Exercise keeps us healthy – and Social Prescribing could help
Social Prescribing is the new buzz-word going the NHS rounds, and your Surgery should have been inundated with advice on how to offer this. Your GP can now “prescribe” exercise and even subsidized Gym memberships in certain areas.
You can’t escape
There is mounting evidence that exercise can contribute to the prevention of many types of cancer. As well as helping lose weight gained. Exercise can also help improve survival rates for those of us who had Corvid-19.
Many cancers, heart disease, diabetes, also benefit, as well as the quality of life in terms of reducing side effects of treatment, especially fatigue and pain.
Researchers recommend that you do 30 minutes of moderate exercise a day. Dana-Farber, the US cancer hospital, has produced this video showing simple exercises that can be done by chair-bound patients, as well as those able to stand
https://www.dana-farber.org/health-library/videos/lebed-method–simple-exercises-for-cancer-patients/
Originally researchers sought to find out if there were specific “doses” of exercise that could be tailored to different people, but pretty well anything will do. Currently walking and cycling are recommended – but later on tennis, exercise in the gym, hydrotherapy, riding, netball, etc. are excellent.
Recommended general physical activity guidelines are at least 150 minutes of moderate exercise or 75 minutes of vigorous exercise a week.
“We don’t know the exact, optimal dose of exercise needed for cancer prevention,” says Alpa Patel, the American Cancer Society’s senior scientific director for epidemiology research. “But we know from the evidence to date that the more you do the better.”
Patel says how exactly exercise affects cancer prevention is several fold; it includes exercise’s effects on reducing inflammation, helping regulate blood sugar and sex hormones, and improving metabolism and immune function. Preliminary studies show this also helps post corvid-19.
“Depending on the specific cancer, one or more of those mechanisms may be more important than the others,” he said. “So, for breast cancer, the benefits of exercise are really driven through the impact on sex hormones.” Hmm. Interesting.
“It can also affect cancer development or risk through reducing obesity, a risk factor for many (diseases),” said Dr. Crystal Denlinger, an oncologist at the Fox Chase Cancer Center in Philadelphia and chair of the National Comprehensive Cancer Network’s panel on survivorship guidelines. Now she’s talking. Although she says “the exact reasons why exercise affects certain cancers in different ways still needs additional research”. Although “at this time, there is no one ‘best’ exercise — anything that gets you moving and active is good.” 
Under the new Social Prescribing guidelines, those visiting their GP in the UK should be able to consult a long list of local gyms, sports centres, etc. that are offering reduced rates to anyone referred by their surgery – you just have to ask.
But macho men with visions of rugby – forget it – that’s not what the experts are thinking of!
What helps
‘Endurance training is more effective for improving cardiovascular performance and reducing inflammation, but resistance training may be a better starting point for frail …… patients,’ he continued. ‘Other types of exercise, such as inspiratory muscle training, are safe and effective, ;,,,,, therefore, the specific exercise should be chosen based on individual characteristics.’
Cardiovascular diseases are common side effects, especiallyif drugs have been used in ICU,… the result of cardiotoxicity, whereby ……treatment impairs heart function and structure, or accelerated development of cardiovascular disease, especially when risk factors such as high blood pressure are present. Furthermore, cardiovascular diseases and cancer often share the same risk factors.
What all the paper and reports do is highlight the importance of an individual exercise plan for each patient, taking into account personal history, treatment, response to exercise, and personal preferences. Exercise should start as soon as possible.
You just have to ask
For many people just out of hospital, exercise is the last thing they want to do. But, if you read reports on findings, it is obvious that this is beneficial for everyone.
If you talk this over with your multidisciplinary team, all those brains can surely come up with a plan that will get you activated, without too much effort! The appropriate ‘dose’ of exercise can then be prescribed, including the intensity, type and training volume (hours/minutes of training per week).
‘Defining the intensity and volume of exercise is important for maximizing the benefits of physical activity while avoiding muscular soreness, fatigue, and sleep disorders,’ said Dr D’Ascenzi.
Patients with low heamoglobin levels should avoid high-intensity activities; those with low platelet levels (needed for blood clotting) should not do contact sports. Activities that could increase the risk of fracture should be avoided in frail patients (try for Hydrotherapy exercise if in this category). Breathlessness or fatigue must be investigated but, after excluding associated health problems, exercise can help cope with fatigue, which is relatively common in many patients.
Dr D’Ascenzi concluded: ‘Physical activity before, during and after cancer treatment can counteract the negative effects of therapies on the cardiovascular system. In addition, it can relieve symptoms such as nausea and fatigue and help prevent unwanted changes in body weight.’
The science behind this …
1. “The benefits of exercise in cancer patients and the criteria for exercise prescription in cardio-oncology” by Flavio D’Ascenzi, Francesca Anselmi, Caterina Fiorentini, Roberta Mannucci, Marco Bonifazi and Sergio Mondillo, 6 October 2019, European Journal of Preventive Cardiology.
DOI: 10.1177%2F2047487319874900
2. “2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: The Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC)” by Jose Luis Zamorano, Patrizio Lancellotti, Daniel Rodriguez Muñoz, Victor Aboyans, Riccardo Asteggiano, Maurizio Galderisi, Gilbert Habib, Daniel J Lenihan, Gregory Y H Lip, Alexander R Lyon, Teresa Lopez Fernandez, Dania Mohty, Massimo F Piepoli, Juan Tamargo, Adam Torbicki, Thomas M Suter and ESC Scientific Document Group, 21 September 2016, European Heart Journal.
DOI: 10.1093/eurheartj/ehw211