#099 The Science of Exercise for Cancer | Kerry Courneya, PhD
Dr. Kerry Courneya, a leading expert in exercise oncology, discusses how exercise has shifted from an optional to a therapeutic intervention for cancer. He explains its role in prevention, enhancing treatment tolerance, improving survival outcomes, and mitigating side effects across various cancer types.
Deep Dive Analysis
19 Topic Outline
Introduction: Exercise as a Therapeutic Cancer Intervention
Cancer Prevention: Lifestyle Shifts and Risk Reduction
Exercise Intensity and Dose-Response for Cancer Prevention
Pre-Diagnosis Exercise Benefits and Cancer Preparedness
Muscle Mass, Sarcopenia, and Cancer Outcomes
Structured Exercise vs. Daily Activity for Cancer Prevention
Cancer Treatment Landscape and Exercise Integration
Exercise for Managing Treatment Side Effects and Tolerance
Mechanisms of Exercise Affecting Primary Tumors
Exercise and Circulating Tumor Cells: Preventing Metastasis
Cancer Metastasis Timelines and Liquid Biopsies
Exercise-Sensitive vs. Exercise-Resistant Cancers
Weight Training for Prostate Cancer on Androgen Deprivation Therapy
Exercise as Monotherapy for Low-Grade Cancers (Active Surveillance)
Psychological Benefits of Exercise in Cancer Patients
Exercise Across the Cancer Care Continuum
Challenges and Support for Exercise Adherence in Cancer Patients
Cost-Effectiveness of Exercise in Cancer Care
Myths and Nuances of Exercise in Cancer
8 Key Concepts
Prehabilitation
This concept involves preparing the body through fitness for the eventuality of chronic disease diagnosis and its treatments. It aims to reduce complications, shorten hospital stays, and improve recovery after medical interventions.
Cachexia
Cachexia is a severe wasting disease phenomenon observed in cancer patients, particularly those with advanced or metastatic cancer, characterized by significant muscle wasting. Low muscle mass in this state is a critical factor driving the risk of recurrence and death from cancer.
Sarcopenic Obesity
This condition describes individuals who have high rates of obesity but also low lean body mass. It highlights that Body Mass Index (BMI) alone is not a sufficient measure of body composition, as the ratio of fat mass to lean mass is a more important factor for health outcomes.
Neoadjuvant Therapy
Neoadjuvant therapy refers to cancer treatments, such as chemotherapy or radiation, administered before the main treatment like surgery. The goal is to shrink or eliminate the tumor prior to surgical removal, and exercise can potentially enhance its effectiveness.
Circulating Tumor Cells (CTCs)
These are cancer cells shed from a primary tumor that travel through the bloodstream, capable of spreading cancer to other parts of the body. Exercise may reduce the survival of these cells due to increased shear stress from blood flow.
Liquid Biopsies
Liquid biopsies are experimental blood tests designed to detect small numbers of circulating tumor cells or circulating tumor DNA. This technology aims to allow for earlier detection of cancer or recurrence than traditional imaging, potentially revolutionizing cancer care.
Active Surveillance
Active surveillance is a cancer management approach for small, low-grade, slow-growing cancers, primarily used in prostate cancer, where initial treatment is withheld. Instead, the cancer is closely monitored, allowing for lifestyle interventions like exercise to potentially delay or prevent the need for more aggressive treatments.
Fear of Cancer Progression/Recurrence
This is a significant psychological issue for cancer patients who, even after successful treatment, live with the anxiety and stress of potential cancer return. This fear can be paralyzing and is often exacerbated by regular follow-up screenings that determine if the cancer has come back.
13 Questions Answered
Assuming you're not smoking, obesity is the second biggest risk factor, followed by alcohol consumption. If none of these apply, exercise is next on the list, with general recommendations of 150 minutes per week of moderate to vigorous aerobic exercise.
Yes, exercise lowers the risk of cancer regardless of obesity status, and even for smokers, though quitting smoking has a larger impact on risk reduction.
Yes, current exercise guidelines for cancer prevention do not specify how exercise must be spread out over the week. Accumulating 150 minutes per week over a weekend can be as beneficial as distributing it throughout the week.
The recommended 150 minutes per week of moderate intensity exercise is above and beyond background activity; daily movement is important but not a replacement for a structured exercise program.
Exercise helps patients complete more of their chemotherapy treatments with fewer reductions or delays. It also improves the delivery of drugs to tumors and makes tumors more radiosensitive by enhancing blood flow and oxygenation.
Low muscle mass is a critical factor driving the risk of recurrence and death from cancer, as cancer can cause muscle wasting (cachexia). Having muscle reserves helps patients endure the disease and its treatments.
Exercise improves the quality and density of blood vessels within primary tumors, enhancing chemotherapy drug delivery and making tumors better oxygenated and thus more sensitive to radiation therapy.
Exercise increases blood flow and shear stress in the vasculature, which makes circulating tumor cells less likely to survive their journey and spread to other organs.
Metastasis varies dramatically by cancer type; sometimes small tumors shed cells that spread quickly, while other times disseminated cells can sit dormant for years before regrowing.
Yes, studies in prostate cancer patients on active surveillance have shown that high-intensity exercise can lower prostate-specific antigen (PSA) levels and reduce the growth of prostate cancer cells in vitro.
Exercise helps cancer patients feel more in control and normal, improving self-confidence, self-esteem, and managing anxiety, depression, and fear of cancer progression or recurrence.
During treatments, no more than 5% to 10% of cancer patients meet exercise guidelines, though this increases to 30% to 40% in the survivorship phase after treatment.
Motivation comes from understanding cancer-specific benefits, starting with realistic and feasible programs, and receiving strong recommendations and support from oncologists and the cancer care team.
32 Actionable Insights
1. Quit Smoking for Cancer Prevention
Quit smoking immediately as it is the biggest risk factor for cancer, and doing so can substantially reduce your risk with fairly quick benefits.
2. Manage Obesity for Prevention
If you are obese, engage in a weight loss program to reduce obesity, as it is the second leading risk factor for developing cancer after smoking.
3. Reduce Heavy Alcohol Consumption
Lower your alcohol intake if you are a heavy drinker, as there is a significant link between alcohol consumption and various alcohol-related cancers.
4. Engage in Lifelong Exercise
Exercise throughout your lifetime to prepare your body for potential chronic diseases and their treatments, acting as ‘pre-habilitation’ for future health challenges.
5. Build Muscle Reserve
Incorporate regular resistance training to build and maintain muscle mass, which is critical for cancer patients and helps combat muscle wasting (cachexia) during illness.
6. Prioritize Structured Exercise
Engage in a good quality structured exercise program combining aerobic and strength training, as this is essential and not replaced by general daily background activity.
7. Aim for 150-300 Minutes/Week
Target 150 to 300 minutes per week of moderate to vigorous intensity aerobic exercise for optimal cancer prevention benefits, with 150 minutes as the minimum.
8. Increase Exercise for Family History
If you have a family history of cancer, aim for the higher end of exercise recommendations (e.g., 300 minutes/week) to maximize benefits and risk reduction.
9. Exercise Regardless of Risk Factors
Exercise to lower your cancer risk even if you are obese, have a family history, or have smoked, as its benefits extend to high-risk populations.
10. Exercise to Reduce Fatigue
Actively exercise during chemotherapy to experience lower fatigue, as resting can paradoxically lead to more reported fatigue in cancer patients.
11. Exercise Improves Treatment Completion
Exercise during chemotherapy to improve your ability to complete treatments, leading to fewer drug reductions or delays, a higher chance of cure, and lower recurrence risk.
12. Enhance Treatment Effectiveness
Exercise to improve blood flow and oxygenation to tumors, which enhances the delivery of chemotherapy drugs and makes tumors more sensitive to radiation therapy.
13. Reduce Cancer Metastasis
Exercise to increase blood flow and shear stress in the vasculature, which helps kill circulating tumor cells and reduces the likelihood of cancer spreading.
14. Boost Immune System with Exercise
Stimulate your immune system through exercise to increase natural killer cells, T cells, and B cells, enhancing immunosurveillance against cancer cells.
15. Lower Recurrence and Mortality
Continue exercising post-treatment to lower the risk of cancer recurrence and dying from cancer, as shown by a growing body of epidemiological research.
16. Prevent Secondary Chronic Diseases
Exercise after cancer treatment to reduce the risk of secondary chronic diseases like cardiovascular disease, osteoporosis, and diabetes, which can be increased by cancer therapies.
17. Manage Fear of Recurrence
Use exercise to manage the fear of cancer progression or recurrence, helping patients cope with psychological stress and feel more in control of their lives.
18. Exercise: A ‘Win-Win’ Intervention
Prioritize exercise as a unique intervention that simultaneously improves quality of life, manages side effects, and enhances disease-free survival in cancer patients.
19. 15-Minute Strength Training
If you only have 15 minutes a day, prioritize heavier, compound strength training (e.g., squats) to target muscle mass, which is critical for treatment, survival, and quality of life.
20. Weight Training During Treatment
Follow a full-body weight training program 2-3 days per week (e.g., 8 exercises, 8-12 reps to failure) during cancer treatment, as it’s been shown to be very beneficial.
21. Combine Aerobic & Resistance
Combine aerobic and resistance exercise during treatment for additional benefits in muscular strength, lean body mass, and symptom management.
22. Consider Higher Intensity Exercise
Explore higher intensity exercise, such as high-intensity interval training (HIIT), as it appears to be more beneficial for driving biological changes relevant to cancer treatment.
23. HIIT for Prostate Cancer
For men with prostate cancer on active surveillance, use high-intensity interval training (HIIT) to lower PSA levels and reduce the growth of prostate cancer cells.
24. Individualize Exercise Programs
Ensure exercise programs are individualized and progress slowly for cancer patients, especially those new to exercise, to ensure safety, tolerability, and adherence.
25. Get Oncologist’s Recommendation
Seek your oncologist’s recommendation for exercise, as their endorsement is crucial for motivating patients to incorporate physical activity into their cancer care.
26. ASCO Recommends Exercise
Be aware that the American Society of Clinical Oncology (ASCO) recommends aerobic and resistance exercise for all cancer patients undergoing curative intent treatments.
27. Seek Exercise Support
Actively seek support and intervention to maintain exercise during cancer treatment, as the natural tendency is to reduce activity levels without assistance.
28. Utilize Community Programs
Access community-based exercise programs like Livestrong at the YMCA or specialized programs at cancer centers, which offer expert support for cancer survivors.
29. Start with Walking Program
If you’re new to exercise or facing tough treatment phases, start with a walking program, as it’s a realistic, feasible, and beneficial way to begin.
30. Break Sedentary Time
Break up extended periods of sitting by getting up and moving around, as sedentary time is an independent risk factor for various cancers.
31. Short Bursts of Vigorous Activity
Accumulate short bursts of vigorous intensity activity (e.g., 1-2 minutes) throughout the day, as these can have beneficial effects even if not part of a continuous workout.
32. Sun Protection During Exercise
Wear sunscreen and protective clothing during outdoor exercise to prevent skin cancer, as regular exercisers have higher rates due to increased sun exposure.
7 Key Quotes
Exercise is not just supportive, it's a therapeutic intervention that recalibrates tumor biology, it enhances treatment tolerance, and it improves survival outcomes.
Dr. Rhonda Patrick
Assuming you're not smoking, which is 80 to 85% of the American population, obesity is actually the second on the list of risk factors for developing cancer.
Dr. Kerry Courneya
The patients that rested during chemotherapy actually reported more fatigue than the patients who exercise.
Dr. Kerry Courneya
Exercise, in some ways, was the original immunotherapy.
Dr. Kerry Courneya
Don't take cancer lying down.
Dr. Kerry Courneya
Exercise is one of these few interventions potentially for patients that can help both with quality of life, side effect symptoms, and also improve disease-free survival.
Dr. Kerry Courneya
If we can demonstrate in a larger study that exercise lowers the risk of recurrence, he said that would change the game. He says, you know what it costs when a breast cancer patient has a recurrence? A million dollars.
Dr. Kerry Courneya
1 Protocols
Standard Full-Body Weight Training Program (for cancer patients)
Dr. Kerry Courneya- Perform weight training 3 days per week.
- Include approximately 8 exercises covering all major muscle groups.
- Train at a moderate intensity, aiming for 8 to 12 repetitions before failure for each exercise.