Exercise and Cancer

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Why is exercise so important: 

Prevention:  Being sedentary and overweight could account for 14% of male and 20% of female cancer deaths in the UK.   The Harvard Centre for Cancer Control, estimates that 15% of colon cancers could be prevented by 30 minutes daily exercise but there is a dose-response relationship, so this could increase 40Ė50% for those at the highest levels of physical activity.

After cancer: Regular exercise after a diagnosis of cancer has been shown; to slow the growth rate of some cancers such as prostate or low grade leukemia's; reduces the risk of cancer coming back and improves cure rates. Several large international studies have clearly shown that individuals who exercise regularly after cancer have lower relapse rates and overall survival. For breast and bowel cancer between 2.5 - 3 hours a week of vigorous exercise appeared to to be the target level, for prostate cancer the target was 3- 5 hours - read full evidence

An increasing tide of good quality clinical research is now showing that that exercise can help alleviate many of the symptoms commonly experienced after cancer treatments. and links to specific exercise regimens are provided below

How does exercise has anti-cancer benefits.  

Over 180 biochemical pathways are triggered during and after exercise most of them having direct anti-cancer effects including:

  • Improving insulin sensitivity

  • Lowering IGF levels

  • Lowering testosterone (in the long term)

  • Improving DNA repair pathways

  • Improving epigenetic expression of good (anti-cancer genes)

  • Reducing chronic inflammation

  • Improving immunity

  • Enhancing anti-oxidant enzyme production

Regular exercise, especially outdoors and in groups has some positive indirect anti-cancr benefits:

  • Reduces excess weight

  • Increases Vitamin D levels

  • Lowers cholesterol

  • Improves mood

The evidence that exercise has direct and indirect anti-cancer benefits

You may wish to look at the presentation slides form National Cancer Research conference 2015 otherwise the following two comprehensive review papers summarises the benefits and biochemical pathways which are changed after exercise to achieve these anti-cancer benefits: 

Exercise induced biochemical and their potential influence on cancer: A scientific review  
 Thomas R and Kenfield S et al British Journal of Sports Medicine January 2017
  Download full paper

 

Physical activity after Cancer: An evidence review of the international literature
Thomas R and Holm M et al British Journal of Medical practitioners 2014; 7(1) 708
 Download full paper

 


 

Search for exercise facilities in your area

A good place to start is one of the 5500 the local council run sports centres in the UK. This will often run group lesson in a number of exercises suitable for a variety of levels. You can also ask your GP for a referral for the 12 week  national exercise referral scheme.  Up until 2010 this only included those with medical or physical conditions such as diabetes, obesity, bad back, cardiac or pulmonary disease and high blood pressure.  In 2010 Professor Thomas, together with McMillan Cancer Support and The Wright Foundation, wrote the national standards  to expand this scheme to specifically include cancer rehabilitation. These were accepted by Skills active in August 2010. From late 2011 a two training providers have instituted programmes for personal trainers to qualify in cancer rehabilitation. This qualification, at the highest level of their training, provides them with the knowledge of how cancer and its treatments affect an individualís ability to exercise in order for them to design bespoke exercise schedules for their clients sympathetic  to the limitations and symptoms which are common after cancer.  Although the scheme varies across the country and between gyms, the programme usually involves 12-24 weeks of supervision by a qualified exercise professional. Ask your GP for a referral if you have any of the existing criteria.

Outside this, the department of health used to run a website which directed people to exercise facilities in their local area - sadly this has been temporarily stopped. In the mean time, the websites below a list of local exercise facilities. You can choose from a wide range of exercise classes which are commonplace throughout the UK in local gyms, local parks and town halls including aerobic, yoga, palates classes, swimming pools, spinning, body pump and circuit training. You can also search for traditional sports which require more organisation than simply turning up for a class as they usually involve a group. Your local municipal sports centre, however, sometimes brings groups together without having to organise it yourself for a range of activities from 5-aside football, squash, tennis, badminton, basketball, volleyball and netball. 
           
Private gyms; Outside municipal gyms and formal exercise classes there are a wide range of private gyms throughout the UK such as:
            -
La fitnessVirgin Active | Fitness first | David Lloyd

Exercise at home with an instructors:
            - Workout at home - Find an exercise professional to train you.  info@workoutathome.co.uk
            - Find a personal trainer - motivatept.co.uk

Walking groups are available in many areas and are a good way to meet new people, view interesting scenery and exercise to a variety of ability levels:
   
        - The ramblers society - www.ramblers.org.uk
            - Walking for health www.walkingforhealth.org.uk 
            - Northern Ireland: Walking for health www.promotingwellbeing.info/walking
            - Northern Ireland www.walkni.com
            - Scotland: Paths for all www.pathsforall.org.uk 
            - Wales: Letís walk Cymru www.ramblers.org.uk/letswalkcymru  

This page summarises some of the evidence within these papers, explaining some of the underlying mechanisms of how exercise fights cancer and provides specific tips how to increase your daily exercise levels. It provides information and links to a wide range of exercise facilities throughout the UK suitable for all abilities and needs. It provides information on the links to articles in national press highlighting the benefits of exercise.

Golf: a good encouragement to walk and clubs are available throughout the world for all levels.
            -
UK Golf clubs

Cycling socially with the family or part of a daily commute, even if only once or twice a week, can be fun and even save money. For information on the UK national network of cycle tracks see:
   
         - National network of cycling tracks - www.sustrans.org.uk
   
         - National cycling groups and clubs -  National cycling groups 

Dance classes; There are numerous dance classes available in most towns either in private or municipal gyms or dance studios. The most common choices include conventional ballroom, line dancing, rock & roll, tango, ceroc and salsa. Some traditional studios offer ballet and the more avant-garde jazz funk and even street dance.  Search for dance classes in your area:
           
- Dance classes
            - Dance groups

Sport governing bodies:
England                        -   www.sportengland.org
Sport Scotland
             - 
  www.ouractivenation.co.uk  and www.sportscotland.org
Sport  Wales
                -  
www.sportwales.org.uk
Sport Northern Ireland
www.sportni.net


Introducing exercise into your daily routines for the long term

Establish a routine: The trick with exercise is that it must be performed regularly. Try to be organized; it is very easy to make excuses for not exercising, if an evening is missed out consider going lunch time instead, if a day is missed consider going twice the next day to catch up. All too often people who say they exercise regularly, when asked closely have excuses, often legitimate, for missing most of the days of the week. It may be worth keeping a wall chart or exercise diary as an aide memoir. If you have trouble getting to a gym or class consider investing in some of the many useful gadgets available to make it more feasible and enjoyable to exercise at home (exercise bikes, treadmills, rowing machines, etc).

Increasing exercise as part of daily activities; Even before you go to the gym or dance classes, you can exercise at home, in the office or on the way to work. It is important that it is enjoyable and stimulating so you really want to exercise regularly and not just as a passing fad.  Even before you consider a gym or dance class an increased level of physical activity can also be achieved by changing simple daily routines.

  • Walk instead of using the car for short journeys.

  • Try getting off the bus or tube one stop earlier. 

  • Park the car in the furthest place in the car park

  • Use the stairs instead of the lift

  • Walk rather than stand on the escalator. 

  • When watching TV or sitting at a desk try to get up and walk around for a few minutes. 

  • Buy a comfortable pair of training shoes

  • Walk around the block for 10 minutes every evening before your evening meal. 

  • Keep a physical activity diary and ensure at least 3 hours per week

At work; Avoid long periods of inactivity - if possible get up from your desk every 30 minutes and walk for 2 minutes, try to take a walk or some other exercise at lunchtime, if walking is unfeasible consider desk exercises - you may look odd but they can keep you alert especially when you get tired or sleepy; do not worry about the comments - people will secretly admire your enthusiasm. In your lunch break try to do some physical activity or at least go for a walk.

Exercise as a social activity. Exercising in a group is a healthy and beneficial alternative to an evening spent in a pub or in front of TV. It can and should be sociable and enjoyable - find something which is fun otherwise you will give it up very quickly. Dances and exercise classes are very cordial places and particularly if performed regularly are a forum to make new friendships and acquaintances. It is a question of changing the habits, changing the frame of mind and adopting a fresh approach to socializing. The majority of recreational activities and sports have a strong social aspect to them. There are a lot of choices, perhaps arrange a gathering with family and friends, look at the availability of activities in your area and then decide which one, as a group, you prefer.  

Personal trainers: If you have the financial means you may wish to consider a personal trainer who could come to your home exercise with you in the park or local gym (ideally they should have a level four qualification in cancer rehabilitation)- search for a registered Personal trainer in your area.


Specific exercise advice. 

Generally regular exercise helps reduce many of the acute risks and late toxicities after a diagnosis of cancer - see coping with symptoms. After specific treatments such as surgery and radiotherapy, as well as generally getting fitter, it is advisable to perform the specific stretches and exercise advised by the nurses/physiotherapist or doctors. You should have been given a specific sheet to follow in these situations. If you feel you unexpected problems on or after treatment or have any worries or barriers to exercise you can asked to be referred to a physiotherapist. Otherwise,  advice sheets can be found by clicking on the headings below:


Some concerns during exercise

Exercise is generally save but of course people can fall off tread mills, fall off a kerb, run into a lampot or sprain an ankle running but the benefits completely outweigh the risks. Nevertheless there are some special precautions which should be taken after cancer as the core muscle may be weaker especially after chemotherapy and / or hormone therapies. If you are concerned in the first instance, the best way to get started is to get some lessons with personal trainer or ask your doctor or GP to refer to an exercise professional who has  qualification in cancer rehabilitation (level 4) on the national exercise referral scheme. This will ensure you are supervised by a a professional who is sympathetic and aware of the limitations and symptoms which are common after cancer; know what to look out for and know what to do if a problem were to arise during exercise.

Cycling and prostate cancer: A recent study reported a six times increase in prostate cancer among elite cyclists compared other cyclists. Prof Thomas, a Consultant Oncologist and Exercise Scientist has summarised the evidence for polyphenols, cycling and prostate health and explains why this data is bias and this should not make men stop cycling provided some simple precautions are considered. The increase in prostate cancer in men who cycled for >eight was compared with men < 3.75 hours per week not the general public. It is important to realise that people who exercise are x3 less likely to get cancer than the general population. There may be an issue in extreme cyclist and a long cycle ride may put up the psa blood test so it may be best to avoid this 24 hours before the test. See full article 

Exercise during chemotherapy; Vigorous exercise will be difficult during chemotherapy and may actually increase the level of fatigue. However regular light exercise and avoiding periods of inactivity will improve fatigue digestion and reduce the risk of thrombosis (blood clots).  A recent major study from New York (The PACES STUDY) randomised women receiving chemotherapy for breast cancer into three groups. Those in the more intense exercise group had, statistically significant:

  • Lower fatigue

  • Less nausea

  • Less heart damage

  • Less weight gain

Heat shock proteins: In September 2010, various newspapers reported the results of a laboratory trial from Ohio and some made the inappropriate conclusion that exercise before chemotherapy is ill-advised. They based this around issues with a chemical called Heat Stock Proteins (HSP) which are activated by the body in response to cellular stress such as attack from chemicals, high temperature, infection or lack of oxygen (hypoxia). More specifically the heat shock protein-1 activates another protein called Hsp-27 that helps to block cell death. It also interacts with a third protein, p21, which allows cells to repair themselves and keep dividing. Much of the research up to now has concentrated on how this mechanism protects normal issues such as the heart in times of hypoxic stress. The main stimulus for the body to produce HSP is a raised temperature (associated with infection), lack of oxygen (such as a heart attack), steroid injections such as dexamethasone (routinely given with chemotherapy) and indeed chemical attack from chemotherapy.

 Researches recently have found that people who exercise regularly tend to have higher baseline HSP levels, and is one of the explanations why they tend to look younger and this protein encourages cellular repair. This seems all good up to now however experiments involving breast cancer cells from Ohio, showed that adding HSP to the cancer cells in the petri dish made them more resistant to chemotherapy because it was also encouraging the cancer cell to repair - which we do not want.  Following this there was a media frenzy warning that exercise could diminish the killing effect of chemotherapy. They made no comment on the fact that, if indeed HSP were increased in the body, it also would also diminish the harmful side effect, including heart damage. And, although this has not been proven, I suspect the benefit in terms tissue protection would out way the tumour sparing effect - thus actually increasing the therapeutic ratio of chemotherapy.  Certainly a therapeutic procedure called hyperthermia (used with chemotherapy and radiotherapy) suggests that heating the tissue actually kills more cancer cells without killing the normal cells. In summary There is no evidence, at all, that in humans exercise diminishes the chemotherapy effect.  There are several benefits of exercising during chemotherapy. In view of the new Ohio experimental data more research is necessary to see if exercise may actually be a way to further increase the therapeutic ratio. We advise regular exercise during chemotherapy and afterward - consider joining a gym or/and a personal trainer. However, although the evidence is poor for any risk, we advise avoiding extreme aerobic exercise (sprinting) 48 hours before chemotherapy especially in very hot climates/ rooms especially if you do not exercise regularly.

Exercise and reactive oxygenated species (ROS): Cellular respiration creates more ROS which in theory could damage DNA and other intracellular structures. Fortunately the improvements in antioxidant levels and immunity more than make sup for this - nevertherless it is very important to maintain a high level of polyphenols and other phytochemicals when exercising

Exercise and testosterone: Although exercise increases testosterone in the first 20 minutes - possibly an issue for prostate caner. However, this transient increases causes the body to reduce testosterone levels via a process called negative feedback. In reality, regular exercisers have lower testosterone levels

In conclusion:

 Exercise is safe, has numerous anti-cancer effects and reduces many toxicities after cancer treatments.


Administration: Lifestyle after cancer: Cancer management: Symptoms

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