Exercise and Cancer

Exercise and Cancer

Improved screening and diagnostic tools have led to more and earlier diagnoses of cancer in Australia. The most common cancers in Australia are prostate, breast, colorectal, melanoma and lung cancer¹. This early detection, coupled with improved treatments and longer survival outcomes, means quality of life and maintaining functional status become even more essential.

Regular exercise has been shown to improve quality of life and function in cancer survivors², and should be utilised through every stage of the cancer survivorship timeline, from diagnosis to end of life care³. Targeted exercise can slow the progression of cancer, reduce the risk of recurrence, and reduce cancer specific overall mortality⁴. With just under 150,000 new cancer diagnoses in Australia in 2020 and 5 year survival rates higher than ever¹, survivorship and health related quality of life are becoming even more vital to the patient and to decrease the burden on the health care system.

Each patient’s program should be individualised to complement and enhance their medical treatment plan, and work toward achieving functional and personal goals. Regular, targeted exercise throughout survivorship aims to:

• Optimise quality of life and physical functioning^2,3
• Manage the chronic and/or late-appearing effects of treatments (e.g. fatigue, lymphodema, fat gain, bone loss)^2,3
• Reduce the likelihood of recurrence⁴
• Reduce the likelihood of developing other chronic diseases for which they may be at risk (osteoporosis, heart disease, diabetes)^2,3,4

Exercise and Prostate Cancer
At the Australian Prostate Centre, we provide a holistic service to men from diagnosis to end of life care. Prostate cancer is currently one of the most common cancers in Australia, with 1 in 6 men diagnosed by the age of 85¹. Our Exercise Physiology service is a major component within the centre, and helps men prepare and recover from surgery, chemotherapy, radiation and hormone therapy.

Surgery
Exercise can improve outcomes after prostate cancer surgery, by reducing the risk of complications, length of hospital stay and the likelihood of long term incontinence⁵. Regular exercise can also improve recovery of sexual function, overall strength, fitness and body composition, psychological wellbeing and slow disease progression following robotic-assisted radical prostatectomy⁶.

Androgen Deprivation Therapy (ADT)
Hormone therapy, or ADT, comes with a long list of potential side effects including: muscle and bone loss, increased fat mass and bone fracture risk, sexual dysfunction and loss of libido, hot flashes, decreased mood and fatigue. A tailored exercise program, commenced at the same time as ADT, can improve fatigue and mood swings, muscle mass, overall strength and quality of life and libido, while maintaining bone mineral density to reduce fracture risk⁷.

Radiation Therapy
Radiation therapy is another common prostate cancer treatment that can create a range of side effects including: fatigue, dry red or itchy skin, anxiety or depression, loss of appetite, weight and muscle strength, reduce physical function and bladder and bowel problems. Exercising before, during and after treatment can improve cardiorespiratory fitness, muscle strength and flexibility, reduce treatment related fatigue, decrease the severity of incontinence and maintain sexual function⁸.

Bone Metastases
The most recent recommendations also focus on safely exercising with bone metastases, which are diagnosed in 88% of men diagnosed with metastatic prostate cancer⁹. Where previously anyone with bone metastases were told not to exercise for fear of injury, the latest recommendations¹⁰ promote regular physical activity to manage the side effects of cancer treatment, with consideration of location and presentation of bone lesions. The exercise prescription should have a strong emphasis on posture, controlled movement and proper technique and be assessed and prescribed by a Cancer Specialist Exercise Physiologist to reduce any potential risks¹⁰.

In 2019 Exercise and Sports Science Australia released a position statement on the importance of exercise medicine in cancer management¹¹. The main takeaway is to ensure every cancer patient receives a personalised exercise assessment and targeted exercise prescription by a Cancer Specialist Exercise Physiologist, focussing on general and cancer-specific health issues and patient goals.

How to find a Cancer Specialist Exercise Physiologist
We offer individual, group and Telehealth exercise programs here at the Australian Prostate Centre in North Melbourne. Each program is prescribed and supervised by highly qualified and experienced Cancer Specialist Exercise Physiologists and tailored to each patient’s medical and personal needs.

All our programs are affordable and we work closely with the patient’s multi-disciplinary team, including their GPs to assist with arranging Care Plans or referrals to further reduce out of pocket costs. Additionally, we have access to fully funded 8 or 12 week programs for any patient on the hormone therapy Eligard, via the EliFIT program.

To refer or enquire about our Exercise Physiology Service, simply call Reception on (03) 8373 7600, or email [email protected].

You can also find a local Cancer Specialist Exercise Physiologist by going to the ESSA website: https://www.essa.org.au/find-aep/ and choose location and “Cancer” as the special interest area.

References:

1. Cancer Council Australia. 2021. Facts and figures: Cancer statistics in Australia. Accessed 29^th March 2022. {https://www.cancer.org.au/canc...}
2. Liska, T. M. & Kolen, A. M. (2020). The role of physical activity in cancer survivors’ quality of life, Health and Quality of Life Outcomes; 18, 2328.
3. Campbell, K. L., Winters-Stone, K., Wiskemann, J., May, A. M., Schwartz, A. L., Courneya, K. S., Zucker, D., Matthews, C., Ligibel, J., Gerber, L., Morris, S., Patel, A., Hue, T., Perna, F. & Schmitz, K. H. (2019). Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable. Med Sci Sports Exerc; 51(11), 2375-2390.
4. Friedenreich, C. M., Neilson, H. K., Farris, M. S. & Courneya, K. S. (2016). Physical activity and Cancer Outcomes: A Precision Medicine Approach. Clin Cancer Res; 22(19), 4766-4775.
5. John, J. B. & McGrath, J. S. (2021). ERAS Protocol in RARP. Robotic Surgery; 1201-1209.
6. Jaime, A. T, Huynh, L. M., Derderian, R., Choi, E. & Wei, H. (2021). Heart-healthy diet and high-intensity interval training as a lifestyle intervention for patients with prostate cancer recurrence following radical prostatectomy. American Urological Association; 203(4), 903-904.
7. Taaffe, D. R., Galvao, D. A., Spry, N., Joseph, D., Chambers, S. K., Gadiner, R. A., Hayne, D., Cormie, P., Shu, D. H. & Newton, R. U. (2019). Immediate versus delayed exercise in men initiating androgen deprivation: effects on bone density and soft tissue composition. BJU Int; 123(2), 261-169.
8. Segal, R. J., Reid, R. D., Courneya, K. S., Sigal, R. J., Kenny, G. P., Prud’Homme, D. G., Malone, S. C., Wells, G. A., Scott, C. G. & D-Angelo, M. e. (2009). Randomized controlled trial of resistance or aerobic exercise in men receiving radiation therapy for prostate cancer. J Clin Oncol; 27(3), 344-351.
9. Huang, J., Shen, J., Rengan, R., Silvestris, N., Wang, M., Erosa, L., Zheng X., Belli, A., Zhang X., Li, Y. & Wu, A. (2020). Incidence of patients with bone metastases at diagnosis of solid tumours in adults: a large population-based study. Ann Transl Med; 8(7), 482.
10. Campbell, K. L., Cormie, P., Weller, S., Alibhai, S., Bolam, K., Campbell, A., Cheville, A. L., Dalzell, M., Hart, N., Higano, C., Lane, K., Mansfield, S., McNeely, M., Newton, R. U., Quist, M., Rauw, J., Rosenberger, F., Santa Mina, D., Schmitz, K. H., Winters-Stone, K. M., Wiskemann, J. & Goulart, J. (2022). Exercise Recommendations for People With Bone Metastases: Expert Consensus for Health Care Providers and Exercise Professionals. JCO Oncology Practice.
11. Turner, J., Marthick, M., Murmane, A., Atkinson, M., Czosnek, L., Lawrence, A., Vardy, J., Krishnasamy, M., Emery, J. & Cormie, P. (2022). ESSA Consencus Statement on the role of accredited exercise physiologists in the treatment of cancer.