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Rehabilitation and physical activity in cancer treatment

26 April 2017

The increased perception of cancer as a chronic disease is fuelling interest surrounding the importance of rehabilitation exercise and physical activity as cancer treatment—and presents an emerging opportunity for physiotherapists to offer their expertise— according to Professor Linda Denehy, APAM, who is Head of the Melbourne School of Health Sciences and Professor in the Department of Physiotherapy at the University of Melbourne.

‘Because treatment for cancer has really improved, cancer is now being swept up in that surge of increased activity in chronic disease,’ says Linda, who will present the keynote address, on exercise as medicine for cancer patients, at Victoria’s Winter Breakfast to be held at Caulfield Racecourse on July 14.

‘It’s a really exciting and emerging field for all physiotherapists to take note of, because of its chronic disease roots, and because this is what we do well—we can follow the patients, right from pre-operatively, through their operation and then back into the community.’

Linda has extensive research expertise in the area of cardiorespiratory physiotherapy, particularly in patient populations who are acutely unwell, including in critically ill patients in the intensive care unit. She currently heads a five-strong research team at the University of Melbourne focusing on exercise and oncology.

‘There’s emerging evidence that exercise should not just be seen as a supportive care to improve patients’ function and health-related quality of life, but that exercise causes mechanistic changes that actually might impact the cancer journey,’ Linda tells InMotion.

‘For example, exercise has been shown to reduce inflammatory markers in the blood—and the cancer tumour growth feeds off inflammation. And there’s some work, especially in mice, to show that exercise can reduce tumour growth compared to no exercise. I’m hoping in the next five years that exercise will be seen as a treatment rather than just a supportive care for people with cancer. But, in the meantime, we know that we can improve function and health-related quality of life for patients either during or after cancer treatment.’

Linda started to explore rehabilitation and exercise in 2007, though her interests in this area date back to her 12 years spent as a clinician at Melbourne’s Austin Hospital where she worked with patients undergoing surgery for lung cancer.

‘It was managing those patients in the acute setting that made me realise that we needed to do something more for them after they’d left the hospital,’ Linda recalls.

Linda’s research was initially focused on lung cancer, in line with her clinical experience, but, more recently this has been broadened to encompass colorectal cancer and to patients post-bone marrow transplant. ‘Exercise as cancer treatment’ is a crucial emerging field for the profession, Linda emphasises, cautioning that, ‘We’re going to lose out to exercise physiologists if we don’t get on to it; and it’s important to support the profession in going into different areas as they become important and emerging’.

‘Physios might get patients who are recovering from chemotherapy or radiotherapy or surgery, who come in to be given exercise programs,’ Linda says. ‘It’s quite a broad appeal across the public and private hospitals, and private/general practice sector, going forward, I think.’

An important subject likely to be addressed during Linda’s Winter Breakfast talk surrounds physiotherapists’ awareness of the limitations and safety considerations of exercise in oncological patients.

‘It’s safe to provide exercise during chemotherapy and radiotherapy, but, clearly, there will be some limitations around what people can do at those times,’ Linda explains. ‘There’s a lot of unanswered questions though—we’re not sure whether we should be providing both aerobic and resistance exercise; we’re not sure what intensity of exercise can actually make an impact— although there is a large systematic review and meta-analysis [conducted by Latrobe University’s Professor Nicholas Taylor, APAM] suggesting that moderate-intensity exercise is as good as other forms or exercise in improving symptoms and health-related quality of life. There’s some evidence that moderate exercise is enough, but then there’s also evidence that the benefits are dosedependent; so the more physically active you are, the greater the benefits are.’


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