Moving More (1/2)

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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.

Moving More

Benefits of Moving More

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.

Movement includes many activities, such as these:

  • Walking or hiking
  • Participation in active sports such as tennis, soccer or basketball
  • A workout at a gym
  • Recreational activities such as dancing, bicycling, swimming, skiing or martial arts
  • Group aerobic activities such as Zumba
  • Active gardening, yard work or housework
  • Movement therapies such as yogaqigong and tai chi.

Finding an activity that is fun will increase both your motivation and your enjoyment.1 Movement can also be combined with social activities, increasing the potential for fun and also strengthening your connections to family and friends.

Frequent movement can help counteract the health risks of prolonged sitting. The American Institute for Cancer Research encourages people to break up long periods of sitting with frequent activity breaks.3 A large analysis of data from the Cancer Prevention Study-II Nutrition Cohort found that, among low to moderately active adults, replacing sitting with light physical activity was associated with a reduction in cancer mortality, all-cause mortality and cardiovascular disease mortality.4

At least a moderate-intensity activity such as brisk walking or climbing stairs is needed for benefit. Moderate-intensity activity increases your heart rate and breathing rate somewhat and should cause you to perspire. Vigorous activity causes your heart rate and breathing rate to increase significantly to the point that you find it difficult to hold a conversation.5 Resistance training such as weightlifting is also beneficial a couple of days a week.

 

Movement and Cancer Treatment

Cancer patients may need to adjust movement types and levels during or after treatments such as surgery, chemotherapy or radiation. Following your doctor’s advice is important, but even within restrictions most patients can increase their level of activity and receive benefit. The American Cancer Society’s (ACS) Nutrition and Physical Activity Guidelines for Cancer Survivors that “the goal should be to be active as much as possible.”

Even modest amounts of increased activity show benefit. A 2014 study of cancer survivors at least 65 years old found that increasing light-intensity activities such as light housekeeping, light gardening and leisurely walking may slow the decline of physical function.6

Benefits of resistance training include improvement in muscle strength and endurance, improvements in functional status, and maintenance or improvement in bone density.7

The American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Survivors (2012) state: “Persons receiving chemotherapy and/or radiation therapy who are already on an exercise program may need to exercise at a lower intensity and/or for a shorter duration during their treatment, but the principal goal should be to maintain activity as much as possible.”8 A 2019 study found that scheduling exercise to accommodate cyclical variations in fatigue due to chemotherapy may increase adherence to supervised exercise.9 Medicine Science in Sports Exercise. 2019 Sep 4.

Recent research is investigating how moving more may interact with cancer treatments, but no definitive conclusions can be drawn yet.10

Clinical Practice Guidelines

2009 evidence-based clinical practice guidelines for integrative oncology recommend referral to a qualified exercise specialist for guidelines on physical activity to promote basic health.”11

The 2018 American Institute for Cancer Research guidelines for physical activity found strong evidence that being physically active decreases these risks:12

In addition, vigorous physical activity decreases the risk of both pre- and postmenopausal breast cancer.

The American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Survivors (2012) recommend “after treatment, a program of regular physical activity is essential to aid in the process of recovery and improve fitness." Guidelines include these specifics:13

  • Engage in regular physical activity.
  • Avoid inactivity and return to normal daily activities as soon as possible following diagnosis.
  • Aim to exercise at least 150 minutes per week.
  • Include strength training exercises at least 2 days per week.

A roundtable convened by American College of Sports Medicine 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."14 Further, the American College of Sports Medicine's Exercise Is Medicine initiative proposes that clinicians assess, advise and refer patients to either home‐based or community‐based exercise or for further evaluation and intervention in outpatient rehabilitation.15

2013 evidence-based clinical practice guidelines from the American College of Chest Physicians suggests supervised exercise-based pulmonary rehabilitation to improve cardiorespiratory fitness and functional capacity for lung cancer patients.16

The 2018 Clinical Oncology Society of Australia guidelines include these recommendations:17

  • Exercise to be embedded as part of standard practice in cancer care and to be viewed as an adjunct therapy that helps counteract the adverse effects of cancer and its treatment
  • All members of the multidisciplinary cancer team to promote physical activity and recommend that people with cancer adhere to exercise guidelines
  • Best practice cancer care to include referral to an accredited exercise physiologist or physiotherapist with experience in cancer care

The 2017 National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology (NCCN Guidelines®) on Survivorship include these recommendations:18

  • Develop a plan for regular physical activity and healthy nutrition as part of management and treatment of anxietydepression and distress.
  • Recommend routine physical activity as part of cancer-associated cognitive dysfunction interventions.
  • Exercise/physical activity is one of the nonpharmacologic treatments recommended for vasomotor symptoms (such as hot flashes/night sweats) disruptive to quality of life and for pain/myalgias.
  • Regular physical activity in the morning and/or afternoon (but not within three hours of bedtime) is recommended for sleep disorders.
  • For general healthy lifestyles, engage daily in general physical activity to include exercise, daily routine activities, and recreational activities. Avoid sitting for long periods.
  • Clinicians should assess individual and community-level barriers to meeting the healthy lifestyle recommendations and support patients in developing strategies to overcome challenges.
  • A risk assessment for physical activity-induced adverse events is recommended.
  • Resistance training of all major muscle groups is recommended for 20 minutes two or three times a week each session.

The American Institute for Cancer Research includes this in their cancer prevention recommendations:19

Scientists recommend that we aim for a minimum of 150 minutes of moderate, or 75 minutes of vigorous, physical activity a week. For cancer prevention and weight control, higher levels of activity provide even more benefit. Work toward achieving 45 to 60 minutes moderate-intensity physical activity daily. Going beyond 60 minutes daily provides additional health benefits.

 

American Cancer Society’s Nutrition and Physical Activity Guidelines for Cancer Survivors

From the American Cancer Society:20

Achieve and maintain a healthy weight.

 

  • If overweight or obese, limit consumption of high‐calorie foods and beverages and increase physical activity to promote weight loss.

 

Engage in regular physical activity.

 

  • Avoid inactivity and return to normal daily activities as soon as possible following diagnosis.
  • Aim to exercise at least 150 minutes per week.
  • Include strength training exercises at least two days per week.
  • Follow the American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention (following).

 

American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention

From the American Cancer Society:21

Achieve and maintain a healthy weight throughout life.

 

  • Be as lean as possible throughout life without being underweight.
  • Avoid excess weight gain at all ages. For those who are overweight or obese, losing even a small amount of weight has health benefits and is a good place to start.
  • Get regular physical activity and limit intake of high-calorie foods and drinks as keys to help maintain a healthy weight.

 

Be physically active.

 

  • Adults: Get at least 150 minutes of moderate intensity or 75 minutes of vigorous intensity activity each week (or a combination of these), preferably spread throughout the week.
  • Children and teens: Get at least 1 hour of moderate or vigorous intensity activity each day, with vigorous activity on at least 3 days each week.
  • Limit sedentary behavior such as sitting, lying down, watching TV, and other forms of screen-based entertainment.
  • Doing some physical activity above usual activities, no matter what one’s level of activity, can have many health benefits.

 

The US Department of Health and Human Services (HHS) issues Physical Activity Guidelines for Americans. The 2008 guidelines (the most recent available), include these findings and recommendations:22

 

  • For most health outcomes, additional benefits occur as the amount of physical activity increases through higher intensity, greater frequency, and/or longer duration.
  • Most health benefits occur with at least 150 minutes (2 hours and 30 minutes) a week of moderate intensity physical activity, such as brisk walking.
  • Both aerobic (endurance) and muscle-strengthening (resistance) physical activity are beneficial.
  • The benefits of physical activity far outweigh the possibility of adverse outcomes.

 

Patients may achieve higher fitness levels in a supervised program compared to a self-directed program.23

Guidelines for People in Treatment or with Advanced Disease

Integrative oncologist and BCCT advisor Keith Block, MD, recommends these approaches for those undergoing chemotherapy treatment, with advanced disease or experiencing wasting (cachexia):24

 

  • Reduce your emphasis on aerobic exercise.
  • Emphasize interval training (repeated short sessions of aerobic-type exercise)
  • Emphasize strength or resistance training
    • Use light weights or isometrics
    • Use short sessions repeated several times daily
  • Emphasize systems such as yogaPilatesqigong or tai chi that increase flexibility
  • Do not overexercise, for this produces inflammation and increases cortisol

 

Movement and Being Kind to Yourself

Hydrating with Movement

If you increase your activity levels, especially if you work up a sweat, you'll probably need to pay more attention to staying hydrated. Maintaining optimal levels of fluid in your body has several positive outcomes:25

  1. Prevent the unpleasant and even dangerous symptoms of dehydration
  2. Enable your body to optimize digestion, hormone balance, immune system function, inflammation and other terrain factors
  3. Allow your body to flush toxins out
  4. Reduce treatment side effects, such as nausea, weakness, constipation and fatigue
  5. Contribute to a general sense of well-being

For people with cancer, dehydration may cause your treatment to be delayed until you can be rehydrated, so staying hydrated is an important consideration in your treatment.

Stay hydrated with water or unsweetened beverages (avoid caffeine and alcohol if you're at risk for dehydration).

Find out more about hydrating on our Dehydration and Hydration page.

Activity and Sleep

When you exercise or are more active can impact not only your fitness and metabolism, but your sleep and your response to cancer treatments.

Integrative oncologist and BCCT advisor Keith Block, MD, and his colleagues offer guidance about how and when to be active to promote normal circadian (sleep-rest) function.26

 

General Exercise and Physical Care Guidelines

  • Get aerobic exercise early in the day.
  • Get morning and daytime sun exposure, 15 to 30 minutes.
  • Avoid exercising to exhaustion, which increases cortisol levels.
  • Tai chi and yoga have been found to improve sleep in older persons and cancer patients.
  • Discourage daytime/evening napping.
  • Avoid overwork and other very stressful activities that could disturb sleep through anxiety and catecholamine release (see Managing Stress).

Nighttime Exercise and Physical Care Guidelines

  • Bright light exposure in early evening but dim lights in last hour before bed (see the section titled "Light" on Creating a Healing Environment)
  • Enjoy a warm bath, soothing music, or other relaxing activity before bed.
  • Reduce stimulating activity before bed.
  • Avoid evening exercise.
  • Do not lie in bed after nighttime waking.
  • Reserve your bedroom for sleep and intimacy only.
  • Develop routine bedtime practices.
  • Improve your sleep environment:
    • Complete darkness
    • Relaxing pillow
    • Comfortable, cool room temperature
    • Control noise level
    • No computer/television or other screens
    • Hide or remove clocks

Mind–Body Guidelines
Routinize your daily schedule of sleep, work, and physical activity
When possible, delegate stressful tasks
Develop a quality social-support network

Cognitive-behavioral therapy for stress and insomnia problems
Adopt effective stress management techniques such as abdominal breathing
If you are restless or awake at night, leave your bedroom
Do not fret over lost sleep, which only increases anxiety
Keep a notebook for middle-of-the-night worries or thoughts
Set aside calming time in the evening for meditation or quiet yoga practice

 

Treating the Cancer

Working against cancer growth or spread, improving survival, or working with other treatments or therapies to improve their anticancer action

A 2017 review of evidence came to these conclusions:27

A growing evidence base indicates that physical activity has potential value at all stages of cancer care.

Preliminary evidence associates regular physical activity after a cancer diagnosis with longer survival and lower risk of recurrence or disease progression.

Preliminary evidence suggests that following an exercise program before treatment (prehabilitation) leads to increased cardiorespiratory fitness, fewer post-operative complications and shorter hospital admissions.

A 2018 review looked at data from more than 5800 patients with one of eight specific tumors: breastcolonprostateovarianbladderendometrialesophageal, and skin cancer (mostly melanoma). The results:28

In comparison to patients who were habitually inactive, habitually active patients experienced a 39% decreased hazard of all-cause mortality and a 36% decreased hazard of cancer-specific mortality. Previously inactive patients who began exercising after diagnosis experienced a 28% decreased hazard of all-cause and cancer-specific mortality in comparison to patients who remained inactive. Patients engaging in 3–4 sessions/week experienced the greatest survival advantages, but 1–2 sessions/week also yielded significant survival advantages in comparison to inactivity.

Maintaining higher leisure-time physical activity levels (at least two to seven hours per week) and increasing such activity in later adulthood were associated with comparable low risks of cancer mortality. The authors conclude that midlife is not too late to start physical activity.29

Improving Muscle Mass and Density

30 Muscle density improves when fat embedded in muscle fibers is reduced.31 Aerobic activity, such as moderate to vigorous walking, dancing, swimming or cycling, can improve muscle density.32

More muscle mass and greater muscle density are highly associated with improved survival in hospitalized patients with advanced cancer33 and lower mortality in patients with advanced non-small cell lung cancer undergoing chemotherapy.34

A cancer diagnosis increases the risk of poorer ambulatory function—a slower walking pace and greater mobility disability. Poorer ambulatory function increases the risk of mortality. Researchers recommend widespread efforts to target and improve ambulatory function during cancer survivorship for survival benefits.35

 

Breast Cancer

 

From The Ecology of Breast Cancer:36

Most but not all studies show that women who regularly exercise after breast cancer treatment experience reduced all-cause and breast-cancer specific mortality compared to sedentary women over follow-up periods averaging four to eight years. In many studies, higher levels of physical activity or exercise before diagnosis are also associated with improved survival after diagnosis and treatment.

As quoted in the same book, a 2010 review and meta-analysis found moderate effects of post-treatment physical activity interventions on measures of hormone and immune parameters.37

A 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-specific mortality in survivors of several common cancers", including breast.38

An investigation of the After Breast Cancer Pooling Project found that very low physical activity was associated with a 22 percent increased risk of breast cancer mortality.39 Another analysis from the same project found that engaging in at least 10 MET-hours per week (see above) of physical activity was associated with a 27 percent reduction in all-cause mortality and a 25 percent reduction in breast cancer mortality compared with women who were less active.40

A clinical trial of an exercise intervention in breast cancer patients found good evidence of cardiovascular benefit: "Our findings strongly support that tailored exercise training during adjuvant breast cancer treatment may counteract a decline in cardiovascular function, and in particular among those receiving chemotherapy."41

See Breast Cancer.

Colorectal Cancer

 

  • A 2018 study of almost 1000 colorectal cancer survivors found a 42 percent reduction in  death at five years for those who followed the ACS guidelines most closely compared to those who followed them least.4243
  • In early-stage colorectal cancer patients, low muscle density was significantly associated with higher overall mortality and worse disease-free survival.44
  • A 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-specific mortality in survivors of several common cancers", including colorectal.45

See Colorectal Cancer.

Lung Cancer

 

  • Greater cardiorespiratory fitness reduces risk of cancer mortality in current smokers.46

See Lung Cancer.

Lymphoma

 

  • An observational study of more than 4000 lymphoma patients found that those with a higher level of physical activity throughout their adult lives and after diagnosis had better overall and lymphoma-specific survival during three years of follow-up. A reduction in activity level after diagnosis was associated with worse outcomes.47

See Lymphoma.

Prostate Cancer

 

  • A 2020 review found moderate evidence of reduced risk of prostate cancer with higher levels of occupational physical activity.48
  • 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 improving survival following the diagnosis and treatment of prostate cancer.49
  • A 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-specific mortality in survivors of several common cancers", including prostate.50

See Prostate Cancer

Uterine (Endometrial) Cancer

 

  • A 2020 review found moderate evidence of reduced risk of endometrial cancer with higher levels of occupational physical activity.51

See Uterine Cancer

 

Credits

This article has been taken from Beyond Conventional Cancer Therapies.

 

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