Physical Activity is Medicine
Authors: Alfredo Carrato
Journal: Journal of the National Comprehensive Cancer Network (2023)

T he frequent lack of appropriate statistical evidence regarding physical activity benefits in patients with cancer has meant that either epidemiologic or retrospective observational studies have provided the basis for our knowledge.The level of evidence for results has been weak and the basis of a controversial and not well-established issue.Scientific and clinical evidence is much more limited for less frequent and low survival cancers such as pancreatic cancer.Conducting randomized controlled trials on physical activity implementation in individuals with cancer is challenging due to the low observed adherence to trial recommendations and completion of quality-of-life questionnaires; the interference of environmental, social, and structural barriers; comorbidities as well as symptoms derived from cancer and its treatment; and the high number of patients needed, which is difficult to achieve in uncommon and deadly cancers.In the article by Neuzillet et al 1 elsewhere in this issue, we can learn from a well-designed randomized trial on the positive effects of increasing physical activity in quality-of-life parameters for patients with advanced pancreatic cancer who are receiving treatment.We have known that healthy habits contribute to a healthier life.Patients with heart disease, type 2 diabetes, hypertension, and cancer, which are quite frequent and major causes of morbidity and mortality in our Western world, do benefit from a systematic increase in physical activity.Patients desire to be more active and would like help and guidance from their doctor.The American Cancer Society recommends that individuals maintain healthy behaviors regarding diet and physical activity in order to reduce cancer risk. 2 Indeed, in a recent analysis, the combination of risk factors (excess body weight, physical inactivity, poor diet, and alcohol consumption) accounted for at least 18.2% of cancer cases and 15.8% of cancer deaths in the United States. 3eeling fit could help patients physically and psychologically cope with the development of cancer, as well as with the therapeutic strategies needed to cure or control this disease.The beneficial effect of physical activity implementation in cancer prevention and during cancer treatment has been demonstrated. 4This finding is potentially the result of a dose-response association 5 and independent of critical confounders such as smoking or increased body mass index. 6Even individuals who were sedentary throughout most of their adult life (age 19-60 years) but routinely increased physical activity in their 50s or 60s showed a lower risk for all-cause mortality (hazard ratio [HR], 0.65; 95% CI, 0.62-0.68),cardiovascular disease-related mortality (HR, 0.57; 95% CI, 0.53-0.61),and cancer-related mortality (HR, 0.84; 95% CI, 0.77-0.92). 7 systematic review and meta-analysis of hundreds of epidemiologic studies with several million participants showed that there was a 10% to 20% reduction in bladder, breast, endometrial, renal, colon, and gastroesophageal cancers in people with a dynamic lifestyle.A 40% to 50% reduction in mortality was also seen in people with prostate, breast, and colorectal cancer who were physically active. 8n the other side, cancer treatments damage patient's tissues and can contribute to accelerated biological aging.Psychological stress from cancer and its treatments favors prolonged toxicities, impairs essential repair mechanisms, and promotes a lack of will to do what has been recommended.Therapeutic objectives are to control disease growth and dissemination, reduce stress, improve sleep, increase physical