Anna L. Schwartz, FNP, PhD

Physical activity is one of the most important things people of all ages and abilities can do to reduce their risks of several cancers and improve health during and after cancer treatment. Exercise has been strongly associated with both preventing cancer and lowering the risk of recurrence and death from the disease. In fact, a direct causal effect of exercise on cancer outcomes is currently being tested in several controlled trials.

In 2018, the American College of Sports Medicine (ACSM) reviewed thousands of research studies on exercise for cancer prevention and updated its exercise guidelines for cancer survivors. And this year, the American Cancer Society released updated recommendations that mirror parts of the ACSM guidelines.

Exercise is an important part of any effort to prevent an initial diagnosis or the recurrence of cancer. The benefits of physical activity are clear:

Is associated with a lower risk of developing seven types of cancer (colon, breast, kidney, endometrium, bladder, stomach and esophageal).

Is linked to Improved survival before and after breast, colorectal or prostate cancer diagnoses.

Reduces risk of recurrence of breast, colon and prostate cancers by 20% to 40%.

Counteracts inactivity and prolonged sitting, both of which may increase the risk of certain cancers, such as endometrial, lung and colon.

So, what should a good preventive exercise routine look like? Recommendations for cancer prevention and general health and to reduce the risk of cancer recurrence include the following:

Engage in moderate-intensity aerobic exercise such as walking, biking, jogging or dancing for 150 to 300 minutes per week. This is agreed upon by both ACSM and the American Cancer Society.

Perform strength-training exercises two days per week, focusing on the large muscle groups (arms, legs, chest, back and stomach). Do 12 to 15 repetitions of each.

Exercise is safe during and after cancer treatment, and there are specific guidelines for cancer survivors who want to improve their quality of life. In general, walking, bicycling, dancing or any enjoyable activity that keeps the body moving and gets the heart rate up is good.

Because many people have never exercised or don’t enjoy it, the ACSM guidelines for cancer survivors focus on the least amount of movement necessary to see significant reductions in anxiety, depression and fatigue and improvements in physical functioning and quality of life. The guidelines are based on carefully conducted studies and in many ways resemble the recommendations for cancer prevention. They are as follows:

Avoid inactivity. This is emphasized by both the ACSM and the American Cancer Society.

Engage in aerobic exercise at least three days a week for a total of 90 minutes, with the goal of building up to 

150 to 300 minutes. This can consist of walking, cycling, swimming, jogging, dancing or any enjoyable activity that increases the heart rate and causes faster breathing.

Perform resistance exercises at least two days a week using body weight, resistance bands, dumbbells or fitness equipment, focusing on large muscle groups. Increase the resistance or weight slowly over time, and perform at least three exercises each for upper and lower body strength.

It’s important for survivors to know that exercise is the best way to treat cancer-related fatigue because as strength and fitness improve, it becomes easier to do activities that are meaningful and important. Exercise also improves sleep and bone health. Fortunately, those who have breast cancer-related lymphedema can do both aerobic and resistance exercise without making the condition worse.

Beginning an exercise program when you don’t feel well is difficult. The first hurdle is learning to pace yourself. Exercising beyond your ability (for too long a time period or at too high an intensity) makes movement unpleasant. When it comes to aerobic exercise, start slowly and gradually build up time and intensity. The same is true for strengthening exercises. Start with light weights and gradually increase the load. Pushing too hard and feeling sore and exhausted are the most common reasons people stop a new exercise program. Be kind to your body. With some time and effort, you will feel the difference as your fatigue improves and you get stronger.

Launched by ACSM, Moving Through Cancer (tinyurl.com/y3b9qrru) is an initiative with the goal
of educating health care professionals and ensuring that all cancer survivors are engaged in an appropriate exercise or rehabilitation program. This includes a registry of cancer exercise programs worldwide, including both live and web-based programs such as Livestrong at the YMCA, Macmillan Move More and phone apps such as Cancer Exercise (annaschwartzphd. com/cancer-exercise-app/).

Also consider including a family member in exercise activities. Research shows physical and emotional health benefits for both cancer survivors and their exercise partners.

The biggest takeaway — for all survivors and their families — is simply this: Move more and sit less.

Anna L. Schwartz, Ph.D., FNP-BC, FAAN, is a professor and associate director of research at Northern Arizona University School of Nursing and an oncology nurse practitioner. A pioneer in exercise oncology research, she was co-author of the American College of Sports Medicine cancer exercise guidelines and is a member of the organization’s Moving Through Cancer task force charged with implementing the exercise recommendations into clinical practice. She is also a member of CURE®’s advisory board.

Articles

Exercise may help prevent cancer or its recurrence and improve quality of life for survivors of the disease.

Exercise May Help Prevent Cancer or its Recurrence

Cancer is a diagnosis that often stops us in our tracks as we are blanketed with fear and uncertainty. There’s so much information, advice and pressure to make critical decisions that will affect health and long-term outcomes. This stress nearly paralyzes some and makes doing the simplest tasks overwhelming.

Once in treatment, life seems more manageable, and a routine quickly ensues. But did anyone ever stop to talk to you about physical activity and exercise? Why not? Everyone tells you to “take care of yourself” and “get some rest,” and of course there are all those pills to take, but what about taking care of the whole body and not just the disease? 

Exercise is one of the most important things you can do for yourself during and many years after treatment. So, why doesn’t the healthcare community talk to patients about this? Is it really a lack of time? Or lack of interest? Or awareness? Whatever the reason, all cancer survivors, whether actively receiving treatment or many years following treatment, should be told to exercise and given specific instructions, or referred to an exercise rehabilitation program to learn how to exercise around their physical limitations.

Scientific studies with cancer survivors during and after treatment consistently show many benefits of exercise — on heart and lung function, muscle strength, balance, fatigue, depression and quality of life. In fact, exercise is the best intervention for cancer-related fatigue. In my studies many people have told me they are “too tired to exercise,” but once they muster the strength to get up and move around, they are amazed at how much better they feel both physically and emotionally. Exercise might not only help prevent many types of cancer, but it also has been associated with a reduced risk of recurrence, and an improved survival rate, for many cancers.

So, why is exercise being kept a secret from patients and survivors? Exercise as simple as walking around the house or block can make you feel better physically and emotionally. On some level, as we strengthen our bodies, our minds and spirits heal, too. 

Take a positive step forward in your survivorship and start exercising. Begin slowly, well below the level of activity that you think you can do. Our brains always think we are superhuman, but bodies that have been resting need time to become strong and fit again. If you aren’t sure where to start or what to do, or have lingering problems from treatment, such as lymphedema or numbness in your hands and feet, ask your physician for a referral to a cancer rehabilitation program or a physical therapist who can guide you to start an exercise program safely. 

Let’s be frank: Many of you find exercise completely unappealing and would prefer to sit and watch TV or work at your computers. But, if you start slowly and don’t push yourself to the point of exhaustion and pain, then exercise won’t be unpleasant. Find a friend or take your dog and head out the door for a short walk. The distance doesn’t matter, and if you only walk to the corner and back, that’s OK. It’s the first step in moving forward to a healthier survivorship. 

Goals help keep you motivated and give you a reason to get up and move. Set short-term, very achievable goals and maybe even set a long-term goal of walking in a cancer charity event. It’s amazing the power and energy you will feel walking and being with other survivors. That energy will carry you forward to continue your commitment to physical activity. 

There’s no question that it’s hard to change your lifestyle from being sedentary to being active, but if you stick with exercise for even 10 or 12 weeks, you will see impressive changes in your body, mind and spirit that will buoy you in your quest to being the healthiest survivor you can be. Getting through cancer takes determination, courage and will that gives you the inner strength to take the steps to live a healthy, physically active life. When you’re physically and mentally strong you can live a full and meaningful life, and isn’t that what we all want for ourselves and our loved ones?  

Anna L. Schwartz, FNP, PhD, is the author of 

Cancer Fitness: Exercise Programs for Patients and Survivors

Did anyone ever stop to talk to you about physical activity and excersise?

Anna L. Schwartz, FNP, PhD

Exercise May Help Prevent Cancer or its Recurrence

Let's Get Moving!

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