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Cancer is a disease associated with the growth of abnormal cells that divide uncontrollably and destroy normal body tissue. Skinner et al. (2005) cancer is not a single disease but rather a term that defines the uncontrolled spread of cells. Furthermore, a study by Dennis J. Kerrigan et al. (2013) found cancer is one of the leading causes of morbidity and mortality throughout the world. Two in one people in the world will be diagnosed with cancer, this is a significant problem. The main points that the study will investigate are the problems that cause cancer to happen, explain the pathophysiological of cancer and how exercise can have an impact on cancer. The study aims to provide evidence-based exercise prescription to cancer patients.
The effects of cancer on physical functioning depends on the stage and type of cancer and the results of treatment. A study by Skinner et al. (2005) found local disease has a small chance of impacting cancer patient day to day activities. However, a study by Adrianne E. Hardman et al. (2009) found, some patients are not limited physically until their disease has progressed to an advanced stage. The difference, patients whose presenting symptom is pain may be limited early with cancer. Andrew Scott et al. (2016) found the most common treatments for cancer are surgery, chemotherapy and radiation therapy. Additionally, a study by Skinner et al. (2005) found surgery can have both minor and vital effects on a patient. This can result in decreased strength, endurance, and range of motion of the affected limb. Andrew Scott et al. (2016) found common effects of chemotherapy can result in fatigue, nausea, vomiting, insomnia, weight gain, and anemia. Furthermore, the same study by Andrew Scott et al. (2016) found radiation therapy can result in fatigue and the possible scar tissue formation in the exposed area. The difficulty of fatigue limits physical activity in a huge portion of cancer patients. The results of the study showed how important rest is for patients to recover, however, long term rest can have a major impact on the reduction of physical activity which can lead to several more problems. A study by Skinner et al. (2005) found patients who have finished treatment for cancer will experience a decrease in lean body mass, aerobic fitness, muscular strength, muscular endurance and affect their flexibility and this will result in a massive increase in body fat. The decrease in overall physical fitness could have a huge impact on the ability of a cancer patient to carry out daily activities.
Each year, approximately 14.1 million new cases of cancer are diagnosed worldwide. In the United Kingdom, more than one in three people will develop cancer at some time during their lifetime, and the latest UK statistics show that more than 331,000 people were diagnosed with cancer in 2011. However, Cancer Research UK (2020) states that one in two people will develop cancer at some point in their lives. Cancer is most common with old age, a study by Andrew Scott et al. (2016, p.103) states that cancer is more common in later life, with 53 percent of cases diagnosed in people aged fifty to seventy-four years and 36 percent after age seventy-five years. However, in Cancer Research UK (2014) found detection systems are improving and more effective treatment options are available, leading to cancer deaths to decrease by 10 percent in the last decade and resulting in half of the patients living longer up to ten years more. Additionally, a study by Dennis J. Kerrigan et al. (2013) found the estimated prevalence, the number of people alive following a cancer diagnosis is currently 3 percent and this represents about two million people. However, a study by Maddams et al. (2012) found since UK population is aging, cancer prevalence is projected to increase by 55 percent in males compared to 35 percent of females in the next two decades, this will result in more than four million people living with cancer by 2030 (Mistry et al. (2011).
Jonathan K. Ehrman et al. (2018) found the normal growth and proliferation of cells within the body is under genetic control. The stem cell theory is the model developed to describe the orderly proliferation of cells, specialization to perform to perform discrete functions and cell death within an organ. Additionally, the study by Jonathan K. Ehrman et al. (2018) studied the stem cell is pluripotent, which meant that it is an uncertain cell with many developmental options still open. The process by which the stem cell is capable of producing special functions within an organ system. However, study by Dennis J. Kerrigan et al. (2013) found some stem cells are activated to transform into hair cells and some cells become cardiac myocytes. The pluripotent stem cell has the volume for self-renewal. Andrew Scott et al. (2016) found that after a stem cell commits to a cell line for instance a hair cell it will no longer will have pluripotent and self-renewed properties and is destined to grow along its specialized pathway of diversity. A great example is a pluripotent hematopoietic stem cell. A study by Jonathan K. Ehrman et al. (2018, p. 380) states that the best example is a pluripotent hematopoietic stem cell, with its capacity to form both red and white blood cells. After it commits to a specific cell line, it can no longer differentiate into other cell types or divide into new cell forms (Jonathan K. Ehrman et al. 2018).
In one early RCT, seventy inpatients with solid tumors receiving high dose chemotherapy followed by stem cell transplantation were allocated to daily exercise on a supine cycle ergometer or to usual care (Dimeo et al., 1997). At discharge, exercisers recorded a significantly smaller decline in physical performance (14 percent) than controls (19 percent), and had been hospitalized for one and a half fewer days. Several treatment related complications were lower among the exercise group, including pain, diarrhea, thrombopenia, and neutropenia. A systematic review of eight RCT’s of exercise interventions for cancer patients undergoing hematopoietic stem cell transplants reported some encouraging results (Wiskemann and Huber, 2008). Exercising during impatient says helped to prevent aerobic and muscular deconditioning, enhance quality of life, and improve immune function. Exercise after discharge led to improvements in aerobic and muscular functioning, quality of life, and body composition.
A comprehensive systematic controlled review published in 2010 summarized all randomized and non-randomized controlled trials involving exercise interventions for cancer populations (Speck et al., 2010). Based on thirty-three trails involving exercise performed during treatment (usually chemotherapy or radiotherapy). Significant small to moderate beneficial effects were evident for aerobic fitness, muscular strength, body fat percentage, and anxiety. Subsequently, another systematic review focused on quality of life outcomes from trails of exercise performed during cancer treatment (Mishra et al., 2012). Collectively, the results from fifty-six RCT or quasi randomized trails indicated an overall small improvement in global quality of life after exercise interventions, compared with control conditions.
The benefits achievable through exercise are not limited to patients with good prognoses. Several systematic reviews of a small, but growing, body of evidence have concluded that exercise interventions may help maintain, or slow the decline in, quality of life and fatigue among patients with advanced cancer (Lowe et al., 2009). A study by Albrecht and Taylor, (2012) found the strongest evidence has come from a large RCT involving 231 patients with incurable disease and short life expectancy (Oldervoll et al., 2011), comparing the effects of an eight-week supervised group exercise intervention with usual care. Unsurprisingly, given the population, the number of patients not completing the trail was high. Nonetheless, encouraging results were reported, with significant increases in physical function outcomes grip strength and walking performance observed for the exercise group. These improvements can be very important for enabling performance of activities of daily living.
In 2010, the American college of sports medicine convened a multidisciplinary expert panel to provide guidelines on exercise for cancer survivors (Schmitz et al., 2010). The panel concluded that exercise is safe and effective during and after cancer treatment. The review concentrated on breast, colon, prostate, gynecological, and hematological cancers and provided cancer specific screening criteria for starting and stopping an exercise program. For instance, they recommend that a colon cancer patient with an ostomy should receive permission from a health professional before participating in exercising. Likewise, if a woman with breast cancer reported swelling in the arm or hand during exercise, it is recommended that upper body exercise should be minimized until appropriate medical evaluation and action took place. A set of guidelines relating to safety considerations for cancer survivors have been published in the ACSM’s guidelines for exercise testing and prescription (Pescatello et al., 2014).
Additionally, a study by Andrew Scott et al. (2016) found the common side effects of cancer treatments include nausea, vomiting, anorexia, altered taste and smell that may lead to reduced nutrient intake. Specialist oncology dieticians can provide individualized guidance to patients in developing suitable diet plans. The general aims are to prevent or correct nutritional deficiencies, achieve or maintain a healthy body weight, preserve lean mass and prevent fat gain. For patients after treatment result in specific long-term alterations to dietary intake. For all patients after treatment completion, dietary advice is aimed at avoiding excess weight gain, and minimizing food associated with increased risk of recurrence. An evidence-based report from the World Cancer Research Fund provided a series of dietary recommendations with regard to preventing cancer that were directed to people with a cancer diagnosis (World Cancer Research Fund, 2007). These included limiting consumption of energy dense foods, avoiding sugary drinks, eating mostly foods of plant origin, e.g., vegetables, fruit, limiting red meat and limiting alcoholic drinks, limiting salt, and avoiding dietary supplements unless prescribed by expert.
To get a cancer patient starting exercise in an exercise program. When in doubt when and where to start, I would use the 50% rule; ask the patient how far can they walk before becoming too tired. And start at half that distance time. The exercise program for cancer patients does not typically involve electrocardiographic monitoring, although some supervision and instruction about heart rate monitoring, proper exercise techniques and cancer specific exercises should be included. The exercise prescription should be reviewed with the patient and the cancer patient should be instructed about proper intensity (RPE scale) and recognizing common adverse symptoms to exercise. Related to current exercise for healthy adults, I will encourage the cancer patients to participate in general (total body) resistance as well as flexibility exercises. Furthermore, prescribing exercise during active treatment should give attention to specific treatment side effects and, when possible, an oncologist should be consulted regarding limitations. Patients with cancer, set backs are common and interruptions are also not uncommon. Instead of not making the patient stop the exercise programs and allow the patients to plan around setbacks and continue to follow to the program when they can.
Cancer is characterized by uncontrollable reproduction of abnormal cells in any part of the body. It can begin in any organ and spread to other organ systems. Cancer is a major cause of morbidity and mortality. Over half of cancer deaths are accounted for by cancer of the lung, breast but the risk factors vary by tumor site. The most common treatments for cancer are surgery, chemotherapy, radiation and hormonal therapy. Both the disease and treatment bring emotional and physical challenges to patients with cancer. Exercise benefits these patients primarily through improving function, reducing fatigue and countering some of the side effects of cancer therapy.
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