Dec 12 / Emily Spillman

Improving life outcomes for cancer patients with Exercise Medicine

As some of you know, I wear many hats and one of those hats is working for GenesisCare as a Personal Trainer. I wrote an article in Lift the Bar (an industry-leading magazine) to try and raise awareness of the benefits of exercise to other Personal Trainers so that if one of their clients, family or friends were diagnosed with cancer they could encourage exercise as part of their treatment and back it up with sound evidence. 
Here is the full article:

GenesisCare is the leading independent provider of cancer care in the UK and is pioneering proven, life-changing integrative oncology approaches such as exercise medicine and wellbeing therapies. I am Emily, a Personal Trainer based at GenesisCare in Bristol and I work alongside a Physiotherapist with years of experience working with cancer patients. With my background in nursing, I have cared for people with cancer in hospital and in the community, so together we make a good team and have a wealth of knowledge and understanding.

Patients at GenesisCare experience the latest innovative cancer treatments and are provided with world-class care. Exercise Medicine is proven to deliver improved outcomes for cancer patients, such as reduced fatigue, pain, depression, and a better quality of life compared to those who do not receive it. When prescribed alongside traditional medical treatment it can have a significantly positive outcome for patients. It can make some therapies work more effectively, speeding up recovery and helping to reduce the chance of the cancer returning.

All GenesisCare patients are prescribed a 12-week personalised programme that consists of 2 x 45 minute sessions per week in purpose-built gyms. It is a small-group model so patients can form social connections and motivate each other. GenesisCare has also partnered with charity Penny Brohn UK to integrate the ‘Bristol whole life approach’ and provides integrative cancer care with services such as counselling, relaxation and acupuncture.

Cancer Research UK has forecast that 1 in 2 people will be diagnosed with cancer in their lifetime (1). However, by adhering to a healthy lifestyle, we are more likely to survive our cancer (2). Research has found that people who are physically active after a diagnosis of prostate, colorectal, or breast cancer have a higher survival rate than people who are inactive suffering from the same cancer types (3). While observational studies have shown this correlation, emerging evidence from pre-clinical trials have sought to understand the mechanism of exercise on a tumour level and interestingly they have shown that when we contract our muscles, we release immune cells called myokines that can promote an anti-cancer environment via multiple pathways (4)(5).
  • ·Better blood perfusion of the tumour- meaning chemotherapy can get into the tumour more effectively.
  • ·Reduced hypoxia of the tumour- better radiotherapy response
  • ·Fat metabolism- reduced systemic inflammation and insulin resistance
  • ·Immune response- increasing immune cell memory, reducing tumour size and recurrence.
It is now recognised that inactivity should be avoided and people should be empowered to use their own endogenous “medicine” (6) to complement and enhance traditional medicine before, during and after treatment.

Before treatment
There is often a short timeframe between diagnosis and starting treatment, and this can be such a crucial time to promote healthy behaviours and increase resilience. Improvements can be seen in as little as two weeks (7).

Exercise Medicine can help to
  • reduce length of stay in hospital
  • ·improve cardiorespiratory fitness (e.g. for cardio-toxic drugs)
  • ·improve nutritional status
  • enhance recovery following treatment
  • reduce post-treatment complications
  • ·enhance quality of life (8)

During treatment
People with cancer are encouraged to participate in 150 minutes of aerobic exercise and 2 strength sessions of moderate to vigorous intensity a week (9)(10). The main benefits help to:

  • ·Reduce the side effects of chemotherapy and radiation such as fatigue.
  • ·Reduce lymphoedema (swelling in upper and lower limbs)
  • ·Reduce anxiety & depression
  • ·Maintain physical function
  • ·Reduce weight gain
  • ·Reduce muscle and bone loss (11)

After treatment
Cancer survivorship is improving all the time but due to the toxicity of cancer treatment or hormone deprivation therapy, this can leave people at risk of developing other secondary conditions such as heart disease, hypertension, diabetes, osteoporosis and early menopause (12). However, continuing to stay active after treatment can help reduce these risks as well as improve sexual health, bladder and bowel function, body image, sleep and psychosocial distress (13).
Even in advanced cancer and palliative phase, exercise has demonstrated improvement in symptoms, quality of life and life expectancy (14).

Undeniably, exercise is an incredibly powerful tool in the fight against cancer, but it should never be used as a replacement for traditional cancer treatment, only to optimise it! I feel incredibly proud to work as a Personal Trainer for a company that has integrated exercise and wellbeing into their standard care. I have used my experience from nursing and Lift the Bar to set up a virtual model during lockdown. This has been invaluable for patients, many of whom have chosen to continue to access the programme in this way particularly ones juggling busy lifestyles or those who live too far away from the centre. We are embracing the new hybrid model, it is convenient for patients and more people can benefit.

As personal trainers we are in a unique and powerful position to promote the positive benefits and reduce the burden of cancer and other diseases in the community. It is an incredibly rewarding field and a true example of how exercise is “medicine”, and such an important adjunct to the management of cancer. Many patients have reported that by following a personalised Exercise Medicine programme, they have experienced a physical and mental lift through their treatment. This has allowed them to take back control and have a more positive experience meaning they can live well with cancer.

References
(1) Tanday S. 1 in 2 people in the UK will get cancer [Internet] National Institute of Clinical Excellence; 2015 [Updated 4th Feb 2015, Cited 25th May 2020]. Available from: https://www.nice.org.uk/news/blog/1-in-2-people-will-get-cancer#
(2) Karavasiloglou N, Pestoni G, Wanner M, Faeh D, Rohrmann S. Healthy lifestyle is inversely associated with mortality in cancer survivors: Results from the Third National Health and Nutrition Examination Survey (NHANES III). PLoS One. 2019;14(6):e0218048. Published 2019 Jun 26. doi:10.1371/journal.pone.0218048
(3) Pedersen, BK. The physiology of optimizing health with a focus on exercise as medicine. Annu Rev Physiol. 2019; 81: 607- 627
(4) Kathleen A. Ashcraft, Allison Betof Warner, Lee W. Jones, Mark W. Dewhirst,
Exercise as Adjunct Therapy in Cancer, Seminars in Radiation Oncology, Volume 29, issue 1, 2019, Pages 16-24, ISSN 1053-4296,
https://doi.org/10.1016/j.semradonc.2018.10.001.
(5) Kim J, Galvao D A, Newton RU, Gray E, Taaffe D. Prostate cancer and myokines: potential effect of systemic alterations by exercise. Nature review urology. 2021; in press
(6) Newton R. Exercise as Medicine for Cancer Management [Internet] Exercise Medicine Research Institute; 2017 [Updated 2017, Cited 25th May 2021]. Available from:https://www.cancerwa.asn.au/resources/2017-04-04-Exercise-Medicine-Newton.pdf
(7) Faithfull S, Turner L, Poole K, et al. (2019) Prehabilitation for adults diagnosed with cancer: A systematic review of long‐term physical function, nutrition and patient‐reported outcomes. Eur J Cancer Care;e13023. https://doi.org/10.1111/ecc.13023.
(8) Macmillan Cancer Support. Prehabilitation for people with cancer. Macmillan Cancer Support; 2020. [Review due 30th November 2021, Cited 25th May 2021]. Available from: https://www.macmillan.org.uk/healthcare-professionals/news-and-resources/guides/principles-and-guidance-for-prehabilitation
(9) American College of Sports Science. Guidelines for Exercise & Cancer [Internet] American College of Sports Science; 2019. [Updated 25th November 2019, Cited 25th May 2021] Available from: https://www.acsm.org/blog-detail/acsm-certified-blog/2019/11/25/acsm-guidelines-exercise-cancer-download.
(10)    Hayes SC, Spence RR, Galvão DA, Newton RU. Australian Association for Exercise and Sport Science position stand: optimising cancer outcomes through exercise. Journal of Sci and Med in Sport, 2009; 12(4); Pages: 428-34.
(11)    Newton, R.U., Galvão, D.A. Exercise in Prevention and Management of Cancer. Curr. Treat. Options in Oncol. 9, 135–146, 2008. https://doi.org/10.1007/s11864-008-0065-1
(12)      Cancer.net. Long-Term effects of Cancer treatment [Internet] Cancer.net; 2019 [Updated Sept 2019: Cited 25th May 2021] Available from: https://bit.ly/3yEMwzs
(13)     Prue Cormie, Eva M Zopf, Xiaochen Zhang, Kathryn H Schmitz, The Impact of Exercise on Cancer Mortality, Recurrence, and Treatment-Related Adverse Effects, Epidemiologic Reviews, Volume 39, Issue 1, January 2017, Pages 71–92, https://doi.org/10.1093/epirev/mxx007
(14)     Eyigor S, Akdeniz S. Is exercise ignored in palliative cancer patients?. World J Clin Oncol. 2014;5(3):554-559. doi:10.5306/wjco.v5.i3.554
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