Dragon boat team Abreast In A Boat got its start three decades ago by a group of breast cancer survivors with the aim of challenging the idea that exercise would result in lymphedema.JOHN LEHMANN/The Globe and Mail
Donald McKenzie is a professor emeritus at the Faculty of Medicine and School of Kinesiology at the University of British Columbia. Kerry Courneya is a professor in the Faculty of Kinesiology, Sport, and Recreation at the University of Alberta.
In June, an article published in the New England Journal of Medicine changed the landscape of cancer treatment by challenging the assumption that physical activity for patients doesn’t influence survival rates.
A large, multinational study with a significant number of leaders and participants from Canada enrolled almost 900 patients who had colon cancer treated by surgery and chemotherapy and then added a structured exercise program for half of them. Patients assigned to the exercise group lived longer than the group that received only health advice.
The differences were striking. Patients who were assigned to the structured exercise program had a 37-per-cent lower risk of dying and a 28-per-cent lower risk of recurrence of the cancer or another new cancer.
‘In control’: Study looks at exercise to boost overall well-being of kids with cancer
Upon receiving a cancer diagnosis, patients have traditionally been encouraged to rest and take it easy. Although exercise has been recommended by some health care practitioners in the management of cancer patients, this research moved the bar from supportive care to curative treatment. While this study involved just patients with colon cancer after chemotherapy, it is not a large leap to suggest that exercise might play a similar role in other types of cancer receiving other treatments.
Indeed, when you look at how exercise compares to the medications used in chemotherapy for this group of patients, exercise is equal to or better than most treatments that are accompanied by significant side effects and expense. Physical activity, on the other hand, has few side effects and is cheap. If physical activity were classified as a medication, the results of this study indicate that it is standard of care – that is, every patient with colon cancer should receive exercise as part of the treatment plan for their disease. Pragmatically, oncologists should be able to request this “drug” as an important part of therapy for their patients.
As all patients should receive a structured exercise program, this opens the research door to study specificity. What is the optimal exercise prescription? Aerobic exercise, resistance training, high-intensity interval training, other interventions – perhaps a combination of them? What is the optimal timing of exercise in relation to other cancer treatments? There is a great deal of research required to identify the molecular/biological changes initiated by physical activity and how they affect the specific cancer and the tumour microenvironment.
In the same month that this study was published, Abreast In A Boat, a breast cancer dragon boat paddling team, celebrated its 30th anniversary. In the 1990s, a very courageous group of 24 breast cancer survivors from Vancouver challenged the myth that exercise would result in lymphedema, a painful swelling of the upper body. They trained in the gym for three months and then learned to paddle a dragon boat. The strenuous, repetitive upper-body exercise that specifically contradicted traditional guidelines for breast cancer survivors did not result in lymphedema.
Two decades after her MS diagnosis, this marathon runner is still as active as ever
The sport was embraced quickly by women and a few men who had been treated for breast cancer. Dragon boat paddling is now an enormously successful program, with thousands of women paddling in hundreds of locations in six continents. Effectively it allows patients to regain some measure of control of their lives, improves function and quality of life, and may even improve survival. It is an excellent demonstration of how sport influences health.
There are other examples of how sport, as a form of exercise, influences health. In particular, there is a long-standing relationship between exercise and cardiovascular disease, diabetes, metabolic syndrome, mental health, and more recently Parkinson’s and other neurodegenerative diseases.
To many, sport and health exist in silos. Sport is recreation and competition, while health is simply medicine. This position is fundamentally flawed and our federal, provincial and municipal governments have work to do. Bridges should exist between the ministries of sport, education and health. The results of this cancer study, coupled with the enormous amounts of data on physical activity and other medical conditions, mandate that more emphasis should be placed on physical activity in our education systems.
This recommendation can’t be ignored any longer. Our governments need to make a significant investment by supporting community sport programs and recreational centres. Local T-ball, soccer teams, pickleball and certified exercise specialists in rec centres are good examples. Incorporating regular exercise and sport into Canadians’ lifelong activities will provide a measurable return for our population’s health and reduce health care costs. Indeed, community sport participation should be measured as a public health indicator. Exercise, including sport, is medicine.