Cancer and Exercise: Using Fitness to Enhance Quality of Life
By Eric Durak, MSc.
Director of Fitness Therapy, ISSA

With over a decade's work in exercise with special populations, there are few health club-based post rehab programs that can claim the high rate of success of the Santa Barbara Athletic Club Cancer Well Fit Program. One of the primary reasons for the success of the program is simply that most cancer patients want to get better. They want to beat their disease, and live healthy lives. If exercise is part of the equation for improved health, then they will tackle it, even if they have no experience per se with exercise training. Secondly, fitness instructors feel that teaching exercise programs for cancer patients is part of the reason they trained in exercise science and fitness in the first place -- to affect change in someone else's lives.

A Historical Perspective

For those who have read published reports in cancer and clinical exercise, they are probably familiar with Winningham's work in aerobic exercise training with cancer patients.¹ Her WAIT (Winningham Aerobic Interval Training) scale is one of the first attempts to promote an interval-training concept with this population base. However, she concentrated on aerobic aspects of training, and used quasi-experimental protocols for her study designs. Since the end of the 1980's, there has been little sports medicine and/or public health research in physical exercise and cancer. It has only been in the late 1990's that more clinical studies have been published.^6,7

Resurgence of Quality of Life Research

In 1989 Dr. David Spiegal of Stanford University published one of the most striking studies in survivorship with metastatic breast cancer patients in the oncology/psychology worlds.² The investigators found that support group participants lived twice as long (36 months vs. 18) as non-support group patients. The finding supported behavioral treatment for cancer, and was one of the first in a series of studies investigating the effects of complimentary treatments in cancer patients that followed in the early 1990's.

Pinto looked at moderate walking programs and used over 5 behavioral outcomes assessments to show physical and psychological improvements in 40 patients.³ Segar et al. studied 29 breast cancer patients and administered a battery of quality of life assessments post exercise training. The authors concluded that exercise improves self-efficacy, self esteem, and mood status during and after chemotherapy.⁴

Epidemiology Research

The prospect of exercise and cancer has been strengthened by many epidemiology reports, especially a recent article by Thune,⁵ who concluded that lifetime physical activity may reduce the risk of acquiring breast cancer by over 30%. Although epidemiology research uses surveys to assess relative risk of disease, they sample thousands of patients, making for good statistical correlations. It is mostly through this research that the general public is becoming increasingly aware of the many benefits of regular exercise.

Clinical Studies

Recent reports from Germany are showing the striking power of exercise for cancer patients. Dimeo and colleagues reported that aerobic exercise can reduce fatigue in patients undergoing high dose chemotherapy,⁶ and that others also receiving autologous stem cell transplantation improve their aerobic capacity, hematocrit levels, and fatigue levels, also. However, Dimeo’s and Winningham's research concentrated on aerobic training alone. In 1994, a comprehensive exercise program began in a health club in California using a four component model of exercise: aerobics (on machines, or walking), strength training (progressive and specific in nature), range of motion, and mind/body fitness (breathing, meditation). The initial report was published in 1998 in the NSCA Journal of Strength and Conditioning Research.⁸ At the end of 10 weeks of exercise, strength improved by over 40%, time on aerobic machines improved by over 30%, and quality of life scores (pain, mood state, and coping) all were enhanced by over 29%. At two years, a follow-up survey was performed with breast, prostate, and other cancer survivors. The survey addressed quality of life issues, level of vigor, health care concerns, and exercise habits. Results indicated that, among other indexes, cancer patients who continued to exercise regularly over two years (the compliance rate was 69% total), level of vigor score was 92% (100% feeling absolutely healthy), compared to a sample of non-exercising controls, who scored just 60%. At two years for all groups surveyed (over 45 participants), there was one cancer recurrence, and one death. This confirms that patients with cancer should consider exercise as an important part of their overall treatment regimen.

Conclusions

A multi-component model of exercise produces changes in physical functioning and quality of life in persons diagnosed with cancer. Even aerobic training alone has produced some impressive changes in physiology and psychology as a result of brief exercise regimes. It should come as no surprise that the Federal Government is taking exercise seriously with the publication on the Surgeon General's Report on Physical Activity (July, 1996 and available from the Centers for Disease Control and Prevention in Atlanta, GA). In addition, this commitment can also be seen in the holding of a recent major summit which reviewed the relationship between physical activity and breast cancer.⁸ Exercise programs for cancer patients represent an unparalleled opportunity for qualified knowledgeable and certified clinical exercise physiologists and other health professionals to implement a program that is good for the community, good for patients, and has implications for research and improved relationships with medical professionals. The next few years will provide some much needed information on long term exercise, effects of strength vs. aerobics, and alternative medical programs (yoga, Pilates). These, along with other forms of exercise, will have a large impact on quality of life and survivorship of cancer patients - the two most important issues faced in by this special population today.