Physical activity is beneficial for patients with cancer, but also challenging

Physical activity is a lifestyle pillar generally recommended by clinicians to individuals to help prevent and manage non-communicable diseases, including cancer, and it is also important for the quality of life (QoL) of people who have already received a diagnosis of cancer.

For patients with breast cancer, observational studies suggest that physical activity is associated with improved prognosis. As presented at the ESMO Congress 2024 (Barcelona, 13–17 September), the OptiTrain breast cancer trial of an intervention involving 16 weeks of high-intensity interval training combined with either resistance (RT-HIIT) or aerobic exercise (AT-HIIT) in 240 women starting chemotherapy showed beneficial effects on breast cancer prognosis, with significant effects on overall survival (OS) and invasive breast cancer-free survival (IBCFS) compared with a control group receiving usual care (Abstract 232O). Cox-proportional hazard modelling revealed a particularly significant effect of the RT-HIIT intervention on OS (adjusted hazard ratio [HR] 0.18), breast cancer-free interval (HR 0.22) and IBCFS (HR 0.22), although patient numbers were small.

Despite evidence of their benefits, programmes need to be tailored to the specific values and beliefs of the individual to support patients more holistically and help them to develop self-motivation to be compliant to the recommendations. This is especially important for patients with a poor prognosis, and/or highly symptomatic disease who tend not to continue with the exercises, especially when they are tired, experiencing side effects from treatment, or are having a challenging time psychologically.

Some technologies (e.g. computer video conferencing, telephone apps) can facilitate patient interaction and may be particularly advantageous for those who live some distance from the hospital. In a second study presented at the Congress, personalised physical activity with remote coaching and interactive learning has also proven beneficial in significantly increasing QoL in the phase III eMouvoir study of 684 breast cancer survivors with evaluable 12-month data (LBA12). Statistically significant differences were observed in physical (p=0.03) and mental health (p=0.01) component summary scores of the 36-item short-form questionnaire at 4 months, although this benefit was not maintained at 1 year.

Also, the benefits of a telephone-based weight loss intervention (WLI) on moderate or vigorous physical activity (MVPA) were described in 540 overweight patients with early breast cancer who participated in a Breast Cancer Weight Loss trial (Abstract 1817MO). The median minutes of MVPA increased significantly between baseline and 6 months in the WLI group compared with a control arm (median increase: 40 minutes versus 0 minutes per week; p=0.0004). MVPA was associated with weight loss; patients who engaged in ≥150 minutes of MVPA per week experienced greater weight loss than those who engaged in <150 minutes per week (p=0.0005). Longer follow-up is needed to evaluate whether increases in MVPA are associated with a lower risk of breast cancer recurrence and mortality. However, the weight loss data are important as obesity is known to be associated with a substantially increased risk of disease recurrence (JAMA Netw Open. 2023;6:e2337780), so this is a strong motivator for becoming more physically active. In addition, losing weight is a visible benefit that can in itself improve patient QoL.

Finally, physical inactivity was associated with a higher symptom burden (p<0.001), lower adherence to remote patient monitoring (p<0.028) and lower engagement with digital educational resources (p<0.001) in a real-world study of 1,850 evaluable patients that explored patient-reported health behaviours (Abstract 1836P). Almost 50% of patients reported that they were physically inactive. These data underline the importance of regular follow-up, monitoring and coaching to ensure the benefits of physical activity are communicated and that patients are encouraged and motivated to be as active as possible, especially in the longer term.

Data presented at the Congress highlight that simple recommendations may not be sufficient to encourage people with cancer to take up healthy lifestyle behaviours, and a more structured approach is needed to help them overcome common hurdles. Healthcare professionals in clinical practice and all stakeholders involved in the care of patients with cancer should consider that physical activity is an important aid contributing to cancer prevention, symptom management and recovery in cancer survivors, with both direct and indirect health benefits. However, programmes for both the population in general and for cancer populations should be tailored to a person’s individual needs and attitudes, their personal and social resources, and specific goals. In this way, it will be possible to increase a person's involvement and self-motivation, and consequently promote a shift from a temporary to a stable behaviour change, contributing to reduce the risk of long-term non-adherence to health recommendations. Finally, technologies applied to the health domain can provide a real opportunity to develop tools and measures capable of identifying individuals at risk of low adherence to the health recommendations, allow for timely interventions and facilitate the adoption of an active lifestyle.