Physical Activity and Cancer Control

doi:10.1016/j.soncn.2007.08.002

Seminars in Oncology Nursing

Volume 23, Issue 4, November 2007, Pages 242-252

https://doi.org/10.1016/j.soncn.2007.08.002 Get rights and content

Objectives

To provide an overview and update of physical activity (PA) research across the entire cancer control continuum.

Data Sources

Previous cancer control frameworks and selected PA and cancer research that has been published over the past 5 years.

Conclusion

There have been major scientific advances in PA research across many, but not all, of the cancer control categories over the past 5 years.

Implications for Nursing Practice

Nurses should have a comprehensive understanding of the potential role of PA across the entire cancer control continuum.

Section snippets

A Framework for Physical Activity and Cancer Control

In 2001, we proposed a framework called Physical Exercise Across the Cancer Experience (PEACE) to help organize, focus, and stimulate research on PA and cancer control.³ At that time, our focus was primarily on the supportive care outcomes of PA (eg, physical functioning, quality of life [QOL]) with less attention to the clinical outcomes (ie, disease and treatment-related outcomes). In 2004, we adapted this framework to more explicitly highlight the clinical outcomes.⁴ Here, we present a

Physical Activity and Cancer Prevention

Physical activity may reduce the risk of developing a primary cancer. Cancer prevention remains the most studied and reviewed cancer control outcome. There are now over 250 studies that have examined PA and cancer prevention,⁶ and the general consensus is that PA is: (a) convincingly associated with the reduced risk of developing colon and breast cancers, (b) probably associated with the reduced risk of endometrial cancer, and (c) possibly associated with the reduced risk of prostate and lung

Physical Activity Cancer Detection

Physical activity may influence cancer detection in two distinct ways. First, acute and/or chronic PA may directly influence cancer detection by affecting the sensitivity and/or specificity of screening tests (eg, mammography, prostate specific antigen, fecal occult blood). Second, PA may indirectly affect cancer detection by facilitating adherence to cancer screening behaviors, thereby resulting in earlier detection. Research on the effects of PA on the sensitivity/specificity of cancer

Physical Activity and Treatment Preparation/Coping

Physical activity may influence treatment preparation/coping in several important ways including: (a) helping individuals cope with their disease physically and emotionally while awaiting treatments, (b) improving health/fitness sufficiently to allow difficult treatments to go forward (eg, lung surgery, cardiotoxic drugs), and (c) delaying the need for treatment by managing the disease and its symptoms. There is still very limited research examining PA for treatment preparation/coping. Jones et

Physical Activity and Treatment Effectiveness/Coping

Physical activity may influence treatment effectiveness/coping in several important ways including: (a) managing the treatment side effects and toxicities, maintaining physical functioning, preventing muscle loss and fat gain, and improving mood states and QOL, (b) facilitating the completion of difficult treatments, and/or (c) potentiating the efficacy of cancer treatments. PA and treatment effectiveness/coping has been an active area of research over the past 5 years that has been summarized

Physical Activity and Recovery/Rehabilitation

Physical activity may help cancer survivors expedite recovery from the acute effects of treatments. This cancer control category is important because over 50% of cancer survivors indicate a preference for beginning PA programs immediately or soon after treatments rather than during treatments.54, 55, 56, 57 Moreover, recent meta-analyses have observed that the effects of PA interventions may be larger in the survivorship time period compared with the treatment period,33, 34 although no direct

Physical Activity and Disease Prevention/Health Promotion

Physical activity may help cancer survivors: (a) optimize QOL and physical functioning, (b) manage the chronic and/or late-appearing effects of treatments (eg, fatigue, lymphedema, fat gain, bone loss), (c) reduce the likelihood of their cancer recurring, and (d) reduce the likelihood of developing other chronic diseases for which they may be at increased risk (eg, osteoporosis, heart disease, diabetes). PA and disease prevention/health promotion research may lend itself to a population-based

Physical Activity and Palliation

Physical activity may help cancer survivors manage symptoms, improve mobility, slow functional decline, and maintain QOL at the end of life. Research on PA and cancer palliation is still very limited, but recent preliminary research has reported promising results.72, 73, 74 Oldervoll et al73, 74 conducted a prospective phase II pilot study to examine the effects of structured PA on 34 advanced cancer survivors with clinician-estimated survival between 3 and 12 months. The trial reported that

Physical Activity and Survival

Physical activity may help cancer survivors live longer by: reducing the risk of cancer recurrence or slowing cancer progression and reducing the risk of other life-threatening diseases including second primary cancers. This cancer control category has received increased attention from PA researchers over the past 5 years. Some studies have examined post-diagnosis PA and cancer survival,75, 76, 77 while others have examined pre-diagnosis PA and cancer survival.78, 79, 80, 81 The results have

Physical Activity Behavior Change for Cancer Control

Physical activity and cancer control research will require supportive research in behavior change. PA behavior change research for cancer (disease) prevention has been pursued for many years, but PA behavior change research for cancer survivors is a more recent phenomenon that has increased significantly over the past 5 years.⁸² The general findings have shown low PA participation rates during and after treatments and some medical (eg, disease stage, type of treatments), demographic (eg, age,

Future Research Directions

This overview has highlighted many important scientific advances in PA and cancer control research over the past 5 years, but there are many unanswered questions that remain. To this end, we provide general suggestions for future research efforts under the eight cancer control categories highlighted in the PACC framework (Table 3). In addition to the recommendations for cancer control, we offer research directions for PA behavior change research. It will be useful to determine: (a) if primary

Conclusion

Physical activity and cancer control research has increased exponentially over the past 5 years. Significant progress has been made in many, but not all, of the cancer control categories. Research to date suggests that PA interventions may reduce the risk of developing some cancers, help cancer survivors cope with and recover from treatments, improve the health of long-term cancer survivors, and possibly even reduce the risk of recurrence and extend survival after a cancer diagnosis. Nurses

Kerry S. Courneya, PhD: Professor and Canada Research Chair in Physical Activity and Cancer, Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada.

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Cited by (167)

Physical activity for cancer prehabilitation: A scoping review
2024, Critical Reviews in Oncology/Hematology
This scoping review aims to synthesize the current landscape of physical activity in cancer prehabilitation and identify knowledge gaps. We searched MEDLINE, EMBASE, SCOPUS and WEB OF SCIENCE for exercise interventions and observational studies that measured exercise or physical activity before cancer treatment from inception to January 20, 2023. Fifty-one articles from 44 unique studies were reviewed, including 32 intervention and 12 observational studies. Surgery is the only treatment modality that has been investigated. Included studies used heterogeneous exercise interventions and measures for physical activity. Colorectal and other gastrointestinal, lung, and urologic cancers are the most studied cancer types. Exercise intervention in cancer prehabilitation is highly feasible. The evidence for improved fitness, functional, psychosocial, and clinical outcomes is promising yet limited. Although research has increased recently, prehabilitation exercise remains a relatively under-investigated area in oncology. We have provided research directions towards an ideal cancer prehabilitation design in the real-world setting.
Efficacy of a self-management program on quality of life in colorectal cancer patients: A randomized controlled trial
2023, European Journal of Oncology Nursing
To test the efficacy of a self-management program based on acceptance and commitment therapy on quality of life, emotional distress, fatigue, physical activity, and fruit and vegetable intake in patients with colorectal cancer.
The study was a randomized controlled trial. A sample of 156 patients with colorectal cancer (stage I–III) was recruited by convenience sampling and participants were allocated randomly assigned to control or intervention groups. The intervention included a colorectal cancer self-management information booklet, two personal skills training sessions, and 12 follow-up telephone calls. The control group received health education leaflets. Outcome variables were assessed in both groups at baseline and every two months thereafter during the six-month follow-up period.
The mean age of participants was 62 years (range: 30–89 years). Generalized estimation equations analyses revealed significant differences over time in changes in anxiety (β = −2.22, p = 0.001), depression (β = −1.48, p = 0.033), fatigue (β = 4.46, p = 0.001), physical and functional measures (β = 6.16, p = 0.005), and colorectal-cancer–specific quality of life (β = 7.45, p = 0.012). However, there were no significant differences in changes in physical activity or fruit and vegetable intake over time.
The self-management skills provided by oncology nurses, including symptom management, psychological adjustment, and relaxation exercises, help colorectal cancer patients to overcome the challenges of cancer survivorship, accelerate their recovery, and improve their quality of life.
NCT03853278 registered on ClinicalTrials.gov.
Physical activity and lung cancer: A synthesis of the literature
2023, Revue des Maladies Respiratoires
L’activité physique (AP) trouve toute sa place dans le continuum de soin, afin de limiter les altérations liées à la maladie et à ses traitements. Cette revue de la littérature collige les données probantes et actuelles relatives à l’AP réalisée aux différentes périodes de traitement pour cancer broncho-pulmonaire.
L’AP est sûre et faisable chez les patients atteints d’un cancer broncho-pulmonaire pendant leur traitement anti-cancéreux. L’efficacité de ces programmes multimodaux est démontrée sur les symptômes, la capacité à l’exercice, la capacité fonctionnelle, les complications post-opératoires, la durée de séjour hospitalier et la qualité de vie. Mais celle-ci reste néanmoins à confirmer dans de futures études, notamment sur le long terme.
L’utilisation de capteurs d’activité et de dépense énergétique ou de questionnaires d’AP pourrait être une aide pour augmenter le niveau d’AP des patients atteints d’un cancer broncho-pulmonaire pendant leur continuum de soin. Pour des patients en difficulté avec les modalités d’entraînement conventionnelles en raison d’un inconfort ou d’une limitation ventilatoire à l’exercice, il pourrait être judicieux de proposer l’entraînement intermittent à haute intensité ou l’entraînement en force des muscles respiratoires. La téléréhabilitation pourrait aussi être déployée pour cette population. Cibler des populations plus à risque de morbi-mortalité est également à investiguer.
Les équipes qui prennent en charge des patients atteints de cancer broncho-pulmonaire pendant ou après leur traitement anti-cancéreux doivent mettre en place des stratégies innovantes pour surpasser les difficultés d’accès aux programmes d’exercice ou d’adhésion, afin que l’AP fasse intégralement partie de la prise en soin de ces patients. Les masseur-kinésithérapeutes tiennent une place importante dans l’accompagnement de ces patients lors de leur évaluation ou de leur traitement.
Physical activity (PA) has its place in the continuum of care, the objective being to limit alterations associated with cancer and its treatments. This review of the literature collates the evidence and current data relating to PA carried out at different periods of treatment for lung cancer.
PA is safe and feasible in patients with lung cancer throughout their oncologic treatment. The efficacy of multimodal programs is demonstrated regarding symptoms, exercise capacity, functional capacity, postoperative complications, length of hospital stay and quality of life. Nevertheless, this result remains to be confirmed with more robust upcoming trial, notably in the long term.
Utilization of activity and energy expenditure sensors or PA questionnaires could help to increase the PA level of lung cancer patients during their continuum of care. For those not at ease with conventional training modalities, it may be judicious to offer intermittent high-intensity training or respiratory muscle strength training. Telerehabilitation could also be implemented. The targeting of populations at high risk should be investigated.
Teams caring for patients with lung cancer during or after their oncologic treatment should develop innovative strategies designed to overcome difficulties of access or adherence to exercise programs, so that the PA be an integral part of the care of these patients. Physical therapists play an important role in supporting these patients during their assessment or treatment.
From evidence to implementation of lifestyle behaviour in cancer prevention and control: A Preventive Medicine Golden Jubilee Commentary
2023, Preventive Medicine
Preventive interventions targeting tobacco, alcohol, healthy diets and physical activity are key strategies to tackle the most pressing health challenges in modern society. A major gap remains in how to translate research evidence into population-level behaviour change to reduce the disease burden. We use the case for the role of physical activity-related behaviour and cancer to illustrate the iterative, multidirectional, and transdisciplinary nature of translational research. The issues we address in this context are generalizable and applicable to other behavioral risk factors and non-communicable diseases. There is now solid evidence that physical activity reduces cancer risk and improves outcomes after cancer diagnosis. Here we provide a framework for how to implement this knowledge into real-world settings. We provide the rationale for combining systems, causal and design thinking to develop interventions that can be implemented for this type of behaviour change. The proposed model is iterative, multidirectional and transdisciplinary. We identify major knowledge gaps in epidemiology and science of behaviour change on physical activity and cancer control and propose approaches to suggest priorities for future research.
Physical Activity in Patients With Kidney Cancer: A Scoping Review
2022, Clinical Genitourinary Cancer
Citation Excerpt :
Whether a PA program before or shortly after surgery for KC is safe, feasible, and has any short- and/or long-term effects on renal function is unknown and an important topic for future research. The survivorship phase refers to the time between the end of primary treatment until the development of cancer recurrence or death,41 therefore, the most critical issues in this phase are supportive care outcomes (eg, physical and psychosocial adverse effects of cancer and its treatments) and disease outcomes (eg, disease-free survival and overall survival). To date, however, there are no high-quality cohort studies designed and powered to examine the association of PA with recurrence and survival in patients treated for KC.
Physical activity (PA) helps many cancer patients improve health-related fitness, treatment-related side effects, quality of life, and possibly survival; however, limited research has been conducted in patients with kidney cancer (KC). The aim of this scoping review focused on PA in patients with KC was to summarize current findings, delineate strengths and limitations, and provide key recommendations for future research. A scoping review was conducted and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines. The electronic databases of PubMed and Cochrane Library were screened for studies on October 14, 2021, and the search was updated on October 31, 2021. The data were abstracted and synthesized by study design. A total of 17 articles from nine independent studies were identified including 1 cross-sectional study (n = 8 articles), 1 randomized controlled trial (n = 2 articles) and 7 cohort studies (n = 7 articles). The cross-sectional study and randomized controlled trial reported on PA participation rates, preferences, social-cognitive correlates, and quality of life in patients with KC. The 7 cohort studies mostly reported on the risk of KC mortality in general population samples. Overall, no conclusions can be drawn from current research on the safety, feasibility, and efficacy (benefits and harms) of PA in patients with KC. Future research is urgently needed on PA in patients with KC, taking into account their unique disease- and treatment-related factors. This research is necessary to inform clinical exercise guidelines in this understudied cancer patient group.
The Effects of Exercise Prescription on Aerobic Performance and Quality of Life During the Course of Lymphoma Chemotherapy: Results of a Prospective Controlled Study
2022, Clinical Lymphoma, Myeloma and Leukemia
: This study is designed to investigate the physical, psychological and quality of life (QoL) effects of a 16 week supervised and structured intensive aerobic and strength training during the first line chemotherapy of lymphomas.
This pre-post study with two groups enrolled ≥18 years of age lymphoma patients scheduled for the first line chemotherapy. Eligible patients were assigned upon patients’ preference either to control group (Group C) involving simple counselling, or intervention group (Group I) involving supervised intensive training. Baseline, interim and final evaluations were performed per protocol. Repeated measures analysis of variance was used to investigate the effect of intervention.
The mean age of 47 enrolled patients was 44 [standard deviation (SD) ± 17] and 27 (57.4%) of them were male. Patients in Group C (n = 19) and Group I (n = 28) had similar baseline characteristics. T_max was significantly higher in Group I (P = .03) without a significant change during the study course (P = .98). Significant increases were observed in the power of some muscle groups, irrespective of the intervention type. The mean adherence rates were 83.0% (SD ± 22.0) and 54.0% (SD ± 23.0); the discontinuation rates were 10.7% (n = 3) and 42.9% (n = 12), at interim and final evaluations, respectively.
Both supervised and structured schemes and simple counselling, prevent further muscle wasting and lead to modest improvements in aerobic performance and muscle strength during lymphoma chemotherapy. These results do not translate into a significant improvement in QoL measures. Non-adherence and discontinuation are important issues to be solved.

View all citing articles on Scopus

Kerry S. Courneya, PhD: Professor and Canada Research Chair in Physical Activity and Cancer, Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada.

Christine M. Friedenreich, PhD: Leader, Population Health Research, Division of Population Health and Information, Alberta Cancer Board, Calgary, Alberta, Canada.

: Kerry S. Courneya is supported by the Canada Research Chairs Program. Christine M. Friedenreich is supported by a Health Scholar Award from the Alberta Heritage Foundation for Medical Research and a New Investigator Award from the Canadian Institutes of Health Research. Both authors are supported by a Research Team Grant from the National Cancer Institute of Canada with funds from the Canadian Cancer Society and the Sociobehavioral Cancer Research Network.

View full text

Physical Activity and Cancer Control

Objectives

Data Sources

Conclusion

Implications for Nursing Practice

Section snippets

A Framework for Physical Activity and Cancer Control

Physical Activity and Cancer Prevention

Physical Activity Cancer Detection

Physical Activity and Treatment Preparation/Coping

Physical Activity and Treatment Effectiveness/Coping

Physical Activity and Recovery/Rehabilitation

Physical Activity and Disease Prevention/Health Promotion

Physical Activity and Palliation

Physical Activity and Survival

Physical Activity Behavior Change for Cancer Control

Future Research Directions

Conclusion

J Nutr

Eur J Cancer

Gynecol Oncol

Gynecol Oncol

Critical Rev Oncol Hematol

Brain Behav Immun

J Pain Symptom Manage

Prev Med

American Cancer Society Guidelines on Nutrition and Physical Activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity

CA Cancer J Clin

Nutrition and physical activity during and after cancer treatment: an American Cancer Society guide for informed choices

CA Cancer J Clin

Framework PEACE: an organizational model for examining physical exercise across the cancer experience

Ann Behav Med

Physical activity in cancer survivors: implications for recurrence and mortality

Cancer Ther

From Cancer Patient to Cancer Survivor: Lost in Transition

Recreational physical activity and sedentary behavior in relation to ovarian cancer risk in a large cohort of US women

Am J Epidemiol

Association of energy intake and energy balance with postmenopausal breast cancer in the prostate, lung, colorectal, and ovarian cancer screening trial

Cancer Epidemiol Bimarkers Prev

Prospective study of physical activity in different periods of life and the risk of ovarian cancer

Int J Cancer

Physical activity and risk of ovarian cancer: results from the Netherlands Cohort Study (The Netherlands)

Cancer Causes Control

Obesity, high energy intake, lack of physical activity, and the risk of kidney cancer

Cancer Epidemiol Biomarkers Prev

Body mass index, physical activity, and risk of renal cell carcinoma

Int J Obesity

Relation of height, body mass, energy intake, and physical activity to risk of renal cell carcinoma: results from the Netherlands Cohort Study

Am J Epidemiol

Physical activity and renal cell cancer risk in a cohort of male smokers

Int J Cancer

Obesity, physical activity and the risk of pancreatic cancer in a large Japanese cohort

Int J Cancer

Body mass index and physical activity as risk factors for pancreatic cancer: the Multiethnic Cohort Study

Cancer Causes Control

Anthropometry, physical activity, and the risk of pancreatic cancer in the European prospective investigation into cancer and nutrition

Cancer Epidemiol Biomakers Prev

Lack of association of physical activity and obesity with incident pancreatic cancer in elderly women

Cancer Epidemiol Biomarks Prev

Obesity, recreational physical activity, and risk of pancreatic cancer in a large U.S. Cohort

Cancer Epidemiol Biomarkers Prev

A meta-analysis of the association of physical activity with reduced risk of colorectal cancer

Colorectal Dis

Leisure-time physical activity and lung cancer: a meta-analysis

Cancer Causes Control

Physical activity and breast cancer: a systematic review

Epidemiol

Physical activity and endometrial cancer risk: a review of the current evidence, biologic mechanisms and the quality of physical activity assessment methods

Cancer Causes Control

Molecular epidemiology of physical activity and cancer

Cancer Epidemiol Biomarkers Prev

Intervention studies in exercise and cancer prevention

Med Sci Sports Exer

Randomized controlled trials of physical activity and breast cancer prevention

Exer Sport Sci Rev

Lifestyle as a predictor for colonic neoplasia in asymptomatic individuals

BMC Gastroenterol

Recreational physical activity and risk of postmenopausal breast cancer based on hormone receptor status

Arch Intern Med

Association of physical activity with hormone receptor status: the Shanghai Breast Cancer Study