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Exercise-Cancer Survivorship

Exercise helps our sex hormones – and more

Image result for cartoon figure bundled up against coldDoctors keep on telling us to exercise in efforts to reduce the risk of certain cancers, and improve treatment outcomes and quality of life for those of us with the disease, .

Just because it’s cold outside shouldn’t mean we neglect exercise, and to make this easier ‘Social Prescribing’ will be on offer at GP surgeries soon, which means they can “prescribe” exercise.

So be warned – if you don’t like exercising you’d better have some cast-iron excuses ready next time you see your GP. !

You can’t escape

Cancer centres both sides of the Atlantic show there is mounting evidence that exercise can contribute to the prevention of bladder, breast, colon, esophagus, kidney, stomach, and uterine cancer.

They also say exercise can help improve survival rates for those of us who had breast, colon, and prostate cancer — as well as quality of life in terms of reducing side effects of cancer treatment, especially fatigue and pain.

How much exercise?

Researchers recommend that people with cancer 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 Image result for cartoon exercise royalty freethat could be tailored to different people with cancer. But pretty well anything will do – exercise in the gym, cycling, walking, hydrotherapy, or more energetic forms such as tennis, riding, netball, etc.

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.”

For readers who want to know more, why exercise works

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.

“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 cancers,” 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 guidelinesNow 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.”  Image result for cartoon rugby

Sorry – 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 visitions of rugby – forget it – that’s not what the experts are thinking of!

Patients with cancer should receive a tailored exercise prescription to protect their heart, reports a paper published today (October 6, 2019) in the European Journal of Preventive Cardiology, a journal of the European Society of Cardiology (ESC).1

‘Cancer patients are often less active than adults without cancer,’ said author Dr Flavio D’Ascenzi, University of Siena, Italy. ‘However, exercise is essential for patients diagnosed with cancer who are under treatment, irrespective of the type of treatment.’

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 cancer patients,’ he continued. ‘Other types of exercise, such as inspiratory muscle training, are safe and effective, particularly in those with thoracic cancer; therefore, the specific exercise should be chosen based on individual characteristics.’

Cardiovascular diseases are common side effects in patients with cancer. This is the result of cardiotoxicity, whereby cancer 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. Therefore, cancer patients are advised to eat healthily, quit smoking, control their weight, and exercise.

What all the paper and reports do is highlight the importance of an individual exercise plan for each patient, taking into account personal history, cancer treatment, response to exercise, and personal preferences. Exercise should start as soon as possible, even before commncing treatment such as chemotherapy.

You just have to ask

For many people, exercise is the last thing they want to do.  But, if you read paper after paper that 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 (as usually done for a drug) can then be prescribed, including the intensity, type of training, 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 hemoglobin 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. Breathlessness or fatigue must be investigated but, after excluding associated health problems, exercise can help cope with fatigue, which is relatively common in cancer 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.’

If you want to know more of 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

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