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REVIEW ARTICLE

Exercise in cancer
P. Rajarajeswaran, A B S T R A C T
R. Vishnupriya
Physical exercise has attracted increased interest in rehabilitation of oncological
College of Physiotherapy, Mother patients. The purpose of this paper is to review the literature and summarize the
Theresa Post Graduate and evidence of physical exercise in preventing cancer, its ability in attenuating the effect
Research Institute of Health
of cancer and its treatments and to provide guidelines for exercise prescription Review
Sciences, Puducherry – 6, India
of recent literature by electronic search of MEDline (Pub Med), Cancer lit, Cochrane
libraries, CINAHL were done using Keywords and the variables were identified and
systematically evaluated. There is strong evidence for reduced risk of colorectal and
breast cancer with possible association for prostate, endometrial and lung cancer with
increasing physical activity. Exercise helps cancer survivors cope with and recover from
treatment; exercise may improve the health of long term cancer survivors and extend
survival. Physical exercise will benefit throughout the spectrum of cancer. However,
an understanding of the amount, type and intensity of exercise needed has not been
Address for correspondence: fully elucidated. There is sufficient evidence to promote exercise in cancer survivors
Dr. P. Rajarajeswaran,
College of Physiotherapy, Mother
following careful assessment and tailoring on exercise prescription.
Theresa Post Graduate and
Research Institute of Health Key words: Exercise, cancer, prevention, rehabilitation
Sciences, Puducherry – 6, India..
E-mail: [email protected] DOI: 10.4103/0971-5851.60050

Physical exercise has attracted increased interest

INTRODUCTION
in rehabilitation of oncological patients in general
and also in palliative care. [5] In a growing body of
More than 10 million people are diagnosed with cancer
research that has investigated exercise in cancer
worldwide; with improvement in early detection and
patients; dramatic improvements in physiologic and
treatment, increasing numbers of patients can be expected psychological functioning have been documented in
to be alive five years after they are diagnosed with cancer.[1] patients participating in exercise programs. At least
These individuals will join the expanding number of cancer 15 meta-analysis have been published reviewing 100
survivors, estimated at about 25 million.[1] Current cancer studies showing the nearly universal to multifactorial
treatment, although increasingly efficacious for improving benefits of exercise in this patient population.
survival are toxic in numerous ways and produce negative Evidence of the benefits of exercise for cancer
short and long term physiologic and or psychological survivors in areas of psychological and quality of life
effects, including pain, decreased cardio respiratory fitness, (QOL) outcomes, [6] cancers related fatigue, [7] physical
cancer related fatigue, reduced Quality Of Life (QOL) and functioning, [8] body weight and composition, [9] muscle
suppressed immune function.[2] Interest in physical activity strength and endurance, [10] immune function [11] and
as a means for primary prevention of cancer is increasing as cardiovascular [12-13] fitness have been reported. It may
the evidence for its protective effect is rapidly accumulating. reduce the risk of cancer recurrence, second primary
cancers and other chronic diseases[4,8] as well as prolong
The International agency for research on cancer (IARC)
sur vival. [5] Exercise may also alleviate symptoms
estimates that 25% of cancer cases worldwide are caused
that interfere with daily life of cancer patients and
by overweight or obesity and a sedentary lifestyle.[3] Physical
survivors such as lack of appetite, diarrhea, paresthesia,
activity is an attractive cancer preventive strategy because constipation, physical fatigue, mental fatigue, treatment
it potentially benefits many health’s end points in addition related fatigue, muscle pain, arthralgia and other pain,
to reducing the risk of certain cancers.[4] Physical activity depression, anxiety and insomnia. [12,13,14] The purpose
may have benefits throughout the spectrum of living with of this paper is to review the literature and summarize
cancer, but cancer survivors are often at increased risk for the evidence of physical exercise in preventing cancer,
becoming too sedentary for several reasons. its ability in attenuating the effect of cancer and its

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Rajarajeswaran and Vishnupriya: Exercise in cancer

treatments and to provide guidelines for exercise all of the studies tested aerobic exercise programs although
prescription. several combined aerobic and resistance exercise programs.
Most of the early studies had significant methodological
METHOD limitations. Despite these limitations however, the
studies have consistently demonstrated that exercise has
Electronic search of MEDline (Pub Med), Cancer lit, beneficial effects on a wide variety of physical fitness and
Cochrane library, CINAHL were conducted using the QOL endpoints in cancer survivors including functional
following Keywords and its combinations- physical activity, capacity, muscular strength, body weight and composition,
exercise, prevention, intervention, cancer, neoplasm, quality flexibility, fatigue, nausea, diarrhea, pain, physical well-
of life, rehabilitation, chemotherapy, symptoms, side effects being, functional well being, depression, anxiety, rigor,
and biological mechanisms. Sources included references anger, mood, self esteem, satisfaction with life and overall
list of all relevant articles and reviews, Clinical Practice quality of life. These studies have resulted in exercise being
guidelines and Books. Review of recent systematic reviews, recommended to cancer survivors by American Cancer
Meta analysis and studies on the topic that have been Society and also as a therapy for fatigue in cancer survivors.
published in recent literature were reviewed and relevant
articles are included. To be included in this review, a study Table 2 summarizes the recent systematic reviews of
had to be published in English Language between 2000 to physical activity in cancer survivors
present (Aug 09). Physical activities in cancer with multiple
intervention and Pilot studies were excluded. The general consensus of these reviews is that physical
activity has modest positive effect on supportive
The following variables were identified and systematically care outcomes including aerobic fitness, physical
evaluated in each paper: cancer type, age, gender, functioning, muscular strength, fatigue and some
oncological treatment, QOL, biological mechanisms, type aspects of quality of life but the results are not as
of exercise program and frequency, intensity, type and time strong as the post-adjunct setting. In the review study
(FITT) outcomes. Papers that met inclusion criteria and by L.M. Oldervoll reported that some promising
quality were studied. Definition of cancer survivor: As effect of physical exercises on overall Quality of life,
suggested by the national coalition of cancer survivorship fatigue, physical functioning, physical capacity and/or
to refer to any individual diagnosed with cancer from the muscular fitness during and after cancer treatment. [75]
time of discovery and for the balance of life.[15] Physical C. Anderson et al. concluded that a six-week exercise
activity (PA) is defined as a bodily movement produced by inter vention for cancer patient with or without
skeletal muscle, which results in a substantial increase in disease and who are undergoing chemotherapy could
energy expenditure over resting level. Physical exercise is lead to a reduction in symptoms and side effects of
defined as planned, structured, repetitive and purposeful chemotherapy.[14] Physical activity may also help cancer
physical activity. survivors manage symptoms, improve mobility, slow
functional decline and maintain quality of life at the
RESULTS end of life.[66] In a prospective phase II study, Olderwall
et al. showed that structured physical exercise program
Exercise in cancer prevention by physiotherapist is a promising intervention for
Exercise may reduce the risk of developing a primary palliative cancer patient with short life expectancy
cancer, Nearly 150 studies have examined the relation and after six weeks there was a significant decrease
between physical activity and cancer prevention at specific in physical fatigue and improvements in physical
cancer sites, studies that meet the inclusion criteria and and emotional functioning and concluded that
quality were studied and the results are summarized in physical exercise (Resistance exercise) is a feasible
Table 1 along with possible biological mechanism. The intervention in a palliative care setting and may be
mechanism stated for association and cancer has not been beneficial. [76] Retraining physical function and
established. These include changes in endogenous sexual independence in activities of daily living are important
and metabolic hormone levels,[35,36] growth factors,[60] factors in palliative patient.[5,77] Figure 1 shows how and
decreased obesity and central adiposity[37] and possible when physical exercise may affect cancer experience.
changes in immune function.[65]
These studies suggest that physical activity may help
Exercise benefits in cancer survivors cancer survivors live longer by: reducing the risk of cancer
A majority of studies tested interventions and most of recurrence or slowing cancer progression and reducing the
these studies used supervised exercise programs. Almost risk of other life threatening diseases including second

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Rajarajeswaran and Vishnupriya: Exercise in cancer

Table 1: Epidemiologic evidence on association between physical activity and cancer and possible
biological mechanisms
Cancer site Average risk Overall level Possible mechnisms Rationale
reduction % of scientific involved
evidence
Colon[16-19] 40-50 Convincing Decreased Physical activity increases gut motility and reduces
gastrointestinal transit mucosal exposure time to carcinogens.
time
Decreased ratio of Strenuous exercise may increase prostaglandin (PG) F,
prostaglandins which inhibits colonic cell proliferation and increases
gut motility while not increasing PGE2, which affects
colonic cell proliferation, opposite to the effect of PGF.
Lowered bile acid Bile acid concentrations may be decreased in
secretion or enhanced physically active (Confounding by diet) persons.
acid metabolism
Breast[20-37] 30-40 Convincing Decreased lifetime Physical activity delays menarche, reduces the number
exposure to estrogen of ovulatory cycles, and reduces ovarian estrogen
production. It also reduces body fat and could reduce
fat-produced estrogens. It increases the production
of sex hormone–binding globulin, resulting in less
biologically available estrogen.
Prostate[38-46] 10-30 Probable Reduced exposure to Physical activity increases production of sex hormone–
testosterone binding globulin, resulting in lower levels of free
testosterone
Endometrium[47,48] 30-40 Possible Decreased percent Fat storage of carcinogens can occur in visceral fat,
Ovary[49-51] 20-30 Insufficient body fat which can be released in overweight individuals.
Lung[52,53] 30-40 Possible NE NE
Testis[54] 10-30 Insufficient NE NE
All cancers[55-65] NE NE Genetic predisposition Constitutional factors influence athletic selection or
of habitually active interest in physical activity and susceptibility to cancer.
people
Exercise-induced Exercise may increase number and activity of
increase in antitumor macrophages, lymphokine-activated killer cells and their
immune defenses regulating cytokines; it may increase mitogen-induced
lymphocyte proliferation.
Improved antioxidant Strenuous exercise increases the production of free
defense systems radicals, whereas chronic exercise improves free radical
defenses by up-regulating both the activities of free
scavenger enzymes and antioxidant levels.
Decreased circulating Increased exercise may decrease levels of insulin and
insulin and glucose bioavailable IGF-I, both of which enhance division of
Decreased insulin and normal cells and inhibit cell death.
insulin-like growth
factors
Definitions adapted from the World Cancer Research Fund and American Institute for Cancer Research (1). Convincing evidence is defined as evidence that is conclusive;
probable evidence indicates evidence is strong enough to conclude that a causal relation is likely; possible evidence indicates a causal relation may exist; insufficient evidence
indicates evidence is suggestive but too sparse to make a more definitive judgment. NE not examined, IGF: Insulin-like growth factors

primary cancers. The results generally show that the higher These components should be used to prescribe health
physical activity is associated with lower rate of breast and related exercise training program for both healthy
colon cancer recurrences, cancer specific mortality and all and chronically ill population to include patients with
causes of mortality. cancer on treatment. Suggestions to prescribe aerobic
exercises for patients in early stage of cancer have
Exercise program and prescriptions been published and to date no one has published
The American College of Sports Medicine (ACSM) guidelines for resistance or flexibility exercise protocol
recommends that an exercise prescription consist of in patient with cancer or recovering from cancer.
five components: frequency, intensity, time, type (FITT It is recommended that patients should undergo a
Principle) and progression. symptom-limited graded exercise test, which serves
as a basis for exercise prescription. Patients present
Table 3 summarizes the FITT principle of exercise physical status and the individual’s current phase of
prescription in clinical programs. treatment or recovery must also be considered.

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Table 2: Systematic reviews of physical activity in cancer survivors, published 2004–2008

Study Studies reviewed Authors’ conclusions
Kirshbaum, 2007[66] Systematic review of 29 intervention and Affirmation of the central proposition that exercise seems to be beneficial
observational studies in breast cancer and safe for a variety of breast cancer patients continues.
survivors
Markes et al. 2006[67] Systematic review and meta-analysis of 9 Improvement can be expected in physical fitness and the resulting capacity
controlled trials in breast cancer survivors for performing activities of daily life. An improvement for other outcomes
during adjuvant therapy is still tenable.
McNeely et al. 2006[68] Systematic review and meta-analysis of 14 Exercise is an effective intervention to improve quality of life, cardio
randomized trials in breast cancer survivors respiratory fitness, physical functioning, and fatigue.
Conn et al. 2006[69] Systematic review and meta-analysis of 30 Exercise interventions resulted in small positive effects on health and well-
intervention studies in cancer survivors being outcomes.
Schmitz et al. 2005[70] Systematic review and meta-analysis of 32 Physical activity improves cardio respiratory fitness during and after cancer
controlled trials in cancer survivors treatment, symptoms and physiologic effects during treatment, and vigor
post-treatment.
Knols et al. 2005[71] Systematic review of 34 controlled trials in Cancer patients may benefit from physical exercise both during and after
cancer survivors treatment.
Douglas, 2005[72] Systematic review of 21 intervention studies There is a growing body of evidence to justify the inclusion of exercise
in cancer survivors programs in the rehabilitation of cancer patients returning to health after
treatment.
Galvao and Newton, 2005[73] Systematic review of 26 intervention studies Preliminary positive physiologic and psychological benefits from exercise
in cancer survivors when undertaken during or after traditional cancer treatment.
Stevinson et al. 2004[74] Systematic review and meta-analysis of 33 Exercise interventions for cancer patients can lead to moderate increases in
controlled trials in cancer survivors physical function and are not associated with increased symptoms of fatigue.
Oldervoll et al. 2004[75] Systematic review of 12 randomized Cancer patients benefit from maintaining physical activity balanced with
controlled trials in cancer survivors efficient rest periods

Table 3: FITT exercise prescription for apparently healthy individuals

FITT principal Frequency Intensity Time Type
components
Cardio respiratory 3 to 5 days per week 40% or 50-85% HRR 20 to 60 minutes Dynamic use of large muscle groups
(Aerobic training) 40% or 50-85% VO2R
55% or 65-90% HRmax
Muscular strength and 2 to 3 days per week 12-16 RPE 1 set of 3 to 20 repetitions 8 to 10 exercises (All major muscles)
endurance (Resistance (e.g. 3 to 5, 8 to 10, 12 to 15)
training)
Flexibility 2 to 7 days per week Stretch to tightness at 15 to 30 seconds 2 to 4 times/ Static stretches (All major muscles)
the end of the range of stretch
motion but not to pain
FITT = frequency, intensity, time, type; HRR = heart rate reserve; HR max = maximum heart rate; RPE = rate of perceived exertion; VO2R = maximum oxygen consumption
reserve. Data adapted from ACSM.

Type or mode of exercise Radiation and chemotherapy may cause scar formation
The main health related types of exercise are aerobic, in joint, which may result in limitation in range of
resistance and flexibility. The best mode of exercise motion and this limitation can be prevented and normal
depends on the person’s goals, health status, and exercise range of motion can be gained by flexibility training.
history and cancer experience. Aerobic training is defined The best mode of exercise for the patient with cancer
as a method of improving cardio respiratory system (e.g. on treatment has not been determined because of the
Cycling, walking) lack of research. However, no mode of exercise has
been determined to be harmful to patient with cancer
Resistance training is defined as a method to maintain or on treatment either.
improve muscular strength, endurance or power, which
is performed against relatively high resistance and few Frequency
repetitions. Resistance exercise is a potent physiological American College of Sports Medicine recommends
intervention to increase muscle mass and attenuate apparently healthy individual to engage in aerobic training
muscle wasting. Flexibility training is defined as a method 3-5 days/week. In a deconditioned population, however,
of maintaining or improving length of the muscle. several shorter exercise sessions per day are generally better

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Figure 1: Framework PEACE: an organizational model for examining when and how physical exercise may affect the cancer experience. [Adapted
from Courneya K.S, Friedenreich C.M.2]

tolerated. It further recommends individuals to undertake fatigue with mild exertion may not be candidates for
two to three non-consecutive days per week of resistance recommended intensity aerobic training but they may
training. Flexibility training ranges from two to three days/ benefit from low level of physical activity. These survivors
week up to five to seven days/week.[78] require supervision in early stages of their recovery by a
physiotherapist. These severely compromised survivors
Intensity may benefit from range of motion exercises and gentle
The intensity recommended for aerobic exercise is 40-85% resistance training within their tolerance levels in early stage
of maximum heart rate calculated by Karvonen method, of rehabilitation. The low level training will allow them
which calculates % of heart rate reserve. to gradually build up their tolerance for activity. These
survivors in early stages of recovery may later progress
Karvonen formula to short bouts walking or bicycling several times per day
Age predicted maximum heart rate (APMHR) = 220 – age. in order to gradually build endurance and allow them to
advance to moderate intensity aerobic exercise.
Target heart rate range = [(APHMR – resting heart rate)
× per cent intensity] + resting heart rate. For persons undergoing chemotherapy or radiation treatment
the goals of exercise is to maintain function and prevent loss
However, any medication that affect’s heart rate, for e.g. of endurance and strength these survivors may be benefited
Beta-blockers, invalidates the formula. For these patient from routine physiotherapy and occupational therapy. Brisk
subjective means of gauging intensity such as rate of walking and static cycling are some safe mode of aerobic
perceived exertion (RPE) assessed by BORG Scale can be exercise. Machine resistance and or free weights are used
used.[79] These individuals should be motivated or advised for resistance exercise of large muscle groups of lower and
to exercise on intensity between 12 and 16 (somewhat upper extremities.
hard to hard) of Borg scale. For resistance exercise,
50 -70% of 1- repetition maximum in two or three sets Duration of exercise
with 8-12 repetitions per set has been shown effective. The American College of Sports Medicine recommends
1- repetition maximum refers to maximum load that that apparently healthy cancer survivors should exercise
a person able to lift once. Lower range of intensity is aerobically between 20-60 minutes, lower range for less
recommended for older and debilitated survivors and fit and old and duration increases according to fitness and
higher range is recommended for apparently healthy age.[78] Resistance training should be less than 60 minutes
survivors. Survivors who are confined to bed or who for whole bodywork. Flexibility training is given for two

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to four repetitions with each stretch holding for about or loss of balance, stationary bicycle may be used in this
15-30 seconds.[78] situation.[81]

Exercise progression Adherence to exercise

It depends on many variables such as the person’s goals, The studies that reported adherence to the exercise program
exercise tolerance and age. Things to remember about obtained a high level of adherence and a low dropout
progression are that every person will adopt differently to rate.[81-86] Adherence rate after completion of cancer
exercise stimulus, hence the rate of adaptation dictate the treatment was 95% or higher and during active therapies
rate of progression. Treatment for cancer progresses far was between 72-86%, which is still in acceptable level.
less predictably, and often non-linearly, because of multiple Lower adherence rate are expected during active
factors including the treatment schedule, fluctuating blood treatment when the patients are experiencing more
counts and varying symptom experiences. Definitive symptoms. Structured exercise protocol might benefit
guidelines for progression exist except for patient with these patients with many or severe symptoms and
early stage disease. The guidelines state 1) Frequency who struggle to regain their normal function such
and duration should be increased before intensity. 2) as those unable to resume work, or who suffer from
Progression should be slower and more gradual for the chronic fatigue and low physical function after the
deconditioned patient and those who are experiencing end of treatment. Some cancer survivors can adopt
severe side effects of treatment. an exercise program independently, many will benefit
from referral to physiotherapist who can who can give
Contraindications to exercise recommendation of exercise program on type, frequency,
Medical screening should be conducted for all survivors duration, and intensity based on survivors age, previous
prior to their participation in an exercise program. fitness level, type of cancer, stage of treatment, type of
General contraindications to exercises are cardiovascular therapy, comorbid conditions. Physiotherapy is essential
insufficiency (e.g. uncontrolled symptomatic heart failure, for survivors with injuries, pain or specific post surgical
acute myocarditis, and recent myocardial infarction), conditions such as lymphedema or amputation.
acute infectious diseases, metabolic diseases (e.g.
thyrotoxicosis, myxedema), mental or physical impairment The study by Pichett M et al. suggests that individual
leading to inability to exercise.[78] In addition to general who lead sedentary lifestyle may benefit from structured
contraindication certain contraindication and precautions exercise programs that include information and support
are specific to cancer survivors they are; Exercise within related to exercise adherence strategy. [87] Counseling
two hours of chemotherapy or radiation therapy as patients is one such strategy that effectively increased
increased circulation may increase the effects of treatment, adherence to exercise and increased physical activity in
Intravenous chemotherapy within previous 24 hours is also general practice.[88] Most survivors preferred that their
a contraindication for cancer survivors.[80] Survivors with Oncologist initiate the discussion of exercise and such
anemia (Hemoglobin <8g/dl) should not exercise until discussion also appears to increase exercise level during
anemia is improved (Hemoglobin >10g/dl),[81] Bedside treatment.[89] Cancer survivors have unique and varied
exercise programs may be prescribed for these individuals exercise counseling and programming preference. In
with frequent and short sessions. Hematological values the study by Jones W.L (307 survivors) 98% preferred
where Absolute Neutrophil count less then 0.5×109µl and recreational exercises, 81% preferred walking, 57%
Platelet count less then 50×109µl is contraindication for preferred unsupervised exercise.[90] These preferences for
exercise as well.[81] Acute onset of nausea during exercise individual survivors should be considered before exercise
and vomiting within previous 24-36 hours, unusual program prescription.
fatigability or muscular weakness, disorientation, blurred
vision, faintness, pallor, night pain or pain not associated Providing reassurance that exercise is safe and beneficial
with injury are also signs of contraindication to exercise.[80] modality may improve exercise adherence for inactive
Survivors with immunosuppressants should avoid public cancer survivors and exercise program prescribed should
gyms until there white blood cell count return to safe build confidence by slowly increasing the intensity. It should
level (>500/mm3),[80] bone marrow transplanted survivors be noted that adherence to exercise program is necessary to
should avoid exposure to public places with risk of obtain improved aerobic fitness. A point to be considered
microbial contamination for one year after transplantation. is transfer of local exercise training into activities of
Survivors with indwelling catheter should avoid resistance daily living for example, resistance exercise may improve
exercise of muscle in the area to avoid dislodgement of muscle strength, endurance and physical functioning but
catheter. Survivors with significant peripheral neuropathies it is known that without integration of functional training
should avoid exercise of the part because of weakness improved muscle strength does not result in improved

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functional task performance for efficient performance of reduces the risk of postmenopausal breast cancer, colon
activities of daily living.[91] An individual must be able to cancer, endometrial cancer, kidney (renal cell), esophagus
perform basic movement and also combination of these (adenocarcinoma) and thyroid cancer.[83] The expert
in order to accomplish more complex tasks,[92] sports may committee of American Cancer Society has concluded that
provide training in such complex tasks. Sports are often increasing vegetable and fruits, increasing fiber, omega 3
included in exercise program to facilitate integration into fatty acid, soy and limiting total fat and saturated fat have
daily life, as it is difficult to become physically active when possible benefit on preventing some cancer recurrence
sedentary.[93] Enjoyment of sports has also been reported and overall survival,[97] but the information available is
to facilitate for adaptation of an active life style.[94] Sports insufficient to conclude the benefits for some sites. Diet
might also have beneficial effect on physical activity level with this recommendation is recommended which dietitian
and physical health, develop sports specific skills, provide must individualize as food intake may be compromised by
a sense of achievement and empowerment, develop self the effects of disease or therapy and to achieve specific
esteem and teach self discipline.[95] Preliminary trails on goals of individual exercise program. It should also be
lifestyle intervention (incorporating short periods of noted that benefits of exercise are independent of weight
moderate activity into their daily routine) are going on for loss and diet.
cancer survivors and these studies have shown promising
effect on improving physical functioning and quality of
DISCUSSION
life and increasing physical activity.[96]
The study suggests that there is strong evidence for
The health benefits of physical activity are independent
reduced risk of some cancers with increasing physical
of whether the physical activity is sport, household,
activity. The strongest evidence exists for colorectal and
occupational or recreational in nature. Some of the ways
to increase physical activity that can be advised are – postmenopausal breast cancer with possible association
using stairs rather than an elevator, always walking to the for prostate, endometrial and lung cancer. The findings
destination when possible, exercising with friends and are supported by identified biological mechanisms. The
family, taking a ten minutes exercise break to stretch and field of oncology will benefit from understanding the
quick walk, walking to visit nearby friends or co workers importance of physical activity both for primary prevention
instead of calling them over phone, planning for active as well as in helping cancer survivors cope with and recover
vacations rather than only driving trips, using a stationary from treatments, improve the health of long term cancer
bicycle while watching TV, planning the exercise routine survivors and possibly even reduce the risk of recurrence
to gradually increase the days per week and minutes per and extend survival after a cancer diagnosis. However, an
session. understanding of the amount, type, and intensity of activity
needed has not been fully elucidated for primary prevention
Adverse event issues and for patients at different stages of disease progression
Of the reviewed studies 14 commented on the presence is still lacking. There is sufficient evidence already to
or absence of adverse events during the period of recommend that at least moderate intensity activity of
intervention. In the 14 studies 12 indicated that no 30 minutes/day for five days/week or more than 45-60
harm was observed as a result of exercise during or minutes vigorous activities for some cancer site is given.
after cancer treatment. McNeely et al. reported that one There is sufficient evidence to promote exercise in cancer
participant complained of nausea during one session, survivors following careful assessment and tailoring on
with no further difficulties. [83] Courneya et al. noted exercise prescription based on health status of individual.
that three participants developed lymphedema out of Additional studies will be needed to more firmly establish
which two had undergone axillary irradiation, a strong physical activity benefits to cancer survivors.
risk factor for lymphedema.[84] The author commented
that it was not clear whether the onset of lymphedema ACKNOWLEDGMENTS
was due to exercise.
We thank our institute (M.T.P.G and R.I.H.S) for setting the
Exercise and diet stage for our performance and we thank Librarian Kumaravel
Overweight and obesity have been associated with many C for his co-operation.
types of cancer, the ideal method to limit weight gain or loss
weight is to unbalance the energy equation by combination
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