Saturday, 7th November 2020


Exercise in the treatment of cancer

Exercise is attracting increasing attention as a treatment for cancers. Regular exercise can reduce the recurrence of some cancers after treatment with drugs, radiation, and/or surgery – and also prolong life. In one study of breast cancer, exercise treatment was associated with double the chance of survival over eight years and two-thirds the chance of recurrence.

The mechanisms through which exercise exerts its antitumor activity are still poorly understood but may be related to a direct effect on tumor cells or to an enhancement of immune function. It is believed that exercise stimulates the production of the immune system’s cytotoxic T cells, which are white blood cells specialized in killing cancer cells.

Exercise in the rehabilitation of cancer 

Cancer treatment causes reduced physical function and impaired quality of life. These negative effects result from most anti-cancer treatments such as surgery, radiation, hormonal treatment, and other targeted therapies. Exercise can be an extremely effective antidote to these ill effects. Some of the benefits include improved quality of life, increased cardiorespiratory fitness, better physical functioning, and less fatigue.

A meta-analysis of trials of exercise treatment in a wide variety of cancer types concluded that such treatment led to improvements in quality of life and fitness both during and after treatment. It has been proposed that physical training should be a part of cancer rehabilitation to facilitate activities and participation in daily life.  The intensity, frequency, and duration of exercise should be similar to the usual Department of Health recommendations. Some of the positive effects of exercise interventions are more pronounced with moderate or vigorous-intensity than with mild-intensity exercise programs.

There is no certainty that one form of exercise is better than any other in cancer patients. Running, brisk walking, cycling, weight lifting, bodyweight or elastic band exercises have all been tried with similar benefits.

Community-based activities may have greater long-term effects. Although most people with cancer identify physical, mental, and social benefits from exercising, cancer survivors have difficulty maintaining exercise after a supervised hospital-based program. Making exercise a part of daily life should help them to continue to perform it.


Prehabilitation involves interventions aimed at improving patients’ health before an anticipated upcoming physiologic stressor so that they are better able to withstand that stress. Prehabilitation emerged as a way to prepare soldiers for battle in the second world war. A study published in 1946 in the British Medical Journal, entitled Prehabilitation, Rehabilitation, and Revocation in the Army, described an experiment in which “good food, lodging, hygiene, and recreation combined with controlled physical training and education” for a period of around two months was found to improve the health ratings of 85% of the 12 000 men who participated.

Nowadays prehabilitation is used to prepare patients for major surgery. The idea is that the fitter the individual the better he or she is to cope with the ill effects of such operations. This may be particularly important for those who are most vulnerable. “Identifying high-risk patients at the earliest possible stage and increasing their physiological reserve prior to surgery is a promising approach that seems to result in remarkable improvements for older patients.” Exercise pre-surgery seems substantially to improve physical and pulmonary function, which are both factors associated with improved ability to undergo surgery while reducing post-surgery complications.

This particularly applies to cancer patients. Physical training increases physical training and resilience in preparation for cancer treatments all of which can be weakening and debilitating.  As an example, lung cancer patients undergoing surgery are usually left physically deconditioned and with functional deficits. Pre-operative exercise interventions improve pulmonary and physical function before and after lung resection and also reduce the complications of surgery.

Importantly, small changes in cardiopulmonary fitness may have a large impact on patients who are frail, including elderly patients with multiple comorbidities.

Should you wear a mask while exercising?

A study reported in the  International Journal of Environmental Research and Public Health looked at the exercise tolerance of a group of physically active and healthy men and women1. They were exercised maximally on a bicycle ergometer. The team assessed the participants, who did the test three times each, once wearing a surgical face mask, once wearing a three-layer cloth face mask, and once with no face mask. The team recorded the participants’ blood oxygen levels and muscle oxygen levels throughout the test using non-invasive measurement tools. There was no difference between the three tests for exercise performance nor for blood and muscle oxygenation.

So the answer is a qualified yes. Wearing a mask will reduce the possibility of transmitting the virus – but it can be quite uncomfortable when exercising and it doesn’t half steam up your specs.

  1. DOI: 10.3390/ijerph17218110


  1. GJ Brooks says:

    Hi Dr Bethell I have been coming to your rehab classes twice a week for over a year now after having 5 stents fitted on three different occasions.
    I have had to stop coming at the moment because I am undergoing treatment for Mesothelioma as a result I am very weak and tired.
    I have had my left lung drained 3 times First 1 1/2 litres 2nd 1 litre and the 3rd an operation at Winchester to remove 2 1/2 litres adding a powder to the cavity wall all done by our wonderful NHS all done within 10 days👏.
    I have been told by the oncologist Dr Reamer in Basingstoke that my body is to weak to undergo the usual treatment so I am on many pain suppressants including morphine, nerve Pregabalin now increased to 100 mg twice a day and a handful of others.
    I have had very bad night swets every night now for 6 weeks changing PJs up to 3 times a night. ( thanks to Bosch washing machines ) my wife can keep up with keeping my 12 pairs of PJs & umpteen pillow cases aired. Hence my prescription from Dr Reamer to assist part of my non invasive treatment.
    Steroids have been introduced for various reasons but one is to increase my appetite to hep put back the 2stone in weight I have lost in just over a year.

    So after all that Dr Bethell I would like to continue to build upon my fitness to overcome this set back & move forward with some sort of plan.
    I intend to start working back in to my home exercise program and routine aerobics I did in between your classes at Alton. I have started a little bit each day to help with the fatigue but as yet I find it exhausting at the moment.
    I am indeed seeking you help for anything you can suggest to help me in my recovery as your wonderful staff in the centre have been doing so well for me.
    Yours very sincerely
    Graham Brooks

  2. cb Everett says:

    Exercise is so very good for many conditions, medical, physical and mental. Case proven.

    However nothing is entirely 100% beneficial that I have come across, so what are the snags and unwanted side effects of exercise? Have you dealt with this already? Fractures, falls, etc.

    • Hugh Bethell says:

      Excellent question Chris. And or course the answer is that exercise does have side effects, particularly if prolonged and very vigorous. Moderate to vigorous exercise is not without its snags but they are much less than the dangers of not taking exercise. I will be covering this subject by January/February.

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