FEATURE: EXERCISE ONCOLOGY EVOLUTION OF EXERCISE ONCOLOGY: Cancer represents the second largest cause of death worldwide. In Australia, 1 in every 2 people will be diagnosed with cancer in their lifetime, with the 5-year relative survival rate from cancer (overall) rising from 48% to 68% since 1985, principally due to improvements in screening, diagnosis, treatment and medical management. Coincidentally, this same period (1984-1986) signifies the origin of exercise oncology in the literature, producing the first research Figure 1. The evolution of exercise oncology research over the prior three decades. papers investigating physical activity or exercise to rehabilitate cancer patients and survivors. In the subsequent two decades, only /home/webapps/asp_au/data/asp/publications/au-sports-medecine-australia/publications/sport-health-vol-36-issue-2-v526 further studies were patient survival (post-diagnosis). and Sport Science Australia (ESSA) reported, with broad-ranging and However, physical activity – by definition as four-year, tertiary trained exercise consistently positive results leading to – refers to any incidental and non- professionals in the realm of exercise the rapid ascension of exercise medicine specific activity requiring bodily for chronic disease management in the prevention and management of movement, which suggests that specific including cancer. cancer in the past decade, while emerging exercise programs may provide even as a potential therapeutic agent to delay greater benefits to the healthy individual Neo-Adjuvant and Adjuvant Exercise disease progression and increase overall (pre-diagnosis) and cancer patient Medicine survival in recent years. Accordingly, (at-diagnosis and post-diagnosis). exercise is a promising and provocative Indeed, exercise – by definition – Primarily, the focus of exercise therapy in oncology, inherently aligned is prescribed physical activity which medicine in oncology has been centred with the exercise medicine movement, is purposeful, programmed, progressive on neoadjuvant and adjuvant settings. showing excellent promise to meet and targeted, primarily focusing on the In particular, exercise can be an effective patients’ needs; particularly due to cardiorespiratory and musculoskeletal preventive, preparatory and rehabilitative the ever-expanding population of systems, to prevent, reduce or reverse tool for surgery (pre-surgical and cancer patients and survivors in cancer-related dysfunction and post-surgical programs) to optimise Australia, and globally. treatment related side-effects. patient condition prior to surgery as a therapy to improve surgical EXERCISE MEDICINE Overwhelmingly, the growing body outcomes and reduce post-surgery IN CANCER: of evidence of exercise oncology dysfunction whilst hastening patient across the full disease spectrum recovery. Furthermore, exercise can Across the Continuum (local to advanced stages) and be used for symptom control during treatment types (surgery, radiotherapy, and following other primary cancer Epidemiological studies provide clear chemotherapy and hormone therapy) therapies including radiotherapy, associations between physical activity demonstrates the clear role of exercise chemotherapy and hormone therapy levels and incidence risk in some cancers in the management of cancer to be post-diagnosis. For example, the (pre-diagnosis), physical activity levels, a safe and effective medicine for most provision of exercise prior to radiation tumour vasculature and metastatic cancer patients. However, given cancer therapy and chemotherapy may optimise propensity (at-diagnosis), and physical is a complex chronic disease, exercise patient condition to enable enhanced activity levels, reductions in risk of cancer must always be prescribed by accredited treatment response or greater tolerance recurrence, or possible increases in exercise physiologists (AEP) of Exercise of therapies, thus minimising the VOLUME 36 • ISSUE 2 2018 7