Exercise during chemotherapy shrinks tumours


Ground-breaking research has shown that cancer patients who followed a course of exercise ahead of surgery saw their tumours shrink markedly when compared to patients who followed the standard care pathway.


The study specifically examined the role of exercise prehabilitation in oesophageal cancer treatment.


Funded by the Guy's and St Thomas' NHS Foundation Trust in the UK, the study is the first evidence that structured exercise intervention enhances tumour regression during pre-surgical chemotherapy.


Patients on the trial also experienced a strengthening of the immune system and a partial reverse of chemo-related deconditioning and loss of muscle mass and function, leading to an improvement in quality of life during treatment.


The team behind the study – which is published in the British Journal of Sports Medicine – said it was an "extremely encouraging moment" to observe an improved response to chemotherapy treatment in cancer patients.


In the trial, the team compared two groups of oesophageal cancer patients undergoing chemotherapy prior to surgery.


Twenty-one patients were assigned to a structured prehabilitation exercise intervention for 16 weeks, while the second group of 19 patients followed standard care without structured exercise.


The exercise intervention programme – or 'prehabilitation' – undertaken during chemotherapy was based on a ‘moderate intensity’ programme in line with World Health Organization (WHO) and UK Chief Medical Officer (UK-CMO) guidelines for physical activity.


The programmes included 150 minutes of moderate-intensity aerobic exercise (ie, walking) and two strength sessions per week.


Biochemical and body composition analyses were performed at multiple times prior to starting chemotherapy, during chemotherapy, following chemotherapy prior to surgery and following surgery, to measure radiological and pathological markers of disease regression.


The results showed that the ‘exercise’ group demonstrated higher rates of tumour regression and downstaging, as well as improved immune function, reduced inflammation, and a reduction in chemotherapy-related reductions in muscle mass and physical deconditioning.


Prehabilitation is increasingly recognised as an important part of supporting cancer patients during treatment and there are a growing number of centres in the UK offering exercise prehabilitation and rehabilitation as part of standard cancer care.


Although this particular study was of oesophageal cancer patients, the team say the data is potentially relevant to any cancer patient undergoing chemotherapy, including for different tumour types and in different settings ie, curative or palliative.


Andrew Davies, a consultant surgeon at Guy’s and St Thomas’ NHS Foundation Trust Hospital and lead author of the study, described the results as “exciting” and more far-reaching than the oesophageal cancer patients enrolled in the study.


He said: “This is the first time a relationship between exercise and chemotherapy response has been shown in a human trial and opens up the possibility of benefitting patients with other types of cancer and those in palliative as well as curative settings.


“The argument for exercise now being a standard part of our treatment strategy for cancer becomes even stronger.”


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