Exercise can be “better than a drug” at slashing the risk of cancer returning after treatment – the bombshell study findings were announced at the world’s largest cancer conference this weekend
Exercise can be “better than a drug” at slashing the risk of cancer returning after treatment, landmark research reveals. A world-first trial found that giving patients an “exercise prescription” with the support of a personal trainer dramatically boosted their survival chances.
People with the most common type of bowel cancer who joined the programme were 37% less likely to die within eight years. The pioneering scheme, which cost around £2,000 to £3,000 per patient, prevented one death for every 14 people enrolled. The findings were announced at the world’s largest cancer conference this weekend, sparking calls for health systems to better support recovering patients to overhaul their lifestyles.
Study leader Dr Christopher Booth, of Queen’s University in Kingston, Canada, said the research “sets a new standard of care for colon cancer”.
He added: “These results demonstrate a novel, first-in-class anti-cancer effect for a new form of cancer therapy. The magnitude of benefit is substantial. In fact, it is comparable — and in some cases exceeds — the magnitude of benefit of many of our very good standard medical therapies in oncology.”
Dr Booth said it was not yet clear whether exercise would have the same benefits for those with types other than bowel cancer. However, the research also detected a link with lower rates of new breast and prostate tumours.
Some 14 patients were newly diagnosed with breast cancer during the study, with only two of those cases occurring among patients in the exercise programme. Professor Sir Stephen Powis, NHS national medical director, said the study showed exercise could “have the power to help more people survive cancer”.
“As the latest science and new targeted drugs continue to lead us towards more personalised cancer care, it’s really exciting that tailored exercise could also prove to be a life-changing treatment,” he said. “These landmark findings suggest that focused steps to exercise, from walks to workouts, could help turbocharge the body’s ability to prevent cancer returning after treatment and help save more lives.
“Being more active can have significant benefits in helping maintain a healthy weight, strengthen the immune system, reduce inflammation and lift mood — and it’s now really encouraging to see that exercise really could have the power to help more people survive cancer.”
The study is the first randomised controlled trial — considered the gold standard of clinical trials — to look at the impact of a structured exercise programme for bowel cancer patients. It recruited 889 people with stage two or three colon cancer, who had been treated with surgery and chemotherapy, from six countries including the UK.
One in three such patients typically see their cancer return, at which point it can become harder to treat. Half of participants were assigned to the structured exercise programme while the rest were given educational materials promoting exercise and good nutrition.
The exercise group met with a physical activity consultant for fortnightly coaching sessions for the first six months, followed by monthly sessions in-person or online for a further two and a half years.
They were supported to increase their baseline level of physical activity by at least 10 MET-hours (a unit of measurement which represents the energy expended) per week. This was equivalent to brisk walking for 45 minutes, three to four times per week, but could also include other activities such as swimming, cycling or cross-country skiing.
Patients in both groups saw their physical function improve — but the benefits were much greater for those in the programme. These included increases in VO2 max (a measurement of the body’s maximum capacity to use oxygen during exercise) and the distance they could walk in six minutes.
The only negative effect was a slightly higher risk of musculoskeletal problems, such as fractures or muscle strains, in the exercise group. Cancer Research UK part-funded the trial. The charity’s chief clinician, Professor Charles Swanton, said exercise could be a “game changer that shifts the course of their recovery” for some patients.
He added: “For an intervention that isn’t a drug, exercise offers remarkable benefits for patients. The findings suggest that oncologists should consider recommending a structured exercise programme after surgery to improve people’s chances of survival. But it’s important to remember that exercise isn’t the best option for everyone.”
The findings were presented at the American Society of Clinical Oncology’s (ASCO) annual conference in Chicago. Dr Julie Gralow, ASCO’s chief medical officer and executive vice president, said there had been “a major shift in understanding the importance of encouraging physical activity during and after treatment”.
She added: “Do I think we’re pushing hard enough? Probably not. This is the highest level of evidence. And this should really help push over even the naysayers in terms of we should be doing all we can to help patients be active.”
The study was presented at a conference session titled “As Good as a Drug”. Asked about the size of the effect seen in the study, Dr Gralow said: “I would have retitled it ‘Better Than a Drug’ because you don’t have all the side effects.
“It’s the same magnitude of benefit of many drugs that get approved — 28% decreased risk of occurrence, 37% decreased risk of death. Drugs get approved for less than that, and they’re expensive and they’re toxic. And I’m not saying substitute this [entirely], but you get that additional benefit.”
The scheme was relatively cheap and could deliver significant cost savings for healthcare services through unused cancer care, researchers added.
Dr Joe Henson, associate professor in lifestyle medicine at the University of Leicester, led some of the exercise sessions. He said: “I saw firsthand that this reduced fatigue, lifted people’s mood, and boosted their physical strength.
“We know that physical activity regulates several key biological processes that could explain these results, and further research will help us uncover why exercise is having such a positive impact.
“Despite its proven benefits, many people still face barriers to engaging in regular exercise. This study shows how important it is to make exercise advice a routine part of cancer care and to offer people tailored support.”
Mr Edwards, chief executive of ukactive, the UK’s trade body for the physical activity sector, said: “This study shows that exercise is vital in our battle to beat cancer and the key is structured, supported physical activity, such as circuit classes, swimming and cycling.
“The Government has a huge opportunity in its 10-Year Health Plan to recognise this evidence and fully integrate gyms, swimming pools and leisure centres into care pathways to reach every community with their life-enhancing benefits.
“Leisure centres already provide 66% of cancer rehab and prehab services so the Government should also use the Spending Review to protect and grow our nation’s fitness facilities or risk increasing costs to the NHS and the Treasury.”
Culture Secretary Lisa Nandy said the Government’s Plan for Change was committed to helping everyone get active “in ways that work for them”.
She added: “This study’s findings are significant — showing regular exercise is one of the most powerful tools we have in both preventing and treating cancer.”
Case Study
Margaret Tubridy, 69, took part in the trial despite having never exercised regularly before. The grandmother-of-five was diagnosed with bowel cancer five years ago.
Margaret, of Glengormley in Northern Ireland, said: “I wanted to take part in the trial to help other people living with cancer. I had never exercised in my life, but with the right support and encouragement I was able to walk more and more.
“From there I started going to classes at the gym and now I do weight training twice a week, pole walking, and I’m in a walking group. I had never been to a gym before, but once I was shown how to use the machines and do the exercises, I loved it.”
Five years after her cancer diagnosis, Margaret, who worked as a receptionist for Mercedes Benz for 26 years, says she is “doing great”. She added: “Taking part in the trial helped me so much – I am stronger, fitter, and my anxiety is better. I never thought at 69 years of age I would be able to do all of this. I am chuffed to bits.”