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With more than 10 million people being diagnosed with cancer worldwide and one Australian diagnosed every four minutes, there has been a substantial amount of research into how to best prolong life and cope with the disease. There has been many improvements in how to detect cancer earlier and how to best treat it once diagnosed and consequently, many patients can be expected to have an increased life expectancy (Parkin, Bray, Ferlay & Pisani, 2002).

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However, with the improved science and treatments comes a lot of extra toxicity which although prolongs life, also produces negative short term and long term physiological or psychological effects. These can include pain, cancer related fatigue, decreased cardiorespiratory fitness, suppressed immune function and a general overall decrease in life quality (Courneya & Freidenreich, 2001).

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Exercise has been shown to be effective in both those with cancer and those recovering from cancer with physical activity benefiting the individual throughout the whole spectrum of the disease. It helps cancer survivors cope with and recover from treatment and is also effective in improving the health of long-term cancer survivors (Rajarajeswaran & Vishnupriya, 2009).

With approximately 25% of cancer cases worldwide being attributed to an overweight or obese and sedentary lifestyle, exercise is an attractive preventative of cancer (Vainio, Bianchine & Lyon, 2008). Yet, exercise can be much more than that with its ability to benefit those living with cancer or those who have survived it.

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There has been an increased interest in the rehabilitation of both oncological patients and those in palliative care (Cheville, 2001). Research has shown that exercise in cancer patients can dramatically improve physiological and psychological functioning including increased physical functioning, body weight and composition, muscle strength and endurance, immune function, cardiovascular fitness and a decrease in fatigue levels.

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Exercise may also assist in easing the symptoms associated with cancer that can impair everyday life such as lack of appetite, diarrhea, muscular pain, constipation, physical fatigue, depression, anxiety and mental fatigue (Rajarajeswaran & Vishnupriya, 2009).

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In terms of how exercise impacts patients with varying types of cancers, there are many studies investigating the effects of both cardiorespiratory and resistance training.

Kirshbaum (2007) reviewed 29 studies and concluded exercise appears to be beneficial and safe for a variety of breast cancer patients. Markes et al (2006) and McNeely et al (2006) also agree and suggest that improvements in physical fitness including cardiorespiratory fitness and capacity for daily activities can be found in those who participate in regular physical activity.

In a literature review of 100 studies conducted by Cormie, Zopf, Zhang & Schmitz (2017), it was found that patients who exercised following the diagnosis of any type of cancer had a lower relative risk of cancer mortality and reoccurrence when compared to those who did not exercise. They also experienced fewer and less severe adverse effects of therapy.

 

How much exercise?

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While it is known that exercise is beneficial throughout the entirety of the cancer spectrum, the amount, type and intensity of exercise has not been fully examined. However, there is sufficient evidence to support the use of exercise in cancer survivors following careful assessment and prescription by an Accredited Professional.

Meneses-Echavaz, Gonzalez-Jimenez & Ramirez-Velez (2014) stated that supervised physical exercise interventions can assist in reducing cancer-related fatigue. It is suggested that a combination of both resistance and aerobic exercise should be included as part of a rehabilitation program for people who have been diagnosed with cancer.

In terms of exactly “how much”, “how intense” or what kind of load the training should entail is yet to be scientifically determined. However, considering the often detrained state and high levels of fatigue in individuals with cancer, it is suggested that even an exercise regime that is low intensity, volume and frequency could significantly promote positive psychological and physiological adaptations which can increase the quality of life in this population (Galvao & Newton, 2005).

 

Suggested Recommendations

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It is recommended that individuals with cancer should aim to work with an accredited professional to develop an individualised exercise program that is specific to them, their cancer and their needs. In addition to a targeted exercise prescription, it is suggested that behaviour change advice and support be incorporated to ensure the client/patient receives the greatest benefits with a very low risk of harm.

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The actual exercise prescription that works best depends on a number of factors including patient assessment, patient goals and cancer-specific health issues. However, in most cases an assortment of moderate to high intensity exercise of both the aerobic and resistance varieties is appropriate. In terms of the total prescription and total weekly dosage, no set values have been determined that are appropriate for all cases.

It is important to remember that exercise in cancer patients is not a “one size fits all” approach and that any exercise programming needs to be provided on an individualised basis by an exercise professional.

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One simple and quick way to determine an appropriate level of exertion for an individual is to do THE TALK TEST. When exercising, the client should be able to talk and sing during Light Intensity, Talk but not sing at a Moderate Intensity and neither talk nor sing at a High Intensity.

Most important of all, exercise should be done at the individuals own pace and under the supervision of a professional if possible.

 

Important Considerations during/after Chemotherapy:

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• Avoid overstretching around catheters

• Stomas should be cleaned before and after exercise

• Monitor acute changes in pain levels, heart rate, blood pressure, rate of breathing and other symptoms such as nausea and vomiting etc. If any unusual symptoms occur, the individual should present to a health care professional

• If the individual has other health issues such as cardiovascular disease, these must be considered further before exercising

• Exercise is not recommended post-surgery until the wound has heals. Once recovered, normal activities may be continued and exercise levels may be gradually increased

• If there are bone metastases, severe peripheral neuropathy, severely reduced blood counts, or other severe side effects or symptoms, it is recommended to see an AEP for support in undertaking a safe and beneficial exercise program (Exercise & Cancer, Essa, 2019)

 

 

TAKE HOME NOTES

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There is ongoing research that suggests exercise plays a vital role in the prevention of cancer and is an effective and safe started to counteract the many psychological and physiological effects of cancer and its treatment

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The many benefits of exercise for people with cancer include but are not limited to:

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• Improved mood and self-esteem

• Improved muscle strength and fitness

• Improve immune function

• Improve physical function to assist in daily living and activities

• Reduced hospitalisation time

• Reduced psychological and emotional stress including anxiety and depression

• Reduced symptoms and side effects such as pain, nausea and fatigue

• Reduced chance of developing new cancers and diseases eg. Diabetes and osteoporosis
  
   

References

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1. Cheville, A. (2001). Rehabilitation of patients with advanced cancer. Cancer, 92: 1039-1048.

2. Cormie, P., Zopf, E.M., Zhang, X. & Schmitz, K.H. (2015). The impact of exercise on cancer mortality, recurrence, and treatment-related adverse effects. Epidemiology Review, 39(1): 71-92.

3. Courneya, K.S. & Freidenreich, C.M. (2001). Framework PEACE: An organizational model for examining physical exercise across the cancer experience. Annals of Behavioural Medicine, 23: 263-272.

4. ESSA (2019). Exercise & Cancer.

5. Galvão, D. A., & Newton, R. U. (2005). Review of exercise intervention studies in cancer patients. Journal of clinical oncology, 23(4), 899-909.

6. Kirshbaum, M.N. (2007). A review of the benefits of wholebody exercise during and after treatment for breast cancer. Journal of Clinical Nursing, 16: 104-121.

7. Markes, M., Brockow, T. & Resch, K.L. (2006). Exercise for women receiving adjuvant therapy for breast cancer. Cochrane Database of Systematic Reviews, 18.

8. McNeely, M.L. et al. (2006). Effects of exercise on breast cancer patients and survivors: a systematic review and meta-analysis. Canadian Medical Association Journal, 175: 34-41.

9. Meneses-Echávez, J.F., González-Jiménez, E., Ramírez-Vélez, R. (2015). Supervised exercise reduces cancer-related fatigue: a systematic review. Journal of Physiotherapy 61: 3–9.

10. Parkin, D.M., Bray, F., Ferlay, J. & Pisani, P. (2002). Global cancer statistics. CA: A Cancer Journal for Clinicians,, 55:74, 74-108.

11. Rajarajeswaran, P. & Vishnupriya, R. (2009). Exercise in cancer. Indian Journal of Paediatric Oncology, 30:2, 61-70.

12. Vainio, H., Bianchine, F. & Lyon (2008). Weight control and physical activity. International Agency for Research on Cancer.