Physical activity and cancer: it’s time for a paradigm shift

In this guest post Jo Foster, Physical Activity Lead at Macmillan Cancer Support, looks at the findings of a new research article published this week in BMC Medicine and tells us more about Macmillan’s physical activity drive.

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Macmillan Cancer Support welcomes new evidence from the Physical Activity during Cancer Treatment (PACT) study suggesting a supervised physical activity programme, offered early in breast cancer treatment, showed positive effects on physical fatigue, submaximal cardiorespiratory fitness and muscle strength.

It is time for a paradigm shift in the way we look at physical activity. Prescribing physical activity early during treatment of breast cancer, indeed for all cancers at all stages of cancer care, can and should be recommended.

We now know that one in four people are living with the consequences of their cancer and its treatment. These consequences are debilitating. They prevent people from returning to work and living independently. They can lead to other long term conditions including type 2 diabetes and cardiovascular disease.

We know that we are now supporting a population of people who have multi-morbidities. In the UK one in two people have two or more co-morbidities and one in three have three or more. With the growing global prevalence of cancer this places a significant burden on health, social care and community services something that most countries cannot afford.

What if there were a low cost, clinically effective intervention that improves clinical and quality of life outcomes and takes the main burden of care away from pressurised health care services?

There is now clear evidence to recommend physical activity in helping to prevent and manage some consequences of treatment and co-morbidities.

The growing evidence base for being physically active during and after cancer treatment provides just that. There is now clear evidence to recommend physical activity in helping to prevent and manage some consequences of treatment and co-morbidities. There is also an emerging evidence base that for some cancers physical activity may reduce the relative risk of disease recurrence, slowing disease progression and cancer specific mortality.

What is particularly interesting about this research is its focus on intervening during treatment soon after diagnosis. The results clearly demonstrating outcomes in reduction in fatigue, anxiety, depression measurements and improved quality of life. This should be of great interest to patients, health care professionals and policy makers alike to ensure that people undergoing treatment can benefit from these clinical and quality of life outcomes.

At Macmillan Cancer Support, as a result of the growing evidence base, we have developed a new service area to enable people affected by cancer to realise the benefits of moving more. Our ambition is to ensure everyone living with and beyond cancer is aware of the benefits of physical activity and enabled to choose to become and to stay active at a level that’s right for them – so that they can live as well as possible for as long as possible.

Our approach focuses on enabling and supporting people who have had a cancer diagnosis to make sustained behaviour change (often in partnership with their chosen supporter, be that a friend or family member).

We are working through local strategic partnerships between clinical care, public health, local government, and local providers of physical activity to provide a person-centred behavioural counselling service. This is led by trained professionals in cancer rehabilitation and behaviour change, working with people who have been referred in from primary or secondary care (or have self-referred).  People are supported to become and stay active whether in a supervised gym-based programme, through their local health walks group or through a get-back-into-sport programme such as walking football or no-strings badminton.

We do meet some health care professionals who still encourage their cancer patients to rest during treatment.  This study provides evidence to intervene during treatment. Our role now is to work in partnership to ensure that happens.

 If you would like to find out more information about the Macmillan Physical Activity team please visit their website and blog, sign up to their monthly newsletter and follow them on twitter. There are heath walk programmes throughout the UK. More information can be found here

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David Colquhoun

I have just read the original paper. It appears that not allowance has been made for multiple comparisons despite the large number of outcomes that were measured. Furthermore, although P values were not reported, it’s obvious from the confidence intervals that they were not much less than 0.05. If one takes into account that a P value close to 0.05 means there is at least a 30% chance of being a false positive (before you even get to the multiple comparison problem), I can’t say that I find the results at all convincing.
I note too that the effect sizes that were observed were far smaller than those used in the power calculation.

The fact that the intervention was not blind provides another reason to be suspicious that the study demonstrates any effects at all.

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