Are Exercise Interventions in Cancer Survivors Effective?

“How long should an exercise intervention last to be effective in cancer patients?” This was the question on everyone’s mind during a recent online panel discussion. The answer, by the featured expert, was a reprimand: “What do you mean by how long? You should exercise forever.”

Often, people see exercise as a way to lose weight or perhaps look better. Only a small fraction of people are aware that exercise not only plays a key role in preventing cancer, but also helps during treatment and recovery. The American Cancer Society recommends at least 150 minutes of moderate-intensity exercise or more than 75 minutes of vigorous exercise every week.

Dr Preetha Menon from Singapore, says: “Physical fitness of a person greatly influences how he fares during cancer treatment. Cancer treatment (chemotherapy, radiation therapy) can take a toll on your health and energy reserves. Being physically active during and post treatment aids in quicker recovery.”

But how and why does exercise help? Does it change the pathology of the cells of the immune system? Published studies on cancer show 50 to 60 per cent reduction in risk of recurrence in those who had vigorous exercise intervention post treatment, which included activities such as running, jogging, swimming and brisk walking.

Some cancers respond better to exercise. Most of the evidence today is around the cancers related to hormone production—breast and prostate. This is because exercise probably reduces oestrogen and androgen. However, colorectal cancer has also been found to be quite responsive. The bottom line, however, is loud and clear—exercise helps.

Concerned about safety?

Traditionally, a lot of people think they are getting frailer and pull back. Observational data studies indicate that exercising has a 60 per cent improvement in overall survival for certain cancers. Hence, the recommendation should be to keep physically active as long as a patient can, as much as he can.

Exercise and side effects

Cancer treatment may have a huge impact on the well-being of the patient. For instance, chemotherapy and radiation therapy cause a lot of nausea, vomiting and gastrointestinal problems, which can make the patient lethargic. Nowadays, exercise is recommended during chemotherapy and there are programmes that focus on dealing with the side effects of surgery and treatment.

Exercise programmes for:

Fatigue—This help patients with fatigue. “If patients push themselves to attend, they are afterwards glad they did it. It really is very helpful,” says cancer exercise expert Carol Michaels.

Emotional health/mood—Exercise groups become support groups, and when someone attends, even when he is going through chemotherapy, he seems to have emotional improvement, which alleviates aches and pains.

Loss of range of motion—Because of surgery and during treatment (especially for breast, uterine and ovarian cancer), there is a lot of tightness and the posture becomes poor. A variety of rehabilitative stretching exercises can help in getting back posture and motion. Once about 80 to 90 per cent of range of motion is revived, strength training can be added to the exercise regime.

Quality of life—Exercise releases endorphins, which are the body’s own endogenous opiate. They also induce production of endo-cannabinoids, which also help you feel better, improve your quality of life and probably help you sleep better.

Inflammation—A May 15 post in the American Society of Clinical Oncology’s newspaper says that an increase in physical activity decreases systemic inflammatory responses.

Neuropathy—A lot of people have neuropathy (damage to nerves), which is a common side effect. When there is neuropathy in the foot, for instance, balance is affected. Exercise can help keep all the surrounding muscles as strong as possible, which can help prevent falls.

A recent report by Macmillan Cancer Support, a British organisation, argues that exercise should be part of standard cancer care. It recommends that all patients getting cancer treatment should engage in moderate-intensity exercise for two-and-a-half hours every week.

Some of the best examples of this are sports personalities and celebrities, who bounce back in no time after their treatment. What do they do differently?

Recently, US tennis player Vicky Duval returned to Wimbledon after undergoing treatment for Hodgkin’s lymphoma. Closer home, we have examples such as Yuvraj Singh, who is playing international cricket post his treatment.

Of course, that does not mean you should run a marathon or scale a mountain. Moderate aerobic exercise, such as riding a stationary bicycle or taking a daily walk, coupled with the use of light weights for strength training, plays an important role in helping survivors resume an active lifestyle post cancer diagnosis and treatment.

Remember to get clearance from your health professional before you start any exercise regime.

This article was first published in The Week magazine dated November 6, 2016 under the title, Work out, work wonders. 

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