All cancer patients should be prescribed exercise, Australian guidelines say

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When Emily Piercell was diagnosed with breast cancer in 2015, along with the usual regimen of chemotherapy, radiation and surgery, an oncologist and a physiotherapist encouraged her to add something else to her cancer care: Exercise.

It was an easy request for the now-30-year-old; exercise had always been an important part of her life. Staying active through exhaustive and toxic cancer treatment proved to be a bigger challenge than she thought.

"There were days I didn't want to go outside for my walk," she told CBC News. "My mom and my sisters would say: we're going."

But Piercell believes that keeping fit, and exercising throughout her treatment, helped her recover faster.

For the past few years, doctors in Canada have increasingly started using the prescription pad to not only write out directions for medications, but for exercise, too — whether it's to treat depression, diabetes or cardiovascular disease.

Now the Clinical Oncology Society of Australia (COSA) has taken it a step further.

In what's being called the first of its kind, the group has released a position statement that calls for exercise to be an essential part of all cancer treatment, prescribed alongside surgery, chemotherapy and radiation.

'Exercise as a pill'

"Cancer patients who exercise regularly experience fewer and less severe side-effects from treatments, they have a lower relative risk of cancer recurrence and a lower relative risk of dying from their cancer," the statement's lead author, Prue Cormie, told CBC News in an email.

Cormie said that if exercise could be turned into a pill, patients would demand it, cancer specialists would prescribe it and governments would subsidize it.

The position statement was endorsed by more than 20 cancer and exercise organizations in Australia and specifically calls on health professionals treating cancer patients to:

• Discuss the role of exercise as a part of a patient's cancer treatment plan.
• Prescribe exercise guidelines to all people with cancer.
• Refer patients to an exercise physiologist and/or physiotherapist with experience in cancer care.

"It's a step forward," said Kristin Campbell, a physiotherapist and associate professor with the University of British Columbia's department of physical therapy.

She said the cancer-related medical community has been "late to the party" when it comes to adopting the idea of incorporating exercise into primary care.

"Exercise has been a big part of cardiovascular disease and diabetes for many years. For a long time, it wasn't part of oncology care because people thought it was different somehow — that you needed to rest to be able to withstand treatment."

But in hindsight, she said, pairing exercise with cancer care makes sense. "Getting people moving after surgery, and keeping people moving, we know the benefits for physical function and health."

In a news release announcing the COSA position statement, the Australian group says the notion that a patient must be protected — or that we must "wrap them in cotton wool" — is old-fashioned.

One Canadian study published late last year found that patients maintained their physical activity levels for two years after they were prescribed an exercise program by their oncologist.

"[Patients] felt like the prescription had more weight behind it … [They realized] 'Oh, this is an important part of my care,'" Campbell said of the study's results. 

Dr. Ellen Warner, an oncologist who treats breast cancer patients at Toronto's Sunnybrook Health Sciences Centre, says any discussion she has with her patients includes the suggestion of exercise, but in a more informal way.

She said she's wary of including it as part of "routine" cancer care.

"I worry that by medicalizing exercise, patients will not enjoy it and stop doing it as soon as their formal treatment is over," said Warner. "I encourage patients to pick types of exercise they enjoy and make it part of their lifestyle for the rest of their life."

Along with prescribing exercise to everyone diagnosed with cancer, the Australian statement calls for patients to be referred to an exercise physiologist, or physiotherapist with experience in cancer care.

That's key, according to Campbell.

Pointing to a recent Canadian review about people with cancer and exercise integration, she said patients want to work with accredited therapists with experience: someone who understands what someone with cancer is going through.

With the last of her treatment out of the way now a year behind her, Emily Piercell was determined to participate in the Toronto Marathon this year. The Windsor, Ont., native had to skip the annual event last year, but promised herself she'd be back.  

"Staying active and getting outside definitely helped me recover faster," she said. "It kept me strong and kept my mind strong."

When Piercell finished her half-marathon last week, it was admittedly with a slower finish time than average. But she didn't care.

"I'm happy that I finished it," she said. "Hopefully next time, even better."

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