1. Fuerst, Mark L.

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Offering exercise during cancer treatment, including chemotherapy, has both short-term and long-term health benefits, according to a new study.

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Exercising during adjuvant chemotherapy helped breast or colon cancer survivors engage in more physical activity 4 years later. Those who participated in an 18-week exercise program while receiving chemotherapy engaged in physical activity 142 minutes per week, or an average of 20 minutes per day more, than those who did not participate in the exercise program.


"Cancer-related fatigue is the most distressing side effect of treatment. Studies show positive short-term effects of exercise during chemotherapy. Regular physical activity levels after diagnosis are associated with better prognosis," lead author Anne M. May, PhD, Associate Professor of Epidemiology at the University Medical Center in Utrecht, Netherlands, told a presscast in advance of the 2018 Cancer Survivorship Symposium (Abstract 99).


"It is well-known that exercise during chemotherapy can lessen treatment-related side effects, such as fatigue, pain, and nausea. Our study is the first to show that people who are physically active during treatment maintain higher levels of physical activity in the long run, and this is really important for their health and well-being."


Exercise Study

A recent randomized trial, the Dutch PACT study, showed beneficial effects on fatigue and physical fitness after an 18-week supervised exercise program in breast and colon cancer patients undergoing adjuvant treatment. The study was a two-armed, multicenter, randomized, controlled trial comparing a supervised exercise program to usual care among 204 breast cancer patients and 33 colon cancer patients undergoing adjuvant treatment, including chemotherapy. About 70 percent of patients also received radiation therapy. Of the 237 participants, mean age 51 years, 197 patients were eligible and approached to participate in the 4-year follow-up measurements.


The exercise intervention included 60 minutes of combined moderate-intensity to high-intensity aerobic and strength training twice a week under the supervision of a physical therapist, plus 30 minutes of home-based physical activity 3 days a week. It also incorporated cognitive behavioral elements aimed at increasing the patients' confidence to be physically active. In addition, physical therapists discussed continued participation in sports after completion of the intervention.


The follow-up study included 128 patients, 110 patients with breast cancer and 18 patients with colon cancer, to determine if the exercise intervention had long-term benefits. Fatigue and physical activity levels were assessed using validated measures: the Multidimensional Fatigue Inventory and the Short Questionnaire to Assess Health-Enhancing Physical Activity. Of the patients surveyed, 70 patients had participated in the exercise program and 58 patients had received usual care.


After 4 years, patients in the exercise group reported engaging in moderate-to-vigorous physical activity, such as cycling or jogging, 90 minutes a day on average, whereas those in the usual care group reported 70 minutes of moderate-to-vigorous physical activity per day.


There was also a trend of lower physical fatigue in the exercise group compared to the usual care group, but the difference was not statistically significant.


Research Findings

"The exercise program was designed to keep patients physically active long-term, so we are really pleased to see that even 4 years later people who received the intervention were still more active," said May. More research is needed to confirm that this exercise intervention would be effective in reducing short-term and long-term side effects in patients treated for other types of cancer, she said.


Prior research suggests that women treated for breast cancer have an increased risk for cardiovascular disease, particularly if they received anthracycline-based chemotherapy. In the next follow-up study from the PACT clinical trial, the researchers plan to explore whether exercise during chemotherapy is protective against cardiovascular disease.


ASCO Expert Timothy Gilligan, MD, MSc, FASCO, Associate Professor of Medicine at the Cleveland Clinic Taussig Cancer Institute, commented: "In the past, patients were often told to rest and reduce their physical activity during treatment, but we now know that exercise is both safe and highly beneficial. As this study shows, exercising during cancer treatment can also make a significant impact on survivors' health and quality of life over the long term. As physicians, we need to do more to help motivate our patients to exercise both during and after treatment.


"The exercise literature shows positive benefits with cancer patients' fatigue. There is consistent data that exercise is good for cancer patients. Long-term impact is an exciting result."


Mark L. Fuerst is a contributing writer.