Brief periods of vigorous activity in the course of daily life are associated with a lower risk of cancer, cardiovascular disease and death, according to recent studies. And for people who already have cancer, getting the recommended amount of exercise is linked to lower mortality. 

“The idea of accruing short bouts of moderate to vigorous activity through daily living activities makes physical activity much more accessible to people who are unwilling or unable to take part in structured exercise,” study coauthor Matthew Ahmadi, PhD, of the University of Sydney, said in a news release.

The Centers for Disease Control and Prevention recommends that people should get at least 150 minutes of moderate-intensity activity or 75 minutes of vigorous activity per week, along with muscle strengthening activity on at least two days. Some 13 types of cancer are associated with low physical activity. A study published in 2022 suggested that getting the recommended amount of moderate-intensity physical activity could prevent 3% of all new cancers, or about 46,000 cases annually in the United States.

But given that most people do not reach these targets, how much activity is enough to see some benefit?

Emmanuel Stamatakis, PhD, of the Mackenzie Wearables Research Hub at the University of Sydney’s Charles Perkins Centre, and colleagues asked whether short bouts of vigorous intermittent lifestyle physical activity (VILPA)—for example, rapidly climbing stairs or running to catch a bus—were associated with cancer incidence among people who do not exercise regularly.

As described in JAMA Oncology, the researchers looked at UK Biobank data from a prospective cohort of 22,398 non-exercising adults (defined as no leisure-time exercise and no more than one recreational walk per week) who used wearable accelerometers to track their activity. About 55% were women, almost all were white and the average age was 62 years. More than 90% of their vigorous physical activity occurred in bouts of one minute or less. The participants accrued a median 4.5 minutes of VILPA per day, but about 6% recorded no vigorous activity.

Over nearly seven years of follow-up, 2,356 new cancers were reported, 1,084 of which were one of the 13 types linked to low physical activity (for example, breast, bladder and colon cancer). Vigorous intermittent lifestyle physical activity and cancer risk had a nearly linear relationship, meaning people who engaged in more vigorous activity saw a greater reduction in cancer risk.

The minimum “dose” of vigorous activity needed to see a risk reduction benefit was 3.4 minutes a day for cancer overall and 3.7 minutes a day for cancers linked to low physical activity. People who engaged in vigorous activity for 4.5 minutes a day had a 20% lower risk for cancer overall and a 31% lower risk for cancers linked to low physical activity, as compared with those who got no vigorous activity. People with more vigorous activity beyond this amount saw larger gains.

“As few as four to five minutes of VILPA daily was associated with a substantially lower cancer risk,” the study authors concluded. “Daily VILPA may be a promising intervention for cancer prevention in populations not able or motivated to exercise in leisure time.”

Ahmadi, Stamatakis and colleagues also recently reported in The Lancet Public Health that short periods of moderate to vigorous activity—even as little as one to three minutes a day—were associated with a reduced risk of cardiovascular events and lower all-cause mortality for people who do not exercise regularly.

What About People With Cancer? 

Physical activity is also beneficial for cancer patients and survivors, improving physical fitness, muscle strength, cancer-related fatigue and quality of life, Yvonne Wengström, PhD, and colleagues at the Karolinska Institute in Stockholm wrote in an editorial accompanying the JAMA Oncology report. But people with cancer need support and information about exercise that does not stigmatize those who can’t easily engage in vigorous activity. “Any physical activity is better than none!” they wrote.

To learn more about the benefits of physical activity for people living with cancer, Jessica Lavery, MS, of Memorial Sloan Kettering Cancer Center, and colleagues looked at the relationship between exercise and mortality among 11,480 participants in the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. The participants completed a standardized survey about their exercise after cancer diagnosis; people who survived less than six months after diagnosis were excluded. About 40% were classified as exercisers and the rest as non-exercisers.

As described in the Journal of Clinical Oncology, 4,665 deaths were reported over a median follow-up period of 16 years after diagnosis. Of these, 1,940 were due to cancer, and 2,725 were due to other causes. A third of those who died were exercisers while 45% were non-exercisers. The median overall survival time after diagnosis was 19 years for people who exercised and 14 years for those who did not.

After adjusting for other factors, people who got the recommended amount of exercise saw a 25% reduction in all-cause mortality compared with those who did not meet national guidelines. People who exceeded the guidelines had an even greater reduction in mortality, but even those who didn’t meet the exercise targets saw some benefit. Exercise was linked to lower all-cause mortality for patients with several cancer types, with risk reduction ranging from 22% for prostate cancer to 59% for endometrial cancer.

Looking specifically at cancer mortality, people who adhered to exercise guidelines had a 21% lower risk of death. When the researchers looked at specific cancer types, however, the reduction in mortality was significant only for kidney cancer and head and neck cancer. Nonetheless, people with other cancer types who exercised were less likely to die of other causes, such as cardiovascular disease.

“Our findings show exercise is a holistic strategy that may complement contemporary management approaches to further reduce cancer mortality (in select sites) while simultaneously lowering risk of death from other competing causes, which combine to improve all-cause mortality,” the study authors concluded.

Exercise, in addition to standard treatment “is one of the best daily pills cancer survivors can take to optimize their longevity,” Stacey Kenfield, ScD, and June Chan, ScD, of the University of California San Francisco, wrote in an accompanying editorial. They noted that the effects of exercise on inflammation, oxidative stress and insulin regulation could all influence cancer progression. “[G]reater awareness/education, referrals to physical activity counseling at the time of diagnosis, and investment in programs targeted at the individual, community, provider/health care system and policy levels are needed to help patients achieve these survival benefits,” they advised.

A limitation of this analysis is that the observational study could not show whether exercise led to improved survival or people who were sicker and closer to death were less likely to exercise; that would require a randomized trial. In addition, the study asked about exercise at one point in time, so it doesn’t reflect the effect of changes in exercise habits—either more or less—after a cancer diagnosis.

To help fill this knowledge gap, Tara Sanft, MD, of Yale University School of Medicine, and colleagues conducted a randomized trial of an exercise and nutrition intervention for women who were diagnosed with breast cancer and starting treatment.

The LEANer (Lifestyle, Exercise and Nutrition Early After Breast Cancer) study enrolled 173 women with Stage I to III hormone receptor-positive/HER2-negative or triple-negative breast cancer. They were randomly assigned to usual care or a home-based exercise and nutrition program delivered by oncology-certified registered dietitians with exercise training. The exercise intervention consisted of 16 sessions in person or via Zoom or phone over the course of a year, with a goal of 150 minutes of moderate-intensity activity per week. Participants received a book about exercise and diet, a recipe book focused on addressing chemotherapy side effects, a set of weights for strength training and a wearable fitness tracker.

The researchers looked at completion of chemotherapy—measured as relative dose intensity (RDI), or the ratio of chemotherapy delivered to the dose prescribed—and pathologic complete response, or absence of cancer in surgically removed tissue or biopsy samples after neoadjuvant (presurgery) chemotherapy. Reduced muscle mass due to cancer-related wasting or side effects that interfere with nutrition (such as nausea or mouth sores) has been linked to lower RDI and higher mortality. Exercise, therefore, could potentially preserve muscle mass and improve RDI.

As described in the Journal of Clinical Oncology, participants assigned to the exercise and nutrition program saw greater improvements in exercise and diet quality compared with those assigned to usual care. But chemotherapy RDI was similar, with both groups receiving more than 90% of their prescribed treatment. More than 80% in both groups achieved an RDI of at least 85%, the threshold associated with diminished effectiveness. The proportion of patients who reduced their chemo doses or delayed therapy was also similar.

However, among the 72 women who received neoadjuvant chemotherapy before surgery, those randomized to the exercise and nutrition program were significantly more likely to have a pathologic complete response compared with the usual care group (53% versus 28%, respectively).

“Although a diet and exercise intervention did not affect RDI, the intervention was associated with a higher pathologic complete response in patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative and triple-negative breast cancer undergoing neoadjuvant chemotherapy,” the study authors concluded.

The mechanisms underlying this association are not yet clear, but more physical activity and a healthier diet may improve metabolism, reduce inflammation, enhance immune function and promote blood flow—and thus drug delivery—to tumors.

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