CHICAGO — An exercise program can reduce the risk that colorectal cancer will return after surgery and chemotherapy, according to a new study.
The benefit from the study’s exercise program was about as large as what researchers might expect from a new drug, experts said, and came from a randomized controlled trial, the gold standard of medical research. Such studies are common for pharmaceuticals, but are difficult to conduct and unusual for exercise programs.
The study was presented here at the annual meeting of the American Society of Clinical Oncology in Chicago and published in the New England Journal of Medicine on Sunday.
“This is the first randomized phase 3 trial in patients with stage III and high-risk stage II colon cancer to demonstrate that post-treatment exercise is both achievable and effective in improving disease-free survival. Exercise as an intervention is a no-brainer and should be implemented broadly,” said Pamela Kunz, an expert in gastrointestinal cancers at the Yale School of Medicine, in a statement provided by ASCO.
The study, led by researchers at Queen’s University in Kingston, Canada, randomly assigned 889 participants, most of them from Canada and Australia, to either participate in a structured exercise program or to receive educational materials on the benefits of exercise. Those on the exercise program got a coach who helped develop tailored exercises for the patient and check in with them periodically for 3 years. Volunteers were evenly split between men and women and had either stage 3 or high-risk stage 2 colon cancer. All the participants also had undergone surgery and chemotherapy after surgery before starting the intervention.
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After a median follow-up of 7.9 years, 93 patients in the structured exercise program had their cancer recur, compared to 131 patients in the health education materials group. This meant patients in the structured exercise program had a 28% lower risk of recurrent or new colon cancer developing than patients who only received health education materials. There were also lower rates of some other cancers among those in the exercise group as well. For example, 14 participants developed breast cancer during the study, but only two were in the exercise arm.
“The overall survival results are even more impressive,” said Christopher Booth, an oncologist and professor of public health at Queen’s University and the study’s presenter. The exercise program led to a 37% reduction in the risk of death, compared to those who only received the educational pamphlet. At eight years, 90% of the patients on the exercise program were alive, compared to 83% of the control group.
“For every 14 people, exercise prevented one person from dying,” Booth said.
In an interview, Booth said that the study had occurred because he was “young and naive enough” to try it. He was still studying for his doctorate when it was suggested that researchers could study exercise to reduce cancer patients’ fatigue. He said he wanted to aim higher based on observational data that suggested a benefit in preventing recurrence. He wrote an early version of the protocol for the study as a class project. The study started in 2009, and took 16 years to complete.
“Patients feel empowered by this, they feel agency for their own health,” he said.
Booth added that a formal cost-effectiveness study has not been done, but that the total cost of the structured exercise program was $3,000 to $4,000 for three or four years. “It’s remarkably affordable,” he said. “There’s a cost argument to be made with health systems.”
Exercise is a pillar of conventional health wisdom and is an easy thing for physicians to recommend. But the study shows that recommending exercise alone is not as beneficial as providing some kind of structure to support patients in making lifestyle changes; patients in the control arm were only educated about exercise but didn’t reap the same benefits as those who had support.
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“Knowledge of this alone will not be sufficient to change lifestyle. The policy implementation is key. We need health systems and hospitals and payers to support these programs so patients have access to physical activity consultants and realize health benefits,” Booth said.
Physicians can also find other ways to help patients commit to regular exercise, said Julie Gralow, the chief medical officer of ASCO, who was not involved with the study. Decades ago, Gralow said she started a support group for women with cancer to exercise together, for example. As a clinician, Gralow said that she also noticed that if she began asking patients how much exercise they got in the last week or two during follow-ups, patients would say, “I knew my visit was coming up, so I did two hikes this weekend,” Gralow said.
And, she added, she’s joined some of her patients to do triathlons and other activities. “When they see you’re doing it, and walking the walk, and if you can fit it into your busy life, so can they,” she said.
