One in every two males and one in every three females in Australia will be diagnosed with cancer by the age of 85. Between 2008 and 2009, Australia spent an estimated A$4,526 million on diagnosing and treating cancerous and non-cancerous tumours.
Surgery, chemotherapy and radiotherapy have advanced in reach and effectiveness but their side-effects can be tough to endure. These include psychological, social and physical conditions, such as depression and reduced fitness and strength.
Exercise has been shown to dramatically improve the lives of people living with cancer, yet it is being underutilised. This is despite the fact it costs next to nothing to administer and research shows it improves patient outcomes while driving down healthcare costs.
Why exercise is important in cancer
Our muscles naturally decrease in size as we age. Exercise helps reverse this trend even if a person is battling cancer.
Supervised resistance training through lifting weights and aerobic exercise such as walking, jogging and cycling can help build fitness, improve physical function and increase physical reserve capacity. This means patients are in better shape to receive cancer treatments.
Exercise is important in preventing cancer too. A 2010 Australian study showed that nearly 2,000 cases of bowel, breast and endometrial cancer could be attributed to insufficient physical activity.
A considerable number of studies suggest exercise plays an essential role in cancer management. For patients with cancer of the brain and nervous system, it helps alleviate often debilitating physical, cognitive and emotional effects and reduces the symptoms of treatment.
Acute symptoms of cancer treatments can include reduction in fitness and strength, and an increase in fatigue. Major professional organisations, such as the American College of Sports Medicine and Exercise and Sports Science Australia, recommend exercising as part of a medical management programme.
They prescribe at least 30 minutes of moderate intensity exercise up to five days per week to reduce these negative treatment effects.
Exercise can also improve quality of life by having an effect on the immune system and helping to control tumour growth. One study measured the effects of physical training on immune blood markers, such as white blood cells, of breast cancer survivors.
It showed that moderate exercise increased the potency of these cells, specifically the natural killer cells responsible for the destruction of infected or cancerous cells. Despite having the same number of these cells as the group that did not do any exercise, the natural killer cells of moderate exercisers had an enhanced ability to fight cancer.
Exercising before surgery
While surgery can improve a number of conditions, it is associated with severe stresses that can decrease daily activities after surgery. Some cancer patients wait around six to ten weeks between diagnosis and surgery. This is an opportune time to engage and prepare patients for treatment with therapeutic exercise.
Previously, cancer patients would be urged to rest before surgery. But getting fit and active, even while unwell, may be the best thing for a patient.
In a current research project, our team asks patients to exercise prior to surgery to get them into the best physical shape for recovery. This is known as “prehabilitation” – as opposed to rehabilitation.
Previous research examining the effects of exercise at either early rehab after surgery or before surgery, including radical mastectomy (removal of breast and underlying tissue), and lung resection (removal of all or part of the lung), has reported significant improvements in overall physical capacity after surgery.
People undergoing radical mastectomy usually experience difficulty in shoulder movement after surgery, yet research has also shown significant improvements in those who had early rehabilitation.
A more recent, one-month study of tailored exercise and nutritional supplementation for patients before surgery showed that the group that engaged in 30 minutes of aerobic exercise and resistance training (consisting of elastic band exercises) three times a week had improved physical performance after surgery.
Compared to the control group who did no exercise, those who exercised before surgery recorded longer walking distances after surgery, which equated to a higher aerobic fitness levels. Around 81% of the exercising group recovered their initial baseline walking capacity within 12 weeks of surgery, compared to 40% of the control group.
Moderate and supervised exercise before cancer surgery is safe, beneficial and increases survival time. It costs very little and has the potential to reduce the growing strains and stresses on our health-care system while increasing productivity and reducing early retirement.
More research is needed to fine tune how much exercise can give the best outcome at different stages of cancer treatment. But the key for now is to take that first step and get to exercising.
Favil Singh receives funding from Edith Cowan University Early Career Research Grant and National Breast Cancer Foundation.
Rob Newton receives funding from the Australian Research Council, National Breast Cancer Foundation, Movember Foundation, National Health and Medical Research Council, Cancer Council Western Australia, Exercise and Sports Science Australia, Prostate Cancer Foundation of Australia