Although the number of cancer cases in 2024 is expected to rise compared with previous years, overall cancer incidence and mortality continue to decline, according to Canadian Cancer Statistics. These declines are attributed to continued improvements in prevention, screening and treatment of cancer.
Recently, a group of researchers from the University of Toronto Faculty of Kinesiology and Physical Education (KPE) came together to discuss the significant roles exercise and nutrition can play in cancer prevention, care and recovery. The interactive, online panel discussion was part of KPE’s ongoing Science Café series featuring faculty experts on a variety of topics.
“As the population ages, new cancer cases and deaths are also increasing, but the good news is that people are living longer after a cancer diagnosis,” said Associate Professor Linda Trinh, who specializes in physical activity & sedentary behaviour interventions for cancer control and survivorship. “However, with this growing survivorship population, we need to think about their supportive care needs to self-manage some of the acute and late-appearing cancer-related side-effects.
“There is strong evidence that exercise can reduce the risk of seven types of cancers - colon, breast, kidney, endometrium, bladder, stomach cancer and esophageal adenocarcinoma - and there is also evidence to show that after a cancer diagnosis, exercise can improve cancer-related symptoms, so there are multiple benefits to doing it.”
Likewise, the audience heard that healthy eating is a cornerstone of lifestyle-related prevention of chronic diseases like cancer, cardiovascular disease and type 2 diabetes.
“Eating fruits and vegetables, leafy greens and whole grains, minimizing red meat and processed food intake, including sugar, are all part of a healthy lifestyle,” said Assistant Professor Amy Kirkham, who is currently working with Assistant Professor Jenna Gillen on two parallel studies involving women with and without cancer to produce new evidence, specific to women, on the effects of Canada’s physical activity and dietary guidelines on the risk of chronic diseases and the well-being of pre- and post-menopausal women.
Kirkham stressed that while Canada’s food guidelines are the same for people with or without cancer, during active treatment, when there are side effects like nausea and fatigue, nutrition can be used to manage some of those symptoms and support the immune system.
“Have grace with yourself,” said Kirkham. “If chemotherapy is making your salad taste like dirt, which we’ve heard some patients say, you can make accommodations.”
The same is true of exercise, said Trinh. While everyone should strive towards 150 minutes of moderate-to-vigorous intensity exercise per week for overall health, cancer-specific exercise guidelines suggest 90 minutes of moderate-to-vigorous intensity exercise - and they don’t have to involve going to the gym.
“Exercise is safe and helpful and cancer survivors should be moving as much as they can tolerate,” said Trinh. “It all adds up and any minute that you’re active counts.”
Trinh recommends walking, light biking or dancing for aerobic exercise and using your body weight for strength training - for example, chair sit-to-stands and wall pushups.
Associate Professor Daniel Santa Mina, talked about the opportunities and challenges of getting the message out about the benefits of exercise.
“We’re lucky to have a lot of resources in a big city like Toronto, including pretty robust exercise programming for people with cancer at the Princess Margaret Hospital” said Santa Mina, who is co-director of the University Health Network’s (UHN) prehabilitation program. “But how do we get exercise to people who don’t live in big cities?”
Santa Mina believes part of the solution is to have models of care that are deliverable through online platforms, as well as trained professionals who are able to deliver this care through new mediums. He detailed some of the work that went into supporting rural and remote community access to exercise oncology resources through the Exercise for Cancer to Enhance Living Well (EXCEL) program.
Professor Catherine Sabiston, who specializes in sport and exercise psychology, stressed the importance of self-care for patients - and their care-givers.
Sabiston is leading a research team, including Trinh and Santa Mina, involved in the development and evaluation of ActiveMatch, a service designed to help women who have been diagnosed with cancer connect with similar women who are looking for support and guidance to help start, continue or change their exercise routines.
“Exercising and eating healthy requires time and energy, and both are becoming increasingly costly,” said Sabiston. “Adding to that, people with cancer can feel tired, stressed, they may be in pain or have mobility impairments.”
While there is no easy way to circumvent these challenges, all researchers agree with taking small steps and celebrating each one.
“Making little bits of movement throughout the day, being intentional about it, celebrating that walk up the stairs or time spent outside … It’s important to be kind and flexible with yourself and practice self-compassion,” said Sabiston, who shared the story of a study participant, who recalled putting the kettle on the stove, hearing the whistle and jumping up to get it, only to realize that she couldn’t have done it a few weeks ago. “The simple inclusion of movement in her day had made such a big improvement in her quality of life.”
The researchers shared some helpful strategies for how people living with cancer can include exercise in their daily lives such as being mindful of the time of day, taking into account when they may be most tired or in pain from treatments and, importantly, not comparing themselves to others.
“A lot of the research in behaviour change focuses on ensuring that cancer survivors make exercise become part of a routine,” said Trinh, who is currently working on a research project examining factors that contribute to adult cancer survivors maintaining their exercise routine.
“Setting up short- and long-term goals, anticipating barriers and planning around them can all help.”
The researchers also discussed the many considerations that need to go into tailoring an individualized approach to exercise and nutrition, including the patient’s gender, race, age, disability, social class and much more.
“One size does not fit all,” said Santa Mina, “and exercise really needs to be adapted to the patients’ circumstances to be most effective.”
Kirkham also highlighted the important role of caregivers.
“We have evidence that if one partner is making physical activity or dietary changes, they will be more successful if their partner, son, daughter or friend makes those changes with them,” said Kirkham. “When you’re going through active treatment, having someone gently nudge you to go for a short walk with them or do your grocery shopping or cook for you is critical.”
Likewise, the researchers all agreed, the caregivers themselves need support.
“A cancer diagnosis is life changing not just for the individual, but also for their close circle,” said Santa Mina, who recalled the impact of watching his close friend deteriorate as he went through cancer treatments. “I couldn’t understand why more couldn’t be done to support him and it seemed obvious that exercise and nutrition could have helped.”
A recent study by Santa Mina and his colleagues found that patients who had gone through the UHN prehabilitation program all underscored the positive impact it had on their physical strength and overall preparedness for surgery, which is simultaneously a key predictor of surgical outcomes.
“Cancer patients shouldn’t just be surviving,” said Santa Mina. “Exercise and nutrition can improve their quality of life - from the time they are diagnosed, all through treatment and after.”