Patients with
cancer undergo various treatments including surgery, radiation, and
chemotherapy managed by oncology and related specialties. There are certain additional
measures that patients can take on their own to improve symptoms and often
increase longevity. Lifestyle measures include nutrition, exercise, sleep,
stress management, adequate social interaction, and avoiding risky substances. These
form the six pillars of Lifestyle Medicine. In addition, spiritual matters are
very important.
It has been known
that exercise can prevent cancer, but only recently has there been a randomized
controlled trial in patients with stage III or high-risk stage II colon cancer
that showed decreased mortality with regular exercise. (New England Journal
of Medicine 2025: 393:13-25). These are patients whose cancer had spread
through the bowel wall to nearby structures or lymph nodes but not distant
spread. After surgery and chemotherapy, patients were randomized to a
structured exercise program or to only receive health education materials.
There was significant improvement in survival in the exercise group versus the
education group, without cancer return at five years, as well as decreased mortality
at almost eight years. Improvements with exercise are in addition to those seen
with the primary therapies.
Exercise is safe
for most patients with cancer. It is beneficial before, during, and after
treatment. Regular exercise can improve muscle strength, decrease fatigue,
anxiety, and depression as well as improve quality of life, strengthen the
immune system, and reduce treatment side effects. (Health Quality Life Outcomes 2020: 18:197).
Mortality benefits have been seen in patients with breast,
colon, and prostate cancers who exercise regularly. We recommend exercise for patients
with all types of cancer to achieve the above benefits even though mortality
benefits have not yet been proven. The Centers for Disease Control and
Prevention recommend that adult patients have 150 minutes of moderate exercise
weekly as well as two days of strength training. This works out to 30 minutes
five days weekly or any amount adding up to 150. Patients do not need to
perform their daily amount of exercise at one time; they can do some exercise
in the morning and some in the afternoon to make up the daily total. Although
these are general guidelines, they do not differ in patients who have cancer. Starting
slowly is key. Begin by walking a few minutes or climbing stairs instead of
riding the elevator and gradually work up to 30 minutes on most days. There is
no minimum amount of exercise that can give one benefit, although the largest
incremental benefit occurs in those who do none and start doing some.
Change is difficult in many circumstances, and patients need
to be motivated and confident that they can indeed change. The new activities
that patients undertake need to be sustainable to be effective, and they will
only yield benefit if patients continue to do them.
Severe fatigue is a significant problem in many patients who
are undergoing cancer treatment. As mentioned above, exercise can help with
this symptom as well as other quality of life issues. Knowing that exercise may
improve one’s long-term outcome is usually not enough motivation to continue physical
activity. Rather, when patients see that they feel better after exercise, this
will be the incentive to continue exercising.
Patients’ care teams can help them acquire the necessary
motivation for exercise as well as other lifestyle measures and guide them on
their individual paths. Lifestyle Medicine providers are well suited to assist
patients’ primary cancer caregivers and patients to maximize their lives in
quality and quantity.
Dr. Birnbaum practices Internal Medicine with Lifestyle
Medicine and sees patients at Johns Hopkins at Water’s Edge in Belcamp, MD in
Harford County.
