What is cancer?
Cancer is the growth of abnormal cells. Cancer can arise from any of our organs or body structure that are composed of tiny cells that has lost its abilities to stop growing. In other words, cancer is the inability of immune cells of the body to identify and destroy the transformation of a normal cell into a cancerous cell as they grow in numbers (1). The risk of cancer increases when the immune system is suppressed by old age, chronic stress, chronic diseases, previous use of chemotherapy or abuse of drugs such as antibiotics, corticosteroids or analgesics.
Cancer cell continue to grow unless it is removed through surgery, chemotherapy, radiotherapy or if the cancer cells shrink and disappear on its own (this is extremely rare but it is possible). Cancer treatments causes profound debilitation that leads to fatigue, decrease in physical function and impaired quality of life(2). Currently, only a third of breast cancer survivors have the aerobic capacity that is above what is required for functional independence (3) and other cancer survivors were observed to have decreased in aerobic capacity by 10-33% after over a 12-week period of chemotherapy (4-6).
How can exercise help?
Compelling evidence has shown that these declines can be minimised or prevented by exercise. Progressive program of restorative exercise during and following treatment has demonstrated with reductions in recurrence and mortality by 30-60% in colorectal and breast cancers (7-9). It has also been found to reduce or prevent negative effects after cancer treatments such as muscle weakness, fatigue, decrease in functional ability, cardiovascular capacity, body composition,neuropathy, and quality of life (2,4,10-20). For example, breast cancer survivors that engaged in weight lifting, not only strengthen their affected arm but had a lower tendency of lymphedema (16) while men with prostate cancer that were going through androgen deprivation therapy gained muscle strength, improved physical function, body composition, quality of life and reduced fatigue through exercise despite battling profound changes in skeletal muscle mass and strength from treatment (17-20).
There is a growing body of evidence that shows regular bouts of exercise (3-5hours of moderate-intensity walking/week) lead to a 30-50% reduction in the risk of cancer-specific mortality and all cause mortality as compared to patients who weren't physically active (21). Simple exercises such as walking 30 minutes 3 - 4 days/week conveys beneficial effects that can improve functional abilities (7). In addition, recent studies have reported that exercise is an effective strategy to improve psychological status such as depression, anxiety and sleep quality in lung, breast, head and neck, colorectal, ovarian and lymphoma cancer survivors during and after treatment (41-47). It has also shown beneficial effects on quality of life (48,49,50), emotional (51), social and role functioning (50) with cancer patients.
It is not surprising that patients with cancer faces the prevalence of depression given the deterioration in emotional, role and social functioning and the chances ranges from 8-24% (22). In most cases, this is where exercise can be beneficial. Regular exercise can positively impact serotonin levels in the brain (23), boosting mood, improves patients' appetite (24) and overall sense of well-being (25). Exercise emits psychological and physiological mechanisms such as thermogenic hypothesis (26), endorphin hypothesis (27,28), monoamine hypothesis (30,31), distraction hypothesis (29), and self-efficacy improvement (32,33). Exercise elevates core body temperature (26), increases release of β-endorphins (27,28), increases in the availability of brain neurotransmitters (eg. dopamine, serotonin, norepinephrine) (30,31) and these mechanisms are responsible for the reduction of depression symptoms. Exercise also serves as a distraction from depressing thoughts while enhancing of self-efficacy through exercise may be a way in which exercise serves its role in antidepressant effects (32,33).
Combining both resistance training with aerobic exercise appears to be most favourable to reduce cancer related fatigue in men with prostate cancer (34,35,36) and improve quality of life in cancer patients. (35-40). In two studies, improvements in cancer related fatigue were observed after 12 weeks of structured supervised exercise (2-3times/week) and fortnightly diet advice (17,18). On top of that, healthy eating and exercise have shown sustained improvements in cancer related fatigue at six months follow up as well (17,18). The inclusion of balance and flexibility training such as Yoga and Taichi have shown to improve quality of life and other cancer-related outcomes (53). A well balanced, structured and progressive exercise prescription with the objective to improve strength, mobility and aerobic capacity is shown to improve functionality for cancer patients in daily activities with reduced risk of falls, discomfort, pain or concerns (52).
Overall, there is growing evidence over the decade evaluating the role of exercise in an oncology setting supporting exercise implementation during and after treatment reduced morbidity, improved function and quality of life with very low risk of harm. However, it is important to note that the mode of exercise, intensity, frequency, duration and progression is dependent on cancer type and the goal of the patient. It is advisable and highly recommended to seek a health professional for the appropriate exercise prescription and dosage for cancer patient's needs to be individualised and targeted according to patient-cancer specific considerations.
Do feel free to contact us if you'll like to seek any exercise consultations specific to your condition.
Always happy to help :)
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