Exercise gains traction as a way to fight cancer

December 10, 2021 – Nancy Howe’s oncologist has been adamant you need to relax. It was 1997, and Howe had just had surgery for head and neck cancer. Now she had to endure 7 weeks of radiation therapy and the side effects that came with it – mostly severe fatigue.

Howe had always been physically active, but had lost muscle and felt depressed whenever she couldn’t exercise due to injuries.

“I knew I would be better off if I stayed as active as possible,” says Howe, of Phoenix, AZ.

Howe challenged her doctor’s orders to rest during cancer treatment, the usual advice in the late 1990s. She continued to go to the gym, although on some days all she could manage was a few. minutes on a stationary bike, and she was walking around her neighborhood. His instinct for perseverance paid off.

“I experienced the treatment much better than I expected,” explains Howe, now 65. “I had more energy and didn’t lose a lot of muscle, which made it easier for me to recover after radiation therapy. “

Unbeknownst to him, Howe had adopted an idea that continues to be accepted in medicine today: exercise is a powerful weapon against cancer.

Research in the rapidly growing field of exercise oncology has left little doubt that staying physically active improves symptoms and side effects during cancer treatment. And now there is strong evidence that exercise reduces the risk of certain cancers and decreases the chances of dying if you are diagnosed with certain forms of the disease.

Yet in the minds of many, including some oncologists, exercise and cancer do not go together, says Kathryn Schmitz, PhD, director of the Oncology, Nutrition and Exercise group at the Penn State Cancer Institute. .

“If you ask an average person on the street if your Aunt Betty who has cancer should exercise, she’ll say, ‘No, she should be sitting with a blanket over her lap,’ says Schmitz, author of Get through cancer and an evangelist for exercise oncology. Cardiologists were ordering heart attack survivors to rest, she said, “but now we get them out of bed the next day and put them in cardiac rehabilitation within a week.”

Attitudes towards oncology exercise are changing, she says, but still have a lot of catching up to do.

Forty years of exercise oncology

The origins of exercise oncology generally date back to the 1980s, when a series of studies at Ohio State University found that breast cancer patients undergoing chemotherapy who exercised regularly – a radical idea at the time – had less fatigue, nausea and disability following treatment.

This groundbreaking work helped spark a tsunami of research into the link between exercise and cancer. In 2019, Schmitz co-chaired an international panel of experts that examined the science and found that exercise during and after cancer treatment relieves fatigue, anxiety and depression, while improving quality of life and physical function. That is, the ability to live a normal day.

Meanwhile, prevention is also part of the equation. Studies strongly suggest that exercise reduces the risk of seven forms of cancer: bladder, breast, colon, endometrium, esophagus, kidney and stomach.

There are also some intriguing clues that exercise helps prevent cancers of the lung, blood, head and neck, ovaries, pancreas, and prostate. And exercise appears to reduce the risk of death in people diagnosed with breast, colorectal and prostate cancer, by around 40% to 50%. These kinds of numbers and this amount of research are hard to ignore.

How can huffing and puffing fight cancer? No one is sure, but Schmitz points out that exercise lowers levels of inflammation and insulin, which are linked to some cancers.

Additionally, exercise induces angiogenesis, or the creation of new blood vessels, she notes, which could mean that more blood-based cancer drugs can be given to malignant tumors.

“Exercise can actually change the potency of chemotherapy,” says Schmitz.

Why it helps

Immune function also plays a role. As cancer weakens the immune system, a single session of exercise produces a flood of immune defense cells, says Michael Gustafson, PhD, scientific director of the Nyberg Human Cellular Therapy Laboratory on the Mayo Clinic campus in Arizona.

Gustafson and his colleagues found that pedaling at full speed on a stationary bike for 10 minutes can 10-fold tumor fighters called natural killer cells; protective T and B cells also rise in the blood.

“I don’t believe that exercise alone can cure you of cancer, but I think it can be very helpful,” he says.

By using exercise to help cancer patients build larger armies of defense cells, Gustafson believes that powerful immunotherapy treatments may be possible to improve. These treatments “teach” a patient’s own immune cells to attack tumors.

It’s also well known that body fat makes the hormone estrogen, which can cause some forms of breast cancer, says Betsy O’Donnell, MD, director of the Lifestyle Medicine Clinic at Massachusetts General Hospital in Boston.

Exercise, in addition to reducing calories, helps reduce body fat, a concern for many breast cancer patients, who often gain weight during treatment.

“Weight gain can also have major implications for self-esteem and quality of life,” says O’Donnell.

In his clinic, patients work with a nutritionist, behavioral psychologist and other specialists, in addition to getting help to improve their physical condition.

Research shows that aerobic exercise (like walking, jogging, or cycling) and strength training (like lifting weights or using resistance bands) may be beneficial for cancer patients.

An often cited 2007 study published in the Journal of Clinical Oncology involving 242 women with breast cancer who were about to start chemotherapy, found that aerobic exercise improved patients’ self-esteem and reduced body fat, while resistance training helped build muscle and made them more likely to complete their treatment.

Need personal programs

Not all cancer survivors are eager to hit the gym during or soon after the rigors of treatment, so tailoring the intensity of an exercise prescription to each patient is critical, says O’Donnell. .

Walking is perhaps the most popular option that many of his patients choose, especially since many people are avoiding gyms due to the COVID-19 pandemic. She recommends walking at least 150 minutes a week, maintaining a pace that allows you to talk but not sing.

And if walking isn’t for you, says O’Donnell, some of his patients dance, learn tai chi, or find some other useful form of movement that they enjoy.

“You really have to meet patients where they are, both in terms of physical ability and desire to participate,” says O’Donnell. (You can find exercise videos for a variety of fitness levels developed by his clinic here.)

Nancy Howe was so convinced that staying active helped her cope with cancer treatment that she quit her job as a software engineer and became a fitness trainer for cancer patients and survivors. A PhD candidate in Nursing and Health Innovation at Arizona State University, her thesis project involves adapting a tool used by physicians to choose the right level of exercise for cancer patients so that it can be used by the patients themselves.

But in the end, the advice to patients is straightforward.

“It’s really important to do something now, wherever you are on your cancer journey,” Howe says. “Begin. “

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