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Cancer and Exercise By Mrs Vera West

     Can exercise aid in cancer treatment? Here is one opinion, with the usual disclaimer that this is not medical advice, only information for debating purposes:

“Cancer is at epidemic proportions around the world. An estimated 1,762,450 Americans are expected to be diagnosed with cancer in 2019,1 and approximately 1,663 die from it every day. Based on what we now know about the origins of cancer, it's clear that this avalanche is largely the result of inappropriate diets and unhealthy living. Lack of exercise is part of this. Evidence shows exercise not only is a key component of effective cancer prevention, but also cancer treatment and prevention of recurrence, so it's really a triple-win. I first heard of this about 30 years ago and was delighted but surprised and did not understand how this could occur, but now the physiology is well understood as I discuss further below. Not surprisingly, few oncologists ever tell their patients to engage in exercise beyond their simple daily, normal activities, and many cancer patients are reluctant to exercise, or even discuss it with their oncologist. This may soon change.

As reported in an October 16, 2019, press release, an international team, led by Kathryn Schmitz, Ph.D., professor of public health sciences at Penn State College of Medicine, is now hoping to shift the paradigm of cancer treatment by 2029, to include prescribed exercise as part of standard care. As reported by the American College of Sports Medicine:

"New guidance from exercise oncology experts recommend systematic use of an 'exercise prescription' by health care workers and fitness professionals in designing and delivering exercise programs that aim to lower the risk of developing certain cancers and best meet the needs, preferences and abilities of people with cancer."

Exercise To Be Prescribed Like Medicine
A comprehensive scientific review of the evidence and new exercise guidelines for cancer patients is detailed in three separate papers published in two scientific journals:
1.    "Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable" published in Medicine & Science in Sports & Exercise
2.    "American College of Sports Medicine Roundtable Report on Physical Activity, Sedentary Behavior, and Cancer Prevention and Control" published in Medicine & Science in Sports & Exercise
3.    "Exercise Is Medicine in Oncology: Engaging Clinicians to Help Patients Move through Cancer" published in CA: A Cancer Journal for Clinicians
In their CA: A Cancer Journal for Clinicians paper, Schmitz and her team urge cancer patients and oncologists to take exercise prescriptions to heart:

"Multiple organizations around the world have issued evidence-based exercise guidance for patients with cancer and cancer survivors. Recently, the American College of Sports Medicine has updated its exercise guidance for cancer prevention as well as for the prevention and treatment of a variety of cancer health-related outcomes (eg, fatigue, anxiety, depression, function, and quality of life). Despite these guidelines, the majority of people living with and beyond cancer are not regularly physically active. Among the reasons for this is a lack of clarity on the part of those who work in oncology clinical settings of their role in assessing, advising, and referring patients to exercise. The authors propose using the American College of Sports Medicine's Exercise Is Medicine initiative to address this practice gap. The simple proposal is for clinicians to assess, advise, and refer patients to either home-based or community-based exercise or for further evaluation and intervention in outpatient rehabilitation."

Exercise Prescriptions — A New Part of Standard Cancer Care
The team goes on to propose a plan for clinical implementation, which would include:
•    Care coordination with appropriate fitness professionals
•    Behavioral changes among clinicians, patients and fitness experts/rehabilitators alike
•    Improving referrals
•    Implementing an exercise program registry
•    Addressing costs and compensation for exercise programs, as well as developing the needed workforce

"In conclusion, there is a call to action for key stakeholders to create the infrastructure and cultural adaptations needed so that all people living with and beyond cancer can be as active as is possible for them," the authors write.To help with the implementation of the new guidelines into clinical practice, the American College of Sports Medicine's (ACSM) Exercise Is Medicine initiative has launched a new program called Moving Through Cancer. This "clinician-focused program aims to ensure that all people living with and beyond cancer are assessed, advised, referred to and engaged in appropriate exercise and rehabilitation programming as a standard of care," ACSM explains.

Cancer Patients Benefit From Exercise in Many Ways
The CA: A Cancer Journal for Clinicians paper cites a number of studies demonstrating the benefits of exercise for patients with cancer. For example, strong evidence exists showing that exercise lowers your risk of developing colon, breast, endometrial, kidney, bladder, esophageal and stomach cancer. The link between exercise and a lower risk for lung cancer is moderately strong, while the evidence for it lowering your risk of certain other cancers is limited. They also cite evidence showing that exercise improves cancer survival after diagnosis, especially for those with breast, colon and prostate cancer. There's also strong evidence that exercise reduces anxiety, depressive symptoms, fatigue and physical function in cancer patients, and moderate evidence showing it improves sleep. "In summary, the scientific evidence base supports exercise, and patients and clinicians generally agree that patients should be moving throughout their cancer therapy and survivorship," the authors state. "The primary goal of this article is to address the above-noted barriers to oncology clinicians making exercise referrals standard practice, including the provision of straightforward tools intended to make it easier for clinicians to recommend and refer patients to safe, effective, and appropriate exercise programming. Other professionals can then take over for further assessment, triage, referral, or intervention, as appropriate."

Exercise Recommendations for Cancer Patients
Based on the scientific evidence, the recommended amount of exercise for cancer patients is up to 30 minutes of moderate-intensity aerobic activity three times a week, and up to 20 or 30 minutes of resistance exercise twice a week. This level of exercise has been shown to be a "safe and effective dose to address anxiety, depressive symptoms, fatigue, quality of life and physical function deficits," the authors state.”

     I would have been surprised if the evidence indicated the contrary, that it was best to lay in bed and rot, or to wrap oneself up in cotton wool. Common sense suggests that a person is best able to face physical threats if fit, and exercise (with a rational diet) is the only way for humans to get fit.



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