When I was diagnosed with breast cancer back in January 2021, aged 40, I asked my oncologist a question. As I was about to embark upon five months of chemotherapy, followed by a mastectomy with full axillary lymph node clearance, 15 rounds of radiotherapy and then eight months of further adjuvant chemo for good measure, I asked if there were any lifestyle steps I should be taking to support my treatment.
“Oh, not really,” she replied, “just rest.”
This old adage of “rest is best” has been the mantra of oncologists for a long time, but it is looking increasingly outdated.
The results of a landmark trial published this week found that exercise can reduce the risk of cancer patients dying by a third, stop tumours coming back, and is even more effective than some drugs. The response in the press has been one of celebration: here’s an intervention that is free, widely available and has no side effects. But also one of surprise: who knew that exercise had such power?
Well, those of us who have spent any time looking into this over the past few years certainly knew.
As a naturally lazy person, who seizes on any excuse not to exercise, I took my oncologist’s advice to heart and spent over a year lying on the sofa. It was only when I started interviewing experts for my book, Reconstruction: How to Rebuild Your Body, Mind and Life After a Breast Cancer Diagnosis, that I discovered all of the evidence for exercise reducing cancer risk – particularly breast cancer.
One study from 2021 found that breast cancer patients who exercised for 2 to 5 days per week had a 63 per cent lower relapse risk than those who are inactive and another from 2022 found that exercise reduces the risk of breast cancer recurrence by up to 60 per cent. Sixty per cent!
This week’s study involved colon cancer patients but Dr Julie Gralow, chief medical officer of the American Society of Clinical Oncology, said there was no reason to think the findings would not be applicable across other cancers. “It’s the same magnitude of benefit of many drugs,” she added. “Twenty eight per cent decreased risk of occurrence, 37 per cent decreased risk of death. Drugs get approved for less than that, and they’re expensive and they’re toxic.”
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The evidence is very much there in the academic papers, but when I was going through cancer, it had not filtered through to the oncologists who were treating patients every day. I personally felt let down that no medical professional ever mentioned this to me.
The chemo drug that I was on for eight months after surgery caused nausea, fatigue, hair thinning, a horrible painful rash all over my skin and my nails to go yellow and start peeling away from my fingers (my big toenail came clean off). The side effects were awful, and that drug reduced my risk of recurrence by about 20 per cent.
Yet no one told me about an intervention that I could do at home or in my local park – that would reduce my risk of recurrence even more. Why not?
“There is a lot of work going on behind the scenes in many hospitals across the UK to try and get exercise programmes funded for people with cancer,” says Sarah Newman, Cancer & Exercise Specialist and Founder of Get Me Back, an online fitness membership for women with cancer. “With this new data, I hope that funding for these exercise services will be prioritised to help as many patients as possible.”
Of course, anyone who has been through cancer treatment will know that it makes you extremely tired, so you shouldn’t feel under pressure or push yourself too hard. Literally a daily walk or a bit of light yoga will help reduce your risk, and also make you feel better emotionally and physically. The exercise used in the study was mainly walking, which is achievable for most of us, even at our lowest ebb.
As for any specific types of exercise to reduce cancer risk, Sarah says it’s more about finding a form of exercise that you like (or at least don’t hate) enough to keep doing it, rather than finding the “perfect” exercise.
“The type of movement you do is not directly linked to reducing risk,” she says. “However, it is worth considering other impacts of your treatment, like menopause, which can affect bone density, so strength training is particularly important to help you live a better quality of life for longer.”
Even with the knowledge of this huge incentive in terms of reducing my future cancer risk, I still found it hard to make exercise a habit. As someone who skived off PE lessons at school, I have always felt that I have neither the time nor the inclination to challenge my body or get even vaguely sweaty. You would never catch me in a gym, and the thought of a HIIT class filled me with dread.
Sarah reassures me that I am very much not alone in this. “Everybody has to start somewhere,” she says. “My advice is always to begin with a daily 20-minute walk, increasing the time each week by a few minutes. When you feel confident, add in a short bodyweight strength circuit a couple of times a week, or seek advice from a cancer specialist to create a programme for you.” Get Me Back’s website offers free introductory videos on YouTube, and online classes every day through its membership.
I started with walking and built up to plodding runs around my local park. Burpees are never going to be my thing, but I found that I could handle slower strength work, with a bit of feelgood stretching, such as yoga, Pilates and barre. Eventually, as I got stronger, I started to find that I hated it less, and maybe even (whisper it) enjoyed moving my body in a way that I knew was good for me. Because obviously, the benefits are not only in terms of avoiding getting cancer again – I’m also reducing my risk of other chronic conditions like heart disease, improving bone density and bolstering my mental health.
I still see my oncologist every four months for a check-up and, at my most recent appointment, more than four years since my diagnosis, after the usual chat about how I’ve been feeling and if I have any concerns, she surprised me with a question: “Do you do much exercise?” Thinking back over my years of researching the evidence, struggling to find a type of exercise that I could do without hating it too much, and learning ways to incorporate it into my life, with all of the trial and error that involved, I almost laughed. Instead, I gave an honest reply: “Yes, I do now,” I replied. “I never used to, but I’ve heard it’s important.”
“Great,” she said. “Keep it up. That’s probably reducing your risk of recurrence more than any drug at this point.”
So it looks as though the message is finally trickling down to medical professionals, and then hopefully out to the people who need it most: those living with and beyond cancer.
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