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.

Moving More as one of the 7 Healing Practices

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.1 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.2

Finding an activity that is fun will increase both your motivation and your enjoyment.

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."3

Both types of movement provide benefits.

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Movement and Cancer Treatment

American Cancer Society’s Nutrition and Physical Activity Guidelines for Cancer Survivors

Achieve and maintain a healthy weight.

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Engage in regular physical activity.

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Achieve a dietary pattern that is high in vegetables, fruits, and whole grains.

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ACS Guidelines on Nutrition and Physical Activity for Cancer Prevention

Achieve and maintain a healthy weight throughout life.

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Be physically active.

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Eat a healthy diet, with an emphasis on plant foods.

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If you drink alcohol, limit your intake.

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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.”

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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:9

  • 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:10

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.

Breast Cancer

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Colorectal Cancer

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Lymphoma

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Prostate Cancer

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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.”21

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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."25
  • “Cancer survivors who exercise can potentially benefit from reduced levels of fatigue, and improved quality of life, physical function, and body composition.”26

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:31

  • A large effect on upper and lower body strength post 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.

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Clinical Practice Guidelines

Clinicians should assess individual and community-level barriers to meeting the healthy lifestyle recommendations and support patients in developing strategies to overcome challenges.

The 2017 National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology (NCCN Guidelines®) on Survivorship include these recommendations:36

  • 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.

Reducing Risk

Reducing the risk of developing cancer or the risk of recurrence

Research has found that getting at least 30 minutes of moderate physical activity every day lowers risks for endometrial, postmenopausal breast and colorectal cancers.

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.

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Clinical Practice Guidelines

The 2018 American Institute for Cancer Research guidelines for physical activity found strong evidence that being physically active decreases these risks:41

  • Colon cancer
  • Breast cancer (postmenopause)
  • Endometrial cancer

 In addition, vigorous physical activity decreases the risk of both pre- and postmenopausal breast cancer.

Cautions

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.42

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.43

A 2017 review of evidence noted a few cautions:44

  • 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 Plans, Protocols and Medical Systems

For more information about plans and protocols, see our Integrative Plans and Protocols page.

Non-cancer Uses of Moving More

Physical activity is used for these conditions and purposes:52

  • 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 December 28, 2018. Note: BCCT has not conducted an independent review of research of moving more. 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.

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