelines encourage individuals to build up to 150 minutes of moderate intensity, and two to three sessions of strengthening, weekly (Cormie et al., 2018; Segal et al., 2017).

Assessment prior to Exercise is Necessary

A comprehensive assessment conducted by specialised healthcare professionals is crucial in optimising rehabilitation outcomes and ensuring interventions are safe and individualised (Maltser, Cristian, Silver, Morris & Stout, 2017). Thorough subjective and objective assessments are conducted, and patient specific comorbidities and effects from cancer treatment are identified. Utilisation of assessments, patient goal setting and validated scales specific to cancer rehabilitation ensure programs are tailored to suit the individual and patient goals are strived for (Segal et al., 2017).

Tailored programs are key

A patient’s cancer treatment may include surgery, chemotherapy or radiation. Each patient then presents with their own history including biopsychosocial factors, lifestyle factors, medications, medical history and comorbidities (Maltser, Cristian, Silver, Morris & Stout, 2017), which all need to be taken into account when developing a patient-specific rehabilitation program.

What are the benefits of Exercise?

Benefits of an exercise-based rehabilitation program have been shown to

• improve physical function, fitness and strength;
• positively impact cancer-related fatigue;
• improving mental health, distress and quality of life;
• reduces the side effects of cancer treatment, and
• assist in reducing the risk of cancer reoccurrence, new cancers developing, and mortality risk

(Cormie et al., 2018; Segal et al., 2017).

Exercise Considerations

Rehabilitation providers must be aware of patient specific precautions, contraindications and restrictions in order to facilitate healing and function. A patient’s multidisciplinary team communicates and works together, including the oncologist and acute team, so that rehabilitation is guided by all stages of the patient’s treatment (Maltser, Cristian, Silver, Morris & Stout, 2017).

Being a part of a group has its benefits

Group-based exercise programs are an excellent opportunity for people to connect with others living with cancer, and create a social and supportive environment. This group-based structure has been shown to achieve greater health outcomes than individual or home-based programs (Segal et al., 2017). This structure also provides a great environment for education and discussion, which is considered best practice in achieving behaviour change and long term positive outcomes (Cormie et al., 2018; Segal et al., 2017).

What has Donvale Rehabilitation Hospital done in response to the evidence?

Donvale Rehabilitation Hospital has developed a 6 week evidence-based multidisciplinary oncological rehabilitation program called ‘Activate’, suited to those who have a primary diagnosis of cancer and are looking to improve their quality of life. The program combines comprehensive health education, exercise and support for participants in a small group environment. Exercises are tailored to the individual’s level of activity, and our agreements with most health funds means out-of-pocket expenses are kept to a minimum.

To ensure your patients achieve best possible outcomes and quality of life during their cancer journey, please contact us. A referral form and brochure can be downloaded from Day Rehabilitation webpage.

References

Cormie, P., Atkinson, M., Bucci, L., Cust, A., Eakin, E., & Hayes, S. et al. (2018). Clinical Oncology Society of Australia position statement on exercise in cancer care. Medical Journal Of Australia, 209(4), 184-187. doi: 10.5694/mja18.00199

Hayes, S., Spence, R., Galvão, D., & Newton, R. (2009). Australian Association for Exercise and Sport Science position stand: Optimising cancer outcomes through exercise. Journal Of Science And Medicine In Sport, 12(4), 428-434. doi: 10.1016/j.jsams.2009.03.002

Maltser, S., Cristian, A., Silver, J., Morris, G., & Stout, N. (2017). A Focused Review of Safety Considerations in Cancer Rehabilitation. PM&R, 9, S415-S428. doi: 10.1016/j.pmrj.2017.08.403

Segal, R., Zwaal, C., Green, E., Tomasone, J., Loblaw, A., Petrella, T., & With Cancer Guideline Development Group, T. (2017). Exercise for people with cancer: a clinical practice guideline. Current Oncology, 24(1), 40. doi: 10.3747/co.24.3376