Alberta Cancer Foundation

Movement As Medicine

Illustration by Kyle Hack.

Dr. Kerry Courneya, a professor in the faculty of kinesiology, sport and recreation at the University of Alberta, has been researching physical activity and its benefits for people diagnosed with cancer since 1994. In every aspect of his research, and through multiple ongoing studies, Courneya is working to address the same questions: Can an exercise program help manage cancer-related side-effects, increase treatment tolerance and response, slow progression, and even limit recurrence? And if it can, what kind of exercise program is most effective?

Because of the knowledge he’s gleaned in this field over the years, Courneya was one of many experts who worked on updating the exercise guidelines for cancer survivors, which were published in the journal Medicine & Science in Sport & Exercise in November 2019. The updated guidelines build on the first exercise guidelines for cancer survivors published in 2010, and are intended for exercise and medical professionals.

In 2010, the number of exercise-related studies for cancer survivors was limited compared to the huge amount of new evidence now available. An international group of experts, led by Kristin Campbell from the University of British Columbia, analysed this new evidence, and the updated 2019 guidelines are the end-result.

Here, Courneya discusses what’s new in the exercise guidelines and what results he hopes his ongoing research will answer.

Why focus your research on the effects of exercise after a cancer diagnosis?

This topic is important because many cancer patients want to know if there is anything they can do themselves to improve their chances and maintain quality of life. Exercise may help cancer patients prepare for cancer treatments, tolerate and respond to cancer treatments, and manage treatment side-effects. Exercise could also help with recovery after treatments and improve long-term outcomes.

What role did you play in the creation of the updated exercise guidelines for cancer survivors?

I was a co-author for the entire guideline, and I was responsible for writing the sections on cancer treatment completion and response. My previous studies — like the analysis of the effects of aerobic and resistance exercise in breast cancer patients receiving chemotherapy, which was published in 2007 — are cited in the guidelines and helped influence them. My ongoing studies did not factor into these updated guidelines because we do not know the results yet.

Can you explain what’s different in these guidelines from the first guidelines published in 2010?

The big difference is that we now provide exercise guidelines for specific treatment side-effects, such as fatigue, sleep quality, depression and bone health.

What are the key points cancer survivors should take away from these updated guidelines?

Exercise is safe and feasible for most cancer patients, even during intensive treatments. They will get benefits like improvements in aerobic fitness, muscular strength and body composition. However, they will also get some unique benefits related to cancer-specific symptoms and side-effects. The big question is whether some patients may even improve their treatment tolerance, treatment response, risk of recurrence and overall survival. But this is an active area of research.

Prescribing Exercise

According to the updated exercise guidelines, there’s strong evidence of consistent improvements to cancer-related side-effects with these three exercise prescriptions:

Side-effect: Anxiety and depression

Between 30 and 60 minutes of moderate intensity aerobic training, done three times per week for 12 weeks. Combining 20 to 40 minutes of aerobic and resistance training twice a week for six to 12 weeks is also recommended.

Side-effect: Cancer-related fatigue 

During a 12-week training program, 30 minutes of moderate-intensity aerobic exercise done three days per week is recommended.

Side-effect: Lymphedema

A long-term resistance training program done two to three sessions per week under the supervision of a fitness professional. The program should begin with the participant lifting lighter weight before slowly progressing to heavier weights.

Get moving!

Alberta Cancer Exercise (ACE) is a free, 12-week community exercise program and five-year study. It began in 2017, and is funded by multiple partners including the Alberta Cancer Foundation. It is specifically for cancer survivors or patients currently undergoing treatment and is run out of community fitness facilities across the province. During the program, ACE instructors, with cancer-specific knowledge and training, lead participants through group classes two times a week.

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