Cancer and exercise

by kellyannmoriarty

So I decided to have the afternoon off and ended up half asleep on the couch until the TV show Catalyst came on, and the topic was cancer treatment. This was the opening line…

“What if I were to tell you there’s a medicine that may double your chance of survival and cause your own body to attack the cancer?”

The medicine?? EXERCISE. I watched the show and started doing my own research to see what the scientific literature had to say… and here is the result of my afternoon off! Just can’t help myself…

OLYMPUS DIGITAL CAMERA Prevention

“Established scientific evidence shows that regular and vigorous physical exercise prevents some cancers, and can also reduce the incidence of cancer by approximately 40%.” 16 Surely it would be safe to say that most people are aware that exercising can reduce their risk of many diseases including cancer. But what about after diagnosis of cancer?

How Exercise Can Assist in Cancer Treatment

In short, exercise

  • boosts blood flow to the tumour cells improving delivery of chemotherapy drugs to the specific sites of cancer
  • increases our body’s production of our own ‘natural killer cells’ that help fight the cancer
  • increases likelihood that a patient will be able to finish their course of cancer therapy (some patients’ treatment ceases due to complications and decline in general health)
  • helps maintain muscle mass
  • helps preserve bone density
  • improves energy, fatigue, mood and general feeling of wellbeing

“Exercise improves a wide array of physical and psychological toxicities including muscle atrophy and weakness, fatigue, obesity, immune function, insomnia, anxiety, cognitive decline and impaired quality of life, among others. Epidemiological data also suggest that increased physical activity via regular exercise reduces the risk of cancer recurrence and cancer mortality.” 2,3,4,5,6,7,8,9,12

The catalyst report interviewed Professor Robert Newton of the Exercise Medicine Research Institute in Perth and talked about his trials on chemotherapy patients undergoing an exercise program with a therapist during treatment. The report also looked at the reasons exercise may assist in improving cancer treatment. For example, preventing the common side effects of muscle and bone loss during chemotherapy. Patients receiving chemotherapy typically lose 10-15% of their muscle mass. One of the trials found that patients who exercised during treatment (including working out on the same day as their cancer therapy!) maintained or even improved their muscles mass during the trial. 10

Studies like these have prompted changes in international cancer management guidelines to include exercise as part of standard cancer treatment regimes. This is from the Cancer Council’s ebook ‘Living with Cancer‘:

“Recent research suggests that exercise benefits most people both during and after cancer treatment. It can help manage some of the common side effects of treatment (see pages 8–9), speed up your return to your usual activities, and improve your quality of life. The evidence also shows there is little risk of exercise causing harm if care is taken and professional exercise advice is followed closely. For some cancers, exercise may even improve treatment outcomes.” 11

Professor Newton believes that exercising just before or just after treatment could be most beneficial because exercise improves blood flow and that “one of the troubles of getting chemotherapy agents into a tumour is that tumours often have a really poor blood supply.”

Most people are aware that whilst chemotherapy can be the best and sometimes only chance of successfully treating cancer, chemo can have devastating effects on patients’ general health, body weight, mental wellbeing, and importantly – immune system. Anything that can be done to strengthen the body’s own natural defence system can assist external treatments like chemotherapy and also help to prevent cancer growth.

Our best natural immune defences against cancer are called ‘natural killer cells’.  A small study conducted in Sweden looked at 10 healthy young men who exercised on a bike for 60 minutes. Their blood was taken before the exercise and then straight after. The bloods were then spun down and the serum was poured over prostate cancer cells to see if they would grow. The serum taken straight after exercise suppressed the cancer cell growth by 30%. “That particular study is landmark,” says Professor Newton, “because what it has done is it’s woken up the scientific community to say, ‘There is something produced during exercise systemically.’ So, the muscles are producing chemicals which are going to all parts of the body and they’re actually destroying tumour cells.”

It gets even more interesting…
In early 2016, another study showed that mice given unlimited access to a running wheel, had different outcomes when they developed cancer. In this study, mice with tumours that had access to a running wheel “showed over 60% reduction in tumor incidence and growth across five different tumour models” (including lung cancer, liver cancer and melanoma). When the researchers looked for the difference, inside the tumour cells of the exercising mice they found an abundance of natural killer cells. 13

Prostate cancer

“There is now irrefutable evidence from large prospective studies that regular exercise after cancer diagnosis will actually increase cancer survival rates by 50–60%, with the strongest effect for breast, colorectal and prostate cancers. A recent study has reported a 49% reduction in deaths from all causes in patients with prostate cancer who did more than three hours of weekly vigorous activity and 61% lower risk of prostate cancer death.” 15,16

Another important side effect to treatment of prostate cancer is bone loss. Up to 53% of patients develop osteoporosis during prostate cancer treatment. When treating men battling prostate cancer, it was found that the type of exercise they do is important in maintaining bone density Catalyst reported. Men who performed impact exercises, particularly jumping, managed to maintain or even increase their bone density during treatment.

Prostate cancer is known to most commonly spread to bone once it progresses to advanced stages. “In particular, it seems that exercising bones with tumours has the ability to slow down tumour growth while also preventing bone loss. This has the potential to increase the survival of advanced prostate cancer patients, and has the potential to preserve bone and muscle which will lead to increased physical function, quality of life and reduced bone pain.” This is the focus of a new pilot study being conducted at the Edith Cowan Medical Research Institute.

Breast cancer

There is an inverse relationship between amount of exercise and risk of breast cancer in women. Strong evidence supports the effect of lack of physical activity on the risk of developing breast cancer. On the flip side, twenty-nine (40%) observational studies have found a statistically significant reduction in breast cancer risk amongst the most physically active when compared to the least active women. 20 The Catalyst report followed the story of one woman who developed nerve problems as a result of chemotherapy. From further research it turns out that anywhere from 11-100% of breast cancer patients experience chemotherapy induced peripheral neuropathy i.e. nerve problems and pain in hands and feet that can progressively worsen without treatment. The likelihood depends on the chemotherapy treatment choice. This particular woman found that her energy and quality of life improved dramatically with exercise and the research indeed supports her findings. 21 Many cancer patients also experience cancer related fatigue (CRF). CRF can be severe fatigue often lasting months or even years after treatment has finished. Exercise has been shown to help not only effectively treat and manage CRF but also prevent the manifestation of this debilitating fatigue. 22,23

 Lung Cancer

Exercising whilst battling lung cancer may sound insane however exercise has been shown to reduce symptoms, increase exercise tolerance, improve quality of life, and potentially reduce length of stay and postoperative complications in patients with lung cancer. 17 Exercise has also been shown to reduce the risk of death from lung cancer. 25

Of course prevention is the best medicine – plenty of encouragement here to get moving right away!

Kelly Moriarty BVSc Cert. IV fitness Dip Nutrition Cert. Yoga teacher

References:

  1. Stress, depression, the immune system, and cancer, Reiche, Edna Maria Vissoci et al., The Lancet Oncology , Volume 5 , Issue 10 , 617 – 625
  2. Brown JC, Huedo-Medina TB, Pescatello LS, Pescatello SM, Ferrer RA, Johnson BT. Efficacy of exercise interventions in modulating cancer-related fatigue among adult cancer survivors: a meta-analysis. Cancer Epidemiol Biomarkers Prev. 2011;20(1):123–133.  [PubMed]

  3.  Irwin ML, Alvarez-Reeves M, Cadmus L, Mierzejewski E, Mayne ST, Yu H, et al. Exercise improves body fat, lean mass, and bone mass in breast cancer survivors. Obesity. 2009;17(8):1534–1541.[PMC free article]  [PubMed]

  4. Gleeson M, Bishop NC, Stensel DJ, Lindley MR, Mastana SS, Nimmo MA. The anti-inflammatory effects of exercise: mechanisms and implications for the prevention and treatment of disease. Nat Rev Immunol. 2011;11(9):607–615.  [PubMed]

  5. Tang MF, Liou TH, Lin CC. Improving sleep quality for cancer patients: benefits of a home-based exercise intervention. Support Care Cancer. 2010;18(10):1329–1339.  [PubMed]

  6. Salmon P. Effects of physical exercise on anxiety, depression, and sensitivity to stress: a unifying theory. Clin Psychol Rev. 2001;21(1):33–61.  [PubMed]

  7. Betof AS, Dewhirst MW, Jones LW. Effects and potential mechanisms of exercise training on cancer progression: a translational perspective. Brain Behav Immun. 2013;30(0):S75–S87. [PMC free article][PubMed]

  8. Ballard-Barbash R, Friedenreich CM, Courneya KS, Siddiqi SM, McTiernan A, Alfano CM. Physical activity, biomarkers, and disease outcomes in cancer survivors: a systematic review. J Natl Cancer Inst. 2012;104(11):815–840. [PMC free article]  [PubMed]

  9. Bittoni MA, Harris RE, Buckworth J, Clinton SK, Focht BC. Abstract 5043: Physical activity and the risk of lung cancer death: results from the Third National Health and Nutrition Examination Survey. Cancer Res. 2014;74(19 Supplement):5043.

  10. http://www.abc.net.au/catalyst/stories/4459555.htm
  11. http://www.cancer.org.au/content/about_cancer/ebooks/livingwithcancer/Exercise_for_People_Living_with_Cancer_booklet_April_2016.pdf#_ga=1.180447015.1641529394.1400819563
  12. Kilari, D., Soto-Perez-de-Celis, E., Mohile, S. G., Alibhai, S. M. H., Presley, C. J., Wildes, T. M., … Mustian, K. M. (2016). Designing exercise clinical trials for older adults with cancer: Recommendations from 2015 Cancer and Aging Research Group NCI U13 Meeting. Journal of Geriatric Oncology, 7(4), 293–304. http://doi.org/10.1016/j.jgo.2016.04.007
  13. Voluntary Running Suppresses Tumor Growth through Epinephrine- and IL-6-Dependent NK Cell Mobilization and Redistribution, Pedersen, Line et al., Cell Metabolism , Volume 23 , Issue 3 , 554 – 562

  14. Endocrine. 2014 Apr;45(3):370-81. doi: 10.1007/s12020-013-0083-z. Epub 2013 Oct 31. “Prevalence of osteoporosis in prostate cancer survivors: a meta-analysis.” Lassemillante AC1, Doi SA, Hooper JD, Prins JB, Wright OR.

  15. http://exerciseismedicine.org.au/wp-content/uploads/2014/05/2014-Prostate-Cancer-FULL.pdf

  16. Curr Treat Options Oncol. 2008 Jun;9(2-3):135-46. doi: 10.1007/s11864-008-0065-1. Epub 2008 Aug 13. Exercise in prevention and management of cancer. Newton RU1, Galvão DA.

  17. 2015 by the International Association for the Study of Lung Cancer “Increasing Physical Activity and Exercise in Lung Cancer” Reviewing Safety, Benefits, and Application, Brett C. Bade, MD, D. David Thomas, MS, JoAnn B. Scott, BA, and Gerard A. Silvestri, MD, MS

  18. Cancer. 2012 Apr 15;118(8 Suppl):2250-60. doi: 10.1002/cncr.27463. A prospective surveillance model for physical rehabilitation of women with breast cancer: chemotherapy-induced peripheral neuropathy. Stubblefield MD1, McNeely ML, Alfano CM, Mayer DK.

  19. http://torontophysiotherapy.ca/top-4-nerve-disorder-side-effects-of-breast-cancer-treatment/
  20. Lynch BM, Ne ilson HK, Friedenreich CM. Physical activity and breast cancer prevention. Phys Activ Cancer 2011;186:13–42.
  21. Wonders KY (2014) The Effect of Supervised Exercise Training on Symptoms of Chemotherapy-Induced Peripheral Neuropathy. Int J Phys Med Rehabil 2:210.doi:10.4172/2329-9096.1000210

  22. Cochrane Database Syst Rev. 2012 Nov 14;11:CD006145. doi: 10.1002/14651858.CD006145.pub3. Exercise for the management of cancer-related fatigue in adults. Cramp F1, Byron-Daniel J.

  23. Dimeo, F. C. (2001), Effects of exercise on cancer-related fatigue. Cancer, 92: 1689–1693. doi:10.1002/1097-0142(20010915)92:6+<1689::AID-CNCR1498>3.0.CO;2-H
  24. Mustian, K. M., Sprod, L. K., Janelsins, M., Peppone, L. J., & Mohile, S. (2012). Exercise Recommendations for Cancer-Related Fatigue, Cognitive Impairment, Sleep problems, Depression, Pain, Anxiety, and Physical Dysfunction: A Review. Oncology & Hematology Review, 8(2), 81–88.
  25. Alfano, C. et al. Physical activity in relation to all-site and lung cancer incidence and mortality in current and former smokers. Cancer Epidemiology Biomarkers and Prevention. 2004. Dec;13(12):2233-41.