Cancer has become a significant global health issue, with its incidence more than doubling over the past three decades. While advancements in diagnostic measures and treatments have led to improved survival rates, cancer patients and survivors continue to face unique challenges related to their physical and mental well-being. Physical activity (PA) and sedentary behavior have emerged as important factors in cancer care, with research indicating their potential to enhance quality of life, reduce adverse effects of treatment, and improve overall outcomes. This article explores the impact of PA and sedentary behavior on cancer patients and survivors and highlights the need for interventions that address these aspects comprehensively.
The Burden of Cancer
Cancer contributes significantly to the global disease burden, accounting for almost 20% of total disease impact worldwide. In Australia, cancer is the leading cause of death, and approximately one in two individuals receive a cancer diagnosis before the age of 85. While mortality rates have decreased over the past decade, the growing population of cancer survivors has brought attention to the long-term consequences of cancer and its treatments. Many survivors experience ongoing pain, fatigue, and physical and mental health issues that affect their quality of life.
The Potential of Physical Activity
Numerous studies have demonstrated the benefits of participating in recommended levels of physical activity for both cancer prevention and the well-being of cancer patients and survivors. Engaging in regular physical activity has been shown to reduce the risk of developing cancer and improve overall outcomes in cancer patients. It can alleviate fatigue, enhance quality of life, and positively impact emotional well-being, social functioning, anxiety, pain, and sleep disturbance. The benefits of physical activity have been extensively reported in breast, colon, and prostate cancer patients, but emerging evidence suggests its positive effects for various other cancer types.
Comprehensive Exercise Interventions
Exercise interventions in the cancer population have varied in modalities and intensity levels, with a combination of aerobic and strength exercises being commonly utilized. Aerobic exercise has proven effective in managing cancer-related fatigue, while resistance training improves overall body strength, bone mineral density, and muscle mass. Combining aerobic and resistance training has demonstrated improved psychosocial health outcomes and reduced fat mass percentage. To ensure personalized care, exercise programs need to consider an individual’s needs and preferences and offer detailed profiles of their physical activity and sedentary behavior patterns.
Physical Activity Guidelines for Cancer Patients and Survivors
The extensive variety of exercise interventions in the cancer population has led to the development and implementation of PA guidelines for people living with and beyond cancer. The Clinical Oncology Society of Australia (COSA) position statement on exercise and cancer care endorses that all people with cancer should avoid inactivity and progress towards and, once achieved, maintain at least 150 minutes per week of moderate, or 75 minutes per week of vigorous aerobic exercise, or an equivalent combination and 2–3 days of resistance exercise per week. Despite the known benefits of PA, only the minority of cancer survivors are meeting the recommended guidelines. Trends demonstrate that cancer patients’ PA declines at diagnosis and progressively wanes during and after treatment. For example, a large epidemiological study in women with breast cancer (n=812) found a decrease in all types of PA levels (approx. 2 hours per week, equating to 11% reduction) after diagnosis of 15 breast cancer. This reduction of PA was more pronounced in women who underwent surgery, radiation, and chemotherapy (50% decline), compared with women who only had surgery (24% decline).
Addressing Sedentary Behavior
In addition to physical activity, addressing sedentary behavior has gained attention in cancer care. Prolonged sitting and excessive sedentary time have been associated with decreased quality of life, metabolic disturbances, and increased risk of cardiovascular morbidity and mortality. Cancer survivors, who often face challenges that contribute to prolonged sitting, are at higher risk for negative health outcomes. Studies in cancer survivors have found that prolonged sitting was linked to decreased quality of life, metabolic disturbances, increased anthropometric measures, heart disease and premature mortality. Tabaczynski et al, found that a sample of breast cancer survivors (n=20) were spending an average of 8.2 h/day in sedentary behaviour, where up to 4 h/day was spent watching TV. This is especially concerning when coupled with the known low levels of regular PA participation in the cancer population. Interventions focusing on reducing sedentary time and promoting non-sedentary activities can be beneficial.
The Importance of a Whole-of-Day Approach
Taking a “whole-of-day” approach to physical activity promotion entails reducing sedentary time while concurrently emphasizing activities of light, moderate, and vigorous intensity. This approach considers the full spectrum of an individual’s daily activities and aims to shift behavior patterns rather than focusing solely on planned exercise bouts. By integrating a range of activities across the intensity spectrum, interventions can effectively address both sedentary behavior and physical activity.
Physical activity and sedentary behavior play significant roles in cancer care, impacting the well-being and quality of life of cancer patients and survivors. Engaging in regular physical activity has shown numerous benefits, while addressing sedentary behavior is crucial for improving outcomes. Comprehensive exercise interventions, personalized to individual needs and preferences, should consider the entire spectrum of movement behaviors throughout the day. By implementing strategies that promote physical activity and reduce sedentary behavior, healthcare professionals