Exercise
Exercise and Breast Cancer Prevention
There is good evidence that even fairly modest levels of physical activity can decrease a woman's risk of getting breast cancer in the first place. Dr Anne McTiernan, of the Fred Hutchinson Cancer Research Center in Seattle, and colleagues prospectively studied data from more than 74 000 women between the ages of 50 and 79 years who participated in the women's health initiative study from 1993 to 1998 ( JAMA 2003;290: 1331-6). Women who said that they engaged in the equivalent of 1.25 to 2.5 hours a week of brisk walking had an 18% lower risk of breast cancer (relative risk 0.82 (0.68 to 0.97)) than inactive women. Women who engaged in the equivalent of 10 hours or more a week of brisk walking had a slightly greater risk reduction.
REMEMBER: Like all the many risk factors for breast cancer, this is just one. It is important, though, because it is something simple and very effective that may be very important for young women at special risk on account of their family history and reproductive choices. For further information on risk factors for breast cancer and causes of breast cancer, click here.
Exercise and Beating Breast Cancer
There are a number of reasons why exercise is important for patients who have had cancer or who are undergoing treatment for it.
Exercise and managing the side effects of breast cancer treatment
There is very good evidence to support that regular exercise reduces some common chemotherapy side-effects such as fatigue, insomnia and cognitive dysfunction. There is also concrete evidence to demonstrate that exercise reduces the joint pain caused by aromatase inhibitors [letrozole (Femara), exemestane (Aromasin) or anastrozole (Arimidex)].
Click here to view the Catalyst episode on Exercise during chemotherapy.
There was also a recent presentation regarding this at the Cancer Survivorship Symposium in Orlando, Florida. This news article discusses the results of the PACT study.
There is good evidence that even fairly modest levels of physical activity can decrease a woman's risk of getting breast cancer in the first place. Dr Anne McTiernan, of the Fred Hutchinson Cancer Research Center in Seattle, and colleagues prospectively studied data from more than 74 000 women between the ages of 50 and 79 years who participated in the women's health initiative study from 1993 to 1998 ( JAMA 2003;290: 1331-6). Women who said that they engaged in the equivalent of 1.25 to 2.5 hours a week of brisk walking had an 18% lower risk of breast cancer (relative risk 0.82 (0.68 to 0.97)) than inactive women. Women who engaged in the equivalent of 10 hours or more a week of brisk walking had a slightly greater risk reduction.
REMEMBER: Like all the many risk factors for breast cancer, this is just one. It is important, though, because it is something simple and very effective that may be very important for young women at special risk on account of their family history and reproductive choices. For further information on risk factors for breast cancer and causes of breast cancer, click here.
Exercise and Beating Breast Cancer
There are a number of reasons why exercise is important for patients who have had cancer or who are undergoing treatment for it.
- A recent article in the Journal of Clinical Oncology shows that when combined with careful attention to diet (see my page here), walking for 30 mins for 6 out of 7 days per week reduces breast cancer recurrence by 50%!
- In general terms, it strengthens the body, probably bolsters the body's immune defences both against infection, and possibly also against cancer cells.
- It elevates mood.
- It elevates energy. There is good evidence from randomised controlled clinical trials that regular exercise during chemotherapy helps to prevent the fatigue that is often experienced by patients when they are receiving chemotherapy. This makes sense, because we know that exercise leads to the production of certain beneficial chemicals, called cytokines, which help to promote the efficiency through increased muscular health. Similarly, for example, there is good evidence that regular exercise helps to prevent degenerative joint disease.
- It helps to prevent weight gain. Some patients gain weight while receiving chemotherapy, and the reasons for this are multiple. Chemotherapy seems to alter the body's metabolic rate. In addition, some people find that they get the "munchies" in an effort to overcome mild nausea. Quite apart from chemotherapy, women undergoing menopause commonly gain weight due to altered metabolism that occurs when oestrogen is withdrawn. Exercise is a critical component in ensuring that weight gain is minimised.
- It helps to preserve bone health. This is particularly important for women who have undergone menopause. Once oestrogen is withdrawn, there is a tendency for bone thinning ("osteoporosis") to occur, and regular weight bearing exercise is a critical element in ensuring continued bone health and bone strength. Osteoporosis can lead to painful bone fractures in later life.
- Healthy sleeping patterns. Many of my patients complain of insomnia. Of course, insomnia can sometimes be due to medications, and it is important to ensure that it is not a symptom of serious depression. However, commonly it is due to poor sleep hygiene, and a critical component of that is exercise. People who exercise regularly, particularly in the morning, rarely have problems with insomnia.
Exercise and managing the side effects of breast cancer treatment
There is very good evidence to support that regular exercise reduces some common chemotherapy side-effects such as fatigue, insomnia and cognitive dysfunction. There is also concrete evidence to demonstrate that exercise reduces the joint pain caused by aromatase inhibitors [letrozole (Femara), exemestane (Aromasin) or anastrozole (Arimidex)].
Click here to view the Catalyst episode on Exercise during chemotherapy.
There was also a recent presentation regarding this at the Cancer Survivorship Symposium in Orlando, Florida. This news article discusses the results of the PACT study.
What sort of exercise should I do?
The best form of exercise is a regular aerobic exercise. If the preservation of bone health is an important issue, then at least a component of this exercise should be weight bearing. Good aerobic choices are walking, cycling, using exercise machines in the gymnasium, such as the treadmill, the rowing machine, the exercise bike, the stepping machine, or the elliptical trainer. These are all excellent, and the treadmill and elliptical trainer offer the additional advantage of being weight bearing. The elliptical trainer has advantages over the treadmill in that is much kinder on the joints. Exercise does not have to be intense. A rule of thumb is the “rule of 4’s”: you need to walk for 4 kilometres in under 40 minutes 4 times a week. Think about the following tips as ways to promote your motivation:
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The Clinical Oncological Society of Australia (COSA) has released a position statement regarding the importance of exercise in cancer patients. They believe it should be prescribed like a medication. Click on the picture below to read it
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Can exercise be dangerous to me?
Many people who are feeling a severe lack of energy field and it may harm them to exercise. My advice is to listen carefully to what your body is telling you, but to push it just a little bit. For example, there will be moments in the day when you have more energy. Try to utilise be safe for the disposal the even brief walking or other exercise. Consider joining an aqua aerobics class. These are often held in servers clubs, gyms or public pools.
I'm embarrassed about attending a gym because of how I look.
Many people feel embarrassed about joining a gym or an aerobics class when they have had a mastectomy or if they have no hair. I can only assure you, that the best policy is to be up front and to joke about these things openly. The vast majority of people are enormously understanding, and they are relieved when you make light of things yourself. These days gyms are attended by people of all shapes and sizes and there is absolutely no reason to be embarrassed or self-conscious about the way you look. The people there are there for a reason, and they're really not concerned about the details of appearance of those around them. It is often helpful and reassuring to have a good friend with you when you first make the jump of attending a gym or aerobics class.
Where can I find out more information?
We run both the ENRICH and ENCORE programs at Macquarie University.
- The ENRICH program is a free exercise and healthy eating program run by the Cancer Council.
- The YWCA ENCORE program is a free 8 week exercise program designed specifically for women who have had a mastectomy, lumpectomy or breast reconstruction at any time in their lives.
The NSW Cancer Council has published a booklet on Exercise and Cancer. It's an incredibly useful resource and a must read for anyone diagnosed with cancer. Click here for a PDF version of the booklet. Their webpage on exercise and cancer is also particularly useful.
Below are some great journal articles which demonstrate the benefits of exercise during breast cancer treatment:
Many people who are feeling a severe lack of energy field and it may harm them to exercise. My advice is to listen carefully to what your body is telling you, but to push it just a little bit. For example, there will be moments in the day when you have more energy. Try to utilise be safe for the disposal the even brief walking or other exercise. Consider joining an aqua aerobics class. These are often held in servers clubs, gyms or public pools.
I'm embarrassed about attending a gym because of how I look.
Many people feel embarrassed about joining a gym or an aerobics class when they have had a mastectomy or if they have no hair. I can only assure you, that the best policy is to be up front and to joke about these things openly. The vast majority of people are enormously understanding, and they are relieved when you make light of things yourself. These days gyms are attended by people of all shapes and sizes and there is absolutely no reason to be embarrassed or self-conscious about the way you look. The people there are there for a reason, and they're really not concerned about the details of appearance of those around them. It is often helpful and reassuring to have a good friend with you when you first make the jump of attending a gym or aerobics class.
Where can I find out more information?
We run both the ENRICH and ENCORE programs at Macquarie University.
- The ENRICH program is a free exercise and healthy eating program run by the Cancer Council.
- The YWCA ENCORE program is a free 8 week exercise program designed specifically for women who have had a mastectomy, lumpectomy or breast reconstruction at any time in their lives.
The NSW Cancer Council has published a booklet on Exercise and Cancer. It's an incredibly useful resource and a must read for anyone diagnosed with cancer. Click here for a PDF version of the booklet. Their webpage on exercise and cancer is also particularly useful.
Below are some great journal articles which demonstrate the benefits of exercise during breast cancer treatment:
- Effects of exercise dose and type on sleep quality in breast cancer patients receiving chemotherapy: a multicenter randomized trial
- Randomized Exercise Trial of Aromatase Inhibitor–Induced Arthralgia in Breast Cancer Survivors
- Effects of Exercise during Adjuvant Chemotherapy on Breast Cancer Outcomes
- Randomized Trial of Exercise Therapy in Women Treated for Breast Cancer