Physical Exercise and Cancer: Exploring Chemotherapy Infusion as an Opportunity for Movement

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ABSTRACT

Objective

Exercise initiated in the early stages of cancer treatment may present as the most opportune time to reduce the detrimental side effects of treatment. Beginning exercise post-cancer treatment may not be early enough to elicit important improvements. The role of exercise alongside chemotherapy treatment, specifically during chemotherapy infusion may be an opportunity for the therapeutic delivery of exercise for cancer patients.

Data Sources

Narrative review of peer-reviewed literature with a focus on exercise during chemotherapy infusions and therapeutic effects of exercise on the tumor microenvironment.

Conclusion

Exercise initiated in the early stages of chemotherapy treatment may present as the most opportune time to improve therapeutic health outcomes and patient experience. If exercise during chemotherapy infusion could be feasible more testing is warranted to explore different modes including resistance-based exercise, dosage, intensity, and its potential affect on tumor hypoxia and chemotherapy drug uptake.

Implications for Nursing Practice

Oncology nurses are in the ideal position to initiate the conversation about exercise during chemotherapy treatments specifically the opportunity to provide light exercise during chemotherapy infusion. Starting exercise during this time may be the most beneficial timing to decrease the myriad of treatment side effects experienced. Further research is required to explore the potential affect of exercise during chemotherapy infusion on health benefits, tumor hypoxia, and drug uptake, all of which seem to be positively affected by physical exercise.

Introduction

A mounting body of evidence has demonstrated the benefits of physical exercise as an adjunct therapy to reduce the adverse physical and psychological effects associated with cancer and its treatment.1, 2, 3 These effects, including improved physical function, reductions in psychological distress and fatigue, decreased proinflammatory processes, and potentially increased treatment efficacy, are important across the cancer treatment continuum.1,3,4 This is particularly important as cancer survivorship continues to increase,4 with exercise also playing an important role in managing the increased risk of comorbidities and recurrence.1,5 Despite this evidence and actions to include exercise as standard care in cancer treatment, most patients do not meet the recommended levels of physical activity.1,2,6 Common barriers to exercise participation include lack of time, concerns around safety, and access to qualified exercise professionals.6, 7, 8, 9

Investigating chemotherapy infusion appointments as an opportunity to engage in or promote physical exercise may affect exercise barriers as this provides an opportune time to see patients due to the extended wait periods patients experience. Prescription of light-intensity exercise, either aerobic or resistance-based, could allow patients to remain active and improve treatment experience, because beginning exercise post-cancer treatment may not be early enough to elicit the improvements needed to reduce the debilitating side effects of chemotherapy. Additionally, the positive effects on therapeutic outcomes from the physiological effect of exercise have been observed with increases in perfusion to the tumor site promoting angiogenesis.3 Changes in the tumor microenvironment enhance drug delivery, and antitumor systemic immune responses10 have also been reported. This review aimed to determine whether exercise during chemotherapy infusion is feasible for cancer patients.

Specifically, this narrative review will briefly discuss (1) chemotherapy infusion as an opportunity for exercise prescription, and (2) evidence from kidney disease on exercise during dialysis treatment. This review will be limited to discussing exercise as an adjunct therapy, in adult patients undergoing chemotherapy treatment.

Section snippets

Chemotherapy Treatment

Chemotherapy treatment is a potent drug therapy developed to prevent further cancer cell growth and spread by targeting cancerous cells. There are numerous side effects associated with chemotherapy including fatigue, pain, gastrointestinal issues, blood disorders, nervous system effects, cognitive dysfunction, and cardiotoxicity.11 Chemotherapy treatment is individualized and dependent on multiple factors including the stage and type of cancer, location, age, general health, ability to cope

Physiological Responses of Exercise: Therapeutic Outcomes

More recently, evidence has suggested that exercise has the potential to improve chemotherapy drug uptake due to the increases in peripheral circulation and changes to tumor vasculature from increases in cardiac output and blood pressure (Fig. 1).3,6 Exercise in rat models with prostate cancer have demonstrated significant increases (200%) in tumor blood flow from an acute bout of low-moderate intensity aerobic exercise.12 Normal physiological responses from exercise include increased cardiac

Chemotherapy Infusion as an Opportunity for Exercise

Scheduled chemotherapy infusion appointments could provide a viable opportunity to exercise during an otherwise sedentary extended wait time. Exercise during chemotherapy infusion has only been trialed in two recent studies investigating feasibility.6,14 In the first trial, the patients diagnosed with mixed cancers (n = 10) completed 20 minutes of continuous aerobic exercise on a stationary cycle ergometer.6 Quantitative measures such as blood pressure, heart rate, oxygen saturation, and rating

Evidence from Kidney Disease on Exercise during Dialysis Treatment

Exercise simultaneously during a disease-specific treatment has been conducted in chronic kidney disease (CKD),16, 17, 18 where specific guidelines for intradialytic exercise have already been developed.17 With similar extended waiting times and treatment-related side effects comparable to cancer patients, there is emerging evidence supporting exercise during treatment to improve health outcomes and alleviate treatment-related side effects for CKD and cancer populations.1, 2, 3,16, 17, 18

Conclusion

Exercise throughout the cancer continuum has been widely validated and shows reductions in mortality and treatment-related side effects.5,21, 22, 23, 24 Even though the Clinical Oncology Society of Australia and Exercise Science and Sport Australia recommend that exercise should be embedded into usual care to assist with treatment-related side effects, disease management and treatment outcomes after initial diagnosis,1,2 people undergoing cancer treatment are not moving enough. Exercise

Disclosures

Dr Toohey is Miss Miller's academic supervisor and editor of this issue. This is an original research contribution relevant to this special issue on exercise in cancer care.

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