Moving More
Also known by these names
- Exercise
- Fitness
- Movement
- Physical activity
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Benefits of Moving More
Moving your body reduces the risk of cancer and 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.
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Authors
Nancy Hepp, MS, BCCT Project Manager
Read more Ms. Hepp is a science researcher and communicator who has been writing and editing educational content on varied health topics for more than 20 years. View profile.  Laura Pole, RN, MSN, OCNS, BCCT Senior Researcher
Read more Ms. Pole is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation and education services for more than 30 years. View profile. Reviewer
Ted Schettler, MD, MPH, BCCT Advisor
Read more Dr. Schettler is science director of the Collaborative on Health and the Environment and the Science and Environmental Health Network. View profile. Last updated August 24, 2021.
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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.
MET-Hours
Exercise may be measured in metabolic equivalents, or METs. MET-hours. 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
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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.
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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.
Movement and Cancer Treatment
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.
American Cancer Society’s Nutrition and Physical Activity Guidelines for Cancer Survivors
From the American Cancer Society:
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
From the American Cancer Society:
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.
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:
Read more
- 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.
Guidelines for People in Treatment or with Advanced Disease
Integrative oncologist and BCCT advisor Keith Block, MD, recommends these approaches for those undergoing chemotherapy treatment, with advanced disease or experiencing wasting (cachexia):
Read more
- Reduce your emphasis on aerobic exercise.
- Emphasize interval training (repeated short sessions of aerobic-type exercise)
- Emphasize strength or resistance training
- Use light weights or isometrics
- Use short sessions repeated several times daily
- Emphasize systems such as yoga, Pilates, qigong or tai chi that increase flexibility
- Do not overexercise, for this produces inflammation and increases cortisol
Movement and Being Kind to Yourself
Hydrating with Movement
If you increase your activity levels, especially if you work up a sweat, you'll probably need to pay more attention to staying hydrated. Maintaining optimal levels of fluid in your body has several positive outcomes:
- Prevent the unpleasant and even dangerous symptoms of dehydration
- Enable your body to optimize digestion, hormone balance, immune system function, inflammation and other terrain factors
- Allow your body to flush toxins out
- Reduce treatment side effects, such as nausea, weakness, constipation and fatigue
- Contribute to a general sense of well-being
For people with cancer, dehydration may cause your treatment to be delayed until you can be rehydrated, so staying hydrated is an important consideration in your treatment.
Stay hydrated with water or unsweetened beverages (avoid caffeine and alcohol if you're at risk for dehydration).
Find out more about hydrating on our Dehydration and Hydration page.
Activity and Sleep
When you exercise or are more active can impact not only your fitness and metabolism, but your sleep and your response to cancer treatments.
Integrative oncologist and BCCT advisor Keith Block, MD, and his colleagues offer guidance about how and when to be active to promote normal circadian (sleep-rest) function.
Read more
General Exercise and Physical Care Guidelines
- Get aerobic exercise early in the day.
- Get morning and daytime sun exposure, 15 to 30 minutes.
- Avoid exercising to exhaustion, which increases cortisol levels.
- Tai chi and yoga have been found to improve sleep in older persons and cancer patients.
- Discourage daytime/evening napping.
- Avoid overwork and other very stressful activities that could disturb sleep through anxiety and catecholamine release (see Managing Stress).
Nighttime Exercise and Physical Care Guidelines
- Bright light exposure in early evening but dim lights in last hour before bed (see the section titled "Light" on Creating a Healing Environment)
- Enjoy a warm bath, soothing music, or other relaxing activity before bed.
- Reduce stimulating activity before bed.
- Avoid evening exercise.
- Do not lie in bed after nighttime waking.
- Reserve your bedroom for sleep and intimacy only.
- Develop routine bedtime practices.
- Improve your sleep environment:
- Complete darkness
- Relaxing pillow
- Comfortable, cool room temperature
- Control noise level
- No computer/television or other screens
- Hide or remove clocks
Mind–Body Guidelines
Routinize your daily schedule of sleep, work, and physical activity
When possible, delegate stressful tasks
Develop a quality social-support network
Cognitive-behavioral therapy for stress and insomnia problems
Adopt effective stress management techniques such as abdominal breathing
If you are restless or awake at night, leave your bedroom
Do not fret over lost sleep, which only increases anxiety
Keep a notebook for middle-of-the-night worries or thoughts
Set aside calming time in the evening for meditation or quiet yoga practice
Treating the Cancer
At least a moderate-intensity activity such as brisk walking or climbing stairs is needed for benefit.
Highlighted Video
BCCT Senior Researcher Laura Pole, RN, MSN, OCNS, offers research on moving more and demonstrates some simple exercises.
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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 indicates 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.
Read more
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.
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.
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More muscle mass and greater muscle density are highly associated with improved survival in hospitalized patients with advanced cancer and lower mortality in patients with advanced non-small cell lung cancer undergoing chemotherapy.
A cancer diagnosis increases the risk of poorer ambulatory function—a slower walking pace and greater mobility disability. Poorer ambulatory function increases the risk of mortality. Researchers recommend widespread efforts to target and improve ambulatory function during cancer survivorship for survival benefits.
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 (see above) 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.
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.
Lung Cancer
Read more
- Greater cardiorespiratory fitness reduces risk of cancer mortality in current smokers.
See Lung 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 2020 review found moderate evidence of reduced risk of prostate cancer with higher levels of occupational physical activity.
- 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 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
Uterine (Endometrial) Cancer
Read more
- A 2020 review found moderate evidence of reduced risk of endometrial cancer with higher levels of occupational physical activity.
See Uterine 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 use of health care.
- Women with mild to moderate depressive symptoms reported significantly better scores in all five measures of depression in a small randomized trial. An intervention combining a brisk 20-minute outdoor walk, increased light exposure throughout the day and a vitamin regimen had high adherence for eight weeks. The goal of the walk was to increase target heart rate of 60% of maximum, and the supplements included vitamins B1, B6, B2, B9, D, and selenium.
Movement has also been shown to reduce these symptoms and side effects of cancer and treatment:
- Anxiety: variable evidence by cancer type and stage of treatment
- Modest evidence of lower anxiety (small effects) across cancer types except during chemotherapy:
- Lower anxiety among cancer survivors in a meta-analysis of RCTs
- No impact on anxiety among people with cancer undergoing chemotherapy in a meta-analysis of RCTs
- Slightly less anxiety among people with cancer with an online physical activity or diet intervention in a meta-analysis of RCTs
- Modest evidence of less anxiety among people with breast cancer both during and after treatment
- Lower anxiety among people with breast cancer with aerobic exercise training for the duration of their chemotherapy in a mid-sized RCT
- Less anxiety among people with breast cancer with exercise during adjuvant therapy in a meta-analysis of RCTs
- Less anxiety among women diagnosed with stage II+ breast cancer with exercise in a meta-analysis of RCTs
- Small-to-moderate improvements in anxiety among women with breast cancer after adjuvant therapy with exercise in a meta-analysis of randomized and quasi-randomized trials
- Modest evidence of no effect among people with colorectal or blood cancers
- No impact on anxiety among people with non-advanced colorectal cancer in physical activity interventions or adults with blood cancers (mostly leukemia, lymphoma and multiple myeloma) doing aerobic physical exercise compared to no intervention or usual care in meta-analyses of RCTs
- Preliminary (mixed results) evidence of effects among people with lung cancer
- Fewer symptoms of anxiety among people with lung cancer with exercise interventions in a meta-analysis of RCTs
- Less anxiety among people with lung cancer with home-based exercise in a meta-analysis of RCTs
- No change in anxiety among adults with advanced lung cancer with exercise training in a pooled analysis of RCTs
- Modest evidence of effects among people (not specific to those with cancer), including those with anxiety and stress-related disorders
- Lower anxiety among healthy older adults in a review of RCTs
- Fewer symptoms of anxiety among overweight or obese women with a lifestyle intervention of physical activity and/or diet in a meta-analysis of RCTs
- Fewer anxiety symptoms, with less improvement among those with physical or mental health conditions compared to healthy volunteers, with resistance exercise training in a meta-analysis of RCTs
- Fewer anxiety symptoms among people with anxiety and stress-related disorders in a meta-analysis of RCTs
- Changes in appetite:
- No effect on appetite among people with lung cancer with home-based exercise in a meta-analysis of RCTs
- Depression
- No impact on depression among people with non-advanced colorectal cancer in physical activity interventions compared to no intervention or usual care in a meta-analysis of RCTs
- Less depression among people with cancer undergoing chemotherapy in a meta-analysis of RCTs
- Fewer symptoms of depression among people with lung cancer with exercise interventions in a meta-analysis of RCTs
- Moderately less depression among people with cancer with exercise-based rehabilitation compared to usual care in a systematic review of RCTs
- Less depression, and improved quality of life among people with lung cancer with home-based exercise in a meta-analysis of RCTs
- Slightly less depression among people with cancer with an online physical activity or diet intervention in a meta-analysis of RCTs
- No change in depression among adults with advanced lung cancer underting exercise training in a pooled analysis of RCTs
- Less depression among people with breast cancer with exercise during adjuvant therapy in a meta-analysis of RCTs
- Less depression among women diagnosed with stage II+ breast cancer with exercise in a meta-analysis of RCTs
- Fewer symptoms of depression among overweight or obese women with a lifestyle intervention of physical activity and/or diet in a meta-analysis of RCTs
- Fatigue
- Less fatigue among people with non-advanced colorectal cancer in physical activity interventions compared to no intervention or usual care in a meta-analysis of RCTs
- Less fatigue among people with lung cancer with exercise interventions in a meta-analysis of RCTs
- Less cancer-related fatigue among people with lung cancer with home-based exercise in a meta-analysis of RCTs
- Less fatigue among people with advanced cancer with exercise in a meta-analysis of RCTs
- A weak trend toward less fatigue among people with cancer with an online physical activity or diet intervention in a meta-analysis of RCTs
- No change in fatigue among adults with advanced lung cancer underting exercise training in a pooled analysis of RCTs
- Less fatigue among people with breast cancer with exercise during adjuvant therapy in a meta-analysis of RCTs
- Less fatigue among women diagnosed with stage II+ breast cancer with exercise in a meta-analysis of RCTs
- Quality of life and physical function:
- Better health‐related quality of life among people with non-advanced colorectal cancer in physical activity interventions compared to no intervention or usual care in a meta-analysis of RCTs
- Generally small and moderate better reported quality of life and physical function in a large review of reviews of RCTs
- Moderately better quality of life among people with lung cancer with exercise interventions in a meta-analysis of RCTs
- Better quality of life among people with advanced cancer with exercise in a meta-analysis of RCTs
- Slightly improved quality of life among people with cancer with an online physical activity or diet intervention in a meta-analysis of RCTs
- Better physical function among people with advanced cancer with exercise in a meta-analysis of RCTs
- Better physical component of health-related quality of life among people with non-small cell lung cancer who underwent lung resection receiving exercise training in a meta-analysis of RCTs of moderate quality
- Better disease-specific global health-related quality of life but no change in physical functioning among adults with advanced lung cancer underting exercise training in a pooled analysis of RCTs dyspnoea fatigue, feelings of anxiety depression
- Better quality of life and physical fitness among people with breast cancer with exercise during adjuvant therapy in a meta-analysis of RCTs
- Better quality of life, fitness and strength among women diagnosed with stage II+ breast cancer with exercise in a meta-analysis of RCTs
- Small-to-moderate improvements in health-realted quality of life, perceived physical function, and cardiorespiratory fitness among women with breast cancer after adjuvant therapy with exercise in a meta-analysis of randomized and quasi-randomized trials
- Pain:
- Lower pain severity in general (not specific to people with cancer) with physical activity in a large review of reviews of RCTs
- No affect on pain among people with lung cancer with home-based exercise in a meta-analysis of RCTs
- Sleep disruption
- Less insomnia among people with advanced cancer with exercise in a meta-analysis of RCTs
- Less insomnia among people with lung cancer with home-based exercise in a meta-analysis of RCTs
- Other symptoms and side effects:
- Improved muscle strength among people with cancer with exercise-based rehabilitation compared to usual care in a systematic review of RCTs
- No affect on coughing among people with lung cancer with home-based exercise in a meta-analysis of RCTs
- Less breathlessness (dyspnea) among people with advanced cancer or after lung resection, but no change among people with advanced lung cancer with exercise in meta-analyses of RCTs
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.
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A study 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. A study found that one year of football (soccer) fitness significantly improved bone mineral density, leg muscle strength, and postural balance in women treated for early-stage breast cancer.
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
Common Benefit
A large study published in 2021 found that traditional risk factors for cardiovascular disease were also related to increased risk of cancer, while a heart-healthy lifestyle is associated with a lower risk of future cancer. Factors that reduce risk (Life's Simple 7) include getting active.
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Reducing the risk of developing cancer or the risk of recurrence
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 the general population, and followed for about 10 years.
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 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.
Breast Cancer
Read more
- 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 breast cancer.
- Other research has found that getting more than 30 minutes of moderate physical activity every day lowers risks for postmenopausal breast. Vigorous physical activity is associated with reduced risk of premenopausal breast cancer.
- A 2020 review found low-quality evidence of reduced risk of breast cancer with higher levels of occupational physical activity.
- 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 cancer.
See Breast Cancer.
Colorectal Cancer
Read more
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.
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- 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 colon cancer in men.
- A 2020 review found moderate evidence of reduced risk of both colon and rectal cancers, in both men and women, with higher levels of occupational physical activity.
- Other research has found that getting more than 30 minutes of moderate physical activity every day lowers risks for colorectal cancers.
- 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 colorectal cancer.
See Colorectal Cancer.
Esophageal Cancer
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- A 2020 review found low-quality evidence of NO reduced risk of esophageal cancer with higher levels of occupational physical activity.
See Esophageal Cancer.
Kidney Cancer
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- 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 kidney cancer.
- A 2020 review found low-quality evidence of nonsignificant reduced risk of kidney cancer with higher levels of occupational physical activity.
See Kidney Cancer.
Liver Cancer
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- 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 liver cancer.
See Liver Cancer.
Lung Cancer
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- Greater cardiorespiratory fitness reduces risk of lung cancer in male former smokers and risk of cancer mortality in current smokers.
See Lung Cancer.
Lymphoma
Read more
- 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 non-Hodgkin lymphoma in women.
See Lymphoma.
Myeloma
Read more
- 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 myeloma.
See Myeloma.
Pancreatic Cancer
Read more
- A 2020 review found low-quality evidence of reduced risk of pancreatic cancer with higher levels of occupational physical activity.
See Pancreatic Cancer.
Prostate Cancer
Read more
- A 2020 review found moderate evidence of reduced risk of prostate cancer with higher levels of occupational physical activity.
- 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 prostate cancer.
See Prostate Cancer
Stomach (Gastric) Cancer
Read more
- A 2020 review found low-quality evidence of reduced risk of stomach cancer with higher levels of occupational physical activity.
See Stomach Cancer
Uterine (Endometrial) Cancer
Read more
- 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 endometrial cancer.
- Other research has found that getting more than 30 minutes of moderate physical activity every day lowers risks for endometrial cancer.
- A 2020 review found moderate evidence of reduced risk of endometrial cancer with higher levels of occupational physical activity.
See Uterine Cancer
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. Another study with mice found that exercise enhanced the effect of immune system CD8+ T cells, which fight certain forms of breast cancer and other solid tumors. As a result of exercise, tumor growth was reduced in mice inoculated with different types of cancer cells.
Preliminary research in both humans and animals has found that exercise promotes an increase in microbial diversity within the gut.
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.
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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
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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
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- Programs and protocols
- Traditional systems
For Professionals
- Better exercise behavior among people with cancer with an online physical activity or diet intervention in a meta-analysis of RCTs
- Better breast cancer‐specific quality of life and global quality of life, plus less anxiety, fatigue and insomnia immediately after home‐based, multidimensional survivorship interventions for breast cancer survivors
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.
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- Peddle-McIntyre CJ, Singh F et al. Exercise training for advanced lung cancer. Cochrane Database of Systematic Reviews. 2019 Feb 11;2(2):CD012685.
- Lee J, Lee MG. Effects of exercise interventions on breast cancer patients during adjuvant therapy: a systematic review and meta-analysis of randomized controlled trials. Cancer Nursing. 2020 Mar/Apr;43(2):115-125.
- Singh B, Spence RR et al. A systematic review and meta-analysis of the safety, feasibility, and effect of exercise in women with stage II+ breast cancer. Archives of Physical Medicine and Rehabilitation. 2018 Dec;99(12):2621-2636.
- van Dammen L, Wekker V et al. A systematic review and meta-analysis of lifestyle interventions in women of reproductive age with overweight or obesity: the effects on symptoms of depression and anxiety. Obesity Reviews. 2018 Dec;19(12):1679-1687.
- 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.
- McGettigan M, Cardwell CR, Cantwell MM, Tully MA. Physical activity interventions for disease-related physical and mental health during and following treatment in people with non-advanced colorectal cancer. Cochrane Database of Systematic Reviews. 2020 May 3;5(5):CD012864.
- Zhou L, Chen Q, Zhang J. Effect of exercise on fatigue in patients with lung cancer: a systematic review and meta-analysis of randomized trials. Journal of Palliative Medicine. 2021 Jun;24(6):932-943.
- Yang M, Liu L et al. Effects of home-based exercise on exercise capacity, symptoms, and quality of life in patients with lung cancer: a meta-analysis. European Journal of Oncology Nursing. 2020 Dec;49:101836.
- Chen YJ, Li XX et al. Exercise training for improving patient-reported outcomes in patients with advanced-stage cancer: a systematic review and meta-analysis. Journal of Pain and Symptom Management. 2020 Mar;59(3):734-749.e10.
- Furness K, Sarkies MN, Huggins CE, Croagh D, Haines TP. Impact of the method of delivering electronic health behavior change interventions in survivors of cancer on engagement, health behaviors, and health outcomes: systematic review and meta-analysis. Journal of Medical Internet Research. 2020 Jun 23;22(6):e16112.
- Peddle-McIntyre CJ, Singh F et al. Exercise training for advanced lung cancer. Cochrane Database of Systematic Reviews. 2019 Feb 11;2(2):CD012685.
- Lee J, Lee MG. Effects of exercise interventions on breast cancer patients during adjuvant therapy: a systematic review and meta-analysis of randomized controlled trials. Cancer Nursing. 2020 Mar/Apr;43(2):115-125.
- Singh B, Spence RR et al. A systematic review and meta-analysis of the safety, feasibility, and effect of exercise in women with stage II+ breast cancer. Archives of Physical Medicine and Rehabilitation. 2018 Dec;99(12):2621-2636.
- McGettigan M, Cardwell CR, Cantwell MM, Tully MA. Physical activity interventions for disease-related physical and mental health during and following treatment in people with non-advanced colorectal cancer. Cochrane Database of Systematic Reviews. 2020 May 3;5(5):CD012864.
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- Zhou L, Chen Q, Zhang J. Effect of exercise on fatigue in patients with lung cancer: a systematic review and meta-analysis of randomized trials. Journal of Palliative Medicine. 2021 Jun;24(6):932-943.
- Chen YJ, Li XX et al. Exercise training for improving patient-reported outcomes in patients with advanced-stage cancer: a systematic review and meta-analysis. Journal of Pain and Symptom Management. 2020 Mar;59(3):734-749.e10.
- Furness K, Sarkies MN, Huggins CE, Croagh D, Haines TP. Impact of the method of delivering electronic health behavior change interventions in survivors of cancer on engagement, health behaviors, and health outcomes: systematic review and meta-analysis. Journal of Medical Internet Research. 2020 Jun 23;22(6):e16112.
- Chen YJ, Li XX et al. Exercise training for improving patient-reported outcomes in patients with advanced-stage cancer: a systematic review and meta-analysis. Journal of Pain and Symptom Management. 2020 Mar;59(3):734-749.e10.
- Cavalheri V, Burtin C et al. Exercise training undertaken by people within 12 months of lung resection for non-small cell lung cancer. Cochrane Database of Systematic Reviews. 2019 Jun 17;6(6):CD009955.
- Peddle-McIntyre CJ, Singh F et al. Exercise training for advanced lung cancer. Cochrane Database of Systematic Reviews. 2019 Feb 11;2(2):CD012685.
- Lee J, Lee MG. Effects of exercise interventions on breast cancer patients during adjuvant therapy: a systematic review and meta-analysis of randomized controlled trials. Cancer Nursing. 2020 Mar/Apr;43(2):115-125.
- Singh B, Spence RR et al. A systematic review and meta-analysis of the safety, feasibility, and effect of exercise in women with stage II+ breast cancer. Archives of Physical Medicine and Rehabilitation. 2018 Dec;99(12):2621-2636.
- Lahart IM, Metsios GS, Nevill AM, Carmichael AR. Physical activity for women with breast cancer after adjuvant therapy. Cochrane Database of Systematic Reviews. 2018 Jan 29;1(1):CD011292.
- Geneen LJ, Moore RA et al. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews. 2017 Apr 24;4(4):CD011279.
- Yang M, Liu L et al. Effects of home-based exercise on exercise capacity, symptoms, and quality of life in patients with lung cancer: a meta-analysis. European Journal of Oncology Nursing. 2020 Dec;49:101836.
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- Chen YJ, Li XX et al. Exercise training for improving patient-reported outcomes in patients with advanced-stage cancer: a systematic review and meta-analysis. Journal of Pain and Symptom Management. 2020 Mar;59(3):734-749.e10.
- Yang M, Liu L et al. Effects of home-based exercise on exercise capacity, symptoms, and quality of life in patients with lung cancer: a meta-analysis. European Journal of Oncology Nursing. 2020 Dec;49:101836.
- Dennett AM, Sarkies M et al. Multidisciplinary, exercise-based oncology rehabilitation programs improve patient outcomes but their effects on healthcare service-level outcomes remain uncertain: a systematic review. Journal of Physiotherapy. 2021 Jan;67(1):12-26.
- Yang M, Liu L et al. Effects of home-based exercise on exercise capacity, symptoms, and quality of life in patients with lung cancer: a meta-analysis. European Journal of Oncology Nursing. 2020 Dec;49:101836.
- Chen YJ, Li XX et al. Exercise training for improving patient-reported outcomes in patients with advanced-stage cancer: a systematic review and meta-analysis. Journal of Pain and Symptom Management. 2020 Mar;59(3):734-749.e10.
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- 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
- 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
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