Cancer, physical activity & athletes

One thing that we didn't explore in depth while at University was co-morbidities associated with the patients that we see. Typically we treat sports performers, but we are seeing an increasing number of those participating in sport who have previously treated for a variety of medical conditions, as survival rates and treatment improve.

Astonishingly, there are more than 100 types of cancer that arise primarily from normal epithelial, connective, and hematopoietic tissues (Patel et al. 2019).

Preventatively, it is widely reported that physical activity can reduce the risk of multiple cancers including colorectal, lung and uterine; and furthermore can prevent cancer from returning (Des Geutz et al., 2013; NHS Foundation Trust 2014). The benefit of physical activity is that is linked with a reduction in obesity which is associated with the development of 13 different cancer types (Patel et al. 2019). Furthermore the risk of breast cancer in physically active women is between 20-40% lower than those who are sedentary; and in athletes could be 50% lower (Luo et al 2019). Exercise seems to limit a large number of cancers with the minimum effective dose being 150-300 min.wk of 'low level' activity.

Central to cancer development is

• cell proliferation (sustained proliferative signaling; evading growth suppressors)

• apoptosis (resisting cell death; enabling replicative immortality)

• changing metabolic control (reprogramming cellular energy metabolism)

• effecting the immune response (evading immune destruction) 

(Patel et al. 2019)

Post-cancer treatment, the common barriers to exercise are fatigue, lack of an exercise partner, fear, not being sporty, co-morbidities, weight gain, employment and family roles (Clark et al., 2007; Hefferson et al., 2013). The perceived benefits of physical activity are increased sense of control, improved body image, a distraction, physical functioning and quality of life (Clark et al., 2007).

Adherence rates to exercise interventions are low in cancer survivors; however, there is no difference in adherence between exercise programmes delivered within a clinical environment or at home, with programmes being less effective in older patients (Bullard et al. 2019; Grimmett et al. 2019).

Some things we need to be aware of with our athletes…

• Patients who may be taking supplementation or steroids, which could increase risk (De Santi et al 2019)

• Skin exposure to sun could increase the risk of developing melanoma. Therefore they should be protected with sun cream, sunglasses and educated where and when appropriate.

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References:

Bullard, T., Ji, M., An, R.et al. A systematic review and meta-analysis of adherence to physical activity interventions among three chronic conditions: cancer, cardiovascular disease, and diabetes.BMC Public Health 19,636 (2019). https://doi.org/10.1186/s12889-019-6877-z

De Castro-Maqueda, G., Gutierrez-Manzanedo, J.V., Ponce-González, J.G.et al.Sun Protection Habits and Sunburn in Elite Aquatics Athletes: Surfers, Windsurfers and Olympic Sailors.J Canc Educ35,312–320 (2020). https://doi.org/10.1007/s13187-018-1466-x

De Santi et al. 2019. Use of hormones in doping and cancer risk. Ann Ig; 31: 590-594 doi:10.7416/ai.2019.2319

Grimmett, C., Corbett, T., Brunet, J.et al.Systematic review and meta-analysis of maintenance of physical activity behaviour change in cancer survivors.Int J Behav Nutr Phys Act16,37 (2019). https://doi.org/10.1186/s12966-019-0787-4

Luo, H., Galvão, D. A., Newton, R. U., Fairman, C. M., & Taaffe, D. R. (2019). Sport Medicine in the Prevention and Management of Cancer. Integrative Cancer Therapies. https://doi.org/10.1177/1534735419894063

Patel et al. 2019. American College of Sports Medicine Roundtable Report on Physical Activity, Sedentary Behavior, and Cancer Prevention and Control. Medicine & Science in Sports & Exercise. 51 (11), 2391-2402.