14. Physical activity

What are the locoregional types of treatment for cancer?

Surgery and radiotherapy

What are the systemic types of treatment for cancer?

• Chemotherapy

• Hormonal therapy

• Immunotherapy

Definition physical activity

Any bodily movement produced by skeletal muscles that requires energy expenditure

All movement including during leisure time, for transport to get to and from places, or as part of a person’s work.

Defenition exercise

Exercise is a subset of physical activity that is planned, structured and repetitive.

Intended to improve or maintain physical fitness

FITT factors

F = frequency

I = intensity

T = time

T = type

MET value

• MET = metabolic equivalent of a task

• 1 MET = energy expenditure at rest

• A measure of intensity of exercise

• Often combined with duration (MET hour/week)

What seven cancers can have lowered risks with exercise?

• Colon cancer

• Stomach cancer

• Esophageal cancer

• Bladder cancer

• Kidney cancer

• Endometrial cancer

• Breast cancer

How much exercise should be be done to lower risk of cancer?

• 150-300 min/week moderate intensity

• OR

• 75 - 100 min/week high intensity

Link between exposure to female sex hormones and cancer

• Women with an early period and late menopause have higher risk of cancer because they are exposed more to the female sex hormone.

Link between sex hormones and physical exercise

• Effect of a 1-year exercise intervention on sex hormone levels in postmenopausal women

• Overall, no favorable effects on sex hormone levels

• But:

  • In women with >2% body fat loss favorable exercise effect on sex hormone levels

  • Fat loss was significantly associated with decrease in estrogen levels

  • But does exercise have an additional beneficial effect beyond the effect of weight loss?

Study to determine if exercise is only good for weight loss to prevent cancer or are there other benefits

• Three groups:

  • weight loss mainly by exercise & small caloric restriction

  • weight loss by caloric restriction only

  • control

• It was found that both diet and mainly exercise, showed favorable effects on sex hormones and some inflammatory markers compared to control

• Compared with diet induced weight loss, equivalent weight loss by mainly exercise has more beneficial effects on:

  • body composition (increase in fat loss & lean mass is preserved)

  • physical fitness

Exercise and prognosis

After cancer diagnosis: physical activity is associated with a better prognosis of breast, colon and prostate cancer.

Study about benefits of exercise in cancer survivors

• Intervention of three years

• Two groups: supervised exercise group and control group

• Exercise group > and including 10 MET hours/week extra physical activity (more than what they already do)

  • Equivalent is 2,5 hour/week bris kwalking

• Findings: five year disease free survival was 72.4% in the exercise group versus 66.0% in the control group - a 6.4 percentage point difference. This was statistically significant and clincially meaningful

• Eight year overall survival: 78.4% in the exercise group vs. 71.3% in the control group - a 7.1 percentage point improvement.

Evidence exercise effects in pts with cancer

Strong evidence: anxiety, fatigue, quality of life

moderate evidence: sleep & bone heatlh

unsufficient evidence: cardiotoxicity, CIPN, cognitive functioning, sexual functioning

Exercise guidelines for cancer survivors:

Exercise for cancer survivors struggling with fatigue

• Exercise at > moderate intensity

• Low intensity is probably not effective

• Dose-response relationship is plausible → up to 150 min/week

• Larger effects: longer sessions (>30’)

• Larger effects: longer duration of program (>12 weeks)

• Setting and level of supervision are not important for this outcome

• However, an IPD-MA shows effects of supervised exercise programs

Lymphedema

• Lymphedema is a chronic condition causing swelling—usually in the arms or legs—when a damaged or blocked lymphatic system cannot drain protein-rich fluid properly

• Historically, there was a widespread belief that exercise—especially strength or resistance training—might increase swelling or exacerbate lymphedema complaints

• Historically, there was a widespread belief that exercise—especially strength or resistance training—might increase swelling or exacerbate lymphedema complaints

• Testing: what is the effect of exercise on cognitive functioning in patients with breast cancer treated with chemotherapy

• Testing: what is the effect of exercise on cognitive functioning in patients with breast cancer treated with chemotherapy

• Again exercise group and control group

• Result: exercise has positiv effects on (mental) wellbeing and self-reported cognitive complaints

• Exercise might have positive effects on tested cognitive functioning in specific subgroups: more research is needed

• Testing: what is the effect of a supervized and individualized exercise program in patients with metastatic breast cancer on quality of life and fatigue?

• A supervized resistance and aerobic exercise intervention resulted in beneficial effects on fatigue HRQoL and other clinically relevant outcomes of patients with mBC.

• We recommend supervized exercise as part of supportive care regimens during palliative treatment.

Question: what are the effects of a 12-week supervised exercise program after esophageal cancer treatment?

• 2 sessions per week of 60 minutes with physiotherapist. Aerobic and resistanc etraining (including HIIT)

• 30/min day active at moderate intensity

• Results: increase in quality of life, decrease in fatigue