Prevention, Survival and Recovery from Cancer: The Case for Exercise

Bernadine M. Pinto, PhD; Professor and Associate Dean for Research, University of South Carolina

The rapid growth of research on the benefits of physical activity for cancer prevention, survival, and recovery led to a multi-disciplinary meeting of national and international experts convened by the American College of Sports Medicine (ACSM, 2018). This Roundtable reviewed the evidence surrounding the effects of physical activity for prevention and management of cancer as well as recovery and survival.

The comprehensive review and recommendations are outlined in three academic papers published (2019) from the Roundtable: Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable, and  “American College of Sports Medicine Roundtable Report on Physical Activity, Sedentary Behavior, and Cancer Prevention and Control” published in Medicine & Science in Sports & Exercise®, ACSM’s flagship research journal. The third paper, “Exercise Is Medicine in Oncology: Engaging Clinicians to Help Patients Move through Cancer,” was published in CA: A Cancer Journal for Clinicians, a flagship journal of the American Cancer Society. The Society of Behavioral Medicine was one of 17 organizations that have endorsed the new guidelines.

The new evidence-based guidance and recommendations include:

• For all adults, exercise is important for cancer prevention and specifically lowers risk of seven common types of cancer: colon, breast, endometrial, kidney, bladder, esophagus and stomach
• For cancer survivors, incorporate exercise to help improve survival after a diagnosis of breast, colon and prostate cancer
• Exercising during and after cancer treatment improves fatigue, anxiety, depression, physical function, quality of life and does not exacerbate lymphedema
• Continue research that will drive the integration of exercise into the standard of care for cancer
• Translate into practice the increasingly robust evidence base about the positive effects of exercise for cancer patients

Healthy adults in the U.S. are encouraged to engage in at least 150 minutes of moderate-to-vigorous physical activity each week, along with resistance training of major muscle groups at least twice per week.  Evidence indicates that prolonged sitting time may increase risk of some types of cancer (e.g., endometrial, lung and colon cancer).Although, the optimal dose of physical activity needed for  preventing cancer with exercise is still unclear, becoming and staying physically active is an important step that people of all ages and abilities can take to prevent cancer. 

These physical activity recommendations may be difficult to achieve for survivors during and following cancer treatment.  The precise type and amount of exercise to treat the many different treatment-related health outcomes experienced by cancer survivors is not clear. However, the essential message is that some activity is better than no activity at all.  Cancer survivors should be moving throughout their cancer treatments and survivorship as tolerated.

This recommendation is one that healthcare professionals can provide to help people recover from surgery and other cancer treatments. Some survivors will need specialized services such as physical therapy or occupational therapy to help them get ready to engage in physical activity. For those with functioning limitations and co-morbidities, it may be advisable to participate in on-site supervised exercise programs in hospital/clinic settings.

Experts now recommend that cancer patients and survivors perform aerobic and strength training for approximately 30 minutes per session, three times a week, to achieve health benefits.

Some examples of aerobic moderate-intensity exercise include:

• Taking a class at the gym (aerobics, Zumba, dance class, water aerobics, etc.)
• Take a walk in your neighborhood
• Hike in a nearby park
• Participate in charity walk/runs
• Go for a bicycle ride

Some examples of strength training include:

• Lift dumbbells
• Use elastic bands
• Do body weight exercises such as chair sit-to-stands and kitchen counter push

Patients with lymphedema or at risk of developing lymphedema should exercise caution with strength training exercises (e.g., wear a compression sleeve).

By starting slow and setting achievable activity goals, gradually increasing these goals and finding ways to make physical activity fun are key to keeping cancer at bay.  Physical activity can also improve functioning and quality of life after cancer.

The challenge for cancer care in the U.S. and for healthcare professionals is to find ways to integrate exercise into standard of care for cancer. Awareness, training, infrastructure, programming, policy, funding and sustainability are areas that require attention. 

The ACSM has started a new initiative called Moving Through Cancer to address these areas and offer resources for patients and healthcare providers. More effort is needed to translate and implement the guidelines to improve the health and wellbeing of 43 million cancer survivors worldwide.

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