Skip to main content

Advertisement

Log in

Preliminary Evidence on the Effects of Exercise on Tumor Biology: a Potential Guide for Prescribing Exercise

  • Cancer Rehabilitation (SR Smith, Section Editor)
  • Published:
Current Physical Medicine and Rehabilitation Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This report reviews the preliminary evidence of how exercise may alter the tumor microenvironment and tumor biology in animal and human studies and how to incorporate this information in clinical practice of oncology rehabilitation.

Recent Findings

Potential mechanisms explaining the impact of exercise on the tumor microenvironment include activating and mobilizing immune cells, reducing inflammation, and modifying tumor vasculature which enhances the delivery of anticancer therapies. Pre-clinical data translates to promising preliminary data in human studies; however, randomized, controlled trials in patients are limited.

Summary

Despite the paucity of robust data demonstrating the beneficial effects of exercise on tumor biology, the strong observational and epidemiological data and limited interventional trials encourage the continued prescribing of exercise by rehabilitation professionals for cancer survivors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Figure 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Betof AS, et al. Modulation of murine breast tumor vascularity, hypoxia and chemotherapeutic response by exercise. J Natl Cancer Inst. 2015;107(5).

  2. McTiernan A. Weight, physical activity and breast cancer survival. Proc Nutr Soc. 2018;77(4):403–11.

    Article  Google Scholar 

  3. •• McTiernan A, et al. Physical activity in cancer prevention and survival: a systematic review. Med Sci Sports Exerc. 2019;51(6):1252–61 Systematic review including 45 reports of epidemiological studies evaluating the assocations between physical activity and risk and survival for different cancers.

    Article  Google Scholar 

  4. Cannioto RA, Dighe S, Mahoney MC, Moysich KB, Sen A, Hulme K, et al. Habitual recreational physical activity is associated with significantly improved survival in cancer patients: evidence from the Roswell Park Data Bank and BioRepository. Cancer Causes Control. 2019;30(1):1–12.

    Article  Google Scholar 

  5. Cormie P, Galvão DA, Spry N, Joseph D, Chee R, Taaffe DR, et al. Can supervised exercise prevent treatment toxicity in patients with prostate cancer initiating androgen-deprivation therapy: a randomised controlled trial. BJU Int. 2015;115(2):256–66.

    Article  Google Scholar 

  6. Guercio BJ, Zhang S, Ou FS, Venook AP, Niedzwiecki D, Lenz HJ, et al. Associations of physical activity with survival and progression in metastatic colorectal cancer: results from cancer and leukemia group b (Alliance)/SWOG 80405. J Clin Oncol. 2019;37(29):2620–31.

    Article  CAS  Google Scholar 

  7. Mishra SI, Scherer RW, Snyder C, Geigle PM, Berlanstein DR, Topaloglu O. Exercise interventions on health-related quality of life for people with cancer during active treatment. Clin Otolaryngol. 2012;37(5):390–2.

    Article  Google Scholar 

  8. Buss LA, Dachs GU. In: Birbrair A, editor. Effects of exercise on the tumour microenvironment, in tumor microenvironment: recent advances. Cham: Springer International Publishing; 2020. p. 31–51.

    Chapter  Google Scholar 

  9. Zhang X, Ashcraft KA, Betof WA, Nair SK, Dewhirst MW. Can exercise-induced modulation of the tumor physiologic microenvironment improve antitumor immunity? Cancer Res. 2019;79(10):2447–56.

    Article  CAS  Google Scholar 

  10. Eschke RK, et al. Impact of physical exercise on growth and progression of cancer in rodents-a systematic review and meta-analysis. Front Oncol. 2019;9:35.

    Article  Google Scholar 

  11. Ashcraft KA, Peace RM, Betof AS, Dewhirst MW, Jones LW. Efficacy and mechanisms of aerobic exercise on cancer initiation, progression, and metastasis: a critical systematic review of in vivo preclinical data. Cancer Res. 2016;76(14):4032–50.

    Article  CAS  Google Scholar 

  12. Idorn M, Hojman P. Exercise-dependent regulation of NK cells in cancer protection. Trends Mol Med. 2016;22(7):565–77.

    Article  CAS  Google Scholar 

  13. Abou Khouzam R, et al. Tumor hypoxia regulates immune escape/invasion: influence on angiogenesis and potential impact of hypoxic biomarkers on cancer therapies. Front Immunol. 2020;11:613114.

    Article  Google Scholar 

  14. Rao D, Verburg F, Renner K, Peeper DS, Lacroix R, Blank CU. Metabolic profiles of regulatory T cells in the tumour microenvironment. Cancer Immunol Immunother. 2021.

  15. Wennerberg E, Lhuillier C, Rybstein MD, Dannenberg K, Rudqvist NP, Koelwyn GJ, et al. Exercise reduces immune suppression and breast cancer progression in a preclinical model. Oncotarget. 2020;11(4):452–61.

    Article  Google Scholar 

  16. Pedersen L, Idorn M, Olofsson GH, Lauenborg B, Nookaew I, Hansen RH, et al. Voluntary running suppresses tumor growth through epinephrine- and IL-6-dependent NK cell mobilization and redistribution. Cell Metab. 2016;23(3):554–62.

    Article  CAS  Google Scholar 

  17. Hojman P. Exercise protects from cancer through regulation of immune function and inflammation. Biochem Soc Trans. 2017;45(4):905–11.

    Article  CAS  Google Scholar 

  18. Murphy EA, Davis JM, Barrilleaux TL, McClellan JL, Steiner JL, Carmichael MD, et al. Benefits of exercise training on breast cancer progression and inflammation in C3(1)SV40Tag mice. Cytokine. 2011;55(2):274–9.

    Article  CAS  Google Scholar 

  19. McCullough DJ, et al. Modulation of blood flow, hypoxia, and vascular function in orthotopic prostate tumors during exercise. J Natl Cancer Inst. 2014;106(4):dju036.

    Article  Google Scholar 

  20. • Florez Bedoya CA, et al. Exercise during preoperative therapy increases tumor vascularity in pancreatic tumor patients. Sci Rep. 2019;9(1):13966 This report includes experiments conducted on mice models of pancreatic cancer and also human tumor specimen of patients who received a preoperative exercise program.

    Article  Google Scholar 

  21. Schadler KL, Thomas NJ, Galie PA, Bhang DH, Roby KC, Addai P, et al. Tumor vessel normalization after aerobic exercise enhances chemotherapeutic efficacy. Oncotarget. 2016;7(40):65429–40.

    Article  Google Scholar 

  22. Garcia E, et al. Blood flow responses to mild-intensity exercise in ectopic vs. orthotopic prostate tumors; dependence upon host tissue hemodynamics and vascular reactivity. J Appl Physiol (1985). 2016;121(1):15–24.

    Article  CAS  Google Scholar 

  23. Kruijsen-Jaarsma M, et al. Effects of exercise on immune function in patients with cancer: a systematic review. Exerc Immunol Rev. 2013;19:120–43.

    PubMed  Google Scholar 

  24. Hoffman-Goetz L. Exercise, natural immunity, and tumor metastasis. Med Sci Sports Exerc. 1994;26(2):157–63.

    Article  CAS  Google Scholar 

  25. Rundqvist H, Veliça P, Barbieri L, Gameiro PA, Bargiela D, Gojkovic M, et al. Cytotoxic T-cells mediate exercise-induced reductions in tumor growth. Elife. 2020;9.

  26. Goh J, Kirk EA, Lee SX, Ladiges WC. Exercise, physical activity and breast cancer: the role of tumor-associated macrophages. Exerc Immunol Rev. 2012;18:158–76.

    PubMed  Google Scholar 

  27. Dethlefsen C, Lillelund C, Midtgaard J, Andersen C, Pedersen BK, Christensen JF, et al. Exercise regulates breast cancer cell viability: systemic training adaptations versus acute exercise responses. Breast Cancer Res Treat. 2016;159(3):469–79.

    Article  Google Scholar 

  28. Moller AB, et al. Molecular and cellular adaptations to exercise training in skeletal muscle from cancer patients treated with chemotherapy. J Cancer Res Clin Oncol. 2019;145(6):1449–60.

    Article  Google Scholar 

  29. Lonbro SFJ, Bentsen S, Voss T, Rittig N, Wang J, Orskov M, et al. Lean body mass, muscle fibre size and muscle function in cancer patients during chemotherapy and 10 wks exercise. JCSM Clin Rep. 2017;2(1):1–15.

    Google Scholar 

  30. • Koelwyn GJ, Jones LW. Exercise as a candidate antitumor strategy: a window into the future. Clin Cancer Res. 2019;25(17):5179–81 Summary on exercise tumor effects by experts in the field.

    Article  CAS  Google Scholar 

  31. Iyengar, N.M. and L.W. Jones, Development of exercise as interception therapy for cancer: a review. JAMA Oncol, 2019, Development of Exercise as Interception Therapy for Cancer.

  32. American Cancer Society, American Cancer Society Updates Guideline for Diet and Physical Activity. 2020.

  33. •• Ligibel JA, et al. Impact of a pre-operative exercise intervention on breast cancer proliferation and gene expression: results from the pre-operative health and body (PreHAB) study. Clin Cancer Res. 2019;25(17):5398–406 Recent interventional study on the effects of exercise on breast cancer outcomes.

    Article  CAS  Google Scholar 

  34. Eickmeyer SM, Gamble GL, Shahpar S, Do KD. The role and efficacy of exercise in persons with cancer. PM R. 2012;4(11):874–81.

    Article  Google Scholar 

  35. Leal LG, et al. Exercise training as therapeutic approach in cancer cachexia: a review of potential anti-inflammatory effect on muscle wasting. Front Physiol. 2020;11:570170.

    Article  Google Scholar 

  36. Perego S, et al. Another weapon against cancer and metastasis: physical-activity-dependent effects on adiposity and adipokines. Int J Mol Sci. 2021;22(4).

  37. Courneya KS, et al. Effects of exercise during adjuvant chemotherapy on breast cancer outcomes. Med Sci Sports Exerc. 2014;46(9):1744–51.

    Article  CAS  Google Scholar 

  38. Courneya KS, Friedenreich CM, Franco-Villalobos C, Crawford JJ, Chua N, Basi S, et al. Effects of supervised exercise on progression-free survival in lymphoma patients: an exploratory follow-up of the HELP Trial. Cancer Causes Control. 2015;26(2):269–76.

    Article  Google Scholar 

  39. Betof AS, Dewhirst MW, Jones LW. Effects and potential mechanisms of exercise training on cancer progression: a translational perspective. Brain Behav Immun. 2013;30(Suppl):S75–87.

    Article  Google Scholar 

  40. Ruiz-Casado A, Martín-Ruiz A, Pérez LM, Provencio M, Fiuza-Luces C, Lucia A. Exercise and the hallmarks of cancer. Trends Cancer. 2017;3(6):423–41.

    Article  CAS  Google Scholar 

  41. Febvey-Combes O, et al. Effects of an exercise and nutritional intervention on circulating biomarkers and metabolomic profiling during adjuvant treatment for localized breast cancer: results from the PASAPAS feasibility randomized controlled trial. Integr Cancer Ther. 2021;20:1534735420977666.

    Article  Google Scholar 

  42. Courneya KS, Vardy JL, O'Callaghan CJ, Friedenreich CM, Campbell KL, Prapavessis H, et al. Effects of a structured exercise program on physical activity and fitness in colon cancer survivors: one year feasibility results from the CHALLENGE Trial. Cancer Epidemiol Biomark Prev. 2016;25(6):969–77.

    Article  Google Scholar 

  43. Newton RU, Kenfield SA, Hart NH, Chan JM, Courneya KS, Catto J, et al. Intense exercise for survival among men with metastatic castrate-resistant prostate cancer (INTERVAL-GAP4): a multicentre, randomised, controlled phase III study protocol. BMJ Open. 2018;8(5):e022899.

    Article  Google Scholar 

  44. Campbell KL, et al. Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable. Med Sci Sports Exerc. 2019;51(11):2375–90.

    Article  Google Scholar 

  45. •• Patel AV, et al. American College of Sports Medicine Roundtable Report on Physical Activity, Sedentary Behavior, and Cancer Prevention and Control. Med Sci Sports Exerc. 2019;51(11):2391–402 These are the ACSM updated guidelines on exercise for oncology patients.

    Article  Google Scholar 

  46. • Schmitz KH, et al. Exercise is medicine in oncology: engaging clinicians to help patients move through cancer. CA Cancer J Clin. 2019;69(6):468–84 Summary guiding clinicians on the application of the ACSM updated guidelines.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to An Ngo-Huang.

Ethics declarations

Conflict of Interest

None of the authors has any potential conflicts of interest to disclose

Human and Animal Rights and Informed Consent

This is a review article and thus, does not contain any active studies with human or animal subjects performed by the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Cancer Rehabilitation

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ngo-Huang, A., Fricke, B.C., Schadler, K.L. et al. Preliminary Evidence on the Effects of Exercise on Tumor Biology: a Potential Guide for Prescribing Exercise. Curr Phys Med Rehabil Rep 9, 136–141 (2021). https://doi.org/10.1007/s40141-021-00316-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40141-021-00316-5

Keywords

Navigation