Thursday, January 28, 2010

Cancer Patients Can Improve Health, Quality of Life with Regular Exercise

As a runner, I am often asked for exercise advice. If the same thing happens to you, reviewing this information for breast cancer survivors may help you assist a friend or loved one with incorporating exercise into their lives.

The good news is that five-year survival rates for early stage colorectal, breast, and prostate cancer currently exceed 90%. Cancer can be viewed as a treatable chronic illness and not the death sentence it was in past generations. The majority of cancer patients can take positive steps to increase their mental and physical health as well as enjoy a high quality of life. With their physician’s permission, regular aerobic and strengthening exercises can be integrated into the cancer survivor’s daily life.

Researchers at the Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, Washington, published a study in 2008 focusing on physical activity and survival after diagnosis of invasive breast cancer. The scientists noted that previous studies suggest that increased physical activity may lower the risk of breast cancer incidence, but noted that less is known about whether levels of physical activity after breast cancer diagnosis can influence survival. The research found that women who engaged in greater levels of activity had a significantly lower risk of dying from breast cancer, regardless of a woman's age, stage of disease, and body mass index.

The University of Northern Colorado Rocky Mountain Cancer Rehabilitation Institute explored the role of exercise training in cancer treatment-induced alterations in muscular fitness and quality of life in a study published in 2007. The researchers studied breast and prostate cancer survivors as they trained in resistance exercise for six months during treatment or following treatment based on their health status and results from a battery of fitness assessments and health status. They concluded that moderate-intensity exercise is a “safe and efficacious means to augment muscular function and improve the quality of life of cancer survivors.”

My mother died from breast cancer when I was 20 years old. I have responded to the genetic threat of breast cancer by modifying my diet, participating in regular exercise and reducing my exposure to pollutants. If I am diagnosed with breast cancer, data from numerous studies points to physical exercise, including aerobic and resistance exercises, as a strong treatment for improving quality of life, self esteem and the health of my body both during and after chemotherapy treatment. I would like to share the conclusions of these studies with breast cancer survivors and encourage them to add regular exercise to their daily lives.

Exercise Can Improve Quality of Life

Can we really ask a breast cancer patient to exercise after she completes chemotherapy treatment? As a child, I remember my mother was very weak and suffered side effects during her chemotherapy treatment. The following studies make a strong case for starting a program of regular physical exercise.

In 2009, The University of Queensland, Australia School of Human Movement Studies investigated the role of exercise during cancer rehabilitation, the period immediately following cancer treatment completion. The research evaluated pointed to the conclusion that exercise during cancer rehabilitation is feasible and can provide patients with physiological and psychological benefits. Patients participated in aerobic or resistance-training exercises and improvements in physical functioning, strength, physical activity levels, quality of life, fatigue, immune function, hemoglobin concentrations and body composition were reported.

Exercise can be a positive part of rebuilding a life after winning the battle against cancer. Several studies have found that exercise improves quality of life for cancer patients after their treatment has concluded.

In 2010, the Center of Community Alliance for Research and Education (CCARE), Department of Population Sciences, City of Hope, Duarte, CA, published a study exploring the relationship between physical well-being outcomes and healthy lifestyle changes by cancer type. The study found that exercise was significantly related to improving physical well-being for breast cancer survivors.

The University of L'Aquila Sport Science, Department of Medicine, Public Health Biostatistics, Epidemiology Unit, Faculty of Movement in L'Aquila, Italy studied the relationship between physical exercise and quality of life in breast cancer survivors. Strenuous exercise was correlated with a higher quality of life. Absent/mild exercise was inversely correlated with a positive perception of disease severity and with quality of life.

A 2010 study by the Institute of Health and Biomedical Innovation, Queensland University of Technology School of Public Health in Queensland, Australia found that exercise improves quality of life among breast cancer survivors. The researchers found that women under 50 years of age who participated in physical activity over 3 METs reported a higher health-related quality of life at 18 months compared with their more sedentary counterparts.

Exercise Can Lessen Depression in Cancer Survivors

Fighting cancer takes a toll on more than just the body, and beating cancer can feel like a hollow victory if the survivor is suffering from depression. Exercise has been proven to help raise self esteem in chemotherapy patients and reduce depression in cancer survivors.

The University of Alberta in Canada in 2007 reported the results of the six-month follow-up of patient-rated outcomes in a randomized controlled trial of exercise training during breast cancer chemotherapy. Breast cancer patients initiating adjuvant chemotherapy participated in resistance or aerobic exercise for the duration of their chemotherapy. Six months later, the resistance exercise group reported higher self-esteem and the aerobic exercise group reported lower anxiety when compared with a control group. During chemotherapy, patients who participated in resistance exercises reported an increase in self esteem, and kept their levels of self-esteem through the six month follow up. Patients who participated in aerobic exercise did not have an immediate change in anxiety level, but reported a reduction in anxiety at the six month mark.

Researchers at the Department of Medicine, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN; and Shanghai Institute of Preventive Medicine, Shanghai, China joined together to study the effects of Exercise, Tea Consumption, and Depression Among Breast Cancer Survivors. The research on Chinese breast cancer survivors found that women who increased their exercise level had lower risk for depression.

Finding the Appropriate Forms of Exercise Can be Frustrating, But Exercise is Well Tolerated by Cancer Survivors

Scientists at the Royal North Shore Hospital, Sydney, Australia studied patient perceptions of arm care and exercise advice after breast cancer surgery. Breast cancer surgery patients were asked to respond to their experience receiving advice about arm care and exercise. Cancer survivors reported inadequate and conflicting advice, lack of acknowledgment of women's concerns about upper limb impairments, an unsupported search for information about upper limb impairments and a fear of lymphedema, a condition of localized fluid retention and tissue swelling caused by a compromised lymphatic system.

According to the American Cancer Society, of the two million breast cancer survivors in the U.S., approximately 400,000 must cope with lymphedema on a daily basis. I remember that my mother would always struggle to find tops with sleeves that were loose fitting at the upper arms.

A small study published in 2008 examining the effects of Pilates exercises on shoulder range of motion and upper-extremity function in women who had been treated for breast cancer found that Pilates exercises may be an effective and safe exercise option for women who are recovering from breast cancer treatments.

Breast cancer patients may be advised to be cautious about any strenuous activity that involves repetitive, resistance-oriented movement in the at-risk arm. Flexibility exercises can help patients maintain a wide range of motion, stretching the arm can increase flow in the lymphatic channels, strengthening exercises using very light weights can also be attempted. Swimming can be a beneficial form of exercise for breast cancer survivors because it combines muscle action on the inside with the additional benefit of water pressure on the outside of the arm.

The University of Pennsylvania Division of Clinical Epidemiology published a study in 2010 reviewing controlled physical activity trials in cancer survivors. The researchers found a positive effect of physical activity interventions post treatment on upper and lower body strength and moderate effects on fatigue and breast cancer-specific concerns. A small to moderate positive effect of physical activity during treatment was also seen for physical activity level, aerobic fitness, muscular strength, functional quality of life, anxiety, and self-esteem. The scientists reported that, with few exceptions, exercise was well tolerated during and post treatment without adverse events.

An exciting study from the Yale School of Medicine provides a direct link between exercise and reducing the incidence of breast cancer in breast cancer survivors.

The Yale School of Medicine Department of Epidemiology and Public Health published the Yale Exercise and Survivorship study in 2009, focusing on the results of aerobic exercise on insulin and insulin-like growth factors in breast cancer survivors. High insulin and insulin-like growth factor-I (IGF-I) levels may be associated with an increased breast cancer risk and/or death. The researchers found that breast cancer survivors that participated in 150 minutes per week of moderate-intensity aerobic exercise, like brisk walking, experienced decreases in insulin, IGF-I, and IGFBP-3, and women in the control group had increases in these hormones.

Several recent studies highlight the positive effects of exercise on cancer patients. For me, the possibility of reducing high insulin and insulin-like growth factor-I (IGF-I) levels with exercise is the most exciting benefit of regular exercise for cancer patients and survivors. Other benefits include higher self esteem, lower depression, a stronger body and a better quality of life. Cancer patients can work with their physicians and a personal trainer to develop an exercise program that they can enjoy on a long term basis.

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