Exercise improves cancer-related outcomes

KMG Communications at COSA ASM 2020. Article #4 of 6.

KMG Communications is rolling out a suite of articles summarising the highlights of key posters and oral presentations under the cardio-oncology theme at the Clinical Oncology Society of Australia (COSA)'s annual scientific meeting (ASM) 2020, with a particular focus on the role of exercise in the cancer patient's treatment journey. This is the fourth article in the series.

There is no doubting that participation in exercise can provide cardiovascular benefits, but how about cancer-related benefits, too? Several studies have already shown that exercise can have positive effects on cancer-related outcomes, and several of the presentations at COSA 2020 provided further evidence in this area.

For example, in the poster 'Effects of a prescribed, supervised exercise program on tumour disease progression in oncology patients undergoing anti-cancer therapy', Daniella Dougherty of Lift Cancer Care Services in South Australia presented the results of a study investigating whether participation in a supervised exercise program could reduce the rate of cancer disease progression.

Overall, there was a 66% decrease in the risk of disease progression and a 76% reduction in the risk of death for patients in the LIFT exercise group compared to the non-exercise group. Moreover, subgroup analyses showed that the risk of disease progression decreased by 90% and 88% for patients with prostate cancer and breast cancer, respectively.

Exercise immunology and cancer-related benefits

While results such as these are extremely promising, one of the challenges in prescribing exercise in this way is that exercise programs for specific types of cancer patient need to be designed and validated, with the desired outcomes proven in experiments and trials. Research in this area is ongoing, and we saw a particularly interesting presentation at COSA 2020 suggesting that exercise dose is an important factor in determining cancer-related outcomes.

Dr Marika Carr from the University of Queensland, Brisbane, explained that previously published epidemiological data point to a link between increased exercise dose and improved cancer patient survival. In the presentation 'Exercise to best support the body's immune response to cancer could intensity be key?' (Abstract #200), Dr Carr reviewed evidence that supports the notion that exercise performed at higher intensities elicits a stronger anti-cancer response via immune-cell-related mechanisms. A comprehensive review of the literature can be accessed in an article by American scholars published last year¹.

Following an acute bout of exercise, adrenaline levels in the bloodstream increase. This, along with the release of cell-signalling molecules from muscle cells (myokines), causes the mobilisation and maturation of natural killer cells and their redistribution to peripheral tissues, including tumours.

High-intensity exercise may support the body's fight against cancer

Physical activity and the subsequent cascade of signalling events promotes a better functioning and more cytotoxic form of natural killer cell to infiltrate solid tumours, and this has been shown to improve prognosis. These effects are further enhanced by the improvements in vascular function that are brought about by exercise.

Increasing the intensity of exercise increases the release of adrenaline and myokines, and further improves vascularisation. Taken together, these data suggest a strong physiological rationale for exercise at high intensities better supporting an anti-cancer immune response.

Open access to the 2020 COSA ASM program

Oral abstracts on the WWW: https://onlinelibrary.wiley.com/doi/10.1111/ajco.13497

Oral abstracts as PDF: https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajco.13497

COSA's 47th Annual Scientific Meeting Quality and Safety Implementation Science Cardio-Oncology, 11-13 November 2020. Asia Pac J Clin Oncol. 2020 Nov;16 Suppl 8:58-207. doi: 10.1111/ajco.13497. PMID: 33161624.https://pubmed.ncbi.nlm.nih.gov/33161624/

Reference

1. Nieman DC, Wentz LM. The compelling link between physical activity and the body's defense system. J Sport Health Sci. 2019;8(3):201-217. doi:10.1016/j.jshs.2018.09.009 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6523821/

This article was first published at KMG Communications on 14 December 2020.