Exercise Is a Cancer Drug!

For patients with cancer, exercise is as effective as cancer drugs, according to a report presented by a coalition of 17 organizations and 40 experts led by the American College of Sports Medicine. The coalition was prompted by a claim that exercise had failed people diagnosed with cancer.

The authors said exercise should now be part of standard treatment for all suitable oncology patients, and physical activity should become a vital sign like blood pressure recorded at every patient visit as routine practice.

The team says that most people currently receiving cancer treatment or who have survived cancer arenotregularly physically active.

Assessing, measuring and advising on a patient’s exercise status is a practice requiring little time or skill from an oncologist.

The new report was published on 16 October in CA: A Cancer Journal for Clinicians , the world’s most scientifically cited journal.

Worldwide there are 44 million people with cancer and 18.1 million new diagnoses each year. According to three large cohort studies involving approximately 13.000 people in the United States and United Kingdom, two-thirds of people living with cancer or who have completed treatment lead entirely inactive / sedentary lives.

Schmitz, a lead author of the report, said: "We are now at a point where we have more evidence for using exercise in oncology than in heart disease," she said. "It is time to speak with one voice; time for a paradigm shift—a new understanding—in cancer treatment."

Since the last American College of Sports Medicine meeting in 2010, more than 2500 randomized controlled exercise trials in cancer have been published. Following these studies, many professional cancer organizations worldwide have called for "exercise as medicine" . However, a randomized controlled trial has not observed improved overall survival among cancer patients with exercise. Because many studies of exercise in cancer are ongoing, this may change in the coming years.

Assess, advise and refer

The assess-advise-refer algorithm has two questions.

• First: "During the past week, did you perform physical activity that made your heart beat faster and your breathing harder than usual for 30 minutes or more?"
• Second: "During the past week, did you perform physical activity to improve muscle strength, such as lifting weights?"

Doctors then ask themselves: "Can this patient exercise safely without medical supervision?"

If so, the doctor should recommend moderate-intensity aerobic exercise three days a week for up to 30 minutes, and resistance exercise for 20 to 30 minutes twice a week.

Finally, if possible, the doctor should refer these patients to the "best available" program.

Challenges in implementing exercise include appropriate patient triage and referral capacity, the need for a program registry and costs.

Countries are at different stages of prescribing exercise. According to Schmitz, the greatest challenge in the USA is the fragile nature of cancer care. "Different medical records do not talk to one another. If they could, to triage patients appropriately and trigger reminders to include them in exercise programming, machine learning could be used," she said.

- Related topic: Exercise and the 14 Cancer Types Whose Risk It Is Proven to Reduce

In another study in 2017, Hayes and colleagues reported reduced mortality risk with exercise in an analysis of combined data from two randomized controlled trials of 8-month exercise programs among cancer patients.

The Australian team, following 237 women with cancer for an average of 8.3 years, reported 15 deaths (11.5%) in the usual-care group versus 11 deaths (5.3%) in the exercise group, a statistically significant difference. In an interview at the 2017 San Antonio Breast Cancer Symposium, Hayes said, "I struggled to publish these results," and complained that many publishers were not interested in the study.

Hayes emphasized that these findings were important and few in number; however, "If a drug could do this, people would be shouting," she also commented.

Schmitz acknowledged that enabling cancer patients to exercise requires a multifaceted solution. "None of us wants the oncologist to be the bad guy. They are overwhelmed. The oncologist does not need to talk more about this; we just need a better workforce and policy changes."

In conclusion, patients care about what their doctors say. If the oncologist does not mention exercise, the patient assumes remaining inactive is fine. Such programs require years of planning. But every oncologist can do two simple things right now to encourage cancer patients to exercise: ask and assess.