Moving More
Also known by these names
- Exercise
- Fitness
- Movement
- Physical Activity
|
Moving your body reduces the risk of cancer and in promotes health after a diagnosis, as noted by the American Cancer Society and several medical groups in their clinical practice guidelines.
Key Points
- Movement can take many forms.
- Finding an activity that is fun will increase both motivation and enjoyment.
- At least 30 minutes of moderate physical activity every day lowers risks for endometrial, postmenopausal breast and colorectal cancers. More activity may be associated with even more benefits.
- Vigorous exercise in short bursts several times a day is also beneficial.
- BCCT is interested in moving more because it may reduce the level of physical function decline, increase survival, enhance tolerance to cancer treatments, and reduce sleep disruption and depression associated with cancer and treatments.
- Moving more is generally beneficial, but some health conditions warrant caution.
- Moving more is beneficial across all cancer types.
- Practices to reduce risk of injury are advised.
|
Movement includes many activities, such as these:
- Walking or hiking
- Participation in active sports such as tennis, soccer or basketball
- A workout at a gym
- Recreational activities such as dancing, bicycling, swimming, skiing or martial arts
- Group aerobic activities such as Zumba
- Active gardening, yard work or housework
- Movement therapies such as yoga, qigong and tai chi.
Finding an activity that is fun will increase both your motivation and your enjoyment.
Finding an activity that is fun will increase both your motivation and your enjoyment. Movement can also be combined with social activities, increasing the potential for fun and also strengthening your connections to family and friends.
Frequent movement can help counteract the health risks of prolonged sitting. The American Institute for Cancer Research encourages people to break up long periods of sitting with frequent activity breaks. A large analysis of data from the Cancer Prevention Study-II Nutrition Cohort found that, among low to moderately active adults, replacing sitting with light physical activity was associated with a reduction in cancer mortality, all-cause mortality and cardiovascular disease mortality.
Anticancer Lifestyle Program
Using expert videos, animation, text and interactives, the Fitness Module of the Anticancer Lifestyle Program explains the connection between fitness and health, providing some tools you need to develop a regular fitness routine.
This course is offered on a “pay-what-you-can” basis for 90-day access to all course modules.
|
Read more
At least a moderate-intensity activity such as brisk walking or climbing stairs is needed for benefit. Moderate-intensity activity increases your heart rate and breathing rate somewhat and should cause you to perspire. Vigorous activity causes your heart rate and breathing rate to increase significantly to the point that you find it difficult to hold a conversation. Resistance training such as weightlifting is also beneficial a couple of days a week.
The US Department of Health and Human Services (HHS) issues Physical Activity Guidelines for Americans. The 2008 guidelines (the most recent available), include these findings and recommendations:
- For most health outcomes, additional benefits occur as the amount of physical activity increases through higher intensity, greater frequency, and/or longer duration.
- Most health benefits occur with at least 150 minutes (2 hours and 30 minutes) a week of moderate intensity physical activity, such as brisk walking.
- Both aerobic (endurance) and muscle-strengthening (resistance) physical activity are beneficial.
- The benefits of physical activity far outweigh the possibility of adverse outcomes.
Patients may achieve higher fitness levels in a supervised program compared to a self-directed program.
Movement and Cancer Treatment
American Cancer Society’s Nutrition and Physical Activity Guidelines for Cancer Survivors
Achieve and maintain a healthy weight.
Read more
- If overweight or obese, limit consumption of high‐calorie foods and beverages and increase physical activity to promote weight loss.
Engage in regular physical activity.
Read more
- Avoid inactivity and return to normal daily activities as soon as possible following diagnosis.
- Aim to exercise at least 150 minutes per week.
- Include strength training exercises at least two days per week.
- Follow the American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention (following).
American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention
Achieve and maintain a healthy weight throughout life.
Read more
- Be as lean as possible throughout life without being underweight.
- Avoid excess weight gain at all ages. For those who are overweight or obese, losing even a small amount of weight has health benefits and is a good place to start.
- Get regular physical activity and limit intake of high-calorie foods and drinks as keys to help maintain a healthy weight.
Be physically active.
Read more
- Adults: Get at least 150 minutes of moderate intensity or 75 minutes of vigorous intensity activity each week (or a combination of these), preferably spread throughout the week.
- Children and teens: Get at least 1 hour of moderate or vigorous intensity activity each day, with vigorous activity on at least 3 days each week.
- Limit sedentary behavior such as sitting, lying down, watching TV, and other forms of screen-based entertainment.
- Doing some physical activity above usual activities, no matter what one’s level of activity, can have many health benefits.
|
Cancer patients may need to adjust movement types and levels during or after treatments such as surgery, chemotherapy or radiation. Following your doctor’s advice is important, but even within restrictions most patients can increase their level of activity and receive benefit. The American Cancer Society’s (ACS) Nutrition and Physical Activity Guidelines for Cancer Survivors that “the goal should be to be active as much as possible.”
Read more
Even modest amounts of increased activity show benefit. A 2014 study of cancer survivors at least 65 years old found that increasing light-intensity activities such as light housekeeping, light gardening and leisurely walking may slow the decline of physical function.
Benefits of resistance training include improvement in muscle strength and endurance, improvements in functional status, and maintenance or improvement in bone density.
The American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Survivors (2012) state: “Persons receiving chemotherapy and/or radiation therapy who are already on an exercise program may need to exercise at a lower intensity and/or for a shorter duration during their treatment, but the principal goal should be to maintain activity as much as possible.” A 2019 study found that scheduling exercise to accommodate cyclical variations in fatigue due to chemotherapy may increase adherence to supervised exercise. Medicine & Science in Sports & Exercise. 2019 Sep 4.
Recent research is investigating how moving more may interact with cancer treatments, but no definitive conclusions can be drawn yet.
Clinical Practice Guidelines
2009 evidence-based clinical practice guidelines for integrative oncology recommend referral to a qualified exercise specialist for guidelines on physical activity to promote basic health.”
Clinicians should assess individual and community-level barriers to meeting the healthy lifestyle recommendations and support patients in developing strategies to overcome challenges.
The 2018 American Institute for Cancer Research guidelines for physical activity found strong evidence that being physically active decreases these risks:
In addition, vigorous physical activity decreases the risk of both pre- and postmenopausal breast cancer.
Read more
The American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Survivors (2012) recommend “after treatment, a program of regular physical activity is essential to aid in the process of recovery and improve fitness." Guidelines include these specifics:
- Engage in regular physical activity.
- Avoid inactivity and return to normal daily activities as soon as possible following diagnosis.
- Aim to exercise at least 150 minutes per week.
- Include strength training exercises at least 2 days per week.
A roundtable convened by American College of Sports Medicine concluded that "exercise training is safe during and after cancer treatments and results in improvements in physical functioning, quality of life, and cancer-related fatigue in several cancer survivor groups." Further, the American College of Sports Medicine's Exercise Is Medicine initiative proposes that clinicians assess, advise and refer patients to either home‐based or community‐based exercise or for further evaluation and intervention in outpatient rehabilitation.
2013 evidence-based clinical practice guidelines from the American College of Chest Physicians suggests supervised exercise-based pulmonary rehabilitation to improve cardiorespiratory fitness and functional capacity for lung cancer patients.
The 2018 Clinical Oncology Society of Australia guidelines include these recommendations:
- Exercise to be embedded as part of standard practice in cancer care and to be viewed as an adjunct therapy that helps counteract the adverse effects of cancer and its treatment
- All members of the multidisciplinary cancer team to promote physical activity and recommend that people with cancer adhere to exercise guidelines
- Best practice cancer care to include referral to an accredited exercise physiologist or physiotherapist with experience in cancer care
The 2017 National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology (NCCN Guidelines®) on Survivorship include these recommendations:
- Develop a plan for regular physical activity and healthy nutrition as part of management and treatment of anxiety, depression and distress.
- Recommend routine physical activity as part of cancer-associated cognitive dysfunction interventions.
- Exercise/physical activity is one of the nonpharmacologic treatments recommended for vasomotor symptoms (such as hot flashes/night sweats) disruptive to quality of life and for pain/myalgias.
- Regular physical activity in the morning and/or afternoon (but not within three hours of bedtime) is recommended for sleep disorders.
- For general healthy lifestyles, engage daily in general physical activity to include exercise, daily routine activities, and recreational activities. Avoid sitting for long periods.
- Clinicians should assess individual and community-level barriers to meeting the healthy lifestyle recommendations and support patients in developing strategies to overcome challenges.
- A risk assessment for physical activity-induced adverse events is recommended.
- Resistance training of all major muscle groups is recommended for 20 minutes two or three times a week each session.
The American Institute for Cancer Research includes this in their cancer prevention recommendations:
Scientists recommend that we aim for a minimum of 150 minutes of moderate, or 75 minutes of vigorous, physical activity a week. For cancer prevention and weight control, higher levels of activity provide even more benefit. Work toward achieving 45 to 60 minutes moderate-intensity physical activity daily. Going beyond 60 minutes daily provides additional health benefits.
Treating the Cancer
At least a moderate-intensity activity such as brisk walking or climbing stairs is needed for benefit.
Working against cancer growth or spread, improving survival, or working with other treatments or therapies to improve their anticancer action
A 2017 review of evidence came to these conclusions:
- A growing evidence base indicate that physical activity has potential value at all stages of cancer care.
- Preliminary evidence associates regular physical activity after a cancer diagnosis with longer survival and lower risk of recurrence or disease progression.
- Preliminary evidence suggests that following an exercise program before treatment (prehabilitation) leads to increased cardiorespiratory fitness, fewer post-operative complications and shorter hospital admissions.
A 2018 review looked at data from more than 5800 patients with one of eight specific tumors: breast, colon, prostate, ovarian, bladder, endometrial, esophageal, and skin cancer (mostly melanoma). The results:
In comparison to patients who were habitually inactive, habitually active patients experienced a 39% decreased hazard of all-cause mortality and a 36% decreased hazard of cancer-specific mortality. Previously inactive patients who began exercising after diagnosis experienced a 28% decreased hazard of all-cause and cancer-specific mortality in comparison to patients who remained inactive. Patients engaging in 3–4 sessions/week experienced the greatest survival advantages, but 1–2 sessions/week also yielded significant survival advantages in comparison to inactivity.
A large prospective cohort study found that maintaining higher leisure-time physical activity levels (at least two to seven hours per week) and increasing such activity in later adulthood were associated with comparable low risks of cancer mortality. The authors conclude that midlife is not too late to start physical activity.
Improving Muscle Mass and Density
Both diet (protein intake) and physical activity contribute to increased muscle mass, with some evidence that physical activity is especially important for women. Muscle density improves when fat embedded in muscle fibers is reduced. Aerobic activity, such as moderate to vigorous walking, dancing, swimming or cycling, can improve muscle density.
|
More muscle mass and greater muscle density are highly associated with improved survival in hospitalized patients with advanced cancer.
Breast Cancer
Read more
From The Ecology of Breast Cancer:
Most but not all studies show that women who regularly exercise after breast cancer treatment experience reduced all-cause and breast-cancer specific mortality compared to sedentary women over follow-up periods averaging four to eight years. In many studies, higher levels of physical activity or exercise before diagnosis are also associated with improved survival after diagnosis and treatment.
As quoted in the same book, a 2010 review and meta-analysis found moderate effects of post-treatment physical activity interventions on measures of hormone and immune parameters.
A review of studies involving more than 35,000 cancer survivors concluded that physical activity after a diagnosis of cancer is associated with a lower risk of "cancer-specific mortality in survivors of several common cancers", including breast.
An investigation of the After Breast Cancer Pooling Project found that very low physical activity was associated with a 22 percent increased risk of breast cancer mortality. Another analysis from the same project found that engaging in at least 10 MET-hours per week of physical activity was associated with a 27 percent reduction in all-cause mortality and a 25 percent reduction in breast cancer mortality compared with women who were less active. Ten MET-hours per week is represented by any one of these activities:
- 3½ hours of housecleaning
- 3 hours of brisk walking
- 2¼ hours of dancing
- 1 to 1½ hours bicycling 10-16 mph
A clinical trial of an exercise intervention in breast cancer patients found good evidence of cardiovascular benefit: "Our findings strongly support that tailored exercise training during adjuvant breast cancer treatment may counteract a decline in cardiovascular function, and in particular among those receiving chemotherapy."
See Breast Cancer.
Colorectal Cancer
Read more
- A 2018 study of almost 1000 colorectal cancer survivors found a 42 percent reduction in death at five years for those who followed the ACS guidelines most closely compared to those who followed them least.
- In early-stage colorectal cancer patients, low muscle density was significantly associated with higher overall mortality and worse disease-free survival.
- A review of studies involving more than 35,000 cancer survivors concluded that physical activity after a diagnosis of cancer is associated with a lower risk of "cancer-specific mortality in survivors of several common cancers", including colorectal.
See Colorectal Cancer.
Lymphoma
Read more
An observational study of more than 4000 lymphoma patients found that those with a higher level of physical activity throughout their adult lives and after diagnosis had better overall and lymphoma-specific survival during three years of follow-up. A reduction in activity level after diagnosis was associated with worse outcomes.
See Lymphoma.
Prostate Cancer
Read more
A 2017 review of physical activity and prostate cancer found that, “in general, benefit showed a dose-response relationship", meaning that more activity produced more benefit. Vigorous activity is needed for the maximum effect. The study authors also noted "several recent observational studies have indicated that physical activity is beneficial in preventing disease recurrence and improving survival following the diagnosis and treatment of prostate cancer.”
A review of studies involving more than 35,000 cancer survivors concluded that physical activity after a diagnosis of cancer is associated with a lower risk of "cancer-specific mortality in survivors of several common cancers", including prostate.
See Prostate Cancer
Managing Side Effects and Promoting Wellness
Managing or relieving side effects or symptoms, reducing treatment toxicity, supporting quality of life or promoting general well-being
Physical activity interventions improve quality of life and other patient-reported outcomes during and after cancer therapy.
Reviews of research support the role of moving more in quality of life:
- "Physical activity interventions improve quality of life and other patient-reported outcomes during and after cancer therapy."
- “Cancer survivors who exercise can potentially benefit from reduced levels of fatigue, and improved quality of life, physical function, and body composition.”
- A large prospective study of breast cancer patients enrolled in the Women's Health Initiative found that increasing levels of exercise before diagnosis was associated with a significant graded reduction in subsequent cardiovascular events in long-term survivors of primary breast cancer.
- Greater muscle density is associated with lower patient symptoms (including anxiety and depression) and reduced health care use.
Movement has also been shown to reduce these symptoms and side effects of cancer and treatment:
A 2010 review and meta-analysis found these effects of physical activity interventions with cancer survivors:
- A large effect on upper and lower body strength after treatment
- Moderate effects on fatigue
- A small to moderate positive effect for physical activity level, aerobic fitness, muscular strength, functional quality of life, anxiety and self-esteem
- With few exceptions, exercise was well tolerated during and post treatment without adverse events.
Read more
A study in Canada found that exercise improved patients' chemotherapy completion rate without causing lymphedema or significant adverse events. A 2012 study found that women with early stage breast cancer who were more active consistently reported lower levels of depression and increased quality of life five years after the intervention compared to those who were less active. A 2019 review concluded that Nordic walking—performed with walking poles similar to ski poles—had a significant and positive impact on a number of breast cancer symptoms including lymphedema, physical fitness, disability and morbid perceptions.
An American College of Sports Medicine roundtable on exercise guidelines for cancer survivors “concluded that exercise training is safe during and after cancer treatments and results in improvements in physical functioning, quality of life, and cancer-related fatigue in several cancer survivor groups.”
A 2017 review found these effects of physical activity on cancer patients: “Exercise is beneficial before, during, and after cancer treatment, across all cancer types, and for a variety of cancer-related impairments. Moderate-to-vigorous exercise is the best level of exercise intensity to improve physical function and mitigate cancer-related impairments. Therapeutic exercises are beneficial to manage treatment side effects, may enhance tolerance to cancer treatments, and improve functional outcomes. Supervised exercise yielded superior benefits versus unsupervised. Serious adverse events were not common.” A separate study also found better results for muscle strength and physical fatigue with a supervised high-intensity program compared to a home-based physical activity program.
Another 2017 review of evidence came to these conclusions:
- Preliminary evidence suggests that following an exercise program before treatment (prehabilitation) leads
to increased cardiorespiratory fitness, fewer post-operative complications and shorter hospital admissions.
- Stronger evidence demonstrates that exercising while undergoing cancer treatment helps to preserve cardiorespiratory and muscular fitness, and to control cancer-related fatigue.
- Similarly, promising evidence indicates that after completion of treatment, undertaking an exercise program leads to increased cardiorespiratory and muscular fitness, reduced fatigue and improved body composition and well-being.
- For patients under palliative care, preliminary evidence suggests that exercise is feasible and may help maintain physical function, control fatigue and improve bone health.
Reducing Risk
Reducing the risk of developing cancer or the risk of recurrence
ACS Recommendations
The American Cancer Society makes these recommendations to reduce cancer risk:
- Be physically active.
- Adults should engage in 150‐300 minutes of moderate‐intensity physical activity per week, or 75‐150 minutes of vigorous‐intensity physical activity, or an equivalent combination; achieving or exceeding the upper limit of 300 minutes is optimal. Children and adolescents should engage in at least 1 hour of moderate‐ or vigorous‐intensity activity each day.
- Limit sedentary behavior such as sitting, lying down, watching television and other forms of screen‐based entertainment.
|
A large 2019 analysis found that engaging in 7.5 to 15 MET-hours per week (see above) was associated with a lower risk of seven of the 15 cancer types studied, including colon (in men), breast, endometrial, kidney, myeloma, liver and non-Hodgkin lymphoma (in women). Other research has found that getting more than 30 minutes of moderate physical activity every day lowers risks for endometrial, postmenopausal breast and colorectal cancers. Vigorous physical activity is associated with reduced risk of premenopausal breast cancer.. Greater cardiorespiratory fitness reduces risk of lung cancer in male former smokers and risk of cancer mortality in current smokers.
Physical activity helps to lower cancer risk in several ways:
- Regular activity helps keep hormone levels healthy and reduce the contribution of high hormone levels to cancer risk.
- Being active may strengthen the immune system.
- Activity helps speed potentially harmful substances through the intestinal tract.
- Staying physically active can help manage body weight and the contribution of body fat to increased risk for many types of cancer.
Physical activity after a diagnosis of cancer is associated with a lower risk of cancer recurrence in survivors of several common cancers.
Read more
From The Ecology of Breast Cancer:
In 1989, scientists from the National Cancer Institute examined the relationship between self-reported physical activity and cancer in the first NHANES cohort, originally assembled from 1971 to 1975, designed to represent
They reported an increased risk of various kinds of cancer among inactive individuals compared to very active people (80 percent increased risk for men and 30 percent increased risk for women), even after correcting for smoking and BMI. The association was strongest for colorectal and lung cancer in men, and post-menopausal breast and cervical cancer in women.
A 2017 review of physical activity and prostate cancer found that, “in general, benefit showed a dose-response relationship", meaning that more activity produced more benefit. Vigorous activity is needed for the maximum effect. The study authors also noted "several recent observational studies have indicated that physical activity is beneficial in preventing disease recurrence and improving survival following the diagnosis and treatment of prostate cancer.”
Another review of studies involving more than 35,000 cancer survivors concluded that "physical activity after a diagnosis of cancer is associated with a lower risk of cancer recurrence" in survivors of several common cancers, including breast, colorectal, and prostate cancers.
A 2017 review of evidence came to these conclusions:
- A growing evidence base indicate that physical activity has potential value at all stages of cancer care.
- Preliminary evidence associates regular physical activity after a cancer diagnosis with lower risk of recurrence or disease progression.
Optimizing Your Terrain
Inactive women with newly diagnosed breast cancer were enrolled in an exercise intervention for about a month after diagnosis and until undergoing surgery. Compared to women participating in a mind-body intervention control group, those exercising demonstrated significant upregulation of 18 unique pathways, including several implicated in immunity and inflammation.
A study with mice found that voluntary exercise accelerated muscle repair in old mice and improved old muscle stem cells function related to rejuvenation.
Cautions
What's the Difference between Exercise and Physical Activity?
According to Ted Schettler in The Ecology of Breast Cancer: "Exercise is a form of physical activity that is usually planned, structured, and done to improve some aspect of fitness such as strength, flexibility, or aerobic endurance. Exercise also improves general health, well-being, and overall quality of life. Physical activity includes activity that is part of daily life. Household, workplace, and lifestyle physical activity are most common."
Both types of movement provide benefits.
|
Moving more is generally well tolerated by patients. However, some health conditions such as heart conditions or deep vein thrombosis may cause exercise to be a problem. Avoid exercise during bouts of vomiting, nausea and diarrhea. Patients may be advised not to exercise on days of chemotherapy treatments or for 24 hours afterward. All patients are encouraged to seek the advice of their healthcare provider before undertaking a new or increased exercise routine.
Physical activity involves the risk of injury. Building strength and balance as exercise is gradually increased, paying attention to proper technique, and other precautions are recommended.
A 2017 review of evidence noted a few cautions:
- Avoid high-intensity activities when immunosuppressed, or when experiencing pain, severe fatigue, or compromised bone health.
- Avoid activities requiring balance when frail or experiencing dizziness or peripheral sensory neuropathy.
- Anyone with a stoma should start with low resistance exercise and progress slowly to avoid herniation.
Integrative Programs, Protocols and Medical Systems
Highlighted Video
Brian Bouch discusses integrative oncology, part 1
Read more
Integrative physician and BCCT advisor Brian Bouch, MD, retired several years ago from an integrative medicine practice in Sonoma, California. After he received a difficult cancer diagnosis, he developed a specialty in integrative oncology. Dr. Bouch was the first medical director of Commonweal. In the following three videos, he talks with Michael Lerner about how he developed his practice, used certain therapies and how he worked with people with cancer.
Bold text indicates topics related to moving more.
- 2:48-10:04 Dr Bouch’s experience with a cancer diagnosis:
- malignant growth in his neck
- primary cancer unknown, 5 years later source known
- ENT oncologist recommended surgery and radical lymph-node dissection
- embarked on is own program detox (Optimal Health Center)
- diet and exercise
- talked with Renneker, Block, Broffman, McKee
- Contact provided with MD Anderson with latest research recommending 80% with his type of cancer do well with chemo and radiation
- 11:45-12:50 How his cancer experience has changed him:
- importance of exercise (qigong, yoga, vegan diet, Zen Buddhism)
- respect for spirituality and how to bring it to our daily lives
- 15:00-26:00 Michael & Brian discuss Integrative Cancer therapies:
- importance of the 7 pillars of health promotion
- creating a healthier person who may be living with cancer, extending their life, or improving their life
- more information on the etiologic factors: genomes (what we are born with with) and epigenetic factors that influence our genes
- measuring the toxic load is one part of functional medicine
- 26:46-32:32 What is happening in our bodies: toxicity
- functional medicine looks at microbiome, leaky gut, mercury, lead and cadmium
- urine and stool sample can provide information on toxicity
- hydrocarbons
- biotoxins (such as from mold) can impact autoimmune system
- 35:00-41:19 Detox before and after chemo
- body/mind retreat
- all raw vegan diet, paleo, ketogenic diet
- exercise 150 min/week; heart rate for person in their 70s would be 116 bpm
- spiritual practice
- tai chi
- qigong
- Buddhist meditation
- sauna
|
- Programs and protocols
- Traditional systems
Non-cancer Uses of Moving More
Physical activity is used for these conditions and purposes:
- Obesity and overweight
- Heart disease
- Type 2 diabetes and metabolic syndrome
- Mental health and mood improvement
- Increase strength and prevent falls
- Increased longevity and quality of life
See also:
BCCT has not reviewed the effectiveness of moving more for non-cancer uses.
|
Written by Nancy Hepp, MS, and Laura Pole, RN, MSN, OCNS; most recent update on September 14, 2020. Note: This summary draws from the American Institute for Cancer Research and other sources as noted. BCCT is grateful to Ted Schettler, MD, MPH, for his review and comments on this page.
- Matthews B. Making Exercise Fun Again. Gene Smart. Viewed December 18, 2017.
- American Institute for Cancer Research. 2018 Physical Activity Guidelines Advisory Committee Scientific Report. February 2018. Viewed August 6, 2018.
- Rees-Punia E, Evans EM et al. Mortality risk reductions for replacing sedentary time with physical activities. American Journal of Preventive Medicine. 2019 May;56(5):736-741.
- Health Hub. Types of Physical Activities. November 23, 2015. Viewed December 18, 2017.
- Office of Disease Prevention and Health Promotion. Physical Activity Guidelines for Americans. US Department of Health and Human Services. January 2, 2018. Viewed January 2, 2018.
- Westphal T, Rinnerthaler G et al. Supervised versus autonomous exercise training in breast cancer patients: a multicenter randomized clinical trial. Cancer Medicine. 2018 Dec;7(12):5962-5972.
- American Cancer Society’s (ACS) Nutrition and Physical Activity Guidelines for Cancer Survivors. Viewed April 26, 2019.
- Rock CL, Doyle C et al. Nutrition and physical activity guidelines for cancer survivors. CA: A Cancer Journal for Clinicians. 2012 Jul-Aug;62(4):243-74.
- Blair CK, Morey MC et al. Light-intensity activity attenuates functional decline in older cancer survivors. Medicine and Science in Sports and Exercise. 2014 Jul;46(7):1375-83.
- Denlinger CS, Sanft T et al. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®): Survivorship. National Comprehensive Cancer Network. July 28, 2017. Viewed January 2, 2018; Brown JC, Ligibel JA. The role of physical activity in oncology care. Journal of the National Cancer Institute. Monographs. 2017 Nov 1;2017(52); Schwartz AL, Winters-Stone K, Gallucci B. Exercise effects on bone mineral density in women with breast cancer receiving adjuvant chemotherapy. Oncology Nursing Forum. 2007 May;34(3):627-33.
- Rock CL, Doyle C et al. Nutrition and physical activity guidelines for cancer survivors. CA: A Cancer Journal for Clinicians. 2012 Jul-Aug;62(4):243-74.
- Kirkham AA, Bland KA et al. "Chemotherapy-periodized" exercise to accommodate for cyclical variation in fatigue.
- Betof Warner A, Jones L. Exercise modulation of anticancer therapeutic tolerability and efficacy. ASCO Daily News. April 11, 2019. Viewed June 10, 2019.
- Deng GE, Frenkel M et al. Evidence-based clinical practice guidelines for integrative oncology: complementary therapies and botanicals. Journal of the Society for Integrative Oncology. 2009 Summer;7(3):85-120.
- World Cancer Research Fund, American Institute for Cancer Research. Physical activity and the risk of cancer. 2018. Viewed August 6, 2018.
- Rock CL, Doyle C et al. Nutrition and physical activity guidelines for cancer survivors. CA: A Cancer Journal for Clinicians. 2012 Jul-Aug;62(4):243-74.
- Schmitz KH, Courneya KS et al. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Medicine and Science in Sports and Exercise. 2010 Jul;42(7):1409-26.
- Schmitz KH, Campbell AM et al. Exercise is medicine in oncology: Engaging clinicians to help patients move through cancer. CA: A Cancer Journal for Clinicians. 2019 Oct 16.
- Deng GE, Rausch SM et al. Complementary therapies and integrative medicine in lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013 May;143(5 Suppl):e420S-e436S.
- Cormie P, Atkinson M et al. Clinical Oncology Society of Australia position statement on exercise in cancer care. Medical Journal of Australia. 2018 May 7.
- Denlinger CS, Sanft T et al. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®): Survivorship. National Comprehensive Cancer Network. July 28, 2017. Viewed January 2, 2018.
- American Institute for Cancer Research. Cancer Prevention Recommendations. From World Cancer Research Fund/American Institute for Cancer Research. Diet, Nutrition, Physical Activity and Cancer: A global Perspective.Continuous Update Project Expert Report 2018. Viewed April 24, 2019.
- Stevinson C, Campbell A, Cavill N, Foster J. Physical activity and cancer: a concise evidence review. Macmillan Cancer Support. 2017.
- Cannioto RA, Dighe S et al. Habitual recreational physical activity is associated with significantly improved survival in cancer patients: evidence from the Roswell Park Data Bank and BioRepository. Cancer Causes Control. 2018 Nov 28. doi: 10.1007/s10552-018-1101-5.
- Saint-Maurice PF , Coughlan D et al. Association of leisure-time physical activity across the adult life course with all-cause and cause-specific mortality. JAMA Network Open. 2019 Mar 1;2(3):e190355.
- Alexandrov NV, Eelderink C et al. Dietary protein sources and muscle mass over the life course: the Lifelines Cohort study. Nutrients. 2018;10(10):1471.
- Myers B. How to increase muscle density. Livestrong. July 19, 2019. Viewed June 1, 2020.
- Boldt A. List of aerobic workouts. November 20, 2017. Viewed June 1, 2020.
- Dalton M. Low muscle density associated with symptoms, health care use, and survival in advanced cancer. ASCO Daily News. May 29, 2020. Viewed June 1, 2020; Azoba CC, Van Seventer EE et al. Relationships among skeletal muscle, symptom burden, health care use, and survival in hospitalized patients with advanced cancer. 2020 ASCO Virtual Scientific Program.
- Schettler T. The Ecology of Breast Cancer: The Promise of Prevention and the Hope for Healing. 2013. Science and Environmental Health Network and the Collaborative on Health and the Environment. p. 73.
- Speck R, Courneya K, Masse L, Duval S, Schmitz K. An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. Journal of Cancer Survivorship. 2010 Jun; 4(2):87-100.
- Brown JC, Ligibel JA. The role of physical activity in oncology care. Journal of the National Cancer Institute. Monographs. 2017 Nov 1;2017(52).
- Nelson SH, Marinac CR et al. Impact of very low physical activity, BMI, and comorbidities on mortality among breast cancer survivors. Breast Cancer Research and Treatment. 2016 Feb;155(3):551-7.
- Beasley JM, Kwan ML Meeting the physical activity guidelines and survival after breast cancer: findings from the after breast cancer pooling project. Breast Cancer Research and Treatment. 2012 Jan;131(2):637-43.
- Harvard Women's Health Watch. MET-hour equivalents of various physical activities. Harvard Health Publishing. December 2009. Viewed February 27, 2019.
- Thune I, Husøy A et al. Cardiovascular function and the effect of exercise training during adjuvant breast cancer treatment. Results from The EBBA-II trial. Presentation at the San Antonio Breast Cancer Symposium (SABCS) 2018. December 7, 2018.
- Van Blarigan EL, Fuchs CS et al. Association of survival with adherence to the American Cancer Society Nutrition and Physical Activity Guidelines for Cancer Survivors after colon cancer diagnosis: The CALGB 89803/Alliance Trial.
- JAMA Oncology. 2018 Apr 12.
- van Baar H, Beijer S et al. Low radiographic muscle density is associated with lower overall and disease-free survival in early-stage colorectal cancer patients. Journal of Cancer Research and Clinical Oncology. 2018;144(11):2139‐2147.
- Brown JC, Ligibel JA. The role of physical activity in oncology care. Journal of the National Cancer Institute. Monographs. 2017 Nov 1;2017(52).
- Pophali P, Larson MC et al. The level of physical activity before and after lymphoma diagnosis impacts overall and lymphoma-specific survival. Presented at the American Society of Hematology 59th Annual Meeting & Exposition. December 11, 2017.
- Shephard RJ. Physical activity and prostate cancer: an updated review. Sports Medicine. 2017 Jun;47(6):1055-1073.
- Brown JC, Ligibel JA. The role of physical activity in oncology care. Journal of the National Cancer Institute. Monographs. 2017 Nov 1;2017(52).
- Brown JC, Ligibel JA. The role of physical activity in oncology care. Journal of the National Cancer Institute. Monographs. 2017 Nov 1;2017(52).
- Schwartz AL, de Heer HD, Bea JW. Initiating exercise interventions to promote wellness in cancer patients and survivors. Oncology (Williston Park). 2017 Oct 15;31(10):711-7.
- Okwuosa TM, Ray RM et al. Pre-diagnosis exercise and cardiovascular events in primary breast cancer. Journal of the American College of Cardiology: CardioOncology. 2019 Sep, 1 (1) 41-50.
- Dalton M. Low muscle density associated with symptoms, health care use, and survival in advanced cancer. ASCO Daily News.
- May 29, 2020. Viewed June 1, 2020; Azoba CC, Van Seventer EE et al. Relationships among skeletal muscle, symptom burden, health care use, and survival in hospitalized patients with advanced cancer. 2020 ASCO Virtual Scientific Program.
- Driver HS, Taylor SR. Exercise and sleep. Sleep Medicine Reviews. 2000 Aug;4(4):387-402; Rubio-Arias JÁ, Marín-Cascales E et al. Effect of exercise on sleep quality and insomnia in middle-aged women: a systematic review and meta-analysis of randomized controlled trials. Maturitas. 2017 Jun;100:49-56; Smagula SF, Stone KL, Fabio A, Cauley JA. Risk factors for sleep disturbances in older adults: evidence from prospective studies. Sleep Medicine Reviews. 2016 Feb;25:21-30; Wu WW, Kwong E, Lan XY, Jiang XY. The effect of a meditative movement intervention on quality of sleep in the elderly: a systematic review and meta-analysis. Journal of Alternative and Complementary Medicine. 2015 Sep;21(9):509-19; American Institute for Cancer Research. 2018 Physical Activity Guidelines Advisory Committee Scientific Report. February 2018. Viewed August 6, 2018; Courneya KS, Segal RJ et al. Effects of exercise dose and type on sleep quality in breast cancer patients receiving chemotherapy: a multicenter randomized trial. Breast Cancer Research and Treatment. 2014 Apr;144(2):361-9.
- Pérez-López FR, Martínez-Domínguez SJ et al. Effects of programmed exercise on depressive symptoms in midlife and older women: a meta-analysis of randomized controlled trials. Maturitas. 2017 Dec;106:38-47; Phillips C. Brain-derived neurotrophic factor, depression, and physical activity: making the neuroplastic connection. Neural Plasticity. 2017;2017:7260130; Wu PL, Lee M, Huang TT. Effectiveness of physical activity on patients with depression and Parkinson's disease: a systematic review. PLoS One. 2017 Jul 27;12(7):e0181515; Brown JC, Ligibel JA. The role of physical activity in oncology care. Journal of the National Cancer Institute. Monographs. 2017 Nov 1;2017(52); Courneya KS, McKenzie DC et al. A multicenter randomized trial of the effects of exercise dose and type on psychosocial distress in breast cancer patients undergoing chemotherapy. Cancer Epidemiology, Biomarkers & Prevention. 2014 May;23(5):857-64.
- Mochcovitch MD, Deslandes AC, Freire RC, Garcia RF, Nardi AE. The effects of regular physical activity on anxiety symptoms in healthy older adults: a systematic review. Revista Brasileira de Psiquiatria. 2016 Jul-Sep;38(3):255-61; Stubbs B, Vancampfort D et al. An examination of the anxiolytic effects of exercise for people with anxiety and stress-related disorders: a meta-analysis. Psychiatry Research. 2017 Mar;249:102-108; Brown JC, Ligibel JA. The role of physical activity in oncology care. Journal of the National Cancer Institute. Monographs. 2017 Nov 1;2017(52); Courneya KS, Segal RJ et al. Six-month follow-up of patient-rated outcomes in a randomized controlled trial of exercise training during breast cancer chemotherapy. Cancer Epidemiology, Biomarkers & Prevention. 2007 Dec;16(12):2572-8.
- Brown JC, Ligibel JA. The role of physical activity in oncology care. Journal of the National Cancer Institute. Monographs. 2017 Nov 1;2017(52); Meneses-Echávez JF, González-Jiménez E, Ramírez-Vélez R. Effects of supervised exercise on cancer-related fatigue in breast cancer survivors: a systematic review and meta-analysis. BMC Cancer. 2015 Feb 21;15:77; Hilfiker R, Meichtry A et al. Exercise and other non-pharmaceutical interventions for cancer-related fatigue in patients during or after cancer treatment: a systematic review incorporating an indirect-comparisons meta-analysis. British Journal of Sports Medicine. 2018;52(10):651-658.
- Speck R, Courneya K, Masse L, Duval S, Schmitz K. An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. Journal of Cancer Survivorship. 2010 Jun; 4(2):87-100.
- Courneya KS, Segal RJ et al. Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. Journal of Clinical Oncology. 2007 Oct 1;25(28):4396-404.
- Mutrie N, Campbell A, Barry S, Hefferon K, et al. Five-year follow-up of participants in a randomized controlled trial showing benefits from exercise for breast cancer survivors during adjuvant treatment. Are there lasting effects? Journal of Cancer Survivorship. 2012; Jul 27.
- Sánchez-Lastra MA, Torres J, Martínez-Lemos I, Ayán C. Nordic walking for women with breast cancer: a systematic review. European Journal of Cancer Care (Engl). 2019 Aug 6:e13130.
- Schmitz KH, Courneya KS et al. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Medicine and Science in Sports and Exercise. 2010 Jul;42(7):1409-26.
- Stout NL, Baima J, Swisher AK, Winters-Stone KM, Welsh J. A systematic review of exercise systematic reviews in the cancer literature (2005-2017). PM & R. 2017 Sep;9(9S2):S347-S384.
- van Waart H, Stuiver MM et al. Effect of low-intensity physical activity and moderate- to high-intensity physical exercise during adjuvant chemotherapy on physical fitness, fatigue, and chemotherapy completion rates: results of the PACES randomized clinical trial. Journal of Clinical Oncology. 2015 Jun 10;33(17):1918-27.
- Stevinson C, Campbell A, Cavill N, Foster J. Physical activity and cancer: a concise evidence review. Macmillan Cancer Support. 2017.
- Rock CL, Thomson C et al. American Cancer Society guideline for diet and physical activity for cancer prevention. CA: A Cancer Journal for Clinicians. 2020;10.3322/caac.21591.
- Matthews CE, Moore SC et al. Amount and intensity of leisure-time physical activity and lower cancer risk. Journal of Clinical Oncology. 2019 Dec 26:JCO1902407.
- World Cancer Research Fund, American Institute for Cancer Research. Physical activity and the risk of cancer. 2018. Viewed August 6, 2018; Al Ajmi K, Lophatananon A, Mekli K, Ollier W, Muir KR. Association of nongenetic factors with breast cancer risk in genetically predisposed groups of women in the UK Biobank Cohort. JAMA Network Open. 2020;3(4):e203760.
- Vainshelboim B, Lima RM, Kokkinos P, Myers J. Cardiorespiratory fitness, lung cancer incidence, and cancer mortality in male smokers. American Journal of Preventive Medicine. 2019 Nov;57(5):659-666. doi: 10.1016/j.amepre.2019.04.020. Epub 2019 Sep 27.
- Schettler T. The Ecology of Breast Cancer: The Promise of Prevention and the Hope for Healing. 2013. Science and Environmental Health Network and the Collaborative on Health and the Environment. pp 71-72.
- Shephard RJ. Physical activity and prostate cancer: an updated review. Sports Medicine. 2017 Jun;47(6):1055-1073.
- Brown JC, Ligibel JA. The role of physical activity in oncology care. Journal of the National Cancer Institute. Monographs. 2017 Nov 1;2017(52).
- Stevinson C, Campbell A, Cavill N, Foster J. Physical activity and cancer: a concise evidence review. Macmillan Cancer Support. 2017.
- Ligibel JA, Dillon D et al. Impact of a pre-operative exercise intervention on breast cancer proliferation and gene expression: results from the Pre-Operative Health and Body (PreHAB) study. Clinical Cancer Research. 2019 Sep 1;25(17):5398-5406.
- Brett JO, Arjona M et al. Exercise rejuvenates quiescent skeletal muscle stem cells in old mice through restoration of Cyclin D1. Nature Metabolism. 2020.
- Schettler T. The Ecology of Breast Cancer: The Promise of Prevention and the Hope for Healing. 2013. Science and Environmental Health Network and the Collaborative on Health and the Environment p. 71.
- Dixon A. Absolute Contraindications to Physical Activities in Geriatric Patients. Livestrong.com. August 14, 2017. Viewed December 18, 2017.
- Harvard Women's Health Watch. 10 tips to prevent injuries when you exercise. October 2013. Harvard University. Viewed December 18, 2017.
- Stevinson C, Campbell A, Cavill N, Foster J. Physical activity and cancer: a concise evidence review. Macmillan Cancer Support. 2017.
- Alschuler LN, Gazella KA. The Definitive Guide to Cancer, 3rd Edition: An Integrative Approach to Prevention, Treatment, and Healing. Berkeley, California: Celestial Arts. 2010; Alschuler LN, Gazella KA. The Definitive Guide to Thriving after Cancer: A Five-Step Integrative Plan to Reduce the Risk of Recurrence and Build Lifelong Health. Berkeley, California: Ten Speed Press. 2013.
- Block KI. Life Over Cancer. New York: Bantam Dell. 2009.
- Cohen L, Jeffries A.
- Geffen J. The Journey Through Cancer: An Oncologist's Seven-Level Program for Healing and Transforming the Whole Person. New York, New York: Three Rivers Press. 2006.
- Lemole G, Mehta P, McKee D. After Cancer Care: The Definitive Self-Care Guide to Getting and Staying Well for Patients with Cancer. New York, New York: Rodale, Inc. 2015.
- MacDonald B. The Breast Cancer Companion: A Complementary Care Manual: Third Edition. 2016.
- McKinney N. Naturopathic Oncology, 3rd Edition. Victoria, BC, Canada: Liaison Press. 2016.
- Centers for Disease Control and Prevention. Physical Activity and Health. June 4, 2015. Viewed December 18, 2017.
View All References
More Information
- American Institute for Cancer Research:
- Cancer.Net: Managing Your Weight after a Cancer Diagnosis: A Guide for Patients and Families
- Stevinson C, Campbell A, Cavill N, Foster J. Physical activity and cancer: a concise evidence review. Macmillan Cancer Support. 2017.
- Meneses-Echávez JF, González-Jiménez E, Ramírez-Vélez R. Effects of supervised exercise on cancer-related fatigue in breast cancer survivors: a systematic review and meta-analysis. BMC Cancer. 2015 Feb 21;15:77.
- Harvard Women's Health Watch: 10 tips to prevent injuries when you exercise
- Alschuler LN, Gazella KA. The Definitive Guide to Thriving after Cancer: A Five-Step Integrative Plan to Reduce the Risk of Recurrence and Build Lifelong Health. Berkeley, California: Ten Speed Press. 2013.
- Moss Reports (purchase required): Select from the list of cancers down the left side of the page for a report describing uses of conventional, complementary, alternative and integrative therapies related to that cancer. Ralph Moss is among the most knowledgeable and balanced researchers of integrative cancer therapies. The cost of his Moss Reports is not negligible, but many patients find them of considerable value. Moss is also available for consultations.
- Ornish Lifestyle Medicine for prostate cancer
- National Comprehensive Cancer Network Professional Guidelines on Survivorship, including Exercise (subscription required)
- National Comprehensive Cancer Network, Patient and Caregiver Resources:
- Finding fitness programs tailored to people with cancer:
- Incorporating non-exercise movement into daily life:
- Moving for Life, Inc.: Moving for Life: Dance Exercise for Health
- US Office of Disease Prevention and Health Promotion: Move Your Way Activity Planner
- Gurdev Parmar and Tina Kaczor: Textbook of Naturopathic Oncology
- University of Arizona Andrew Weil Center for Integrative Medicine: Introduction to Integrative Oncology (2019-2021)
- Anticancer Lifestyle Foundation: Anticancer Lifestyle Program
- Moss Reports: The Center For Better Bones Conversation
- Dawn Lemanne and Victoria Maizes: Advising Women Undergoing Treatment for Breast Cancer
- Kathryn H. Schmitz PhD, MPH Anna M. Campbell PhD and others: Exercise is medicine in oncology: engaging clinicians to help patients move through cancer
- American Institute for Cancer Research: New American Plate Challenge
- Live by Living
- Dr. Ralph Moss: Dealing with the Trauma of Cancer: Dr. Moss interviews Dr. James S. Gordon
- UK Royal College of Anaesthetists, Macmillan Cancer Support, and the National Institute for Health Research Cancer and Nutrition Collaboration: Prehabilitation for People with Cancer
- Andrew Weil Center for Integrative Medicine: CanHEAL
- American Institute for Cancer Research: American Institute for Cancer Research Blog
- Block KI, Block PB, Gyllenhaal C: Integrative Treatment for Colorectal Cancer
- Integrative Cancer Review
- Lise Alschuler and Karolyn A. Gazella: iThrive Plan
- US Department of Health and Human Services: Physical Activity Guidelines for Americans
- Dwight McKee, MD, editor: Clinical Pearls
- September 2018 Issue of the Journal of Alternative and Complementary Medicine
- Karen Basen-Engquist and others: Moving Research Into Practice: Physical Activity, Nutrition, and Weight Management for Cancer Patients and Survivors
- Wayne Jonas, MD: Your Healing Journey: A Patient’s Guide to Integrative Breast Cancer Care
- The New School at Commonweal: Dwight McKee, MD: 40 Years Practicing Integrative Cancer Medicine, Part 1
- The New School at Commonweal: Dwight McKee, MD: 40 Years Practicing Integrative Cancer Medicine, Part 2
- The New School at Commonweal: Ted Schettler: The Ecology of Breast Cancer
- EmpowHER: Keith Block: My Activity
- Donald I. Abrams, MD, and Andrew T. Weil, MD: Integrative Oncology, 2nd Edition
- Ted Schettler, MD, MPH: The Ecology of Breast Cancer: The Promise of Prevention and the Hope for Healing
- American Institute for Cancer Research: Cancer Health Check
- Lise Alschuler, ND, FABNO, and Karolyn Gazella: The Definitive Guide to Cancer, 3rd Edition
- Keith I. Block, MD: Life over Cancer: The Block Center Program for Integrative Cancer Treatment
- Lorenzo Cohen and Alison Jefferies: Anticancer Living: Transform Your Life and Health with the Mix of Six
- Morgan Freeman and Lori McCreary: The C-Word
- Jeremy R. Geffen, MD, FACP: The Seven Levels of Healing®: Celebrating Life and Spirit on the Journey through Cancer
- Gerald Lemole, MD; Pallav Mehta, MD; and Dwight McKee, MD: After Cancer Care
- World Cancer Research Fund and the American Institute for Cancer Research: Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective
- Gary Deng, MD, PhD: Complementary Therapies for Pain Management
- Donna Wilson: Exercise and Recovery
- Ting Bao, MD: The Role of Integrative Therapy in Cancer Care
- National Cancer Institute: Office of Cancer Complementary and Alternative Medicine
- Michael Lerner: Choices In Healing: Integrating the Best of Conventional and Complementary Approaches to Cancer
- American Academy of Anti-Aging Medicine and Metabolic Medical Institute: Integrative Cancer Therapy Fellowship Modules
- Glenn Sabin with Dawn Lemanne, MD, MPH: N of 1
This work is licensed under a