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National Fitness
News e-Zine
Summer 2016, Volume 5, Issue 2
Ɣ Physical Activity &
Breast Cancer
Ɣ Women & Heart Disease
Ɣ Nutrition & Menopause
The last line of Samuel Beckett’s ‘The Unnamable’
reads: “You must go on, I can’t go on, I’ll go on’. It was
this very quote that a breast cancer survivor told me
had been her mantra for her cancer journey. It reflects
how a cancer diagnosis and its ensuing treatment can
be accompanied by a vast array of difficult and
enduring challenges, many of which can negatively
impact survivors’ quality of life for months and years
after treatment completion.
Treatment Plan
A patient’s treatment plan for cancer can involve a number
of different therapies (including chemotherapy,
radiotherapy and surgery). While these therapies are
effective in the treatment of cancer, they can be
accompanied by a number of adverse side-effects such as
fatigue, nausea, lymphedema, pain, peripheral neuropathy,
weight gain and psychosocial distress. Cancer-related
fatigue ‘a distressing, persistent, subjective sense of
physical, emotional, and/or cognitive tiredness or
exhaustion related to cancer or cancer treatment that is not
proportional to recent activity and interferes with usual
functioning’1 is a commonly reported symptom among
cancer survivors, and can present a significant barrier to
being physically active. As survival rates have increased,
greater numbers of cancer survivors are living with the
negative side-effects of treatment for longer. While a
number of options are available to support survivors in the
management of treatment-related side effects, exercise is
an inexpensive choice that holds an added benefit of
having a positive effect on other components of survivors’
health and well-being.
Guidelines for Physical Activity
The American Cancer Society’s Guidelines on Physical
Activity2 recommend that cancer survivors avoid inactivity
and return to normal activities of daily living as soon as is
possible following diagnosis. The guidelines recommend
engagement in regular physical activity with the aim of
achieving at least 150 minutes of exercise per week and to
include strength training exercises on at least two days per
week2. However, a physical activity plan should be
individually tailored and take into account participants’
current health status and preferences for physical activity.
Goal setting can be effective in motivating participants and
can map progress and achievements. In addition to
increasing cancer survivors’ physical activity levels, it is
important to limit the time spent in sedentary activities.
The Role of Exercise
Exercise can play a key role at all stages of the cancer
journey, including prevention, treatment and survivorship.
Many chronic illnesses (e.g. cardiovascular disease,
diabetes and cancer) can be prevented through positive
lifestyle changes including regular physical activity, eating
a healthy diet, limiting alcohol consumption and stopping
smoking. Up to one-third of cancers in economically
developed countries have been shown to be related to
overweight or obesity, physical inactivity and/or poor
nutrition3 and could therefore be prevented. Specifically in
relation to breast cancer risk, physical activity may offer
protective effects through a number of different
mechanisms, including positive effects on body fat,
hormone metabolism and the immune system.
“You must go
on, I can’t go
on, I’ll go on”
Samuel Beckett
Effects of Exercise During Treatment for Cancer
Research is also investigating the effects of exercise
during treatment for cancer. The PACES trial4 evaluated
the effectiveness of a moderate-to-high intensity
supervised exercise programme and a low-intensity homebased physical activity programme to usual care in breast
cancer patients undergoing adjuvant chemotherapy. Both
interventions began with the first cycle of chemotherapy
and participants continued the intervention for three weeks
after the last cycle of chemotherapy. Outcome measures
included physical fitness, fatigue and chemotherapy
completion rates which were assessed at baseline, at
completion of chemotherapy and 6 months after
chemotherapy completion. While both intervention groups
resulted in positive effects compared to usual care, the
higher intensity supervised exercise programme resulted in
more favourable effects on cardiorespiratory fitness,
fatigue and chemotherapy completion rates. Both
interventions were deemed safe and feasible for breast
cancer patients undergoing adjuvant chemotherapy.
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Importance of Exercise for Survivorship
Exercise can also play an important role in survivorship.
Exercise has been shown to be safe and effective for
cancer survivors with resultant improvements in
cardiovascular fitness, muscle strength, body composition,
fatigue, anxiety, depression, quality of life and physical
activity levels. Findings from qualitative research regarding
cancer survivors’ experiences of exercise-based
rehabilitation reported that exercise provided a number of
psychological, social and physical benefits. Exercise
provided survivors with a sense of mastery over their
disease and assisted in the shift in identity from being a
cancer patient to being a healthy individual again5. Groupbased exercise in the rehabilitation setting was reported to
provide an important social and peer support network for
cancer survivors where participants demonstrated
solidarity, empathy, and increased motivation5.
physically active or to re-engage with physical activity
after an extended break. These interventions have the
potential to help survivors develop a solid baseline of
physical conditioning from which to build upon, while also
providing the knowledge and skills survivors need to
continue to be regularly physically active independently.
‘Move On’ - 12 Week Rehabilitation Programme
‘Move On’ is a 12 week community-based exercise
rehabilitation programme that caters specifically for
cancer survivors. ‘Move On’ is part of MedEx Wellness
which is located at Dublin City University. MedEx is the
collective name given to a number of community-based
exercise rehabilitation programmes which offer medically
supervised exercise classes for patients with chronic
illnesses. ‘Move On’ has been operating since 2012 and
over 350 cancer survivors have participated in the
programme to date. Dr. Noel McCaffrey, Medical Director
of MedEx, said: ‘Move On assists cancer survivors in the
transition from cancer patient to cancer survivor. The
programme provides a supportive environment for
participants to exercise in a medically supervised setting
alongside those who are also on the cancer journey. The
programme empowers cancer survivors to increase their
confidence to be physically active and has a positive
impact on their physical functioning’. Preliminary data has
shown that the programme has had a positive impact on
participants’ body mass index, cardiorespiratory fitness,
strength and flexibility7.
Research
My PhD, supervised by Dr. Catherine Woods and the
MedEx team, is looking at the effect of a ‘MedEx Move
On’ intervention on cancer survivors’ long term physical
activity levels, health behaviour change and
psychological wellbeing. A Delphi study has also been
conducted which explored how the referral process to
community-based exercise programmes for cancer
survivors can be optimized. Qualitative research in the
form of focus groups and one to one interviews will also
be undertaken to explore the barriers cancer survivors
experience in being regularly physically active and in
attending a structured exercise programme.
Structured Exercise Programmes
Despite the benefits of exercise throughout the cancer
journey, it has been reported that physical activity
initiation, re-initiation, and maintenance present particular
challenges for cancer survivors who have completed
treatment6. Many cancer patients experience a decrease
in their activity levels after diagnosis and only a small
minority of survivors remain active during treatment.
While exercise levels increase somewhat following
treatment, for most survivors, physical activity levels don’t
return to their pre-diagnosis levels. Barriers to exercise
reported by cancer survivors include environmental
factors (e.g. lack of cancer-specific exercise
programmes), physical deconditioning (e.g. shortness of
breath) and social isolation (e.g. lack of motivation).
Structured exercise programmes can provide cancer
survivors with an excellent starting point to being
Health care professionals are encouraged to consider
physical activity promotion as part of standard care for all
cancer patients. As the evidence base in the field of
physical activity and cancer continues to grow, it is hoped
that exercise rehabilitation will form a core component of
cancer survivors’ treatment and survivorship journey.
Biography
Mairéad is a clinical exercise physiologist who specialises
in chronic illness rehabilitation. Mairéad is currently
completing her PhD at Dublin City University in the area of
physical activity and cancer. She is passionate about the
use of exercise to support those living with chronic
illnesses to improve their quality of life. Cancer survivors
face challenges in adopting regular physical activity and
Mairéad is excited to be undertaking a PhD that aims to explore these
issues and contribute to the research base in this area.
Acknowledgements: Mairéad is funded by the Irish Cancer Society
(ICS), and would like to thank the ICS, her PhD supervisors and the
MedEx participants for their support and assistance.
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