Exercise Benefits Cancer Patients Undergoing Radiotherapy

Over the past 14 years, thousands of fitness industry professionals at IHRSA member clubs have received the Health Benefits of Exercise Report (originally Health e-Review) newsletter. Since 2006, we’ve shared over 1,300 research articles on the health benefits of exercise with our members.

To create this newsletter, we search PubMed, a free search engine supported by the National Library of Medicine, collating over 30 million articles from science journals and other sources for relevant, quality evidence on the health benefits of exercise. We select three peer-reviewed articles, summarize the key findings, and provide social media images—formatted for Facebook, Instagram, and Twitter—for you to share with your community.

For the first time, we are making the newsletter available as an open-access article.

This month, we discuss:

1. How exercise can help alleviate adverse side effects of cancer treatments involving radiotherapy
2. The potential for physical activity/exercise interventions as both a prevention and mental health promotion strategy for young people
3. The effect of taking up an exercise program on depression and hostility in healthy, sedentary adults

Exercise Is Beneficial for Cancer Patients Undergoing Radiation Therapy

Radiotherapy is a common component in cancer treatment, and about 50% of cancer patients undergo radiotherapy as part of their treatment, either alone or in conjunction with other treatments like chemotherapy. Several adverse effects are associated with radiotherapy, including cancer-related fatigue, sleep disorders, and depression. A study published in SAGE Open Medicine reviewed evidence from 29 original studies, looking at the effects of exercise interventions during radiotherapy on treatment-related adverse effects.

According to the review, exercise can be linked to improvements in cancer-related fatigue for people with breast cancer; it seemed to prevent increases in fatigue in people with prostate, rectal, and head and neck cancer. In nine studies pertaining to breast cancer, exercise interventions could be linked to improvements in exercise capacity, muscle strength, pain, sleep quality, and quality of life. Additionally, subgroup analysis conducted as part of one study suggests that supervised exercise may be more effective than home-based exercise. It also suggests that combined aerobic and resistance training may be more effective than either one alone at reducing cancer-related fatigue.

In patients with prostate cancer, physical activity increased exercise capacity and muscle strength and decreased proinflammatory markers. Researchers also found an inverse link between self-reported cancer-related fatigue and exercise levels. For people undergoing rectal cancer treatment, exercise improved physical performance and muscle strength and helped prevent declines in cardiovascular fitness, fatigue, and quality of life. Patients with head and neck cancer saw improvements in functional exercise capacity and some areas of quality of life, and exercise seemed to prevent muscle strength losses. People with non-small cell lung cancers tolerated moderate to high-intensity exercise, but there wasn't enough evidence to draw conclusions about more specific outcomes.

According to the authors, these findings mean that “in view of the value of exercise during [radiotherapy] to manage treatment-related side effects, exercise programmes should be incorporated as a routine part of cancer patient care during [radiotherapy], similar to cardiac and pulmonary rehabilitation.”

The benefits of physical activity on people undergoing cancer treatment are not new to the fitness industry. A number of clubs offered cancer wellness programs prior to COVID-19 restrictions, and according to at least one cancer expert, “working with the fitness industry is the Holy Grail.”

Physical Activity, Exercise Promote Mental Health in Young People

Depression, anxiety, attention hyperactivity disorder (ADHD), and behavior problems are among the most commonly diagnosed mental health disorders in youth. Some evidence has suggested that physical activity can help prevent or improve mental health, yet physical activity often declines in the teenage years. A study published in BMJ Open Sport & Exercise Medicine reviewed the available evidence on the effectiveness of physical activity for mental health promotion, and prevention of mental health disorders, in teens and young adults. The review included 29 studies, 22 of which did not recruit people based on existing mental health symptoms.

In the 22 studies that included people with no mental health symptoms, there was an association between physical activity and improvements in:

• affect and mood,
• anxiety symptoms,
• body image,
• depression symptoms,
• fatigue,
• self-perception and self-esteem,
• quality of life,
• resilience,
• social skills,
• stress, and
• substance use.

Five studies that recruited people with existing symptoms found a link between exercise and a reduction in depression symptoms and a high level of substance use.

These findings suggest that physical activity and/or exercise can be a targeted or preventive strategy as well as a promising mental health promotion strategy.

Physical Activity Lowered Depression, Hostility Scores in Healthy Adults

Previous research has shown a link between physical activity and improvements in anxiety, depression, hostility, and anger. A study published in the journal Health Psychology looked at how going from a sedentary to active lifestyle changed circulating cytokines (markers of inflammation) and impacted depression, anxiety, anger, and hostility in otherwise healthy adults. The randomized-controlled trial included 119 adults ages 20-45 who were previously sedentary and had no history of anxiety or depression. Participants were randomized to either a 12-week exercise group consisting of four times weekly self-directed gym visits with individualized programming, or a waitlisted control group. Participants submitted bloodwork and took tests to assess depression, anxiety, hostility, and anger at the beginning of the trial, after 12 weeks of exercise, and following four weeks of deconditioning (abstaining from exercise).

Following the 12 week program, the exercise group saw a statistically significant decrease in depression—39% compared to the control group—and hostility and small but not statistically significant changes in anxiety and anger. Following the four weeks of deconditioning, some of the declines in depression and hostility were still observed but were no longer statistically significant. The study also observed no effect of exercise on inflammatory markers.

While study authors were surprised to find no significant link between exercise and anxiety and anger, they noted that this could be because higher intensity exercise tends to be more effective than lower intensities, where the anxiety levels were already low at baseline. This study supports existing evidence that physical activity provides psychological benefits, even among healthy people with no existing or history of mental health issues.

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