Exercise is Medicine

In order to be a Survivor-Thriver and significantly reduce risk of recurrence, cancer patients must be encouraged to develop a life-long habit of regular exercise with clear guidelines, measurable goals and behaviors and coaching support if necessary to successfully integrate a new habit. Exercise has the potential to reduce all cause mortality in cancer survivors by 25%.

According to investigator, Lee W. Jones, PhD, of Memorial Sloan Kettering Cancer Center in New York City, in a study involving 11,480 survivors, with 16 year median follow up, patients who followed exercise guidelines enjoyed a 25% reduced risk of all-cause mortality compared with patients who did no exercise (HR 0.75, 95% CI 0.70-0.80).   [1]

Additionally, patients who followed exercise guidelines also showed a significant reduction in cancer mortality (HR 0.79, 95% CI 0.72-0.88), as well as mortality from other causes (HR 0.72, 95% CI 0.66-0.78).[1]

Exercise was associated with a reduction in all cause mortality (for breast, endometrial, head and neck, hematopoietic, prostate, and renal cancers), cancer-specific mortality (for head and neck, and renal cancers), and other cause mortality (for breast, colon, endometrial, hematopoietic, and prostate cancers).

In patients who adopt an active lifestyle and follow exercise guidelines, the benefits may last for two decades after diagnosis.  [2]  Meeting versus not meeting the exercise guidelines was associated with a 25% reduced risk of all-cause mortality, a 21% reduced risk of cancer mortality, and a 28% reduced risk of death from other causes. [2]  

“Compared with no exercise, there were statistically significant reductions in cancer-specific mortality among those exercising below the exercise guidelines and larger reductions for those meeting and exceeding the guidelines, 19%, 25%, and 33% reductions, respectively, which demonstrates that all levels of exercise are beneficial.” [2]

“The American Cancer Society guidelines recommend that physical activity assessment and counseling begin as soon as possible after diagnosis, to help patients prepare, tolerate, and respond to treatments, and manage symptoms and treatment side effects.” [3]

Exercise Guidelines in the study included moderate-intensity exercise 4 or more days per week, with each session, on average, 30 or more minutes in duration and/or strenuous-intensity exercise 2 or more days per week, with each session, on average, 20 or more minutes in duration.

On the very first patient visit I talk about the value and importance of exercise and include an exercise prescription in every patient’s care plan from day one.   I ask patients to accumulate 60 minutes of movement activity daily.  They can start with 10 or 15 minute sessions until they build up more fitness, strength and stamina.  

Unfortunately, only 38% of cancer patients in the study were classified as “exercisers”.    Some cancer patients think, mistakenly, that they should rest and convalesce and that exercise may do harm.  On the contrary, patients undergoing all types of treatments and those in remission and in recovery benefit from some type of appropriate movement.  Of course, each patient should be assessed individually and given appropriate guidelines, training and supervision.   Using apps that track activity can increase interest and compliance.

The reality is that the awareness of the positive impact of exercise is very low among cancer patients and cancer survivors.  Exercise is truly one of the “big levers”, a source of significant impact upon the health, well-being, mood, sleep, bone density, muscle mass, prognosis, quality of life and SURVIVAL of cancer patients.  

I envision all cancer treatment centers having an exercise room at their facility!!!

I propose a new specialty “Exercise Oncology”!  

The OutSmart Cancer System is a HEALTH MODEL.  Every patient receives exercise guidelines, support and coaching to develop and sustain lifestyle and self care habits that create a body where cancer cannot thrive.

Selected References

1. Jessica Lavery, Lee Jones et al
   Pan-Cancer Analysis of Postdiagnosis Exercise and Mortality
   DOI: 10.1200/JCO.23.00058 Journal of Clinical Oncology  PMID: 37651670
   
   
2.  Stacey Kentfield, June Chan
   Meeting Exercise Recommendations Is Beneficial for Cancer Survivors
   DOI: 10.1200/JCO.23.01528 Journal of Clinical Oncology
   Published online September 20, 2023. PMID: 37729601
   
   
3. Rock CL, Thomson CA, Sullivan KR, et al:
   American Cancer Society nutrition and physical activity guideline for cancer survivors.
   CA Cancer  J Clin 72:230-262, 2022