EXERCISE AS TREATMENT Before and After Cancer
In this article
WHO defines physical activity as any skeletal-muscle movement expending energy, and exercise as its planned, purposeful, repetitive subset.
Regular exercise benefits people regardless of age, sex or physical capacity : it benefits everyone . It controls weight, strengthens the immune system , relaxes psychologically, reduces stress, strengthens muscles, improves sleep and productivity, and prevents or treats obesity, metabolic syndrome, diabetes, hypertension, anxiety, and many cancers.
Thus, exercise can be called a treatment / therapy . Although first-line for hypertension and obesity, it is not yet standard in prevention or postdiagnosis care despite substantial international evidence.
Reasons include cancer's subtype-specific plans, no broad exercise trials across subtypes, and consequent lack of reimbursement.
The Physical Activity Guidelines Committee shared strong evidence for reduced colon, breast, kidney, uterine, bladder, esophageal, and stomach cancer risks.
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>> CURRENT SCIENTIFIC EVIDENCE |
Observational data support associations of higher activity with risks of colon, breast, kidney, endometrial, bladder, esophageal adenocarcinoma, gastric cardia, and lung cancers. |
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Observational data support higher postdiagnosis activity associated with lower disease-specific mortality in breast, colon, and prostate cancer. |
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Limited preclinical data support antitumor activity in rodent or human cancer models. |
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Randomized trials support benefits for patient-reported outcomes and symptom-control endpoints. |
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>> LIMITATIONS |
Observational activity assessed by self-report at only one timepoint. |
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Widely differing activity or exercise “doses” associated with lower primary cancer risk or mortality. |
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Biological activity, including effects on tumor or microenvironment, unknown. |
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Response predictors, including clinicopathology, subtype, and genomic signatures, unknown. |
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>> FUTURE DIRECTIONS |
Preclinical or co-clinical tests demonstrating tissue and tumor marker modulation in relevant animals. |
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Early dose-finding escalation studies identifying feasible doses in target populations and settings, phase 1a. |
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Relevant scientific studies assessing biological activity of feasible doses. |
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Confirm feasibility in safety and dose-expansion phase 1b, assessing preliminary antitumor efficacy. |
The committee found no thyroid or rectal risk association but showed high activity in breast, colon, and prostate cancer reduces deaths .
Nkondjack and colleagues found BRCA 1/2 mutation carriers had no breast risk benefit. King and colleagues found BRCA 1 carriers' ovarian risk fell %54 and BRCA 2 carriers' %23.
A meta-analysis of 53 studies found, in 35, regular effective activity reduced cancer progression.
Most comprehensive systematic mouse studies also showed anticancer properties.
Observational benefits appear, but exercise's tumor microenvironment effects remain incompletely shown clinically despite some knowledge. For example, approximately 12 months of weekly 360 minutes increased men's pro-apoptotic Bax expression but reduced it in women, particularly the colon.
Another study assessed biochemical markers with exercise lasting 150 or 300 minutes over 6-12 months, studying sex steroids, growth hormones, inflammatory cytokines, and DNA damage and repair factors. Results were inconsistent and clinical significance unclear.
Internationally, 2 large trials examine stage 2 and stage 3 colon cancer and metastatic prostate cancer exercise effectiveness and microenvironment effects. Other studies assess diet and exercise across cancers.
Equal exercise types and doses affect people differently because basal and maximum metabolic rates and capacity differ. Studies therefore use broad ranges: weekly moderate 120-360 minutes or vigorous 75-230 reduced breast cancer risk. In breast cancer patients, mortality-reducing amounts were 120-250 moderate or 75-150 vigorous minutes.
Cancer development is influenced by genetic and environmental factors . Exercise effects depend on tumor size, receptor positivity or negativity, such as estrogen receptor in breast cancer, gene levels such as p27, and immune response such as CD3+ density. Success therefore depends on age, sex, capacity, tumor size, and subtype.
Unfortunately, Our Country Is Among the Least Active Worldwide
In our country, coronary disease %9.3, type 2 diabetes %11.3, breast cancer %16.3, colon cancer %16.6, and all-cause mortality %15 are attributable to physical inactivity . After Malta and Serbia, we rank in Europe for physical inactivity -related diseases at number 3.
Conclusion
Exercise appears promising in efficacy, cost, and adverse effects. It also substantially lowers heart attack, hypertension, vascular obstruction, obesity, and related deaths, while improving confidence. Future trials clarifying exercise biology and microenvironment effects may support standard regimens tailored by age, capacity, and subtype.
Sources
Development of Exercise as Interception Therapy for Cancer: A Review.
JAMA Oncol. 22 Aug 2019.
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