Access the full text.
Sign up today, get DeepDyve free for 14 days.
review memo (2021) 14:154–156 https://doi.org/10.1007/s12254-021-00698-1 Importance of performance status and physical activity in cancer patients David Kiesl Received: 21 September 2020 / Accepted: 1 March 2021 / Published online: 24 March 2021 © The Author(s) 2021 Summary Keywords Exercise · Movement recommendations · Background This review summarizes current data on Cancer · CRCI · Cognition the effects of exercise interventions and physical ac- tivity in cancer prevention, treatment and related side effect management, as well as on the rehabilitation of Cancer is one of the world’s largest health problems cancer patients. and, along with cardiovascular disease, one of the Patients and methods The overall quality of patient leading causes of death. The individual “age-adjusted” studies is still poor due to methodological limita- risk of death decreased between 2014 and 2019 for tions. Major limitations of the interventional exercise most types of cancer, which is primarily due to the de- studies conducted include their designs, with regard velopments and improvements in screening and treat- to missing randomization or the absence of control ment modalities in recent years [1–3]. Despite these groups, and the use of heterogeneous assessment successes and new treatment options, the time un- methods to quantify and objectify physical activity. der and post treatment for patients is often associ- As a result, there are no speciﬁc exercise recom- ated with long-term impairments . With reduced mendations in cancer patients as yet that would mortality, cancer and its treatment-related morbidity essentially differ from exercise recommendations for moved into the focus of research [4, 5]. healthy subjects. Nevertheless, due to major ﬁndings In oncology, movement and training interventions and empirical data, the ﬁeld of research into exer- as forms of therapy have long been neglected and re- cise- and physical activity-related effects on disease ceived little welcome. In addition to the three main and therapy-associated aspects is young and rapidly blocks of oncological treatment, which remain sur- emerging. gical, radiation and drug therapy, sport and move- Conclusion Exercise potentially contributes to the ment therapy were virtually unused. Physical activ- prevention and rehabilitation of cancer and repre- ity was considered to be unknown and unsafe. In the sents a powerful tool in the prevention of various side past few years, however, there has been a noticeable effects under chemotherapy. Current data from inter- change. Exercise therapy and sport seem to have been ventional studies show preliminary positive effects for ﬁnding their way into oncological rehabilitation more diverse movement programs and especially through and more, becoming a permanent pillar of modern speciﬁc combinations of endurance and resistance oncology. The reason for this can be seen through training. Additional randomized controlled trials with the positive effects that result from numerous stud- standardized assessments and controlling for poten- ies examining physical activity and cancer in detail. tial confounders are needed to conﬁrm and expand In addition to the scientiﬁc ﬁndings, practical expe- these ﬁndings. riences demonstrate that physical activity and sports are safe, powerful and supportive tools in oncological Dr. D. Kiesl () therapy [6, 7]. It is now well known that physical activ- University Clinic of Hematology and Internal Oncology, ity lowers the risk of cancer and mortality and that it Johannes Kepler University Hospital Linz, Med Campus can signiﬁcantly reduce the incidence of disease and II, Johannes Kepler University, Krankenhausstraße treatment-speciﬁc side effects such as nausea, vom- 7a, 4020 Linz, Austria firstname.lastname@example.org iting, reduced bone density, cardiac toxicity, cancer- 154 Importance of performance status and physical activity in cancer patients K review Avoiding muscle shortening related fatigue, depression, lymphedema and incon- Compensation of strength deﬁcits tinence [8–10]. This directly results in an increase in Reduction and prophylaxis of lymphedema patient quality of life both during and after therapy. Contracture prophylaxis; reduction of restricted The majority of studies have investigated the ef- mobility fects of exercise on neurocognitive side effects under Treatment and prevention of osteoporosis chemotherapy on the basis of the broad ﬁeld of stud- Improvement in general ﬁtness ies conducted in patients with neurodegenerative dis- Improvement of body strength and self-esteem eases. Reduction of fatigue Therefore, there is strong evidence for the bene- Improvement of quality of life ﬁts of aerobic endurance training, anaerobic exercise and the correlates of daily physical activity levels on patients with neurodegenerative diseases such as de- The main types of exercise suggested for cancer pa- mentia, Alzheimer’s, as well as depression and fatigue, tients are endurance sports. Recommendations in- as often seen in cancer patients [11–13]. Several stud- clude swimming, cycling and walking, amongst many ies show that the neuroprotective effects of exercise others. In sports that require the use of poles, such are achieved through a number of neuronal biochemi- as cross-country skiing and Nordic walking, breast cal mechanisms, such as increased cerebral angiogen- cancer patients in particular should be made aware esis, as well as hippocampal neurogenesis and plas- to only exercise after the surgical site has completely ticity [14–16]. healed due to the high level of arm use. In addition to the above-mentioned beneﬁts, it is Another important pillar of rehabilitation is water known that physical activity, regardless of the type of therapy. To avoid overexertion, patients should start cancer, has positive effects on the structural changes with light water aerobics. Positive aspects of water of the central nervous system . Current studies therapy include the low risk of injury and the im- indicate that both long and short exercise units sig- proved lymphatic circulation through the hydrostatic niﬁcantly increase cognitive functions of juvenile as pressure. well as adult patients in speciﬁc neurocognitive tasks Research in the application of resistance training [17, 18]. is still sparse; however, light strength training as an Besides aerobic exercise, other types of training, essential supplementary method of exercise therapy such as resistance training [19, 20], have been under in an oncological setting is already being regularly investigation. In particular a combination of resis- adopted and is recommended at least once a week. tance and endurance training, as well as alternative Strength endurance is recommended when training forms of core-stability training such as yoga, tai chi with weights, which should be carried out under ther- or qigong, have been associated with positive effects apeutic supervision including monitoring of exercise . intensity, blood pressure, heart rate and subjective Exercise and physical activity have therefore re- well-being. ceived increasing attention in the ﬁeld of rehabilita- tion and as a possible treatment component that can Take home message be safely, feasibly and effectively carried out [4, 8]. Constant physical activity during treatment reduces With regard to the various training modalities, super- not only side effects, but also recovery times between vised one-on-one support, training units in group set- and after therapy and ultimately enhances patient sur- tings, as well as self-performed home training can vival [22–24]. be recommended. The question as to the level at Patients that consistently exercise are in much bet- which training is effective and which load intensities are ter general condition, ﬁtter despite chemotherapy and needed to reproduce or amplify the above-mentioned show fewer cardiovascular problems, states of exhaus- positive effects needs to be investigated in further stud- tion or depression. ies. Exercise therapy can be started at a very early stage Funding Open access funding provided by Johannes Kepler of patient care. Physical training for cancer patients, University Linz. especially post-surgery, is based on initial mobiliza- Conﬂict of interest D. Kiesl declares that he has no competing tion exercises, which can be carried out in the hos- interests. pital 24 h after surgery. However, this should only be done as part of a physiotherapeutic process and under Open Access This article is licensed under a Creative Com- supervision by a therapist. Endurance and resistance mons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in training at this stage leads to an increase in mobility, any medium or format, as long as you give appropriate credit a reduction in the side effects of cancer therapy and to the original author(s) and the source, provide a link to consequently an increase in quality of life. the Creative Commons licence, and indicate if changes were Speciﬁc goals in cancer patients due to the type of made. The images or other third party material in this article entity can include: are included in the article’s Creative Commons licence, unless K Importance of performance status and physical activity in cancer patients 155 review indicated otherwise in a credit line to the material. If material 13. Stern Y,MacKay-Brandt A, Lee S, McKinleyP,Mcintyre K, is not included in the article’s Creative Commons licence and Razlighi Q, et al. Effects of aerobic exercise on cognition in your intended use is not permitted by statutory regulation or younger adults. Neurology. 2019;92(9):e1–e12. exceeds the permitted use, you will need to obtain permis- 14. Mattson MP. Lifelong brain health is a lifelong challenge: sion directly from the copyright holder. To view a copy of this from evolutionary principles to empirical evidence. Ageing licence, visit http://creativecommons.org/licenses/by/4.0/. Res Rev. 2015;20:37–45. 15. Tari AR, Norevik CS, Scrimgeour NR, Kobro-Flatmoen A, Storm-Mathisen J, Bergersen LH, et al. Are the neuropro- tective effects of exercise training systematically mediated? References Prog Cardiovasc Dis. 2019;62(2):94–101. 16. Xu Q, Partk Y, Huang X, et al. Physical activities and future 1. Carioli G, Malvezzi M, Rodriguez T,BertuccioP,Negri E, La risk of Parkinson disease. Neurology. 2010;75(4):341–8. Vecchia C. Trends and predictions to 2020 in breast cancer 17. Lees C, Hopkins J. Effect of aerobic exercise on cognition, mortality in Europe. Breast. 2017;36:89–95. https://doi. academic achievement, and psychosocial function in chil- org/10.1016/j.breast.2017.06.003. dren: a systematic review of randomized control trials. Prev 2. Bertuccio P, Alicandro G, Malvezzi M, etal. Cancer mortality Chronic Dis. 2013; 10. https://doi.org/10.5888/pcd10. in Europe in 2015 and an overview of trends since 1990. Ann Oncol. 2019;30(8):1356–69. https://doi.org/10.1093/ 18. ChangYK,LabbanJD,GapinJI,EtnierJL.Theeffectsofacute annonc/mdz179. exercise on cognitive performance: a meta-analysis. Brain 3. Bedillion MF, Ansell EB, Thomas GA. Cancer treatment Res. 2012;1453:87–101. effects on cognition and depression: the moderating role of 19. SteindorfK,SchmidtME,KlassenO,UlrichCM,OelmannJ, physical activity. Breast. 2019;44:73–80. https://doi.org/ Habermann N, et al. Randomized, controlled trial of resis- 10.1016/j.breast.2019.01.004. tance training in breast cancer patients receiving adjuvant 4. Wefel JS, Kesler SR, Noll KR, Schagen SB. Clinical charac- radiotherapy: results on cancer-related fatigue and quality teristics, pathophysiology, and management of noncentral of life. Ann Oncol. 2014;25(11):2237–43. nervous system cancer-related cognitive impairment in 20. Schmidt ME, Wiskemann J, Armbrust P, Schneeweiss A, adults. CA Cancer J Clin. 2015;65(2):123–38. https://doi. Ulrich CM, Steindorf K. Effects of resistance exercise on fa- org/10.3322/caac.21258. tigueandqualityoflifeinbreastcancerpatientsundergoing 5. Wiviott SD, Raz I, Bonaca MP, et al. Dapagliﬂozin and adjuvant chemotherapy: A randomized controlled trial. Int cardiovascular outcomes in type 2 diabetes. N Engl J Cancer. 2015;137:471–80. J Med. 2019;380(4):347–57. https://doi.org/10.1056/ 21. Janelsins MC, Peppone LJ, Heckler CE, et al. YOCAS© NEJMoa1812389. yoga reduces self-reported memory difﬁculty in cancer 6. Rank M, Halle M, Freiberger V. Sporttherapie bei Kreb- survivors in a nationwide randomized clinical trial: inves- serkrankungen: Grundlagen–Diagnostik–Praxis. Stuttgart: tigating relationships between memory and sleep. Integr Schattauer; 2012. mit19 Tabellen. Cancer Ther. 2016;15(3):263–71. https://doi.org/10.1177/ 7. Baumann FT, Schüle K. Bewegungstherapie als supportive und präventive Maßnahme in der Onkologie. Bewegungs- 22. Cannioto RA, Hutson A, Dighe S, et al. Physical activity therapieundSportbeiKrebs. Köln: DeutscherÄrzte-Verlag; before, during and after chemotherapy for high-risk breast 2008. pp. 21–32. cancer: relationships with survival. j Natl Cancer Inst. 8. ZimmerP,ObersteM,BlochW,SchenkA,JoistenN,HartigP, 2020;:djaa46. 113(1):54–63. https://doi.org/10.1093/jnci/ etal. Impactof aerobic exercisetraining during chemother- djaa046. apy on cancer related cognitive impairments in patients 23. Bigley AB, Simpson RJ. NK cells and exercise: implications suffering from acute myeloid leukemia or myelodysplas- for cancer immunotherapy and survivorship. Discov Med. tic syndrome—Study protocol of a randomized placebo- 2015;19(107):433–45. controlledtrial. Contemp Clin Trials. 2016;49:1–5. 24. Cormie P, Zopf EM, Zhang X, Schmitz KH. The impact of 9. Courneya KS, Segal RJ, Mackey JR, Gelmon K, Reid RD, exercise on cancer mortality, recurrence, and treatment- Friedenreich CM, et al. Effects of aerobic and resis- related adverse effects. Epidemiol Rev. 2017;39(1):71–92. tance exercise in breast cancer patients receiving adjuvant https://doi.org/10.1093/epirev/mxx007. chemotherapy: a multicenter randomized control trial. J Clin Oncol. 2007;25(28):4396–404. Publisher’s Note Springer Nature remains neutral with regard 10. Van der Leeden M, Huijsmans RJ, Geleijn E, de Rooij M, to jurisdictional claims in published maps and institutional Konings IR, Burrart LM, et al. Tailoring exercise inter- afﬁliations. ventions to comorbidities and treatment-induces adverse effectsinpatientswithearlystagebreastcancerundergoing chemotherapy: a framework to support clinical decisions. 7 For latest news from interna- Disabil Rehabil. 2017. 40(4):486–496. https://doi.org/10. tional oncology congresses see: 1080/09638288.2016.1260647. 11. Prakash RS, Voss MW, Erickson KI, Kramer AF. Physi- http://www.springermedizin.at/ cal activity and cognitive vitality. Annu Rev Psychol. memo-inoncology 2015;66(19):19.1–19.29. 12. Erickson KI, Leckie RI, Weinstein AM. Physical activ- ity, ﬁtness, and grey matter volume. Neurobiol Ageing. 2014;35(2):20–8. 156 Importance of performance status and physical activity in cancer patients K
memo - Magazine of European Medical Oncology – Springer Journals
Published: Jun 1, 2021
Keywords: oncology; medicine/public health, general
Access the full text.
Sign up today, get DeepDyve free for 14 days.