The Physician and Sportsmedicine
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Exercise: Answering a Cancer Patient's Call


Though I have devoted my career to sports medicine, in which physical activity and prevention are primary and the expectation is quick recovery from injury or illness, I don't lose sight of the fact that there is another world out there, a world of sick people. The burdens of poverty and disease are real, and the malnutrition, war, and infectious disease rampant in developing countries create a material contrast with sports medicine. Even in North America diseases such as cancer often disrupt or cut short the lives of otherwise healthy people.

It might initially seem incongruous, but the focus of sports medicine has, over the last decade, been applied to the suffering of cancer patients—not, of course, in an attempt to cure the disease itself, but in recognition of the potential of exercise to improve functional capacity, increase muscle strength, and, particularly, combat the profound fatigue often experienced by cancer patients during and after treatment. Exercising also empowers cancer patients and long-term survivors and gives them a sense of control and identity.

I spoke recently with Don McKenzie, MD, PhD, a professor of sport medicine at the University of British Columbia in Vancouver, about his work with women who have breast cancer. "When you get the diagnosis of cancer, you get 'medicalized' to the extreme," he said. "You lose control. The two ways cancer patients regain some control is through their diet and through exercise. Physical activity helps to offset the physical side effects of chemotherapy and radiation."

McKenzie feels that cancer rehabilitation is where cardiac rehabilitation was 25 years ago, but that this situation will change because patients are demanding it. "We don't know what the precise exercise prescription is right now," he says. "The correct dose-response relationships haven't been worked out. But the sports medicine physician is in the position to answer the call from these patients."

In this issue, Kerry Courneya, PhD, et al, assess our current understanding of the role of exercise in cancer management (page 49). They emphasize that cancer is increasingly a chronic disease (the 5-year survival rate for all cancers is 60%), and that most evidence suggests that exercise improves patients' quality of life during and after cancer treatment. This has held true across a range of cancer types and patient ages. Despite the growing evidence, however, most cancer patients are not counseled by their physicians to exercise.

Meanwhile, others are already moving ahead. For example, "Abreast in a Boat" is a society of breast cancer survivors who use dragon boat racing as a form of exercise and social support, and to raise awareness of the importance of exercise in breast cancer treatment. Dr McKenzie, who serves as medical director, has observed phenomenal interest and growth in this group, which has more than 30 teams on three continents. Another organization, Team Survivor USA, has approximately 2,000 participants in eight states. According to Karen Van Kirk, affiliate manager of the national organization and executive director of Team Survivor California, the year-round programs typically offer weekly walking groups and individualized indoor training. Either format, she says, allows participants to set their own physical goals and receive emotional support from peers. The emphasis on individual goals makes the program workable for all types of patients.

McKenzie, Courneya, and other researchers—as well as those putting new ideas into practice—have recognized that the enormous economic investment in research is not necessarily producing the types of short-term change that people expect in their lives. I hope that by building on the work of investigators who have helped prolong cancer patients' survival, this new phase can help patients regain as much human performance—and humanity—as possible.

Gordon O. Matheson, MD, PhD