Exercise is a prescription that every cancer patient deserves and that they can control | Ranjana Srivastava

Don’t take it personally, doctor, but it was a terrible experience.

I told her that I didn’t feel uncomfortable and that I sympathized because in the 15 months since she was diagnosed with cancer, she had undergone multiple surgeries, chemotherapy, and radiation, not to mention leading to hospitalization and hiccups. This, along with the psychological pain and ripple effects throughout the family, that no health care system can completely mitigate.

What if I’ve done all of this and it comes back?

I squeezed her hand to acknowledge the fear that wells up in the heart of every patient who has sacrificed so much to reflect on the consequences of a terrifying diagnosis. Through experience, I know what Are not I have to say, especially right after being diagnosed. You don’t promise a cure; instead, you highlight good prognostic features and reasonable therapeutic advances, while reassuring patients that you and your team will be there in the years to come.

Sometimes I can’t help but think how boring this reassurance sounds, until I notice the sheer relief of patients who somehow thought the end of chemotherapy was over. treatment is the end of our relationship.

If cancer is a journey, then patients have the right to expect guidance along the way instead of being overwhelmed early and pushed aside. But truth be told, oncologists handle treatment well but survival is poor. Typically, we give brief advice on quitting smoking and limiting alcohol intake, and direct patients to see a GP for the rest of their lives. If only it were that easy.

But there is a prescription that every cancer patient deserves: a prescription backed by evidence for individually controlled action. That prescription would be for exercise.

Many cancer patients endure the rigors of chemotherapy to achieve small benefits but at the risk of significant toxicity. There is growing evidence that when it comes to reducing risk, even moderate exercise can provide benefits comparable to the most promising cancer treatments. So while exercise is no substitute for cancer treatment, it is certainly a valuable and underutilized companion.

The 2018 Physical Activity Guidelines for Americans recommend 150 minutes of moderate-intensity aerobic exercise or 75 minutes of vigorous aerobic exercise, spread throughout the week, with the added benefit of Get from two days of muscle-strengthening exercise.

The most recent evidence for the benefits of exercise comes from a study of nearly 12,000 cancer patients whose self-reported exercise habits were divided into four categories of no exercise, under guidance, meeting guidelines and exceed guidelines.

This research has yielded several important results.

First, only 38% of patients identified as exercisers, and in the entire study population, the average time spent in moderate exercise (light sweating) and strenuous exercise (increasing heart rate and breathing to very high levels) is only 44 and 19 minutes per year. corresponding week.

This finding did not surprise me; it can be explained by inertia and fatigue combined with poor health literacy. It is not uncommon to find that patients stop exercising during cancer because of a perceived need to conserve energy. But sedentary patients eventually gain weight and lose muscle mass and aerobic capacity, which affects them for years. Indeed, patients are often surprised to learn that one of the best ways to manage the side effects of cancer treatment and reduce complications is to continue or adopt a regular exercise routine.

The study’s second finding is truly striking. Meeting versus not meeting exercise guidelines was associated with a 25% reduced risk of death. Compared to no exercise, all levels of exercise (from below guidelines to above guidelines) are beneficial. Those who exercised lived 5 years longer, with differences in survival appearing within 5 years and persisting for at least 20 years after diagnosis. Given the modest survival benefits associated with a wide range of treatments, frankly, every oncologist dreams of prescribing something capable of such impressive results.

These findings underscore the oft-repeated mantra that any exercise is better than no exercise. In addition to standard treatments, exercise is actually one of the best medicines cancer patients can take daily to improve longevity. Indeed, if exercise could be marketed as a pill it would be a blockbuster.

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Some limitations of the study are that exercise was only assessed once during the 11-year follow-up period, and changes in exercise during this period were not recorded. It’s possible that some people who have exercised all their lives still get cancer, and that survivors who increase their exercise experience greater benefits. But incomplete knowledge should not stop us from acting on what we know and advocating for a more comprehensive approach to cancer that includes exercise, not as a mainstay. optional column which is an essential pillar.

Exercise affects the body in many ways through influencing inflammation, immunity, cellular stress and insulin regulation, each of which can influence cancer progression. Future studies using wearables and artificial intelligence to interrogate the data could help illuminate new ways to incorporate exercise into treatment regimens and elicit behavioral change.

So where do we come from?

Just as they urge medication adherence, oncologists as trusted providers must encourage patients to exercise. In practical terms, there will hardly be time to discuss the ever-expanding categories on the physician list, which is why support from exercise physiologists and other experts is needed. considered a regular problem.

Similar to how they receive chemotherapy based on individual parameters, patients will receive tailored exercise prescriptions at the start of treatment.

An exercise prescription is the start; Infrastructure is very important. Bridging the gap between recommendation and implementation requires patient access to affordable community facilities. When I think of all the patients’ exhausted health and their lost ability to work, not to mention the associated depression, I can’t help but think that subsidizing the cost of exercise during treatment cancer can reduce the ultimate cost to society.

However, patients should note that exercise doesn’t have to be expensive: most people can easily do it with brisk walking, light jogging or cycling.

Often in cancer medicine, it is easy to be seduced by the next new thing, only to realize that the hype has exceeded hopes. Luckily, when it comes to exercise, the good news keeps getting better. This is the prescription every cancer patient deserves.