Physical Activity in Cancer

Original Editor - Samara Paull

Top Contributors - Vidya Acharya, Wendy Walker, Adam Vallely Farrell, Kapil Narale, Tony Lowe, Kim Jackson, George Prudden, Simisola Ajeyalemi, Khloud Shreif, Giulia Neculaes, Admin, Michelle Lee, Tarina van der Stockt, Rucha Gadgil, Nicole Hills and Lucinda hampton  

Introduction[edit | edit source]

Cancer is a condition where cells in a specific part of the body grow and reproduce uncontrollably. The cancerous cells can invade and destroy surrounding healthy tissue, including organs. There are more than 200 different types of cancer, each with its own methods of diagnosis and treatment. For more detailed information on the pathophysiology and management of several of the different forms of cancer take a look at the Oncology Physiopedia page.

Decrease in physical fitness has been reported in both patients and survivors of childhood and adult cancers. This decline in physical activity is secondary to the side effects of both the disease and its treatment[1]. Cancer survivors have an increased risk for negative health and psychosocial effects following treatment. Beyond people with cancer, insufficient physical activity is the leading risk factors of death worldwide.

Mcdc7 osteoporosis compare.jpg

By addressing physical activity and stress reduction techniques patients can control some of these modifiable risk factors[2]. Furthermore, such adverse effects are aggravated by physical inactivity (such as reduced bone mineral density, loss of muscle mass, increased BMI and impaired motor performance) therefore more emphasis is being placed on integrating exercise and activity both during and after treatment[3].

With the increasing number of people diagnosed with cancer and surviving it, quality of life outcomes are increasing in importance with numerous studies supporting physical activity and its positive impact. In one systematic review, exercise and physical activity had a clinically relevant positive impact on health related quality of life both during and after medical intervention in people with cancer[4].

Definitions[edit | edit source]

Physical Activity[edit | edit source]

Physical activity is defined as any bodily movement produced by skeletal muscles that result in energy expenditure.It includes all forms of activity, such as everyday walking or cycling to get from A to B, active play, work-related activity, active recreation (such as working out in a gym), dancing, gardening or playing active games, as well as organized and competitive sport[1]. Exercise is a subset of physical activity that is planned, structured, repeated and has a final or an intermediate objective to the improvement or maintenance of physical fitness[2]

Besides having significant health benefits, PA is also preventative in many diseases including cardiovascular disease and diabetes. General recommendations for daily physical activity are based on age and can be found at this link[5]: http://www.who.int/dietphysicalactivity/publications/9789241599979/en/

Cancer[edit | edit source]

Cancer is a related group of diseases in which cell’s in the body begin to grow and divide uncontrollably. It can spread to other areas of the body. The National Cancer Institute states there are over 100 types of cancer based on its location in the body and can be found in both children and adults[6].

In 2012, an estimated 14.1 million new cases of cancer occurred worldwide. More than 4 in ten cancers occurring worldwide are in countries at a low or medium level of Human Development Index (HDI). The four most common cancers occurring worldwide are lung, female breast, bowel and prostate cancer. These four account for around 4 in 10 of all cancers diagnosed worldwide. [7]

Cancer is a major cause of morbidity and mortality in Ireland with 7500 dying annually, roughly 1 in every 4 people. Cancer has a 5-year survival goal and if it is to return, it will usually occur within 5 years. Although cancer incidence appears to be falling, the actual number of people developing cancer is expected to increase because our population is ageing. The Irish Cancer society report that 20,000 Irish people develop cancer and 7,500 die yearly[8]. Ireland has the 4th highest breast cancer mortality rates worldwide (approx.26/100,000). [8]

Benefits of PA for Individuals with Cancer[edit | edit source]

Physical activity is not only beneficial for patients following activity cancer treatment but also during to help with the negative side effects secondary to the treatment itself. It has a positive impact on both physical and psychosocial factors such as fatigue, low mood and stress, overall deconditioning and loss of independence[9]. Specific programs also provide benefits following treatments including post surgical tumor removal and lymphoedema management[9].

PA as prevention for cancer[edit | edit source]

Physical activity has also been linked to the prevention of certain cancers including Breast, Colon, Endometrial and Prostate, as well as some cancers associated with increased weight gain[9]. It also prevents the re-occurrence of the same cancers[10].

Please see: http://fyss.se/wp-content/uploads/2011/06/19.-Cancer.pdf for more information on the biological mechanisms of physical activity on cancer.

PA in Pediatric Cancer[edit | edit source]

There are few systematic reviews that exist summarizing the positive effects of physical activity in pediatric oncology in comparison to adult studies. However, Baumann and Bloch (2013)[11] determined that exercise interventions are not only feasible and safe, but also no adverse side effects were reported.  There was a positive effect on fatigue, strength and quality of life[11].

Beyond physical benefits there was increased self report of improvements in comfort and resilience to the disease following a relatively short term supervised exercise training programs[12]. Li et al. (2013) reported an adventure based health education program led to statistically significant improvements in their participants’ self-efficacy[13]. Physical activity has also been shown to safe and effective despite the aggressiveness of neoadjuvant chemotherapy during treatment for solid tumors in pediatric cancer patients[14]. More studies are needed regarding cognitive abilities, growth and re-integration into peer groups, school and sports.

Barriers to PA in Cancer[edit | edit source]

  • Being IMMUNO-COMPROMISED (secondary to low white cell count) leads to a high risk of infection. Patients need to be aware of the cleanliness of their environment. For example very busy public gyms can lead to infection, and hand washing must always be a priority.
  • Having LOW PLATELET AND HEMOGLOBIN LEVELS (Anemia) leave patients fatigued and at higher risk for internal bleeding. Contact and high impact sports are not recommended when blood counts are low. Make sure to check with a physician before engaging in activity
  • Over 90% of patients undergoing cancer treatment experience FATIGUE and PAIN related symptoms. It is important to encourage daily low intensity physical activity to prevent deconditioning and further increase fatigue.
  • FEAR and feeling overwhelmed sometimes makes it harder to prioritize physical activity amongst their other chemotherapy, radiation and medication schedules.

Contra-indications to PA in Cancer[edit | edit source]

Bertorello et al. (2011) studied physical activity and late effects on long term Acute Lymphoblastic Leukemia survivors and determined not only is exercise NOT contra-indicated but should be promoted as much as possible[15] and No exercise related risks were encountered in either adults or children with hematological cancer[16].

However, if a child or adult has an implanted device for chemotherapy, such as a Broviac, or a feeding tube or catheter, swimming may be contra-indicated due to the high risk of infection.

Also, with certain cancers extra precautions need to be considered[17][18].

  • Bone cancer or osteosarcoma: patients need to understand their weight bearing status which can change based on the integrity of the bone. They are at higher risk for fracture and should consider lower impact activities such as swimming or yoga. This is also true of patients with osteoporosis.
  • Chemotherapy induced peripheral neuropathy: Sensation changes or loss in the hands and/or feet may make certain activities more difficult or increase likelihood of injuries and falls. Stationary biking is a good alternative to running because of its low impact and allows longer duration of activity prior to fatigue.
  • Following breast cancer resections, patients should begin with gentle range of motion activities and should avoid aggressive upper extremity strengthening programs. A physical therapist can progress their exercise program to help prevent lymphodema and further injury to the area.

Guidelines for PA in Cancer[edit | edit source]

Exercise guidelines vary based on the type of cancer, your age, stage of cancer and your treatment.

However, there are a large number of studies which show that physical activity is safe and appropriate for prior to, during and after active treatment[1][3][4][5][11][12][12][19].  With any exercise program it is important for an individual to consult with their doctor and medical team prior to beginning any intervention.

Most recommendations state moderate amount physical activity daily to improve quality of life, muscular endurance and aerobic fitness. In summary:

  • 150 minutes of moderate intensity aerobic fitness over 3-5 days with resistance training at least 2 days per week involving large muscles groups
    • For children is it recommended to engage in 60 minutes of vigorous activity daily
    • This amount can be broken into smaller intervals throughout the day to prevent fatigue
  • All exercise should include a warm up and a cool down
  • Specifically for people with cancer it is recommended to consult a physician prior to beginning a program and to attend one with supervision initially.

Promotion of PA[edit | edit source]

Therapeutic Yoga[edit | edit source]

Yoga THRIVE is a therapeutic yoga program for cancer survivors. It is a research based, modified program to help with physical manifestations of cancer treatment like joint stiffness and pain and also emotional symptoms like stress and fatigue[20].

One study found that gross motor function improved in children participating in therapeutic yoga[21]. It is important to acknowledge that yoga has not been proven to cure or prevent cancer; however it can have positive benefits during and after treatment. More studies are needed for yoga as a complementary therapy for cancer patients[22].

Exercise Manuals[edit | edit source]

The Pediatric Oncology Exercise Manual (or POEM) is an evidence based tool for both parents and health professionals aimed at increasing physical activity for children with cancer.

Stride to Survive is another exercise guide aimed towards young adults who have completed treatment and want to begin a safe exercise program and increase their physical activity.

Resources[edit | edit source]


References will automatically be added here, see adding references tutorial.

  1. ↑ 1.0 1.1 Braam KI, van der Torre P, Takken T, Veening MA, van Dulmen-den Broeder E, Kaspers GJL. Physical exercise training interventions for children and young adults during and after treatment for childhood cancer. Cochrane Database of Systematic Reviews 2016 Mar 31;3:008796
  2. ↑ Rabin C, Pinto B, Fava J. Randomized Trial of a Physical Activity and Meditation Intervention for Young Adult Cancer Survivors. Journal of Adolescent & Young Adult Oncology 2016 Mar;5(1):41-47
  3. ↑ 3.0 3.1 San Juan AF, Wolin K, Lucia A. Physical activity and pediatric cancer survivorship. Recent Results in Cancer Research 2011;186:319-347
  4. ↑ 4.0 4.1 Gerritsen JKW, Vincent AJPE. Exercise improves quality of life in patients with cancer: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med 2016 Jul;50(13):796-803
  5. ↑ 5.0 5.1 WHO. Physical Activity Fact sheet [Internet]. 2017 [cited 26/05/2017]. Available from: http://www.who.int/mediacentre/factsheets/fs385/en/
  6. ↑ National Cancer Institute. What is cancer? 2015 [cited 27/05/2017]. Available from: https://www.cancer.gov/about-cancer/understanding/what-is-cancer
  7. ↑ http://www.cancerresearchuk.org/health-professional/cancer-statistics/worldwide-cancer#heading-Zero
  8. ↑ 8.0 8.1 https://www.cancer.ie/about-us/media-centre/cancer-statistics#sthash.NaGuepDS.dpbs
  9. ↑ 9.0 9.1 9.2 American Cancer Society. ACS Guidelines on Nutrition and Physical Activity for Cancer Prevention. Benefits of Physical Activity. 2017 [cited 26/05/2017]. Available from: https://www.cancer.org/healthy/eat-healthy-get-active/acs-guidelines-nutrition-physical-activity-cancer-prevention/guidelines.html
  10. ↑ World Cancer Research Fund, American Institute for Cancer Research. Food, nutri- tion, physical activity, and the prevention of cancer. A global perspective. Washington (DC): American Institute for Cancer Research (AICR); 2007
  11. ↑ 11.0 11.1 11.2 Baumann FT, Bloch W, Beulertz J. Clinical exercise interventions in pediatric oncology: a systematic review. Pediatr Res 2013 Oct;74(4):366-374
  12. ↑ 12.0 12.1 12.2 San Juan AF, Chamorro-Viña C, Moral S, Fernández del Valle M, Madero L, Ramírez M, et al. Benefits of intrahospital exercise training after pediatric bone marrow transplantation. Int J Sports Med 2008 05;29(5):439-446
  13. ↑ Li HCW, Chung OKJ, Ho KY, Chiu SY, Lopez V. Effectiveness of an integrated adventure-based training and health education program in promoting regular physical activity among childhood cancer survivors. Psychooncology 2013 Nov;22(11):2601-2610
  14. ↑ Fiuza-Luces C, Padilla Jr, Soares-Miranda L, Santana-Sosa E, Quiroga JV, Santos-Lozano A, et al. Exercise Intervention in Pediatric Patients with Solid Tumors: The Physical Activity in Pediatric Cancer Trial. Med Sci Sports Exerc 2017 02;49(2):223-230
  15. ↑ Bertorello N, Manicone R, Galletto C, Barisone E, Fagioli F. Physical activity and late effects in childhood acute lymphoblastic leukemia long-term survivors. Pediatric Hematology & Oncology 2011 Aug;28(5):354-363
  16. ↑ Wolin KY, Ruiz JR, Tuchman H, Lucia A. Exercise in adult and pediatric hematological cancer survivors: an intervention review. Leukemia 2010 Jun;24(6):1113-1120
  17. ↑ Wolin KY, Ruiz JR, Tuchman H, Lucia A. Exercise in adult and pediatric hematological cancer survivors: an intervention review. Leukemia 2010 Jun;24(6):1113-1120
  18. ↑ American Cancer Society. Physical Activity for the Cancer Patient. Precautions for cancer survivors who want to exercise. 2017 [cited 26/05/2017]
  19. ↑ Cancer Care Ontario. Guideline 19-5: A Quality Initiative of the program in Evidence-Based Care, Cancer Care Ontario. Exericse for People with Cancer. 2015 [cited 26/05/2017]
  20. ↑ 24. Tom Baker Cancer Centre. Integrative Oncology Program. Yoga THRIVE. 2017 [cited 01/06/2017]
  21. ↑ Geyer R, Lyons A, Amazeen L, Alishio L, Cooks L. Feasibility study: the effect of therapeutic yoga on quality of life in children hospitalized with cancer. Pediatric Physical Therapy 2011 Winter;23(4):375-379
  22. ↑ Smith, K.B. & Pukall, C.F. An evidence-based review of yoga as a complementary intervention for patients with cancer. National Institute for Health Resources 2010 March; Database of Abstracts of Reviews of Effects (DARE): 1-3
Retrieved from "https://www.physio-pedia.com/index.php?title=Physical_Activity_in_Cancer&oldid=186028"