Can exercise help improve cancer survival?

Father and daughter walking in the park

Exploring the potential of exercise in cancer care

“Learning that exercise could help prevent and manage cancer was mind blowing to me. If it's so impactful, why aren't people doing it?”

Dr Cindy Forbes, a Research Fellow in the Wolfson Palliative Care Research Centre at Hull York Medical School, was fascinated that exercise could help reduce people’s risk of cancer.

Keeping active can help you lose weight or keep a healthy weight, which reduces the risk of 13 different types of cancer. And if you’re exercising a lot, it can even help prevent many cancers, including breast and bowel cancer. (1, 2)

While there is evidence supporting the beneficial effects of exercise on cancer recovery and quality of life, this evidence comes from observational studies. To provide more decisive answers on the impact of exercise on cancer survival and recurrence, there is a need for larger-scale randomised controlled trials, which can offer more robust and conclusive insights into this aspect of cancer management and prevention.

Dr Cindy Forbes

Dr Cindy Forbes is leading a study to assess whether exercise has an impact on survival from, and recurrence of, cancer.

Dr Cindy Forbes is leading a study to assess whether exercise has an impact on survival from, and recurrence of, cancer.

This sparked the idea for CANFit, a large feasibility study to assess the impact exercise has on survival from, and recurrence of, cancer.

The study aims to recruit people with high-risk, early-stage cancer across the three cancer groups: breast, lung and bowel.

"Exercise can help people recover from breast and bowel cancer. could it improve the chances of survival from cancer, or reduce the risk of cancer recurring, too?"
Dr Cindy Forbes

The study is funded by Yorkshire Cancer Research and is run in collaboration with the Hull Health Trials Unit and Sport, Exercise, and Rehabilitation Science at the University of Hull, and the Advanced Wellbeing Research Centre at Sheffield Hallam University.

The exercise programme: helping cancer patients to build healthy habits

The researchers have developed a tailored exercise intervention, which patients will take part in shortly after they have completed their programme of cancer treatment.

The study will be conducted as a ‘basket trial’; a type of clinical trial that will test how well the same exercise intervention works in patients with different types of cancer. These will be run as three trials concurrently in the same study.

The exercise programme will be delivered remotely over 12 weeks by specialist trainers. Participants will learn about the exercise programme, and the trainers will help them with goal setting, helping to build an action plan, and support patients to overcome any barriers they may face.

The exercise intervention has been informed by behaviour change theories and techniques to help participants build healthy habits, so that they can then keep doing the exercise programme on their own without regular trainer contact.

Dr Forbes, who is lead investigator for the study, said “A lot of people have said they prefer distance-based activity and doing it in their own time. However, previous evidence has shown that supervised programmes have been more effective in changing any outcome, whether it's physical function or quality of life, than when a programme is unsupervised.

“So, we have developed the exercise intervention in CANFit to bridge the gap between having regular contact and ‘supervision’ with a trainer, but the flexibility to do their exercise sessions whenever they want.”

Championing the recruitment of cancer patients to join the study

Starting in 2023, the researchers will begin recruiting 660 cancer patients across Yorkshire to the study at the Queen’s Oncology Centre at Castle Hill Hospital, part of Hull University Hospitals NHS Trust, and Weston Park Cancer Centre, part of Sheffield Teaching Hospitals NHS Foundation Trust.

The participants will be identified and recruited by ‘champions’ at each of these sites, including oncologists, research nurses, and cancer nursing specialists.

The study researchers have created a flyer for the champions to use when discussing the study with patients, and to hand over to the patient should they want to take part.

Dr Forbes said, “The cancer specialists we are working with are very supportive of the study. We know they’re incredibly busy, so we need to make recruitment quick and easy for them.

“We have created a quick guide flyer that will explain the study and how to get involved, that they can give to the patient. Then it's on us to follow them up. We’ve had conversations with our champions in the NHS about this approach. They are fully supportive of it – it should be quick and easy to fit into their clinical practice.”

The Hull Health Trials Unit will then securely collate all of the data of participants in the study. The Unit, based in Hull York Medical School at the University of Hull, is an integral part of the study, and is involved in the design of the study, the logistics around collecting and storing the data, through to the eventual statistical analysis and reporting. The Trials Unit have a Data Safe Haven, allowing sensitive health data to be securely stored.

Exercise equipment

Will exercise improve cancer survival and recurrence rates?

Starting with 12 weeks of active intervention under supervision of a trainer, followed by another 12 weeks of tapering support, the participants of the research study will be followed for two years in total.

Researchers will carry out assessments six months and one year after participants started the study, and then again after two years. Their findings will show whether there is a potential difference in survival between those who took part in the study, and those who received the standard NHS care.

The study will follow the same protocol for each cancer group – breast, bowel and lung cancer – but the results will be analysed separately. This way, the results will show if exercise has a different effect on a particular cancer.

Looking ahead to the results, Dr Forbes said, “The results could be different for each type of cancer. For example, a small amount of exercise might make a big difference in certain cancers, or maybe we need to do a lot of exercise for other cancers to have a smaller effect.”

Ultimately, Dr Forbes said “Helping people self-manage is one of the most important things that we can do.”

For more information about the study, contact Dr Cindy Forbes or visit the Wolfson Palliative Care Research Centre.

References

1. Brown, K. F., Rumgay, H., Dunlop, C., Ryan, M., Quartly, F., Cox, A., ... & Parkin, D. M. (2018). The fraction of cancer attributable to modifiable risk factors in England, Wales, Scotland, Northern Ireland, and the United Kingdom in 2015. British journal of cancer, 118(8), 1130-1141.

2. McTiernan A, Friedenreich CM, et al. Physical Activity in Cancer Prevention and Survival: A Systematic Review. Med Sci Sports Exerc. 2019;51(6):1252-61.