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People with cancer 'need more exercise'

Monday 16 July 2012

“Doctors and nurses need to ‘bust the myth’ that cancer patients should simply rest to recover,” The Daily Telegraph has reported. It says that a charity has found only one in five cancer patients who have been through treatment have been told how regular physical activity could benefit them.

The Telegraph says that Macmillan Cancer Support has found that “only a fifth of patients who have been through treatment are told of the ‘wonder drug’ type benefits of exercise”.

These benefits are spelled out in a review of medical research carried out by Macmillan to accompany a survey of cancer patients’ physical activity. These benefits, identified in systematic reviews of randomised controlled trials, include improvements in physical function and psychological wellbeing.

Macmillan has also highlighted a developing body of evidence from cohort studies which has suggested that regular exercise could reduce the risk of some previously treated cancers from returning, and this in turn, improves survival rates. Macmillan cites research that found that people who took regular exercise had:

  • about 40% lower risk of breast cancer returning
  • about 50% lower risk of colon cancer returning or dying of colorectal cancer
  • about 30% lower risk of men dying from prostate cancer

Based on its findings, Macmillan has produced a pack of information that can offer help for people with cancer to get enough appropriate physical activity (PDF, 2.41Mb).

How much exercise are people with cancer getting?

Macmillan Cancer Support and YouGov carried out a survey of 1,098 people aged 18 to 88 years old living with cancer in the UK in April 2012. Almost two fifths (37%) of those surveyed were not currently physically active at all.

Of the 417 people who had completed their treatment in the last two years:

  • 77% had not been spoken to by their oncologists about the importance of being physically active during or after cancer treatment
  • 79% said the same about their clinical nurse specialists
  • 82% said the same about their GPs

Macmillan says this lack of physical activity comes despite there being plenty of evidence about the benefits of physical activity during and after cancer treatment.

What are the benefits of exercise for people with cancer?

Macmillan also carried out a brief review of the evidence about physical activity in people living with and beyond cancer. The review found evidence from systematic reviews of randomised controlled trials that physical activity can:

  • improve or prevent the decline in physical function without increasing tiredness (fatigue) during cancer treatment
  • improve aspects of psychological wellbeing during and after cancer treatment
  • help recover physical function and improve fatigue after cancer treatment

The review found evidence from cohort studies and systematic reviews of cohort studies that physical activity can reduce the risk of cancer coming back and of dying during or after treatment for some cancers:

  • One systematic review found that leisure time physical activity was associated with a reduction in risk of death in women with breast cancer, and two studies also found a reduction in cancer recurrence and death associated with 2.5 hours of moderate-intensity physical activity per week.
  • Two studies found a reduction in risk of colorectal cancer recurrence and death associated with about six hours moderate physical activity per week.
  • Two studies also found a reduction in risk of prostate cancer progression and death associated with three hours moderate physical activity per week.

There was also evidence that physical activity could reduce the risk of developing other long-term conditions such as heart disease and diabetes. The review also found that there was accumulating evidence among people with advanced cancer that physical activity could help maintain independence and wellbeing towards the end of life.

What level of exercise is suitable for people with cancer?

Macmillan suggests that otherwise healthy cancer survivors (those living with and beyond cancer) should be advised to gradually build up to the levels of health-related physical activity recommended for the general population. Adults in the general population are currently advised to engage in 150 minutes of moderate-intensity physical activity per week.

They say that those with cancer complications or other health conditions as well as cancer (called co-morbidities) that would stop them being able to do moderate-intensity exercise should still aim to be as active as their abilities and conditions permit them to be.

They say that the evidence shows that if activity recommendations are carefully tailored to each person with cancer, they are likely to have a positive impact.

How can someone with cancer avoid adverse effects from exercise?

Macmillan suggests that although there are potential side effects for some patients, most of these can be avoided with appropriate precautions, such as:

  • low- to moderate-intensity exercise such as swimming or brisk walking while avoiding high-intensity exercise such as sprinting, or high-volume exercise
  • assessing the effects that exercise has on cancer symptoms – those who have cancer and find symptoms such as shortness of breath or feeling sick (nausea) worsen during or after exercise should seek advice from the doctor in charge of their care
  • modifying exercise type based on site of treatment (for example, avoiding exercise bike after prostate or rectal cancer surgery)
  • incorporating balance and co-ordination exercises such as tai chi for people at risk of falls, while avoiding those needing considerable balance or co-ordination such as running on a treadmill
  • avoiding high impact or contact activities if you have cancer in your bones or your are at risk of osteoporosis (weakening of the bones)
  • progress resistance exercises in small and gradual stages to prevent build-up of lymph fluid (lymphoedema) that can cause swelling of your arms and legs

If you have been diagnosed with cancer it is likely that you have been referred to a specialist cancer nurse who should be able to advise you about what types of exercise will be suitable for you. Your GP can also provide advice.

Analysis by Bazian
Edited by NHS Website

Links to the headlines

Cancer patients urged to exercise

The Independent, 16 July 2012

Glasgow fitness classes for cancer patients begin

BBC News, 16 July 2012

Links to the science

Macmillan Cancer Support.

‘The importance of physical activity for people living with and beyond cancer: A concise evidence review’ (PDF, 199kb)

July 2011