Exercise is good for everyone, including people with cancer. Why is further research needed? Professor Anne May of the UMC Utrecht is often asked this question. “Everyone with cancer deserves the best possible exercise program, but patients are not always given the right tools to start exercising,” she says. “I want to further improve exercise programs with my research.” Anne also calls on insurers and politicians to better regulate compensation. Yesterday she delivered her long-awaited inaugural lecture.
“Exercise in cancer helps enormously to alleviate all kinds of symptoms of the disease and the treatment,” says Anne. She has been working at UMC Utrecht for almost 20 years as an epidemiologist and exercise researcher. In 2019 she was appointed Professor of Clinical Epidemiology of Life with and After Cancer.
Anne: “In the meantime, hundreds of studies have been conducted worldwide into the effect of exercise and sports, during and after treatment. We now have scientific evidence that exercise helps people with cancer to feel less tired, anxious and depressed, and to recover as well as possible after treatment.
Exercising during chemotherapy reduces side effects and makes people last longer, which may also make chemotherapy more effective.”
There is even some evidence that exercise can improve cancer survival. “In a group of patients with metastatic colorectal cancer, we saw that people who adhered to the exercise recommendations after diagnosis survived longer than people who did not,” says Anne.
Improving reimbursement for exercise care
The evidence that exercise has a positive effect on cancer seems to have been provided. However, it is not the case that everyone with cancer can participate in an exercise program as standard. Exercise care is included in the basic health insurance package for only 10% of patients. This has to do with how the compensation is arranged.
Anne: “The positive effects of exercise during treatment do not directly benefit the hospital, but society as a whole and, of course, the people with cancer themselves. The costs of the exercise programs clearly outweigh better health and have a great social benefit. In addition, they reduce the costs of other after-treatments. We should be willing to bet on that!”
A customized exercise program for every patient
Anne has plans to be able to offer every patient a customized exercise program. A training is built according to the FITT factors: frequency (how often per week), intensity (how intensive), time (how long each time) and type. The latter is the type of physical training, such as endurance training, strength training or interval training. Since these are four factors with different levels, many variations are possible.
“Exercise programs are still very generic, and we still know little about what the most optimal program is. In addition to the type of cancer and the treatment, the most optimal program can also differ per type of side effect. We will look into that in the coming years. we will go from one size fits all towards individualized exercise programs, so that each patient is offered a program that is most effective for them,” she says.
Investigating the effect of exercise at the cellular level
Anne also wants to investigate how exercise actually works in cancer. “We still know little about the biological mechanisms. That is why we are going to investigate the effect of physical exertion at the level of the cells,” she says.
“My goal is for exercise care to be standard and reimbursed care, in every line of our healthcare system”
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“This month, for example, we are starting a study among patients with bladder cancer who are following an exercise program. At various points in the treatment, some tumor tissue is removed from the patients. We are going to measure the effect of exercise on the cancer cells.”
Exercise programs for people with metastatic cancer
Most research into exercise in cancer has been done with patients who receive treatment in order to be able to heal. Anne’s research also focuses on people who can no longer heal, and how exercise can help them stay fit while living with the disease.
Anne: “Next year we hope to be able to publish the results of the first major international study of metastatic cancer. In this study, 350 women with metastatic breast cancer participate in a 9-month exercise program. We already know that the women have maintained the training very well, that there were virtually no injuries and that many women continue to exercise on their own initiative after the 9 months. It is a way for them to keep control and to stay fit. I find that very encouraging.”
Awareness among healthcare providers about exercise care
Only 1 in 4 people with cancer who need exercise care makes use of this. In addition to the financial aspects, patients indicate that they lack information, are not always motivated and sometimes do not dare to move during treatment. That is why Anne thinks it is important that care providers gain more knowledge and awareness about the possibilities of exercise care. In this way, people with cancer can be given the choice to exercise.
“It is very important that people talk about exercise in the consultation room. Patients start training if their therapist suggests it. So surgeons, radiotherapists, oncologists and general practitioners: touch on this subject! In this way, together we can communicate the importance of exercise care even more clearly. My goal is for exercise care to be standard and reimbursed care, in every line of our health care system.”
More information and useful links
Organizations that can help you with exercise in cancer:
Photo in header by Ed van Rijswijk
