Skip To Navigation Skip to Content
Individuals & Caregivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregedivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregafgivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
 

NCHPAD - Building Healthy Inclusive Communities

Font Size:

A Review of the Literature on Cancer and Exercise


A review of the current literature reveals that there are few randomized, clinically controlled studies on the topic of exercise training in people with cancer (Pinto & Maruyama, 1999; Friendenriech & Courneya, 1996). Only eight randomized, controlled studies were found for this review. Winningham, MacVicar, and colleagues published the earliest studies on aerobic exercise training and cancer. These touchstone studies were performed on subjects with breast cancer who were undergoing chemotherapy during the time of the studies. Aerobic exercise in these studies was performed three times per week for 10 weeks, at 60% to 85% of the individual subject's maximal heart rate. The first publication from this group examined the effects of aerobic exercise training on nausea (Winningham and MacVicar, 1988). In this study, 42 female subjects were divided into an aerobic exercise-training group, a placebo group, and a control group. Measures of nausea, on the Derogatis Symptom Check List-90-Revised, were significantly lower in the exercise group as compared to either the placebo or the control groups (p < .05). Patients reported that feelings of nausea disappeared following a few minutes of aerobic exercise and that the nausea did not return for the rest of the day. This study supported aerobic exercise training as a method to use to manage nausea in women undergoing chemotherapy treatments for breast cancer.

The second study published by this group investigated the effects of aerobic exercise training on body weight and body composition (MacVicar, Winningham, and Nickel, 1989). Twenty-four female subjects were randomized to an exercise group or a control group. As is common in breast cancer, all the subjects gained weight. The exercise group gained 0.82 kg and the control group gained 1.99 kg. The weight gain for each group was not statistically different. However, skinfold measures at the end of the study revealed a significant difference between the exercise group and the control group (p < .05). The exercise group lost 3.19 mm of subcutaneous fat while the control group gained 9.6 mm. The skinfold measures suggested that there was a marked difference in lean body mass between the exercise and the control group. The exercise group gained 2.04 kg. of lean body mass and the control group lost 1.26 kg of lean body mass (F = 5.26, p = .033). This study supported aerobic exercise training during chemotherapy regimens as a method to maintain muscle tissue and limit fat weight gain in women with breast cancer.

The final study published by these investigators examined the effects of aerobic exercise training on functional capacity (Winningham, MacVicar et al., 1989). Forty-five subjects were randomized to an exercise group, a placebo/flexibility group, or a control group. The exercise group demonstrated significant improvements on VO2max in liters, in workload, and in test duration, compared to the control and the placebo groups (p < .05). The authors concluded that aerobic exercise training would improve the physical functions of women undergoing chemotherapy treatments for breast cancer. It was suggested that these improvements in physical function would enable people with cancer to have more energy and be more independent in self-care and activities of daily living. Enhanced energy might also limit feelings of fatigue from cancer and its treatments. The authors recommended further research to investigate the impact of this phenomenon in cancer patients. However, there were no additional controlled studies on this topic until 1995.

In 1995, Nieman and colleagues examined the effects of eight weeks of exercise on the immune function of females with a previous diagnosis of breast cancer. The people in this study had a previous diagnosis of breast cancer that averaged 3.0 to 1.2 years prior to the start of this study. Subjects were randomly assigned to an exercise or a control group. Six subjects completed the exercise-training regimen, and six subjects served as controls. The exercise group participated in 60 minutes of supervised aerobics and weight training, three times per week for eight weeks at 75% of their maximal heart rate. The results from this study were equivocal. Changes in circulating immune cells and Natural Killer Cell Activity (NKCA) were reported to be non-significant, even though the two parameters used for natural killer cytotoxic activity (NKCA) increased by 11.6% and 42.9% in the exercising group. The authors indicated that the limitations of their study included the small sample size and, possibly, insufficient training time. Additionally, the parametric statistical analysis chosen for this study had insufficient statistical power to detect a significant difference between the exercise and the control group, and the immune parameters did not appear to be similar for the exercise and the control group at the start of the study.

The six remaining studies on exercise and cancer were published between 1997 and 1999. In 1997, Mock and colleagues examined the effects of moderate-intensity aerobic exercise on physical function, fatigue, emotional distress, and sleep disturbances in subjects with breast cancer undergoing radiation therapy. Statistically significant differences (p < .05) were found between pre- and post-test values in the exercise group for fatigue, anxiety, and sleep disturbances, but not for depression. The authors found that moderate, self-paced walking exercise during the weeks of radiation treatment for breast cancer improved adaptive responses as demonstrated by improved physical function and lower reported levels of fatigue, anxiety, and sleep disturbances. The authors concluded that people undergoing radiation treatment for breast cancer would benefit from moderate-intensity aerobic exercise training to manage symptoms related to their treatment.

Segar and colleagues (1998) performed a study on the influence of moderate-intensity aerobic exercise training on psychological well-being in subjects with breast cancer. This study examined the influence of aerobic exercise on self-esteem, depression, and anxiety in 24 breast cancer survivors. Subjects were randomly assigned to an exercise group, an exercise group with behavior modification, and a control group. Self-paced aerobic exercise was performed for 30 to 40 minutes, four days per week for 10 weeks, at 60% of the subjects' predicted maximal heart rate. The results of this study indicated a significant difference between the two exercise groups and the control group on measures of state and trait anxiety, and depression, but not on self-esteem (p < .05). The authors in this study concluded that self-paced exercise training appears to be safe for subjects undergoing radiation treatment for breast cancer, and that aerobic training will improve symptoms of anxiety and depression in this population.

The remaining three studies on exercise training in subjects with cancer were performed at the Freiberg University Medical Center in Germany under the direction of Dr. Fernando Dimeo. All these studies were performed on subjects with various types of cancers who were concurrently undergoing high-dose chemotherapy. The first study published by this group was in 1997. Dimeo and colleagues performed a pilot study that examined the feasibility and effectiveness of aerobic exercise training in 16 patients undergoing high-dose chemotherapy and autologous peripheral stem cell transplantation. 32 subjects diagnosed with solid tumors or non-Hodgkin's lymphoma were assigned to either an exercise group or a control group. Subjects in the exercise group walked on a treadmill five days per week for six weeks at 85% of their predicted maximal heart rate. Subjects were kept at corresponding lactate concentration levels of 3 (0.5 mmol/L) during exercise. The variables examined in these subjects were physical function, cardiac function, fatigue, and hemoglobin concentrations. Following six weeks of training, hemoglobin concentrations and walking speed values for both groups improved. However, the exercise group's values were significantly statistically higher than those of the control group (p < .05). The conclusions from this study were that cancer patients recovering from high-dose chemotherapy should not be instructed to rest, but should increase physical activity to reduce their feelings of fatigue and improve their physical function.

The second study published by this group examined the effects of moderate-intensity aerobic exercise training on physical performance and on the number and severity of treatment-related complications (Dimeo, et al. 1997). 80 subjects with solid tumors undergoing high-dose chemotherapy were selected to participate in this study. Subjects were randomly assigned to a training group or a control group. Twenty-eight subjects completed the training and 32 subjects served as controls. All subjects were evaluated one week prior to hospitalization and again at discharge. Aerobic training was performed for 30 consecutive minutes daily on a supine cycle ergometer, at 50% of the subject's maximal heart rate, for approximately six weeks. At discharge, the exercise group had significantly higher maximal physical performance levels than the control group. The loss of physical performance in the control group was 27% greater than the loss in the exercise group (p < .05).

Treatment-related complications were markedly different for some of the variables between the exercise and the control groups. The duration of neutropenia, the severity of diarrhea, the severity of pain, and the duration of the hospitalization were significantly reduced in the exercise group as compared to the control group (p < .05). The authors concluded that low to moderate levels of aerobic exercise training could be safely performed by people during high-dose chemotherapy treatments to prevent physical performance declines and lessen the severity of some symptoms related to cancer and its treatments.

In the final study published by this group, Dimeo, et al. (1999) evaluated the effects of moderate-intensity aerobic exercise training on fatigue and psychological well-being in 59 subjects undergoing chemotherapy followed by autologous peripheral blood stem cell transplantation. Twenty-seven subjects participated in the exercise group and 32 subjects were in the control group. Subjects trained on a supine bicycle ergometer for 30 minutes daily at 50% of their cardiac reserve during their hospitalization. Psychological distress and fatigue were evaluated before and after the training regimen using the Profile of Mood States Test (POMS) and the Symptom Checklist 90. The results of this study showed that the exercise group had significantly decreased levels of fatigue and physical complaints compared to the control group (p < .01). The training group also had significant improvements in several values related to psychological distress (p < .05). The authors concluded that aerobic training during chemotherapy should be used to reduce fatigue and improve symptoms of psychological distress in subjects undergoing treatment for cancer.

A summary of the literature to date supports moderate levels of aerobic exercise training as an effective method for people with cancer to use in order to manage their disease, its symptoms, and symptoms related to its treatment. Aerobic exercise training has been used safely and effectively for various types of cancer and during different phases of the disease process. Aerobic exercise training can be safely used during chemotherapy and radiation treatments to relieve treatment-related symptoms of fatigue and nausea. Aerobic exercise can be used effectively to promote physical function that may enhance a person's ability to perform self-care, vocational, and social activities. Aerobic exercise has been found to improve psychological well-being and to relieve depression and anxiety. Aerobic exercise training is an effective rehabilitation method for the recovery of function following cancer treatment and during the remission phase. Aerobic exercise can also be used as a palliative measure to maintain function in the event that a person begins to fail. In light of the existing research support, aerobic exercise training should be an integral component in the lifestyle of people fighting through or recovering from cancer.


blog comments powered by Disqus