Exercise Reduces Cancer Death Risk, Benefits Older Survivors During Treatment

Cancer survivors who engaged in even small amounts of exercise reduced their risk of cancer-related death, according to a study reported Feb. 17 in JAMA Network Open. The findings come as a multidisciplinary panel of 16 experts from across North America published a consensus statement in the journal Cancer declaring exercise essential for cancer survivors older than 65 during treatment, throughout recovery and beyond.

The JAMA Network Open study pooled data from six large-scale studies, tracking more than 17,000 cancer survivors with an average age of 67. About 49% of the survivors had been diagnosed with early or mid-stage cancer. Survivors of bladder (24%), endometrial (22%), and lung (18%) cancers accounted for more than half of the patients.

Results showed that any amount of physical activity lowered risk of cancer death by 33% for bladder cancer patients, 38% for those with endometrial cancer, and 44% for people with lung cancer. As exercise levels rose, the risk of death fell for many types of cancer. Compared with survivors who didn't exercise before or after diagnosis, lung and rectal cancer survivors had a 42% and 49% lower risk of death if they started working out. However, active people who quit working out following their cancer diagnosis showed no significantly reduced risk of death.

The expert panel, called ACES (Advancing Capacity to Integrate Exercise Into the Care of Older Cancer Survivors), was led by Oregon Health & Science University physicians and professors. The panel included exercise scientists, geriatricians, medical oncologists, physical therapists and a patient advocate and exercise professional. Their year-long effort culminated in a series of recommendations for older cancer survivors that dispel the myth that it's too risky for them to exercise and fill a gap in guidance for the largest demographic of cancer survivors in the United States.

Development of the consensus statement was funded by a National Cancer Institute grant, and the guidelines are meant to complement the current cancer survivor exercise recommendations from the American College of Sports Medicine, the American Society of Clinical Oncology, and National Comprehensive Cancer Network.

In 2016, there were an estimated 15.5 million cancer survivors in the U.S., 62% who were 65 or older. By 2040, that number is projected to jump to 26.1 million, with 73% age 65 or older. Yet there is a surprisingly small number of rigorous, controlled exercise trials in older cancer survivors that could inform evidence-based practice.

The ACES panel examined the current American College of Sports Medicine general cancer survivor guidelines and agreed that they apply to older cancer survivors: avoid inactivity; engage in 30 minutes of moderate‐intensity aerobic and/or resistance exercise three times per week; strive toward 150 minutes of moderate to vigorous aerobic exercise per week, plus twice‐weekly resistance exercise, with recommended additional exercise prescriptions specific to older cancer survivors.

For health care providers, the panel created a suite of recommendations on prescribing and delivering exercise for cancer survivors 65 and older. Guidance includes monitoring for signs of poor tolerance during exercise, such as fatigue, pain, dizziness and weakness, and adjusting exercise accordingly; adding balance and flexibility training to exercise routine; and modifying exercises or involving caregivers, family or friends if unsupervised exercise is unsafe.

For older cancer survivors, maintaining their independence may be more important to them than living longer. Exercise is key to achieving and maintaining independence as long as possible, but it must be integrated up front, alongside treatment. A regular exercise program will increase chances of being able to perform activities of daily living such as bathing, dressing, eating, plus higher-level activities like grocery shopping and cleaning, without dependence on others.