What Type of Exercise is Best for Cancer?

Chris Tse Chest Press Set UpSo you might have been waiting for this post for a few weeks. In the last blog post we talked about how exercise is used in cancer prevention, and in the first blog post of this series we talked about the general benefits of exercise with respect to cancer. I’ve been skirting around the issue of the type of exercise that is optimal for prevention, during and after treatment partially because of the variability in the type of exercises used in research. The protocols for exercise can range from prescribed and monitored personal training to questionnaires about general exercise levels. Needless to say I opened up a pandora’s box when I started doing more research on the topic. It is both interesting and exciting to see the evolution of the field in such a short period of time.  I haven’t even touched the research on Yoga and Tai Chi yet!

So you might be asking:

“What magical exercise regimen is being used to prevent, treat, and potentially avoid recurrence?”

Answer:

“Nothing your grandparents wouldn’t do.”

Yes that’s right, let’s bring it back to the basics.  Drop all the bells and whistles that we are inundated with in the fitness industry: high intensity interval training (HIIT), aquafit, Zumba, Cross-Fit etc…  – Sorry did I miss your workout style?  whatever it is, scratch that off the list too – The current exercise regimen that is being used: an average of 150 to 225 minutes a week worth of moderate to high intensity aerobic exercise with a mixture of resistance training.  The goal is to get that heart rate up and those muscles burning!

Whether monitored with a trainer or done independently, aerobic exercise includes(1,2,3,4,5):

  • walking (treadmill, track, or outside)
  • bicycling
  • running (treadmill or outside)
  • elliptical cross trainer
  • swimming
  • callisthenics
  • row machine
  • stair climbing
  • nordic skiing
  • tennis
  • rollerblading

The goal in aerobic exercise throughout all of the research was to keep it at about 70 – 80% of the person’s heart rate max (find out how to roughly calculate that by clicking here)(3) or to 80% of a person’s VO2 Max (find out how to calculate that by clicking here)(1,2,4,5). The key is to gradually build to the goal, whether that is measured with heart rate or the VO2 scale. Long term studies brought patients from relative inactivity to 80% VO2 Max in the span of 12 weeks, even while undergoing treatment!  The amount of time is also progressively increased; in some cases 15 minutes of sustained exercise is used initially and then increased to 45 minutes over the span of 18 weeks(4,5).  These periodization protocols are no different compared to a typical person who walks into Blitz and is looking to develop a plan to run 5 to 10 kilometers.  We should never expect to start off any exercise regimen full tilt, it should be a progressive climb over time to the point where the body can adapt to a greater challenge.

As for the general resistance protocols, most of the current strength training regimens include(1,4,5):

  • machine assisted leg extensions
  • machine assisted leg curls
  • machine assisted leg press
  • calf raises
  • chest press
  • machine assisted seated rows
  • triceps extensions
  • biceps curls
  • modified curl ups

All of the strength workouts were structured so that the person would be able to do about 8-12 repetitions of these 9 exercises at 60 – 70% of their one repetition maximum for 2 sets of each exercise. In some cases the resistance would increase by 10% if the participant was able to do more than 12 repetitions(4).  The exercises have been the mainstay in the fitness industry since the introduction of machines to gyms.  The importance of progression is also key: as a person gets stronger and can complete more repetitions, we increase the weight or challenge.

The therapeutic effects of exercise both during and after treatment that were studied (on top of the previously mentioned biomarkers in the last blog) are(1,2,3,4,5):

  • improved balance
  • increased exercise capacity
  • increased lean muscle mass
  • reduced gain in fat mass
  • reduced bouts of depression
  • reduced anxiety
  • reduced fatigue
  • reduced nausea
  • increased flexibility
  • improvement in mood
  • increased self esteem
  • increased physical well being
  • increased satisfaction with life
  • improved sleep during and after treatment
  • improved overall quality of life

The overwhelming body of evidence is pointing towards the more the better.  Recent studies looked at high amounts of cardiovascular exercise (225 minutes per week) in combination with resistance training twice a week in comparison with a lower amount of cardio (150 minutes per week) with resistance training, no treatment, aerobic only, and resistance training only. The research found that the optimal therapeutic level attained with the higher amount of cardio and resistance training(1,4,5).  If we’re breaking that down it means:

  • 45 minutes of aerobic exercise 5 days a week
  • 2 strength training sessions at an average of 30 minutes per session

This may seem daunting.  Actually for most people it means a big change in lifestyle. It was found that, in some cases, exercise supervised by a fitness expert led to a more successful adherence to the regimen.  Remember that it’s all about progression.  Start small, 10 minutes a day of aerobic exercise and one day a week of strength training then add 5 minutes of cardio every few weeks until you achieve the desired intensity and time and add an extra day of strength training.  This is achievable for everyone, we just need discipline!

Now some of the Blitz community might be asking why we haven’t integrated these programs into our classes and personal training sessions?

Ultimately our H.I.I.T. styled workouts and compound exercises are meant to stimulate both cardiovascular and musculo-skeletal systems.  There was an article written by Dr. Martin Gibala in the Globe and Mail that talked about the progressively growing body of research H.I.I.T. and how it is gradually being integrated into treating cardio-metabolic diseases like coronary artery diseases and metabolic syndromes.  In our training protocols we manage to stimulate most if not all of the same muscle groups as the 9 exercises listed above but we simply do it in a different way. The exercises are hidden in movements that involve multiple muscle groups which jacks up the heart rate and grows muscle.  Dr. Gibala says that if we treat exercise like a drug: resistance training and cardiovascular training, as listed above, are seen as the old reliable drugs, whereas H.I.I.T. is seen as an emerging and still under-tested drug.  I strongly believe that the evidence in both mental health and cancer research is pointing towards a combinatorial drug like H.I.I.T. that will be most effective in prevention, co-treatment, and recurrence phases.  So hang tight, science will catch up with us eventually!

References:
(1) McNeely, M., Campbell, K., Rowe, B., Klassen, T., Mackey, J. Courneya, K.; Effects of exercise on breast cancer patients and survivors:a systematic review and meta-analysis. Canadian Medical Association Journal. 2006.July;175(1):34-41.
(2) Courneya, K.; Exercise in Cancer Survivors: an Overview of Research. American College of Sports Medicine. 2003. 1846-1852.
(3) Friedenreich, C., et. al.; Alberta Physical Activity and Breast Cancer Prevention Trial: Sex Hormone Changes in a Year Long Exercise Intervention Among Postmenopausal Women. Journal of Clinical Oncology. 2010. March;28(9):1458-1466.
(4) Courneya, K. et. al.; Effects of Aerobic and Resistance Exercise in Breast Cancer Patients Receiving Adjuvant Chemotherapy: A Multicenter Randomized Controlled Trial. Journal of Clinical Oncology. 2007. October;25(28):4396-4404.
(5) Courneya, K. et. al.; Effects of Exercise Dose and Type on Sleep Quality in Breast Cancer Patients Receiving Chemotherapy: a Multicenter Randomized Trial. Breast Cancer Res Treat. 2014. February.

 

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About Chris Tse

I’m a scientist turned owner of Blitz Conditioning, a Fitness Columnist at CBC Radio on Thursdays at 8:20 am, and owner of Tse Social Strategy. Follow me on Twitter or Read my full bio.

Comments

  1. Very informative. Thanks folks.

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