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Physical exercise in cancer therapy – the more individualized, the better

No. 57 | 30/10/2018 | by Koh

Regular exercise not only reduces the risk of cancer. Physical training can also support the therapy of a tumor disease. An international consortium of researchers, including scientists from the German Cancer Research Center (DKFZ) and the National Center for Tumor Diseases (NCT) Heidelberg, has discovered: Patients who exercise regularly not only feel physically fitter and stronger, they also rate their own quality of life as better and suffer less frequently from chronic fatigue syndrome. However, some patient groups seem to benefit more than others.

Cancer patient during resistance training
© University Hospital, Media Center Heidelberg

Thanks to modern therapy methods, mortality from tumor diseases is decreasing. While before 1980 two thirds of cancer patients succumbed to their disease, today more than half can be cured permanently. However, the success of the therapy is often accompanied by serious side effects. Even after treatment has been completed, many patients suffer from physical weakness, chronic fatigue syndrome and ultimately a loss of quality of life.

However, this does not have to be an inevitable fate. Numerous studies from recent years suggest that moderate to strenuous exercise is suitable for alleviating the side effects of cancer therapy and improving the quality of life. The individual patient benefits from this not only through improved physical well-being. "This can decide, for example, whether chemotherapy can be carried out as planned and thus indirectly contributes to the success of the treatment," explains Karen Steindorf, a researcher at the DKFZ and the NCT Heidelberg.

However, the effect of exercise varies considerably from study to study, as the type, duration and intensity of the exercise program and the patients investigated differ considerably. Led by Laurien Buffart from the Free University of Amsterdam, the international research consortium POLARIS (Predicting OptimaL cAncer RehabIlitation and Supportive care) has therefore taken a closer look at the therapeutic benefits of sport in cancer. The scientists combined the data of patients from a total of 34 trials. The aim was to find out what effect sport during and after cancer therapy has on chronic fatigue syndrome, on physical endurance, on muscle strength, on self-reported physical functioning in everyday life and on quality of life.

The result: "Sport helps, but not everyone benefits equally from it", summarizes Steindorf, who was involved in the consortium with two trials on sports therapy against breast cancer. With regard to fatigue and physical functioning in everyday life, such as carrying suitcases or climbing stairs, sport was particularly beneficial for patients who had severe problems in these areas. In terms of muscle strength and quality of life, all patients benefited from training during cancer therapy, regardless of their baseline level. After completion of cancer therapy, however, moderate strength training seemed to strengthen less athletic patients in particular and to help them achieve a better quality of life. Patients who already have moderate to good fitness probably need more intensive training. In addition, it was found that patients with very low endurance performance benefit less from endurance training during therapy than others. It is possible that these patients were overwhelmed with training during the strenuous cancer therapy.

"Basically, we firmly believe that all cancer patients can benefit from endurance and strength training," says Steindorf. "We would therefore advise all patients to exercise more in order to improve their personal well-being and quality of life". The findings from the study suggest, however, that it may make sense to tailor sports therapy even more closely to the individual conditions of every patient in order to exploit its effects even more efficiently. "Our goal is an individualized sports therapy," summarizes the Steindorf.

Laurien M. Buffart, Maike G Sweegers, Anne M. May, Mai J. Chinapaw, Jonna K. Van Vulpen, Rob U. Newton, Daniel A. Galvão, Neil K. Aaronson, Martijn M. Stuiver, Paul B. Jacobsen, Irma M. Verdonck-de Leeuw, Karen Steindorf, Melinda L. Irwin, Sandi Hayes, Kathleen A. Griffith, Alejandro Lucia, Fernando Herrero-Roman, Ilse Mesters, Ellen van Weert, Hans Knoop, Martine M Goedendorp, Nanette Mutrie, Amanda J. Daley, Alex McConnachie, Martin Bohus, Lene Thorsen, Karl-Heinz Schulz, Camille E Short, Erica L James, Ronald C Plotnikoff, Gill Arbane, Martina E. Schmidt, Karin Potthoff, Marc van Beurden, Hester S. Oldenburg, Gabe S. Sonke, Wim H. van Harten, Rachel Garrod, Kathryn H. Schmitz, Kerri M. Winters-Stone, Miranda J. Velthuis, Dennis R. Taaffe, Willem van Mechelen, Marie-José Kersten, Frans Nollet, Jennifer Wenzel, Joachim Wiskemann, Johannes Brug, Kerry S Courneya:
Targeting exercise interventions to patients with cancer in need: an individual patient data meta-analysis. Journal of the National Cancer Institute 2018, DOI: 10.1093/jnci/djy161

A picture is available for download: 
Caption: Cancer patient during resistance training

Note on use of images related to press releases
Use is free of charge. The German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ) permits one-time use in the context of reporting about the topic covered in the press release. Images have to be cited as follows: "Source: University Hospital, Media Center Heidelberg".
Distribution of images to third parties is not permitted unless prior consent has been obtained from DKFZ's Press Office (phone: ++49-(0)6221 42 2854, E-mail: Any commercial use is prohibited.

The German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ) with its more than 3,000 employees is the largest biomedical research institution in Germany. More than 1,300 scientists at the DKFZ investigate how cancer develops, identify cancer risk factors and search for new strategies to prevent people from developing cancer. They are developing new methods to diagnose tumors more precisely and treat cancer patients more successfully. The DKFZ's Cancer Information Service (KID) provides patients, interested citizens and experts with individual answers to all questions on cancer.

Jointly with partners from the university hospitals, the DKFZ operates the National Center for Tumor Diseases (NCT) in Heidelberg and Dresden, and the Hopp Children's Cancer Center KiTZ in Heidelberg. In the German Consortium for Translational Cancer Research (DKTK), one of the six German Centers for Health Research, the DKFZ maintains translational centers at seven university partner locations. NCT and DKTK sites combine excellent university medicine with the high-profile research of the DKFZ. They contribute to the endeavor of transferring promising approaches from cancer research to the clinic and thus improving the chances of cancer patients.

The DKFZ is 90 percent financed by the Federal Ministry of Education and Research and 10 percent by the state of Baden-Württemberg. The DKFZ is a member of the Helmholtz Association of German Research Centers.


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