General physical activity advice
Individuals with cancer are encouraged to be as physically active as their ability and condition allows, even during and after treatments such as chemotherapy, radiotherapy, immunotherapy or surgery.
General benefits of physical activity
Benefits of exercise for people with cancer
- Significantly longer disease-free survival and longer overall survival in colorectal cancer1.
- Reduces the risk of cancer specific mortality by 28-44% and all-cause mortality by 25-48%2.
- Reduces the risk of developing certain types of cancer (colon, breast endometrial, kidney, bladder, oesophageal, stomach)3
- Improve treatment tolerance and reduce treatment toxicity4
- Reduces the risk of cancer recurrence by 21-35%2
Guiding principles
Most physical activity guidelines recommend:
- Moving more and sitting less
- Working toward walking at a moderate pace for around 30 mins five days/week
- Performing some resistance based strengthening exercises (twice per week if possible)5-7.
Exercise can be completed continuously or in shorter bouts, depending on how the individual is feeling. It is important to first progress time spent performing physical activity and then the distance covered.
In general, moderate levels of physical activity are prescribed as between 4-6 out of 10 on the rate of perceived exertion (RPE) scale.
Respiratory education and breathing exercises
Evidence suggests that respiratory exercises should be taught and practiced in preparation for major (cancer) surgeries. Respiratory education and breathing exercises attenuate the negative pathophysiological impacts of anaesthesia and surgery including low lung volumes particularly functional residual capacity (FRC) and lung atelectasis.
Respiratory exercises prior to surgery are well supported in the literature for patients having major abdominal and lung surgery to reduce the incidence of postoperative pulmonary complications. Research evidence suggests complications can be halved using this universal patient education8,9.
Respiratory exercises involve a combination of techniques of breathing control, deep breathing, ‘huffing’ and coughing, that can be taught to patients via a video, written information or directly by a health care practitioner trained in this technique. It is commonly called the Active Cycle of Breathing Techniques (ACBT) or can be called simply deep breathing exercises.
aCOUGH
aCOUGH is a pulmonary care program focused on patient and carer education that reduces the incidence of postoperative pulmonary complications10.
The bundle includes educating patients on:
- ACBT
- Brushing teeth and using mouthwash twice daily
- The reasons for and importance of early mobilisation after surgery.
See Respiratory care bundle (aCOUGH) for more details.
An example of a patient handout on ACOUGH.
For surgical populations that are at risk of pelvic floor dysfunction
Currently there is limited evidence for preoperative pelvic floor muscle exercise in reducing pelvic organ prolapse or urinary incontinence in the gynaecological cancer surgery population12. However, clinicians may consider providing education and exercises that may help pelvic floor/bladder/bowel related outcomes as individuals with cancer may find it easier to familiarise themselves with these exercise techniques prior to surgery, rather than post operatively or once dysfunction arises.
A useful resource to provide and discuss with patients is the Continence Australia handout which is also available in multiple languages. Alternatively, there are video resources.