The term “cancer survivor” refers to anyone who has been diagnosed with cancer, no matter where they may be in their journey. With earlier detection and improvements in screening and treatment, cancer survivors are living longer. ACSM recommends for patients to aim for 150 minutes per week of moderate aerobic exercise with an additional two to three sessions of strength training (such as weight lifting) unless contraindicated. A 2017 systematic review suggests that there is sufficient research to support the promotion of exercise for adults with cancer, and some to support the promotion of exercise in group or supervised settings and for a long period of time to improve quality of life and muscular and aerobic fitness (1). Exercising at moderate intensities can be sustainable for longer periods of time and could encourage the formation of an exercise habit. It is important that an assessment be conducted to evaluate the effects of disease, treatments, and comorbidities and that a survivor receives clearance from their oncologist (1).

Why exercise is so important for cancer patients.

The benefits from exercise for this population are extensive. Cancer survivors are almost three times more likely to report fair or poor health after treatment and twice as likely to have psychosocial disabilities and physical and functional limitations as persons without cancer (6). In addition to the possibility of neuropathy, lymphedema, and cardiotoxicity as mentioned above, some other lingering effects of treatment include but are not limited to cancer-related fatigue, weight gain, weight loss, depression, anxiety, insomnia, altered body composition, and changes in bone mineral density. Of these, strong evidence suggests that exercise can directly improve fatigue, weight changes, depression, anxiety, and bone health (7).

• Fatigue: Fatigue occurs in approximately 50-90% of patients undergoing treatment. While it may seem contradictory, exercise happens to be the number one non-pharmaceutical approach to combatting cancer-related fatigue. It can be hard to get started, but great benefits will be reaped if one can get going…even if it’s something as small as walking around the block for 10 minutes or doing house cleaning. A meta-analysis of 70 studies reported that exercise reduces fatigue by 32% during treatment and by 38% after cancer treatment [8]. Resistance, aerobic, flexibility and mixed training programs have all demonstrated improvements in fatigue levels.
• Weight loss/weight gain: There are many mechanisms that can cause a patient to lose weight. One is associated with the side effects of chemotherapy such as nausea, vomiting, diarrhea, and anorexia. Another mechanism is the presence of an altered metabolism and increased inflammatory cytokines that speed up muscle degradation and can lead to a more serious condition called cancer cachexia (7). On the other hand, weight gain and/or increased fat-to-lean mass ratio can be caused by certain cancer therapies, especially hormonal therapies (7). Exercise can mediate inflammation and help maintain lean mass to help keep weight in check.
• Depression/Anxiety/Insomnia: Some of us are familiar with the endorphins and serotonin increase that exercise brings on, but exercise is also associated with increased levels of endocannabinoids which have an anti-anxiety effect and promote a sense of well-being [9]. Physical activity also helps patients develop an increased sense of control in his/her own life. Exercise also reduces many negative emotions such as anger, contempt, disgust, guilt, fear and nervousness. The anti-anxiety and antidepressant effects of exercise has been demonstrated in patients undergoing treatment [10, 11] as well as cancer survivors [12]. Insomnia is often induced by increased depression and anxiety, so by treating the root of the problem (depression and anxiety), insomnia can be reduced.
• Bone health: Bone density can be by hormonal therapies or by metastases to the bone. In those without mets, impact and weight exercise training are preferred to maximize bone health (7). Impact exercises include activities such as running and jumping. Weight and resistance training refer to activities that require the shortening (contraction) and elongation of muscles. By loading the bones through impact and weight bearing activity, you help to prevent further bone loss. If mets are present in the bones, you will want to be extra careful when choosing appropriate activities. As with other exercises, if a patient is experiencing bone metastases or a loss of bone mineral density, it will be essential to seek out advice from an experienced fitness professional.

How family and friends can help show their support (fitness and nutrition wise).

Encouragement! Exercise can be daunting for some. It is important to recognize the benefits of exercise and help your loved one find a good regimen that fits their needs. You may also consider exercising with them. That way you hold each other accountable and both get the amazing benefits of exercise.

Where our readers can go for more information.

Look for an ACSM Cancer Exercise Trainer in your area.

ACSM.org, WCRF/AICR

References:

1. Segal, R., Zwaal, C., Green, E., Tomasone, J. R., Loblaw, A., Petrella, T., & Exercise for People with Cancer Guideline Development Group (2017). Exercise for people with cancer: a systematic review. Current oncology (Toronto, Ont.), 24(4), e290–e315. doi:10.3747/co.24.3619
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