A marathon does not have to last 42 kilometers, each person has their own. “Exercise during treatment was key to maintaining my mood and some sense of normality. When you go through cancer, your life takes a dramatic turn, where you can barely control what happens,” says Diana (42 years old). She was diagnosed with her breast tumor in the middle of the pandemic. Her routine changed suddenly: she went from working, climbing, and traveling to suffering early menopause, mastectomy, and treatment drips. “In that scenario, doing some physical activity gave me a feeling of being able to do something good for myself, while the chemo did its job,” she adds.
According to the latest data collected by the Spanish Society of Medical Oncology (SEOM), in 2023 35,001 new cases of breast cancer will be diagnosed, this type of tumor being more common among women in our country. In Spain, approximately 30% of cancers diagnosed in women originate in the breast. This tumor continues to be the leading cause of death from cancer among women. As GEICAM currently states, it is possible to face it with better results than a few years ago; but the quality of life of those who manage to overcome it needs to be improved. Today is World Day that seeks to raise awareness about this disease.
Physical activity, according to research, is an ally in this type of pathology, since it reduces the risk of chronic diseases, the side effects of treatments, and can improve prognosis and survival.
Risk reduction
Taking into account its multifactorial nature, the reduction in the risk of suffering from this disease through exercise may be due to different biological routes. Ana Lluch, co-coordinator of the Breast Cancer Biology Research Group of the INCLIVA Health Research Institute, oncologist at the Hospital Clínico de València and emeritus professor in the area of Medicine at the University of Valencia, explains: “We know that physical exercise reduces For example, the percentage of body fat mass, obesity and overweight in general imply higher levels of sex hormones, as well as an increase in pro-inflammatory cytokines, so reducing these levels would prevent a lack of control in programmed cell death. of our body, and uncontrolled cell multiplication. Physical exercise, among other effects, also strengthens the immune system, reduces oxidative stress and free radicals.” However, Lluch clarifies that it is essential not to establish categorical statements, since more research is necessary to reinforce the findings that have been made so far “and to obtain more evidence regarding the amount of physical exercise necessary to obtain a clear reduction in risk of suffering from cancer.”
The Oncological Physical Exercise Program that the GEICAM Group launched in 2017 was created with the aim of developing projects on its benefits in the evolution of the tumor, generating a network of specialists in the field and disseminating its advantages to patients, institutions, and the population. general. The oncologist explains that 1,017 women recently diagnosed with breast cancer and 1,017 women without the disease participated in the epiGEICAM study, to study, through questionnaires, the impact of lifestyle (including the practice of physical exercise, the type of diet and alcohol consumption) in the development of breast cancer in Spain. And he explains: “We observed that Spanish women with a sedentary lifestyle have a 71% higher risk of developing breast cancer throughout their lives than women who comply with international recommendations for physical exercise (150 minutes of exercise per week). moderate aerobic physical activity, or 75 minutes of vigorous aerobic physical activity each week) and that 13.8% of new cases could be avoided by performing physical activity.”
A part of the treatment
“When I finished the treatment and the most severe postoperative period, I was incorporated into activities as simple as walking. After almost a year, when my oncologist gave me the green light, I started incorporating strength training twice a week. Which has been completely key in my recovery,” explains Diana as she leaves the gym. The patient trains in a supervised manner, controlled by a professional, paying attention to her body sensations and adapting the exercise to her needs. She progresses little by little and this means that she can transfer the gestures that she makes in the living room to her daily life: climbing stairs, carrying her scooter to go to work or going for a walk on routes in nature.
Dr. Joaquin Gavilá, head of Clinical Medical Oncology at the Valencian Institute of Oncology Foundation (IVO), also advises patients like Diana to practice exercise. “It is part of what we know as a comprehensive approach to breast cancer,” he admits.
The WHO (World Health Organization) recommends doing 150 minutes of moderate physical activity per week since its benefits have been observed in physical, mental, and psycho-physical aspects. “On a physical level, we see a clear example in situations associated with lower bone mineral density, such as osteoporosis caused by systemic treatments and lytic bone metastases. [aquellas que favorecen la destrucción de hueso]. Exercise increases bone mineral density of the lumbar spine and femoral neck in adults and, therefore, can prevent bone fractures and other events associated with the skeleton,” explains Gavilá.
Aerobic vs strength
After cancer patients face new challenges. “I had a premature menopause and a general change in my body. In this scenario, exercising has helped me not only feel better but also to reconcile with myself and rebuild myself, to return to the active life that I had always enjoyed,” Diana acknowledges.
Research indicates that, on a physical level, aerobic and strength exercise determine significant changes in body composition by decreasing the percentage of fat, increasing lean mass and causing improvements in strength. “By reducing the percentage of body fat, there is a lower probability of obesity and therefore a lower risk of recurrence. On a psychological and psycho-physical level: it allows a lower perception of pain, especially the shoulder pain that remains after surgery and radiotherapy for breast cancer, improves fatigue, anxiety, and depression, as well as quality of life and self-esteem,” Gavilá emphasizes.
Lymphedema
About 30% of patients may develop lymphedema, an abnormal accumulation of lymphatic fluid that results from inadequate lymphatic transport in the operated arm, three years after treatment. Reviews note that strength training appears to be a safe and non-harmful exercise intervention for lymphedema risk. Gavilá clarifies: “It is usually a general belief that breast cancer patients should avoid upper body exercise, but training with progressive strength exercises does not increase the incidence of lymphedema and, on the contrary, can determine favorable effects.” in patients who are at risk, clearly reducing their signs and symptoms.”
From theory to practice
The recommendations for cancer patients from the American College of Sports Medicine (ACSM) are similar to those of the WHO for healthy patients: 30 minutes of brisk walking for five days a week. In this case, to reduce the risk of other diseases, it is also recommended to perform some strength activities combined with aerobic activities. One study showed that active women after being diagnosed with breast cancer had a 67% lower risk of relapse and a 45% lower risk of death than those who had an inactive lifestyle. If you have doubts about the benefits and general guidelines for patients, the GEICAM research group generally suggests avoiding inactivity, as well as meeting the recommendations of international health guidelines whenever possible. It is important to exercise during treatment, adapting the intensity to the needs of each stage. This will help maintain physical independence and improve the patient’s quality of life. The exercise should be developed by a qualified professional, individualized, adapted to each level and based on scientific evidence. Ana Lluch recommends: “It is never too late to start being active. The benefit of physical exercise is also observed in people who have not been active; We found evidence that shows that women who increased their physical activity after menopause may also have a lower risk of breast cancer than those who do not. The free time available today is usually limited, so it is important to find an activity that is entertaining and that creates adherence. We could make a simile with medications, which must be taken from time to time, with a certain dose and maintained over time for it to take effect; We have to do physical exercise at least…”