Exercise Benefits Patients With Cancer on Active Therapy

Roxanne Nelson, BSN, RN

November 22, 2016

Exercise is safe and beneficial for patients with breast and prostate cancer who are undergoing active treatment, according to new findings.

"The implications first and foremost are that these findings add to the growing evidence base that exercise can be beneficial to cancer patients and survivors," commented lead author, Brian Focht, PhD, director of the Exercise and Behavioral Medicine Lab at The Ohio State University Comprehensive Cancer Center, Columbus.

"But what differentiates these studies is that we are focused on more specific issues, such as how should exercise be prescribed, especially for individuals who are undergoing treatment," he told Medscape Medical News.

There really isn't a one size fits all, he said, and lifestyle changes, diet, and exercise all have to be geared to the individual. "Undergoing chemotherapy generally isn't a time when people are thinking of exercise," he said. "There is evidence showing safety and efficacy but many patients are experiencing fatigue, although interestingly, exercise has the opposite effect, and may offset fatigue and give additional energy."

For the patients with breast cancer, the researchers conducted a large meta-analysis that examined the effects of exercise on women who were receiving chemotherapy and/or radiation.

Those who exercised experienced improvements in muscular strength, cardiovascular functioning, and quality of life compared with patients who didn't exercise.

Results were similar for patients with prostate cancer, who experienced an "astonishing level of improvement," Dr Focht said in an interview.

The prostate cancer study, a small randomized pilot trial that assigned men undergoing androgen deprivation therapy (ADT) to an intervention that involved diet changes and exercise or standard care, showed that after 3 months, men in the intervention group lost weight, increased their functional ability, and improved their quality of life.

Both studies were presented at the American Institute for Cancer Research (AICR) 2016 Research Conference. The breast cancer trial was also published in the Journal of Community Support Oncology.

Improvements in Strength and CVD Health

A growing body of evidence supports the premise that regular physical activity may play a protective role and decrease the risk for many types of cancer, and that it may also help temper the adverse effects of treatment.

Some data suggest that exercise after a cancer diagnosis could influence outcomes, such as findings from a Swedish study showing that patients with prostate cancer who exercised 1 or more hours a week reduced all-cause mortality by 26% and prostate cancer–specific mortality by 32% compared with men who reported exercising less than 1 hour a week.

However, Dr Focht and colleagues note that most research to date has focused on post-treatment care and the restoration of function.

Thus, if exercise is to be established as a standard part of cancer care, there is a need for clarity in the evidence that supports the safety and efficacy of exercise interventions during different types of treatment, they note.

The breast cancer meta-analysis included 17 randomized trials with a total of 1175 participants who were undergoing active cancer therapy.

Interventions included resistance training and aerobic exercise or a combination of the two types. The authors looked at both physiologic and psychosocial outcomes and then calculated Cohen d effect sizes for each outcome.

Aerobic exercise yielded an array of improvements, including quality of life (d = 0.56), sleep (d = 0.41), self-efficacy (d = 0.64), behavior (d = 1.30), social well-being (d = 0.90), metabolic equivalent tasks (MET; d = 0.60), MD Anderson Symptom Inventory score (severity, d = 0.56; interference, d = 0.78), and Profile of Mood States score (d = 0.59).

Aerobic fitness also moderately improved (d = 0.47).

For resistance training, participants experienced improvements in body fat (d = 0.98), lean body mass (d = 0.90), and strength (d = 0.78). There were also negligible changes in fatigue (total d = 0.02), quality of life (global d = 0.01), depression (d = 0.01), and cognitive function (d = 0.30).

Only 1 study examined the effects of a combined exercise intervention during chemotherapy, and those results were mixed.

Patients had a significant increase in fatigue at end of chemotherapy (d = –0.41) but returned to baseline at their 6-month follow-up (d = 0.02).

There was only a negligible change in the 6-minute walk test (6MWT; d = 0.20) and MET (d = 0.18) at end of their treatment, but a significant improvement was seen at 6-month follow-up (6MWT, d = 0.31; MET, d = 0.43).

Commenting on the study, Curtis Miyamoto, MD, professor and chair of the Department of Radiation Oncology at the Lewis Katz School of Medicine at Temple University in Philadelphia, Pennsylvania, noted that this study "confirms what many of us in practice have been recommending to our patients under treatment for breast cancer."

"Although this is a mix of different exercise programs with some subjectivity it still has validity," Dr Miyamoto told Medscape Medical News. "Exercise has many benefits and the sooner it begins the better — these benefits include maintaining range of motion, stress management, improved self-image, decreased lymphedema, bone strengthening, depression, and cardiovascular improvement."

He emphasized that it does need to be done under a physician's supervision and individualized because there are also potential risks. "We at the Fox Chase Cancer Center at Temple University Hospital recommend it to our patients."

Pilot Program Promising

In the prostate cancer study, 32 men undergoing ADT were randomly assigned to a plant-based diet and a strength training and aerobic exercise intervention or to standard care.

Body composition, mobility, and strength were measured at baseline, 8 weeks, and 12 weeks.

After 3 months, Dr Focht noted that men in the intervention group were walking three to four times more quickly than those in the group receiving standard care. "Functional ability increased dramatically, and along with that, their quality of life also increased."

Their functional ability, which included measurements such as a lift-and-carry test, also dramatically increased, as did their quality of life.

Favorable changes were also noted for body composition. Men in the intervention group lost on average 4.4 pounds (2 kg) and 1% of their body fat over a 3-month period; conversely, men receiving standard care gained almost 1% of body fat.

"In prostate cancer, we found good evidence that exercise can be beneficial for patients," said Dr Focht. "Some of the adverse effects of ADT include loss of muscle mass and strength and added fat. We found that combining a healthier diet with exercise had a complementary effect and improved health and quality of life."

More Evidence in Breast Cancer

Another new study, led by Lynn Panton, PhD, professor and interim associate dean for research and graduate studies at Florida State University, Tallahassee, found 6 months of moderate-intensity resistance exercise training helped breast cancer survivors avoid developing lymphedema.

"At one time, women were told they shouldn't do upper body activities after surgery and treatment because doctors thought it could actually cause swelling to become worse," said Dr Panton in a statement. "But we're finding that strength training can really help women recover from treatment and help prevent and reduce this swelling."

Published in the journal Supportive Care in Cancer, the study included 27 women who participated in a 6-month resistance exercise training intervention.

The program consisted of 10 exercises 2 days per week and included 2 sets of 8 to 12 repetitions at 52% to 69% of the participants' 1-repetition maximum.

Arm circumferences was assessed at baseline and every 2 weeks afterward.

The results showed no significant changes in percentage difference of arm circumferences at any point during the study period (before, 1.31% ± 6.21%; after, 0.62% ± 6.55%), and no adverse lymphedema-related events were reported.

Better Sleep for Patients With Lung Cancer

Yet another new study found that exercise may also help patients with lung cancer.

Researchers in Taiwan have reported that walking several times a week improves sleep and quality of life in these patients.

Published online November 3 in the British Journal of Cancer, lead author Chia-Chin Lin, a nursing professor at Taipei Medical University, and colleagues randomly assigned 111 patients with lung cancer to a 12-week home-based walking program or usual care.

The intervention consisted of walking at a moderate intensity for 40 minutes three times a week.

Outcome measures included objective sleep (total sleep time [TST], sleep efficiency, sleep onset latency, and wake after sleep onset), subjective sleep (Pittsburgh Sleep Quality Index [PSQI]), and rest-activity rhythms (r24 and I < O), which were evaluated at baseline and 3 and 6 months.

Overall, patients who participated in the walking program had better sleep quality at both time points.

The PSQI (Wald chi-square = 15.16; P = .001) and TST (Wald chi-square = 7.59; P = .023) of exercise participants significantly improved 3 and 6 months after start of the intervention, and the moderating effect of I < O on TST was significant (β of group × I < O = 3.70; P = .032).

"The walking program is an effective intervention for improving the subjective and objective sleep quality of lung cancer patients and can be considered an optional component of lung cancer rehabilitation," the authors conclude.

No funding was disclosed for any of the studies, and none of the authors have disclosed any relevant financial relationships.

Dr Focht and colleagues' studies were presented at the American Institute for Cancer Research (AICR) 25th Research Conference on November 14, 2016.

J Community Support Oncol. 2016;14:200-209. Abstract

Support Care Cancer. Published online August 11, 2016. Abstract

Br J Cancer. Published online November 3, 2016. Abstract

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