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Regular exercise is vital before and after a diagnosis of cancer as well as during cancer treatments. An increasing tide of good quality clinical research is now showing that that at lea  can help alleviate many of the symptoms commonly experienced after cancer treatments. What's more over significant biochemical changes occur after exercise in he body most of which have profound anticancer properties. It is not a surprize then that large cohort trials have clearly linked  3- 5 hours of vigorous physical activity a week with a reduce the risk of cancer relapse and improve the chance of an fulfilling survival. The evidence for these facts were presented at the National Cancer Research conference 2015 and have been reviewed and summarised in two important publications which can be accessed below:

Exercise induced biochemical and their potential influence on cancer: A scientific review  
 Thomas R and Kenfield S et al British Journal of Sports Medicine December 2016
  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


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 national exercise referral scheme and links to articles in national press highlighting the benefits of exercise.


Search for exercise facilities in your area - click here
The websites below have a comprehensive list 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. 

Search by post code tools: Enter your post code then the exercise which attracts you and the website will list the facilities in your area:
            -  Active places website - the DoH funded website
Private gyms; Outside municipal gyms and formal exercise classes there are a wide range of private gyms throughout the UK such as:
La fitness
            - Virgin 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 (0207339 8541)
            - Northern Ireland: Walking for health www.promotingwellbeing.info/walking
            - Northern Ireland www.walkni.com
            - Scotland: Paths for all www.pathsforall.org.uk (01259 218 888)
            - Wales: Let’s walk Cymru www.ramblers.org.uk/letswalkcymru (02920 646890)


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
Sport Northern Ireland


Tips for sustaining exercise as a long term goal

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.  

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.

The national exercise referral scheme

There are over 5500 community recreation centres in the UK so most people have one in their area. A scheme already exist which enables doctors to refer people for exercise rehabilitation, supervised by appropriately qualified exercise professionals. 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 individual’s 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. Hopefully, as the scheme expands in 2012/13,  patients in the UK will be able to request their doctor to refer them to their local gym for a personal programme supervised by a specifically qualified instructure.

 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. 

What are the benefits of exercise - download full paper

Worldwide published evidence clearly demonstrates that regular exercise helps well-being and cancer in four main ways:-

Exercise prevents cancer In terms of prevention, its has been estimated that being sedentary and overweight could account for 14% of male and 20% of female cancer deaths in the UK.  For bowel cancer, for example, most environmental studies have demonstrated a reduction in the order of 40–50% for those at the highest levels of physical activity, with many demonstrating a dose-response relationship. The Harvard Centre for Cancer Control, for example, estimates that at least 15% of colon cancers could have been prevented by 30 minutes daily exercise a week. These data suggest that increasing physical activity is one of the major factors that is amenable to modification by individuals wishing to reduce their risks of cancer.

Exercise helps to fight established 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.

Exercise after cancer reduces relapse rates and improves survival. Several large international studies have clearly shown that individuals who exercise regularly after cancer have better outcome sin terms of 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

Exercise has been proven to helps side effects and risks during and after cancer treatments. Regular exercise increases the sense of self empowerment for both the patients and carers who can also join in with the activities. It improves social integration and can make you feel good about yourself. Many patients reported that exercise restored their confidence earlier after cancer treatments finished. As well as these general measured, the is strong evidence that exercise  has major benefits on many of the symptoms and side effects experienced during and after cancer treatments:

Underlying mechanisms of how exercise fights cancer
A number of important physiological changes occur in the body during and after exercise which have specific anticancer properties. As well as helping reduce weight which in the long term has anti-cancer benefits these include:

Direct pathways:

Indirect pathways:


Specific exercise advice

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:


Worries and concerns  Exercise is generally save of course people can fall off tread mills or sprain an ankle running but the benefits completely outweigh the risks. Nevertheless there are some special precautions which should be taken after cancer. If concerned in the first instance, the best way to get started is to 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. About 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).  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.



Links and further resources:

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