Moving More (2/2)

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Moving your body reduces the risk of cancer and promotes health after a diagnosis, as noted by the American Cancer Society and several medical groups in their clinical practice guidelines.

Managing Side Effects and Promoting Wellness

Managing or relieving side effects or symptoms, reducing treatment toxicity, supporting quality of life or promoting general well-being

Reviews of research support the role of moving more in quality of life:

  • "Physical activity interventions improve quality of life and other patient-reported outcomes during and after cancer therapy."52
  • “Cancer survivors who exercise can potentially benefit from reduced levels of fatigue, and improved quality of life, physical function, and body composition.”53
  • A large prospective study of breast cancer patients enrolled in the Women's Health Initiative found that increasing levels of exercise before diagnosis was associated with a significant graded reduction in subsequent cardiovascular events in long-term survivors of primary breast cancer.54  
  • Greater muscle density is associated with lower patient symptoms (including anxiety and depression) and reduced use of health care.55
  • Women with mild to moderate depressive symptoms reported significantly better scores in all five measures of depression in a small randomized trial. An intervention combining a brisk 20-minute outdoor walk, increased light exposure throughout the day and  a vitamin regimen had high adherence for eight weeks. The goal of the walk was to increase target heart rate of 60% of maximum, and the supplements included vitamins B1, B6, B2, B9D, and selenium.56  

Movement has also been shown to reduce these symptoms and side effects of cancer and treatment:

  • Anxiety: variable evidence by cancer type and stage of treatment
    • Modest evidence of lower anxiety (small effects) across cancer types except during chemotherapy:
      • Lower anxiety among cancer survivors in a meta-analysis of RCTs57
      • No impact on anxiety among people with cancer undergoing chemotherapy in a meta-analysis of RCTs58
      • Slightly less anxiety among people with cancer with an online physical activity or diet intervention in a meta-analysis of RCTs59
    • Modest evidence of less anxiety among people with breast cancer both during and after treatment
      • Lower anxiety among people with breast cancer with aerobic exercise training for the duration of their chemotherapy in a mid-sized RCT60
      • Less anxiety among people with breast cancer with exercise during adjuvant therapy in a meta-analysis of RCTs61  
      • Less anxiety among women diagnosed with stage II+ breast cancer with exercise in a meta-analysis of RCTs62
      • Small-to-moderate improvements in anxiety among women with breast cancer after adjuvant therapy with exercise in a meta-analysis of randomized and quasi-randomized trials63
    • Modest evidence of no effect among people with colorectal or blood cancers
      • No impact on anxiety among people with non-advanced colorectal cancer in physical activity interventions64 or adults with blood cancers (mostly leukemia, lymphoma and multiple myeloma) doing aerobic physical exercise65 compared to no intervention or usual care in meta-analyses of RCTs
    • Preliminary (mixed results) evidence of effects among people with lung cancer
      • Fewer symptoms of anxiety among people with lung cancer with exercise interventions in a meta-analysis of RCTs66
      • Less anxiety among people with lung cancer with home-based exercise in a meta-analysis of RCTs67  
      • No change in anxiety among adults with advanced lung cancer with exercise training in a pooled analysis of RCTs68
    • Modest evidence of effects among people (not specific to those with cancer), including those with anxiety and stress-related disorders
      • Lower anxiety among healthy older adults in a review of RCTs69
      • Fewer symptoms of anxiety among overweight or obese women with a lifestyle intervention of physical activity and/or diet in a meta-analysis of RCTs70
      • Fewer anxiety symptoms, with less improvement among those with physical or mental health conditions compared to healthy volunteers, with resistance exercise training in a meta-analysis of RCTs71
      • Fewer anxiety symptoms among people with anxiety and stress-related disorders in a meta-analysis of RCTs72
  • Changes in appetite:
    • No effect on appetite among people with lung cancer with home-based exercise in a meta-analysis of RCTs73
  • Depression74  
    • No impact on depression among people with non-advanced colorectal cancer in physical activity interventions compared to no intervention or usual care in a meta-analysis of RCTs75
    • Less depression among people with cancer undergoing chemotherapy in a meta-analysis of RCTs76
    • Fewer symptoms of depression among people with lung cancer with exercise interventions in a meta-analysis of RCTs77
    • Moderately less depression among people with cancer with exercise-based rehabilitation compared to usual care in a systematic review of RCTs78
    • Less depression, and improved quality of life among people with lung cancer with home-based exercise in a meta-analysis of RCTs79
    • Slightly less depression among people with cancer with an online physical activity or diet intervention in a meta-analysis of RCTs80
    • No change in depression among adults with advanced lung cancer underting exercise training in a pooled analysis of RCTs81
    • Less depression among people with breast cancer with exercise during adjuvant therapy in a meta-analysis of RCTs82  
    • Less depression among women diagnosed with stage II+ breast cancer with exercise in a meta-analysis of RCTs83
    • Fewer symptoms of depression among overweight or obese women with a lifestyle intervention of physical activity and/or diet in a meta-analysis of RCTs84
  • Fatigue85
    • Less fatigue among people with non-advanced colorectal cancer in physical activity interventions compared to no intervention or usual care in a meta-analysis of RCTs86
    • Less fatigue among people with lung cancer with exercise interventions in a meta-analysis of RCTs87
    • Less cancer-related fatigue among people with lung cancer with home-based exercise in a meta-analysis of RCTs88
    • Less fatigue among people with advanced cancer with exercise in a meta-analysis of RCTs89
    • A weak trend toward less fatigue among people with cancer with an online physical activity or diet intervention in a meta-analysis of RCTs90
    • No change in fatigue among adults with advanced lung cancer underting exercise training in a pooled analysis of RCTs91
    • Less fatigue among people with breast cancer with exercise during adjuvant therapy in a meta-analysis of RCTs92  
    • Less fatigue among women diagnosed with stage II+ breast cancer with exercise in a meta-analysis of RCTs93  
  • Quality of life and physical function:
    • Better health‐related quality of life among people with non-advanced colorectal cancer in physical activity interventions compared to no intervention or usual care in a meta-analysis of RCTs94  
    • Generally small and moderate better reported quality of life and physical function in a large review of reviews of RCTs95
    • Moderately better quality of life among people with lung cancer with exercise interventions in a meta-analysis of RCTs96
    • Better quality of life among people with advanced cancer with exercise in a meta-analysis of RCTs97
    • Slightly improved quality of life among people with cancer with an online physical activity or diet intervention in a meta-analysis of RCTs98
    • Better physical function among people with advanced cancer with exercise in a meta-analysis of RCTs99
    • Better physical component of health-related quality of life among people with non-small cell lung cancer  who underwent lung resection receiving exercise training in a meta-analysis of RCTs of moderate quality100
    • Better disease-specific global health-related quality of life but no change in physical functioning among adults with advanced lung cancer underting exercise training in a pooled analysis of RCTs101 dyspnoea fatigue, feelings of anxiety depression
    • Better quality of life and physical fitness among people with breast cancer with exercise during adjuvant therapy in a meta-analysis of RCTs102  
    • Better quality of life, fitness and strength among women diagnosed with stage II+ breast cancer with exercise in a meta-analysis of RCTs103  
    • Small-to-moderate improvements in health-realted quality of life, perceived physical function, and cardiorespiratory fitness among women with breast cancer after adjuvant therapy with exercise in a meta-analysis of randomized and quasi-randomized trials104
  • Pain:
    • Lower pain severity in general (not specific to people with cancer) with physical activity in a large review of reviews of RCTs105
    • No affect on pain among people with lung cancer with home-based exercise in a meta-analysis of RCTs106
  • Sleep disruption107
    • Less insomnia among people with advanced cancer with exercise in a meta-analysis of RCTs108
    • Less insomnia among people with lung cancer with home-based exercise in a meta-analysis of RCTs109
  • Other symptoms and side effects:
    • Improved muscle strength among people with cancer with exercise-based rehabilitation compared to usual care in a systematic review of RCTs110
    • No affect on coughing among people with lung cancer with home-based exercise in a meta-analysis of RCTs111
    • Less breathlessness (dyspnea) among people with advanced cancer112 or after lung resection,113 but no change among people with advanced lung cancer114 with exercise in meta-analyses of RCTs

A 2010 review and meta-analysis found these effects of physical activity interventions with cancer survivors:115

  • A large effect on upper and lower body strength after treatment
  • Moderate effects on fatigue
  • A small to moderate positive effect for physical activity level, aerobic fitness, muscular strength, functional quality of life, anxiety and self-esteem
  • With few exceptions, exercise was well tolerated during and post treatment without adverse events.

A study found that exercise improved patients' chemotherapy completion rate without causing lymphedema or significant adverse events.116 A 2012 study found that women with early stage breast cancer who were more active consistently reported lower levels of depression and increased quality of life five years after the intervention compared to those who were less active.117  A 2019 review concluded that Nordic walking—performed with walking poles similar to ski poles—had a significant and positive impact on a number of breast cancer symptoms including lymphedema, physical fitness, disability and morbid perceptions.118 A study found that one year of football (soccer) fitness significantly improved bone mineral density, leg muscle strength, and postural balance in women treated for early-stage breast cancer.119

An American College of Sports Medicine roundtable on exercise guidelines for cancer survivors “concluded that exercise training is safe during and after cancer treatments and results in improvements in physical functioning, quality of life, and cancer-related fatigue in several cancer survivor groups.”120

A 2017 review found these effects of physical activity on cancer patients: “Exercise is beneficial before, during, and after cancer treatment, across all cancer types, and for a variety of cancer-related impairments. Moderate-to-vigorous exercise is the best level of exercise intensity to improve physical function and mitigate cancer-related impairments. Therapeutic exercises are beneficial to manage treatment side effects, may enhance tolerance to cancer treatments, and improve functional outcomes. Supervised exercise yielded superior benefits versus unsupervised. Serious adverse events were not common.”121 A separate study also found better results for muscle strength and physical fatigue with a supervised high-intensity program compared to a home-based physical activity program.122

Another 2017 review of evidence came to these conclusions:123

  • Preliminary evidence suggests that following an exercise program before treatment (prehabilitation) leads
    to increased cardiorespiratory fitness, fewer post-operative complications and shorter hospital admissions.
  • Stronger evidence demonstrates that exercising while undergoing cancer treatment helps to preserve cardiorespiratory and muscular fitness, and to control cancer-related fatigue.
  • Similarly, promising evidence indicates that after completion of treatment, undertaking an exercise program leads to increased cardiorespiratory and muscular fitness, reduced fatigue and improved body composition and well-being.
  • For patients under palliative care, preliminary evidence suggests that exercise is feasible and may help maintain physical function, control fatigue and improve bone health.

 

Reducing Risk

Reducing the risk of developing cancer or the risk of recurrence

Physical activity helps to lower cancer risk in several ways:

  • Regular activity helps keep hormone levels healthy and reduce the contribution of high hormone levels to cancer risk.
  • Being active may strengthen the immune system.
  • Activity helps speed potentially harmful substances through the intestinal tract.
  • Staying physically active can help manage body weight125 and the contribution of body fat to increased risk for many types of cancer.

From The Ecology of Breast Cancer:126

In 1989, scientists from the National Cancer Institute examined the relationship between self-reported physical activity and cancer in the first NHANES cohort, originally assembled from 1971 to 1975, designed to represent the general population, and followed for about 10 years.

They reported an increased risk of various kinds of cancer among inactive individuals compared to very active people (80 percent increased risk for men and 30 percent increased risk for women), even after correcting for smoking and BMI. The association was strongest for colorectal and lung cancer in men, and post-menopausal breast and cervical cancer in women.

A 2017 review of evidence came to these conclusions:127

  • A growing evidence base indicate that physical activity has potential value at all stages of cancer care.
  • Preliminary evidence associates regular physical activity after a cancer diagnosis with lower risk of recurrence or disease progression.

 

Breast Cancer

 

  • A large 2019 analysis found that engaging in 7.5 to 15 MET-hours per week (see above) was associated with a lower risk of  breast cancer.128
  • Other research has found that getting more than 30 minutes of moderate physical activity every day lowers risks for postmenopausal breast. Vigorous physical activity is associated with reduced risk of premenopausal breast cancer.129
  • A 2020 review found low-quality evidence of reduced risk of breast cancer with higher levels of occupational physical activity.130
  • Another review of studies involving more than 35,000 cancer survivors concluded that "physical activity after a diagnosis of cancer is associated with a lower risk of cancer recurrence" in survivors of several common cancers, including breast cancer.131

See Breast Cancer.

Colorectal Cancer

 

ACS Recommendations

The American Cancer Society makes these recommendations to reduce cancer risk:132  

  1. Be physically active.
  2. Adults should engage in 150‐300 minutes of moderate‐intensity physical activity per week, or 75‐150 minutes of vigorous‐intensity physical activity, or an equivalent combination; achieving or exceeding the upper limit of 300 minutes is optimal. Children and adolescents should engage in at least 1 hour of moderate‐ or vigorous‐intensity activity each day.
  3. Limit sedentary behavior such as sitting, lying down, watching television and other forms of screen‐based entertainment.
  • A large 2019 analysis found that engaging in 7.5 to 15 MET-hours per week (see above) was associated with a lower risk of colon cancer in men.
  • A 2020 review found moderate evidence of reduced risk of both colon and rectal cancers, in both men and women, with higher levels of occupational physical activity.133
  • Other research has found that getting more than 30 minutes of moderate physical activity every day lowers risks for colorectal cancers.134
  • Another review of studies involving more than 35,000 cancer survivors concluded that "physical activity after a diagnosis of cancer is associated with a lower risk of cancer recurrence" in survivors of several common cancers, including colorectal cancer.135

See Colorectal Cancer.

Esophageal Cancer

 

  • A 2020 review found low-quality evidence of NO reduced risk of esophageal cancer with higher levels of occupational physical activity.136

See Esophageal Cancer.

Kidney Cancer

 

  • A large 2019 analysis found that engaging in 7.5 to 15 MET-hours per week (see above) was associated with a lower risk of kidney cancer.137
  • A 2020 review found low-quality evidence of nonsignificant reduced risk of kidney cancer with higher levels of occupational physical activity.138

See Kidney Cancer.

Liver Cancer

 

  • A large 2019 analysis found that engaging in 7.5 to 15 MET-hours per week (see above) was associated with a lower risk of liver cancer.139

See Liver Cancer.

Lung Cancer

 

  • Greater cardiorespiratory fitness reduces risk of lung cancer in male former smokers and risk of cancer mortality in current smokers.140

See Lung Cancer.

Lymphoma

 

  • A large 2019 analysis found that engaging in 7.5 to 15 MET-hours per week (see above) was associated with a lower risk of non-Hodgkin lymphoma in women.141

See Lymphoma.

Myeloma

 

  • A large 2019 analysis found that engaging in 7.5 to 15 MET-hours per week (see above) was associated with a lower risk of myeloma.142

See Myeloma.

Pancreatic Cancer

 

  • A 2020 review found low-quality evidence of reduced risk of pancreatic cancer with higher levels of occupational physical activity.143

See Pancreatic Cancer.

Prostate Cancer

 

  • A 2020 review found moderate evidence of reduced risk of prostate cancer with higher levels of occupational physical activity.144
  • A 2017 review of physical activity and prostate cancer found that, “in general, benefit showed a dose-response relationship", meaning that more activity produced more benefit. Vigorous activity is needed for the maximum effect. The study authors also noted "several recent observational studies have indicated that physical activity is beneficial in preventing disease recurrence and improving survival following the diagnosis and treatment of prostate cancer.”145
  • Another review of studies involving more than 35,000 cancer survivors concluded that "physical activity after a diagnosis of cancer is associated with a lower risk of cancer recurrence" in survivors of several common cancers, including prostate cancer.146

See Prostate Cancer

Stomach (Gastric) Cancer

 

  • A 2020 review found low-quality evidence of reduced risk of stomach cancer with higher levels of occupational physical activity.147

See Stomach Cancer

Uterine (Endometrial) Cancer

 

  • A large 2019 analysis found that engaging in 7.5 to 15 MET-hours per week (see above) was associated with a lower risk of endometrial cancer.148
  • Other research has found that getting more than 30 minutes of moderate physical activity every day lowers risks for endometrial cancer.149
  • A 2020 review found moderate evidence of reduced risk of endometrial cancer with higher levels of occupational physical activity.150

See Uterine Cancer

Optimizing Your Terrain

Inactive women with newly diagnosed breast cancer were enrolled in an exercise intervention for about a month after diagnosis and until undergoing surgery. Compared to women participating in a mind-body intervention control group, those exercising demonstrated significant upregulation of 18 unique pathways, including several implicated in immunity and inflammation.151

A study with mice found that voluntary exercise accelerated muscle repair in old mice and improved old muscle stem cells function related to rejuvenation.152 Another study with mice found that exercise enhanced the effect of immune system CD8+ T cells, which fight certain forms of breast cancer and other solid tumors. As a result of exercise, tumor growth was reduced in mice inoculated with different types of cancer cells.153

Preliminary research in both humans and animals has found that exercise promotes an increase in microbial diversity within the gut.154

Cautions

Moving more is generally well tolerated by patients. However, some health conditions such as heart conditions or deep vein thrombosis may cause exercise to be a problem. Avoid exercise during bouts of vomiting, nausea and diarrhea. Patients may be advised not to exercise on days of chemotherapy treatments or for 24 hours afterward. All patients are encouraged to seek the advice of their healthcare provider before undertaking a new or increased exercise routine.156

Physical activity involves the risk of injury. Building strength and balance as exercise is gradually increased, paying attention to proper technique, and other precautions are recommended.157

A 2017 review of evidence noted a few cautions:158

  • Avoid high-intensity activities when immunosuppressed, or when experiencing pain, severe fatigue, or compromised bone health.
  • Avoid activities requiring balance when frail or experiencing dizziness or peripheral sensory neuropathy.
  • Anyone with a stoma should start with low resistance exercise and progress slowly to avoid herniation.

Integrative Programs, Protocols and Medical Systems

For Professionals

  • Better exercise behavior among people with cancer with an online physical activity or diet intervention in a meta-analysis of RCTs166
  • Better breast cancer‐specific quality of life and global quality of life, plus less anxiety, fatigue and insomnia immediately after home‐based, multidimensional survivorship interventions for breast cancer survivors167

Credits

This article has been taken from Beyond Conventional Cancer Therapies.

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