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CANCER AND EXERCISE

ABOUT CANCER
characterized as the uncontrolled proliferation of cells
not a single disease; highly variable because it can develop in any type of cell and involve any organ
system
can be:
- benign: cells multiply but do not invade other tissues
- grow but does do much.
- malignant: cells invade local tissues or migrate to other parts of the body (metastasis)
- matastisist matastisize = end up in tisues they didnt originate in.
other types depend on cells of origin
- carcinomas: from endothelial cells (forming the lining of organs)
- sarcomas: from connective tissues bones and muscles
- lymphomas: form in tissues responsible for immune functions
- leukemias: originate in cells that form white blood cells

in 2007 cancer passed CV disease as most frequent cause of mortality /morbidity in Canada

RISK FACTORS
specific to types
smoking
poor diet
inactivity (has surpassed all others as the most common risk)
genetics = ppl can get this through genetics
**carcinogens too little attention, but a growing controversy to treat or prevent? - limited research
funds compared to treatment funding. (pervasive role of drug companies is a growing policy
controversy)
often a trigger; exist in low levels in society; not enough info for it
paid attention to treating it, not preventing.
GENERAL EFFECTS
for the disease itself - depends on type and stage
localized disease - often no compromise of lifestyle until advanced stages
some systemic forms and forms with pain which may alter lifestyle immediately
TREATMENTS
considerable therapeutic advances in recent years:
- early detection
- new treatments
5 year survival rates now exceed 60% for all cancers; more patients living with cancer as a chronic
disease
traditional oncology treatment regimens:
- chemotherapy
- surgery can be a prolonged process (3 yrs +)
- radiation
more recently, structured exercise programs added
significant deconditioning effects recognized
due to prolonged bed rest or reduced activity

Surgery effects
- local and central effects leading to decreased strength, endurance, ROM, decline in other organ functions
(i.e. lung cancer lobe removal compromised pulmonary function)
Chemotherapy effects
- fatigue nausea vomiting insomnia weight gain anemia
- agents not always specific: tissue destruction can be systemic with side effects
Radiation effects
- fatigue
- tissue scar formation in treated area
- also can have long lasting damage to other adjacent tissues
General effects of treatment and the disease
- generalized fatigue is the most common complaint among patients and survivors
- limits activity
- potential long term health effects of deconditioning leads to secondary health issues - low aerobic
fitness, fat gain and loss of lean mass ending with all the usual associated diseases
- complete recovery requires reconditioning as part of extended treatment
EXERCISE TESTING
- protocols and comprehensive test batteries have been developed to assess oncology patients at all stages
- very complex based on individual disease and varied treatment protocols - changes in all areas of
physical fitness are monitored - (body composition, aerobic fitness, strength, and muscular endurance,
flexibility) (and also quality of life psychological data)
- provides important clinical information
prior to treatment
- to establish functional baseline
- to identify other diseases which may alter treatment
- to help track side effects of treatment
- the many effects of the treatments and exercise interactions are not well studied:
o radiotherapy for lung cancer causes fibrosis exercise effects on whether this is transient or
permanent are unclear
o radiotherapy for breast cancer often results in shoulder adhesive capsulitis; will exercise prevent
of alter this?
during active treatment
- to allow individualized treatments including exercise prescriptions
post treatment / recovery phase
- to track reconditioning and the exercise program
- to assess patients abilities to do specific tasks including daily living and work related (especially in
demanding physical jobs where safety is a concerns
Precautions and contraindications to testing:
- patients with good prognosis and cancer survivors are tested regularly
- maximal tests are not advised with:
- metastatic cancer
- in advanced disease

- until blood counts are acceptable


testing of patients in palliative care is rare

EXERCISE PRESCRIPTION
guidelines and protocols for monitoring are in development
a challenging, complex area of exercise research
efficacy of exercise prescription for patients undergoing treated for, or recovering from cancer not well
studied
current literature difficult to interpret due to
- methodological issues and variations (i.e., self reports of exercise, incomplete data (no records of
intensity etc), small sample sizes, no control groups etc)
- variations in the status of subjects (i.e., type of cancer, stage of treatment, training regimen
variations

Trends
aerobic exercise for patients with good prognosis produces:
- improved quality of life
- less fatigue (not more)
- improved functional capacity
- fewer hospital days
- reduced bowel disturbances (diarrhea, etc
- less pain
- better body composition
- higher hemoglobin levels

little research about resistance training; but very preliminary evidence shows:
- reduced cachexia (muscle wasting)
- strength retention
- restoration of losses after treatment

clinical concerns have been expressed about:


- cumulative fatigue of treatment and exercise
- immunosuppression after exercise
- heart failure risks following chemotherapy (heart may be compromised by the toxicity of the
meds)
- fracture of bones weakened by treatments disease or inactivity
research underway to answer these concerns
exercise can be tolerated and leads to positive physical and emotional responses without exacerbating pain,
nausea or fatigue
exercise has become a part of cancer treatment and will be prescribed increasingly over the next years.

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