Cancer and Exercise: Living Longer, Living Better

  •   February 2, 2015
  •  Leanne Loranger, PT


Peter and his wife Ellen* were both diagnosed with cancer in their late 50s. In 2002, Peter was diagnosed with prostate cancer and in 2004 Ellen was diagnosed with breast cancer.

Peter received extensive treatment, including surgery, radiation, hormone therapy and chemotherapy. To say he had all the treatments available is an understatement. He told me once that his hope was for his current treatment to remain effective long enough for the next treatment to be invented. Similarly, Ellen went through surgery, chemotherapy and radiation.

Canadians have a 41-45% chance of developing cancer within their lifetime, with the most common cancers being lung, breast, colorectal and prostate.1 The good news is that with new and more effective treatments being discovered each year, more and more people are surviving cancer than ever before.1

That should be a good news story, but how good this news is depends on what survival looks like. The fact is that the short- and long-term side effects of treatment commonly experienced by cancer survivors (those who are in the midst of treatment and those who have completed treatment) can have a significant impact on their quality of life. Common problems include fatigue, memory problems, pain, muscle wasting and changes to the heart, lungs and bones.2

One study found that 71% of cancer survivors noted one or more of these problems even 10 years after completing their treatment.2  Research also shows that the distress that cancer survivors experience relates more to their level of disability than to their diagnosis, stage or treatment for cancer.2

There is also evidence to suggest that exercise can have a significant effect on physical function and quality of life for those who are currently undergoing treatment, or who have completed treatment for cancer, regardless of the type of cancer, stage of cancer or prognosis.2 Exercise has also been shown to decrease an individual’s risk of developing cancer.3

At the time of his semi-retirement, Peter told me his job is to exercise and take care of his health. To that end, he had a regular workout with a personal trainer and used the stationary bike year round, he also continued to downhill ski in the winter and hike and golf in the summer (always insisting on walking the 18 holes).

Afraid of the risk of lymphedema, Ellen started exercising at the local gym and says that if she skips her workouts her shoulder feels tighter. In case that wasn’t enough motivation, she also noted that those regular workouts have helped her to be a better golfer.

Peter and Ellen’s exercise programs were both successful in allowing them to continue to travel extensively. During his time as a cancer survivor Peter celebrated the marriages of both his children and the birth of four grandchildren while enjoying a high quality of life until the final year of his illness. Sadly, Peter died from cancer in 2014, 12 years after his diagnosis.

The last ten years saw Ellen accompany Peter on their many adventures and she continues to enjoy a high quality of life. Regular exercise is a major contributor to that.

Research suggests that Peter and Ellen’s experience with exercise as cancer survivors is not unusual.

Some things that you may not know about cancer and exercise:

  1. Participating in exercise during and following treatment helps to decrease cancer related fatigue.4,5,6
  2. Some cancer survivors avoid adopting exercise programs due to the inaccurate belief that the effort would be “ludicrous or futile.”4
  3. Many cancer survivors report avoiding exercise due to a fear of increasing their symptoms of fatigue, nausea and shortness of breath, but exercise has been shown to decrease these symptoms.4
  4. In addition, exercise has been shown to slow or prevent the functional declines often associated with cancer and cancer treatment. 7
  5. Participating in regular exercise also helps to improve self-esteem and self-efficacy,7,8 providing an important sense of control to a difficult and often out-of-control  time in one’s life.
  6. Participation with exercise is “associated with improved survival, prevention of new cancers, and earlier detection of some types of cancer.”2
  7. Both physical abilities2,8 and quality of life have been shown to improve among cancer survivors who participate in exercise programs.2,6,7
  8. The benefits listed were demonstrated among a mixed patient group that included those who were done cancer treatment, those who were receiving active treatment and those who were in the end stages of cancer.4


Interestingly, most survivors significantly overestimate the amount of exercise they are getting through routine daily activities. Many have also indicated that they believe their physician’s generic recommendations to keep active are an indication that they should continue with their daily activities rather than engaging in more formal exercise.4 Although, at Physiotherapy Alberta we often advocate for active lifestyle adoption rather than formal exercise regimes, this is one case where people may benefit from a more formalized, supervised exercise programs, both to ensure safety when exercising4,8 and to ensure participation.4

Cancer survivors have unique signs and symptoms and may have other health conditions to factor into their exercise planning, therefore there are no one-size-fits-all recommendations for what exercises to participate in and which ones to avoid.8 Depending on the type of cancer, the presence of metastatic disease and treatment considerations, specific recommendations are most appropriate to ensure safe exercise.

Consulting a physiotherapist who is experienced in cancer care is a good first step. Find a physiotherapist who works with cancer survivors here. Search for “Cancer care and rehabilitation” or "lymphedema".

* Names have been changed


References:

  1. Canadian Cancer Society’s Advisory Committee on Cancer Statistics. Canadian Cancer Statistics 2014. Toronto: Canadian Cancer Society; 2014. Available at: http://www.cancer.ca/~/media/cancer.ca/CW/cancer%20information
    /cancer%20101/Canadian%20cancer%20statistics/Canadian-Cancer-Statistics-2014-EN.pdf  Accessed January 19, 2015.
  2. Cheifetz O, Dorsay JP, Hladysh G, MacDermid J, Serediuk F, Woodhouse LJ. CanWell: Meeting the psychosocial and exercise needs of cancer survivors by translating evidence into practice. Psycho-Oncology 2014; 23:204-215.
  3. National Cancer Institute. Physical Activity and Cancer. Available at: http://www.cancer.gov/cancertopics/factsheet/prevention/physicalactivity Accessed January 20, 2015.
  4. Cheville AL, Dose AM, Basford JR, Rhudy LM. Insights into the reluctance of patients with late-stage cancer to adopt exercise as a means to reduce their symptoms and improve their function. Journal of Pain and Symptom Management 2012; 44(1): 84-94.
  5. Cramp F, Byron-Daniel J. Exercise for the management of cancer-related fatigue in adults. Cochrane Database of Systematic Reviews 2012; 11: 1-97.
  6. Kim SH, Shin MS, Lee HS, Lee ES, Ro JS, Kang HS, Kim SW, Lee WH, Kim HS, Kim CJ, Kim J, Yun YH. Randomized pilot test of a simultaneous stage-matched exercise and diet intervention for breast cancer survivors. Oncology Nursing Forum 2011; 38(2): 97-106.
  7. Suh EE, Kim H, Kang J, Kim H, Park KO, Jeong BL, Park SM, Jeong SY, Park KJ, Lee K, Jekal M. Outcomes of a culturally responsive health promotion program for elderly Korean survivors of gastrointestinal cancers: A randomized controlled trial. Geriatric Nursing 2013; 34: 445-452.
  8. Drake D, Flazer P, Xistris D, Robinson G, Roberge M. Physical fitness training: Outcomes for adult oncology patients. Clinical Nursing Research 2004; 13(3): 245-264.