FEATURE: EXERCISE ONCOLOGY EXERCISE IS MEDICINE FOR CANCER – THE EVOLUTION AND ROLE OF EXERCISE ONCOLOGY DIAGNOSIS CANCER CONTROL CATEGORIES Prevention Detection Treatment Treatment Recovery/ Disease Palliation Survival Preparation/ Eff ectiveness/ Rehabilitation Prevention/ Coping Coping Health Promotion Prescreening Screening Pretreatment Treatment Survivorship End of Life PREDIAGNOSIS POSTDIAGNOSIS CANCER-RELATED TIME PERIODS Figure 2. Phases of the pre-diagnosis and post-diagnosis cancer continuum, where exercise can beeffective in the prevention and management of cancer (signified by a red border) potential for dose-limitation due be able to increase the potency for cancer patients. While epidemiological to patient deconditioning through-out. or effectiveness of concomitantly studies described earlier have provided Similarly, exercise during and following applied therapies such as chemotherapy associations to this effect, the next these therapies (including hormone or radiotherapy through modulatory frontier of exercise oncology is to use therapy), may prevent, reduce or reverse changes in the tumour microenvironment exercise as a prescribed and purposeful side-effects experienced on-treatment, and systemic changes in the body itself. medicine (with a dose and response which is critical to improving a patient’s For example, exercise appears to be-able relationship, including the establishment physical function, independence and to restore the size, shape and morphology of a minimum effective dose) in order quality of life. Collectively, this body of vasculature (blood vessels) inside to demonstrate the direct effect of of research has produced level 1 the tumour which improves oxygenated exercise on disease progression and (strong) clinical evidence, asserting blood supply and tumoural perfusion. overall patient survival. This work is the role of exercise for cancer patients This may allow greater distribution of being conducted in Perth (Western to improve quality of life across several chemotherapy throughout tumours in Australia) at the Exercise Medicine key metrics, including the mitigation particular avascular regions; and may Research Institute (Edith Cowan of cancer-related fatigue and restoration drive higher tumour cell death following University), as a National Health and of physical function and exercise capacity, radiation therapy due to an oxygen- Medical Research Council (NHMRC) notably in response to treatment enhancing effect. Indeed, therapies Centre of Research Excellence in driven changes in body composition. delivered through systemic means will Prostate Cancer Survivorship, across The effectiveness of exercise as inevitably hold a synergy with exercise, the disease spectrum through studies a neoadjuvant and adjuvant therapy though immunotherapy has yet to be led by Prof Robert Newton, Prof Daniel to minimise, manage and, in some explored in animal or human studies Galvão, and Dr Nicolas Hart: cases, reverse the side-effects of to date. primary therapies, has been very • Newton et al. (2018): https://bmjopen. promising to date. Targeted Exercise Medicine bmj.com/content/8/5/e022899 Synergistic Exercise Medicine Exercise, as independent and targeted • Galvão et al. (2018): https://bmjopen. medicine, may itself have impressive bmj.com/content/8/4/e022331 Exercise oncology has continued therapeutic abilities to potentially to broaden in recent years with several modulate cancer-specific outcomes, • Hart et al. (2017): https://bmjopen.bmj. novel avenues being explored that have which is of direct clinical interest com/content/7/5/e014458 the potential to significantly improve to patients, clinicians and exercise outcomes in cancer patients and professionals. As a targeted medicine, GUIDELINES/ survivors. Beyond the well-established exercise may exert its own systemic RECOMMENDATIONS neoadjuvant and adjuvant applications and localised anti-cancer or anti-tumour described above, exercise is also effects, independent of other therapies, Clinical exercise guidelines have been emerging as a synergistic medicine with to generate or underpin delays in disease produced to provide national and cancer therapies – which means it may progression and improvements in survival international position stands on the 8 VOLUME 36 • ISSUE 2 2018