Why movement matters after a cancer diagnosis

By 2040, it is expected that there will be 27.5 million new cancer cases and 16.3 million cancer deaths, simply due to the growth and aging of the global population. In developed countries, one in two of us will get cancer in our lifetime.

The good news is that cancer survival has doubled in last 40 years and over 50% of people diagnosed with cancer will survive cancer for 10 or more years.

The problem

For many cancer survivors, treatments such as surgery, chemotherapy, radiotherapy, hormonal treatment and targeted biological treatments lead to chronic/ late appearing side effects such as fatigue, cardiorespiratory and muscular weakness, metabolic syndrome, osteoporosis, lymphoedema and depression and this can have a profound effect on their quality of life.

The remedy

One way to combat these side effects is to stay active. There is now convincing evidence that being active at all stages of the cancer journey (pre-surgery, during cancer treatments, in the survivorship phase, with advanced cancer and during palliative care) can provide significant physical and psychological benefits (Stevinson et al., 2017). Strong observational evidence shows that higher levels of physical activity are associated with lower risk of cancer recurrence and mortality following breast, colon, and prostate cancer (Li et al., 2016). Furthermore, specific doses of exercise have been shown to effectively address anxiety, depression, physical function deficits, cancer related fatigue, bone health, sleep, lymphoedema and quality of life (Winters-Stone, 2018). In addition, exciting new evidence supports the concept that exercise may directly improve the effectiveness of chemotherapy treatments (Cheville et al., 2015, van Waart et al., 2015, Courneya et al., 2007, Hayes et al., 2018), which partly may explain the cancer survival benefits (Moore et al., 2016). In summary, the evidence is strong enough to consider exercise/ physical activity rehabilitation programmes, as an integral additional cancer treatment and it should be embedded as a standard part of cancer care, similar to that offered in cardiac rehabilitation.

Exercise guidelines for cancer:

General recommendations based on published US and Australian guidelines are:

• Avoid inactivity and try to return to some activity as soon as possible after surgery.
• Aim to continue to be physically active as far as possible while undergoing cancer treatments such as chemotherapy but be aware that treatment-related toxicities which can increase risk of anemia, infection and affect cardiorespiratory fitness and bone health.
• After cancer treatments, most cancer survivors should build up to age-appropriate guidelines for health-enhancing physical activity (typically aerobic exercise for two and a half hours per week, resistance exercise twice weekly, and balance/coordination exercise twice weekly)
• For those with cancer complications or co-morbidities that prohibit moderate-intensity exercise, avoidance of total inactivity is nonetheless advised.

During chemotherapy and radiotherapy, and with some of chronic or late appearing side effects of cancer treatment, it is essential to acquire further knowledge on how to recognise contra-indications and / or which exercises have to be modified or excluded. For example, there are essential modifications to strength training exercises required if a woman has developed lymphoedema after breast cancer surgery and radiotherapy: or if a client diagnosed with colon cancer has a colostomy bag it is important to improve the client’s confidence by incorporating safe and effective exercises for core muscle stability; or a prostate cancer survivor who is on hormone treatment will need to incorporate specific weight bearing exercises to decrease risk of bone thinning.

Our courses at various levels provide the students with a list of potential issues to look out for at each session with a client and guidelines on when to stop, reduce or alter an exercise or activity and when to refer back to the appropriate health care professional.