Physical activity and regular exercise are associated with a reduced risk of diagnosis or reoccurrence of many types of cancer. Exercise is also a safe and effective way to counteract the adverse physical and psychological effects of cancer and its treatment.

Did you know?

Not getting enough physical activity is a key risk factor contributing to disease burden in Australia.¹

According to the 2017-2018 Australian National Health Survey, less than 45% of adults (aged 18-64) met the Australian guidelines for physical activity, 23% met the guidelines for muscle strength training (at least 2 days/week), and only 15% met the guidelines for both physical activity and muscle strengthening.²

Almost half of Australian adults described their work day as ‘mostly sitting’.³

Exercise may reduce side effects of cancer treatments, and lower the risk of reoccurrence and mortality, yet it is not routinely prescibed as part of a patient’s treatment plan.^{4, 5}

The Facts

Physical inactivity and sitting time

• Prolonged sitting time is associated with more than 30% higher risk of endometrial and ovarian cancers.⁶
• Sedentary behaviour at work may be associated with a 15.5% higher risk of breast cancer.⁷
• Sedentary behaviour increases cancer mortality risk by about 13%.

Cancer prevention

• Physical activity lowers the risk of breast, endometrial and other cancers.⁹

Physical activity before and after diagnosis

• Being physically active both before and after a cancer diagnosis has survival benefits. The relationship between pre-diagnosis physical activity and survival from breast cancer has been extensively studied. 
• Patients who were most physically active before being diagnosed with breast cancer were associated with an 18% lower cancer-specific mortality risk than patients who were least active.⁸ 
• Patients who were most physically active after being diagnosed with breast cancer were associated with an even greater reduction in risk when compared with patients who were least active.⁸
• Patients with breast, colorectal and prostate cancers who were most active had a 21% to 45% lower mortality risk from all causes than those who were least active.⁸

Side effects of cancer treatment

• Exercise has additional benefits for cancer patients.¹⁰

• Cancer-related fatigue
  • Exercise is beneficial for reducing cancer-related fatigue.^11-13 Larger effects have occurred when exercising during active cancer treatment, rather than after.^{14, 15}
  • Exercise (including aerobic, resistance and mixed forms) has been identified as having a greater impact on reducing cancer-related fatigue than pharmaceutical or psychological interventions alone.¹⁶

• Physical fitness
  • Exercise has strong positive effects on physical fitness measures, including: aerobic exercise tolerance^{17, 18}, peak power¹⁹, strength¹¹, flexibility²⁰ and various measures of cardiorespiratory fitness.^{21, 22}  The most positive outcomes and larger effects were associated with moderate to vigorous exercise intensity.

• Psychological function
  • Exercise has a positive impact on psychological functioning, including mood, depression and anxiety.^{11, 19, 20}

• Physical function
  • Therapeutic exercise interventions may help restore function in specific body regions, including flexibility and progressive resistance exercises for the upper extremities^{23, 24} and pelvic floor strengthening.²⁵

• Quality of life
  • Exercise may improve health-related quality of life. Moderate‐ or vigorous‐intensity exercise have greater positive effects than low-intensity exercise.²⁶

• Tolerating treatment
  • Physical activity can help cancer patients tolerate aggressive treatments with fewer and milder adverse effects.²⁷

• Biomarkers associated with cancer progression
  • Exercise positively impacted the immune system and inflammatory biomarkers of cancer patients, both during and after cancer treatment.²⁸ Outcomes were most positive with moderate or vigorous exercise.^{19, 29}

Dosage

• Exercise dosage is important. For example, studies examining breast cancer risk found significant reductions in risk occurred with 120 to 360 minutes/week of moderate intensity exercise (or 75 to 230 minutes/week of vigorous intensity exercise).³⁰
• Similarly, studies found that breast cancer mortality improved when physical activity after diagnosis ranged from 120 to 250 minutes/week of moderate intensity exercise (or 75 to 150 minutes/week of vigorous intensity exercise).³¹

Safety

• In general, exercise interventions at moderate and vigorous intensity are safe in supervised settings with few adverse effects.^{11, 32}
• Cancer patients who lack physical conditioning can still use low intensity exercise to improve overall physical function and reduce cancer-related fatigue, anxiety and depression.¹⁰

Timing

• Specific benefits of exercise vary depending on the type and timing of exercise. For example, exercise started during treatment had a greater impact on cancer-related fatigue, while regular exercise started once treatment is completed had a greater impact on quality of life, physical function, and upper and lower body strength.¹⁰

Barriers and facilitators to exercise

• Barriers include treatment and disease side-effects; time pressures; low mood or motivation; family responsibilities; lack of social support; poor weather; preference for other activities; and fear of movement connected to fear of pain.³³
• Facilitators include social support and guidance; having accessible, tailored and appropriate services; seeing the benefits of exercise; having an exercise routine; and having previous positive experiences with exercise.³³

What can we do about it

To prevent cancer:

• Reduce sitting time
• Adopt a physically active lifestyle, engaging in at least 30 minutes of moderate to vigorous physical activity on five or more days of the week.
• Current physical activity guidelines recommend 150 to 300 minutes/week of moderate-intensity physical activity (e.g. walking) or 75 to 150 minutes/week of vigorous-intensity aerobic activity (e.g. jogging, cycling, swimming), although the precise amount needed to reduce risk of cancer is still uncertain.⁸

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For cancer patients⁵:

• Although generally safe, patients should be screened and appropriate precautions taken.
• Return to normal daily physical activity (as much as current abilities and conditions allow) as soon as possible after diagnosis. Aim to build up to and maintain at least 150 minutes/week of moderate intensity or 75 minutes/week of vigorous intensity aerobic exercise; and two to three sessions/week of moderate to vigorous intensity resistance exercises (e.g., lifting weights) that target the major muscle groups.
• Exercise programs should be designed by an accredited exercise physiologist or physiotherapist to suit individual ability, health status, anticipated disease trajectory and adverse effects of the cancer and treatment.

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