Exercise May Improve Quality of Life for Cancer Patients

Even during treatment, Lance Armstrong kept up his training.

During the fall and winter of 1996 and 1997, after surgery to remove a cancerous testicle, the world-class cyclist received chemotherapy. Between bouts of chemotherapy, even as he was losing muscle, he rode. After therapy, he rode some more.

Last July, a fully recovered Armstrong won the most prestigious event in cycling--the Tour de France.

And, although researchers can’t say whether Armstrong’s training during treatment helped him beat the disease, they do say studies increasingly indicate that physical activity can help cancer patients.

“Based on my expertise, what would I recommend if my mum was diagnosed with breast cancer? I would recommend exercise,” said Kerry S. Courneya, a researcher at the University of Alberta, Edmonton. The Canadian scientist’s review of 24 studies on exercise and cancer was published in Annals of Behavioral Medicine.

The studies have limitations, Courneya said. But, taken together, they indicate that staying active while cancer is in an early stage can help people retain quality of life and retard the loss of strength and endurance that accompanies the disease and its treatment.

“Cancer patients, even though they are on chemotherapy or during radiation, show many of the same types of fitness benefits that many of the regular population would show,” he said.

However, there are many forms of cancer, and the research does not cover all of them, so any conclusions must be limited to the types of cancers studied, Courneya cautioned. Most of the studies involved breast cancer.

The new research looks so promising that the American Cancer Society is revising its exercise recommendations, according to Colleen Doyle, director of nutrition and physical activity.

“It used to be there wasn’t anything out there, so we would tell people, ‘Conserve your energy,’ ” Doyle said.

But, although the research indicates exercise can be helpful, there still are people who should not do it, Doyle said. These include patients whose cancer has spread to the bone or who have lost bone density as a side effect of cancer treatment, she said.

Similarly, treatment may result in nerve damage that can make a person prone to falls, and certain medications can affect major organs in ways that limit activity, she said.

“We will certainly recommend that people talk to their health-care providers before they do anything,” Doyle said.

The studies were too varied, and the numbers of people involved in each were too small, for Courneya to estimate the size of the benefits. But the scope of the benefits ranged from increased flexibility to decreased fatigue, depression and anxiety, the review found.

Those quality of life issues are very important to cancer patients. Restoring himself to health was less than 10% physical, Armstrong told a congressional hearing recently. “The big part of it is the psychological factor,” he said.

Intense exercise isn’t necessary to achieve the benefits, Courneya said. Moderate activity like brisk walking is sufficient.

The way in which activity can improve the lives of cancer patients is not understood, Courneya said. However, moderate activity can improve immune functions that could help fight cancer.

And exercise can reduce estrogen levels, which could help breast cancer patients because estrogen is thought to promote tumor growth, he said. Breast cancer patients who are obese also have worse odds, and exercise can help people lose weight.

The field is too new to be able to tell if people who exercise will live longer than those who do not exercise, said Dr. Anne McTeirnan of the Fred Hutchinson Cancer Research Center in Seattle. However, the Fred Hutchinson center, USC and the University of New Mexico are setting up a study to follow 1,200 women with breast cancer, and activity is one of the factors that will be examined, she said.

Exercise can help cancer patients get more out of life, provided the amount and type of exercise is calibrated to the patient’s condition, said Pamela Massey, director of rehabilitation services at the M.D. Anderson Cancer Center in Houston.

Breast cancer patients who have had a mastectomy, for instance, might get a special focus on improving the strength and flexibility of their shoulder muscles, she said. A person with n advanced cancer might be encouraged to use a wheelchair, although not to the point of getting worn out, she said.