Exercise and oncology: The role of physical activity in disease prevention and health promotion

The field of exercise-oncology has evolved significantly over the past 30 years. Numerous studies have examined the role of structured exercise interventions—often incorporating aerobic or resistance training at moderate-to-vigorous intensities, sometimes in conjunction with multi-modal strategies—for individuals living with and beyond cancer.^1,2 However, the current one-size-fits-all approach to exercise prescriptions may not fully capitalize on the potential health benefits for diverse cancer populations. The rapid advancements in technology, such as mobile health platforms, and a growing focus on precision medicine, have sparked interest in personalized exercise plans tailored to individual needs in oncology settings.3, 4, 5

Recent updates in physical activity (PA) guidelines by various countries and organizations have aimed to improve the safety and efficacy of exercise interventions post-cancer diagnosis. Yet, the efficacy of personalized exercise programs for cancer survivors remains a relatively untapped area of research. In this special issue of the Journal of Sport and Health Science, we address this gap by exploring the effectiveness of both traditional and innovative m-health exercise and multimodal programs, in enhancing health outcomes and preventing disease in cancer-affected individuals. It has a multi-national scope, presenting data-based findings from studies conducted in Canada,⁶ the UK,⁷ Iran,⁸ the Netherlands,⁹ and the USA.¹⁰ These studies serve to not only present the current evidence supporting the role of exercise in health promotion and disease prevention among cancer survivors, but also to offer insights into how these findings could shape future interventions in the field of exercise and oncology.

In detail, the first 2 papers^6,7 examined the associations of PA and health outcomes in individuals living with and beyond cancer. Trinh et al.’s study⁶ explored the link between PA, sedentary behavior, and cognitive function in a global sample of cancer survivors during the coronavirus disease 2019 pandemic. A survey administered globally from July to November 2020 assessed self-reported PA and cognitive function. Participants (n = 371) were categorized based on changes in PA and sedentary behavior: no change, desirable change (increased PA or reduced sedentary behavior), and undesirable change (decreased PA or increased sedentary behavior). Overall, no significant differences in cognitive scores were found across these categories. However, long-term cancer survivors (diagnosed or treated ≥5 years ago) who made desirable activity changes reported better cognitive function compared to those with undesirable changes. The findings suggest that promoting PA and reducing sedentary behavior could be beneficial for long-term cancer survivors’ cognitive health during the pandemic.

Lally et al.⁷ examined physical activity in 1348 Australian adults living with cancer, comparing self-reported and device-assessed metrics. The aim was to evaluate their accuracy for determining whether participants met PA guidelines and to see if meeting these guidelines impacted fatigue, quality of life, and sleep. According to various metrics, only 10.8%–49.5% of participants met PA guidelines. The agreement between self-reported and device-based measures was moderate at best. Importantly, meeting physical activity guidelines was linked to reduced fatigue across all measures. Better quality of life was associated with meeting guidelines via self-reported moderate-to-vigorous PA (MVPA), while good sleep quality was related to self-reported measures. The findings underscore the discrepancy in activity measures and suggest that less than half of cancer survivors met recommended PA levels, which could have significant health implications. Future research should utilize multiple methods for assessing physical activity.

The other 3 randomized controlled trials8, 9, 10 explored the feasibility of implementing personalized exercise prescriptions, evaluated the effectiveness of novel exercise programs incorporating m-health approaches, provided an international perspective on the current status of exercise interventions in oncology, and outlined directions for future research. In a study from Iran, Isanejad et al. ⁸ compared the impacts of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on various health metrics in 30 non-metastatic breast cancer survivors undergoing adjuvant endocrine therapy. The 12-week exercise intervention focused on cardiorespiratory fitness, quality of life, and metabolic markers. HIIT resulted in a 16.8% increase in peak oxygen uptake compared to baseline, outperforming MICT and the control group. Both HIIT and MICT significantly improved high-density lipoprotein cholesterol levels and various aspects of quality of life compared to the control. However, no significant changes were observed in body weight, insulin resistance, or inflammatory markers. The study suggests that HIIT is a time-efficient way to improve cardiorespiratory fitness and quality of life in breast cancer survivors. Further research is needed to confirm these results and explore the long-term clinical implications.

In a study from the Netherlands, Golsteijn et al. ⁹ assessed the long-term effectiveness of OncoActive, a digital and print program aimed at encouraging physical activity (PA) in prostate and colorectal cancer survivors. In this study, 478 participants were randomized to the OncoActive intervention (n = 249) or usual care (n = 229). Both groups were assessed on PA and health markers, like fatigue and depression at 0, 6, and 12 months. At 12 months, no significant differences in most PA metrics were found between the groups. However, OncoActive participants reported more days with at least 30 min of PA and experienced lower long-term fatigue. Initial gains in PA within the OncoActive group were maintained at 12 months. The results of this study suggest that while OncoActive may not dramatically outperform usual care in boosting PA, it has benefits like reducing fatigue and could offer an early start toward long-term recovery.

From an m-health lens, Gao et al.¹⁰ evaluated the impact of a multi-component mobile health intervention on PA and quality of life of 126 cancer survivors in the USA, over 6 months. Participants were randomized into four groups: personalized exercise prescriptions delivered via weekly email, Facebook-based health education, a combination of both (multi-component), or a control group. All participants were provided a Fitbit tracker. The study found that only the multi-component group showed a significant increase in daily physical activity steps and physical health, compared to the control group. Additionally, the social media (Facebook) group showed significant improvements in perceived social support. No other significant differences were observed. The findings suggest that a comprehensive mobile health intervention can effectively improve physical activity and health outcomes among cancer survivors.

The findings that emerge from this special topic in the Journal of Sport and Health Science suggest that exercise plays a critical role in improving the well-being of cancer survivors, aiding in promoting health and wellbeing. Regular participation in PA can enhance physical health, quality of life, cardiovascular fitness, cognitive function, and mitigate the adverse side effects of cancer treatment/rehabilitation. Insights are provided for intervention design and refinement to address cancer- and treatment-related side effects. In the digital era, m-health programs have emerged as a feasible and convenient tool to further bolster these benefits. The m-health programs often combine wearable technology, exercise/fitness apps, and social media platforms to create comprehensive health interventions. For example, Fitbit trackers can monitor daily PA steps, while research-graded apps can provide tailored workouts and feedback.¹¹ Social media platforms offer community support and additional educational resources.¹² Studies have shown that multi-component, m-health interventions can significantly improve daily PA and overall physical health in cancer survivors.¹⁰ Moreover, these platforms are especially useful in remote monitoring and real-time adjustments to exercise programs, making them highly adaptable to individual needs.^13,14 Overall, the combination of exercise and m-health fitness programs offers a promising avenue for enhancing the quality of life among those living with and beyond cancer.¹⁵

Emerging research directions in the field of exercise-oncology could focus on the integration of Artificial Intelligence and machine learning algorithms within m-health fitness programs. These technologies could personalize exercise regimens in real-time based on cancer survivors’ current physiological state, monitored through wearables. To achieve long-term clinical and health benefits, behavior change must be sustained. Developing theory-based, m-health interventions increases the likelihood of PA maintenance and contributes to the understanding of the mechanisms of behavioral change in these interventions. Additionally, longitudinal studies could investigate the long-term impacts of such m-health interventions on cancer recurrence rates and survival outcomes. Another novel avenue could be the inclusion of virtual reality elements in m-health fitness programs to enhance participant engagement and adherence. Exploring the synergy between pharmacological cancer treatments and personalized exercise prescriptions delivered through m-health approaches could also offer groundbreaking insights.

Competing interests

Both authors declare that they have no competing interests.