Thursday, September 1, 2011

The role of physical therapy in cancer

Physical therapists are exercise experts, providing support for a wide range of people to
optimise their physical ability. They prescribe exercise as part of a structured, safe and effective
Their skills can help in preventing and treating the four main non-communicable diseases in the
world, as identified by the United Nations: cardiovascular disease, respiratory disease, diabetes
and cancer.
Cancer is an umbrella term used to describe more than 100 different diseases with the
common characteristic of uncontrolled malignant cell growth. It is a leading and growing cause
of death worldwide, with the total number of cases globally increasing, as the world population
grows and ages.
The growing global population with cancer faces unique challenges – from their disease and
from the treatments they receive. Physical therapists can make a unique contribution to helping
them achieve health and a good quality of life. The prescribed exercises and lifestyle advice
that physical therapists provide can also help people reduce their risk of getting cancer.
Cancer facts
Cancer is a leading cause of death worldwide and accounted for 7.6 million deaths (around
13% of all deaths) in 2008.
Source: International Agency for Research on Cancer
Deaths from cancer worldwide are projected to continue to rise to over 11 million in 2030.
More than 30% of cancer can be prevented by modifying or avoiding key risk factors, including:
 being overweight or obese
 physical inactivity.
Other risk factors include:
 tobacco use
 low fruit and vegetable intake
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 alcohol use
 HPV-infection
 urban air pollution
 indoor smoke from household use of solid fuels.
Source: World Health Organization
The link between physical activity and cancer
Large population studies have identified a strong association between lower levels of physical
activity and higher cancer mortality. Walking or cycling an average of 30 minutes per day has
been associated with a 34% lower rate of cancer death and a 33% improved cancer survival.
Source: Orsini N, Mantzoros C S et al. Association of physical activity with cancer incidence,
mortality, and survival: a population based study of men. British Journal of Cancer. 2008 98:
Increasing numbers of studies are indicating that physical activity can reduce the incidence of
cancer. World Health Organization recommendations say that undertaking 150 minutes of
moderate intensity aerobic physical activity a week can reduce the risk of breast and colon
cancers. The same amount of exercise can also reduce the risk of diabetes and heart disease.
Source: Global Recommendations on Physical Activity for Health, released by the World Health
Organization in 2011
According to the International Agency for Research on Cancer: “Physical activity is one risk
factor for non-communicable diseases which is modifiable and therefore of great potential
public health significance. Changing the level of physical activity raises challenges for the
individual but also at societal level.”
Physical activity helps people with the effects of treatment for cancer
A systematic review of controlled trials of physical activity interventions in cancer survivors,
during and after treatment, showed that physical activity had a significant effect. A large effect
was shown on upper and lower body strength, and a moderate effects on fatigue and breastcancer-
specific concerns. Exercise was generally well-tolerated during and after treatment, with
minimal adverse events. The study abstracted data from over 82 studies.
Source: Speck RM, Courneya KS et al. An update of controlled physical activity trials in cancer
survivors: a systematic review and meta-analysis. J. Cancer Surviv. 2010 Jun;4(2):87-100.
A panel of experts convened by the American College of Sports Medicine concluded that
exercise training is safe during and after cancer treatments and results in improvements in
physical functioning, quality of life and cancer-related fatigue in several cancer survivor groups.
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Source: Schmitz KH, Courneya KS et al. American College of Sports Medicine roundtable on
exercise guidelines for cancer survivors. Med Sci Sports Exerc. 2010 Jul;42(7):1409-26.
Physical activity helps improve outcomes for people with cancer
Studies have indicated a relationship between higher physical activity levels and lower mortality
in cancer survivors. A recent meta-analysis reported that, post-diagnosis, physical activity
reduced breast cancer deaths by 34%, all causes mortality by 41% and disease recurrence by
Source: Ibrahim EM, Al-Homaidh A. Physical activity and survival after breast cancer diagnosis:
meta-analysis of published studies. Med Oncol. 2010 Apr 22.
Studies also indicate the volume of exercise necessary to bring benefits. The Nurses’ Health
Study reported 50% fewer cancer recurrences in women who exercised more than three hours
per week. Among people who have had colo-rectal cancer, a study found a 50% lower rate of
recurrence and related death in those who exercised more than six hours per week.
Source: Holmes, MD, Chen WY et al. Physical activity and survival after breast cancer
diagnosis. JAMA 2005 293: 2479-2486.
Meyerhardt J A, Giovannucci E L et al. Physical Activity and Survival After Colorectal Cancer
Diagnosis. Journal of Clinical Oncology 2006 Vol 24, No 22 (August 1): 3527-3534.
Current lack of physical activity among people with cancer
Generally, cancer survivors display low levels of physically activity. A study has reported that in
Canada less than 22% of cancer survivors are physically active.
Source: Courneya KS, Katzmarzyk PT et al. Physical activity and obesity in Canadian cancer
survivors: population-based estimates from the 2005 Canadian Community Health Survey.
Cancer 2008 Jun;112(11):2475-82.
This information may be freely reproduced with acknowledgement to WCPT. It is designed as a
resource, and does not necessarily represent an official WCPT view or policy. It was produced
with the kind assistance of Julie Walsh-Broderick, HRB Research Fellow, Department of
Physiotherapy, Trinity Centre for Health Science, St James’s Hospital, Dublin.

Article about physical therapy
The article below has been written by WCPT for you to publish in your newsletters, magazines
and journals, or to pass on to other publications as background information. Please note that
although WCPT is happy for you to reproduce this article, if you are making any changes they
should be checked with the WCPT Secretariat. If you refer to “physiotherapists” rather than
“physical therapists” in your country, we suggest you change the text appropriately.
Physical therapists at the heart of the global battle against cancer
By Marilyn Moffat, President of the World Confederation for Physical Therapy
This September the United Nations will hold its first ever summit on non-communicable disease
- only the second such meeting to focus on global disease. The summit, involving heads of
state, is an official recognition that non-communicable diseases (cardiovascular diseases,
chronic respiratory diseases, diabetes and cancer) are an increasing global health challenge.
They already claim 35 million lives a year – around 60 per cent of deaths.
For physical therapists, the official recognition that a global strategy is required to reduce this
burden of disability and deaths is highly significant. The profession of physical therapy, known
in some countries as physiotherapy, helps millions of people every year to prevent these
conditions and their risk factors – most importantly obesity. They also manage their effects,
along with the effects of aging, illness, accidents, and the stresses and strains of life.
Physical therapists specialise in human movement and physical activity, promoting health,
fitness, and wellness. They identify physical impairments, limitations, and disabilities that
prevent people from being as active and independent as they might be, and then they find ways
of overcoming them. They maximise people’s movement potential.
So when the World Health Organization points out that physical inactivity is one of the leading
risk factors for global mortality, causing 3.2 deaths annually, and that physical activity can
reduce non-communicable diseases, it is clear that the profession has a major part to play. In
any global actions that emerge from the UN Summit on Non-Communicable Diseases in New
York on 19th and 20th September, physical therapists must be central to plans and
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That is why World Physical Therapy Day, held every year on 8th September, is particularly
important this year. It is a day when physical therapists can publicise their work, educate the
public and policy makers about what they do, and try and ensure that the public benefit from
their skills.
Many people do not recognise the contribution physical therapists make in keeping people
healthy and independent. This year on World Physical Therapy Day, WCPT is particularly
drawing attention to physical therapists’ role in reducing the risk of cancer, and helping people
recover from its effects. The World Health Organization has this year drawn attention to the role
of physical activity in reducing cancers – 150 minutes a week of moderate physical activity can
reduce the risk of breast and colon cancers, according to WHO’s new Global
Recommendations on Physical Activity for Health.
But the physical therapy contribution in cancer goes wider than that. Studies have also
indicated a relationship between higher physical activity levels and lower mortality in cancer
survivors. One recent meta-analysis reported that, post-diagnosis, physical activity reduced
breast cancer deaths by 34% and disease recurrence by 24% (Ibrahim EM, Al-Homaidh A.
Physical activity and survival after breast cancer diagnosis: meta-analysis of published studies.
Med Oncol. 2010 Apr 22). Another meta-analysis found that exercise brings people with breast
cancer improved peak oxygen consumption and reduced fatigue (McNeely ML, Campbell KL et
al. Effects of exercise on breast cancer patients and survivors: a systematic review and metaanalysis.
CMAJ. 2006 Jul 4;175(1) 34-41).
I conduct workshops around the world, demonstrating how adults with chronic health problems
can improve their health by learning how to exercise safely under the guidance and instruction
of physical therapists. Activity has to be introduced carefully if a person is overweight, unfit,
older, or has a chronic disease. Physical therapists do this by examining the person,
recommending exercises that are safe and appropriate for them, and educating them about
how to look for signs of trouble.
This makes them the ideal professionals to prescribe exercise programmes for cancer.
According to the World Health Organisation, cancer is a leading cause of death worldwide and
accounted for 7.6 million deaths (around 13% of all deaths) in 2008. Deaths from cancer
worldwide are projected to continue to rise to over 11 million in 2030, yet more than 30% of
cancer deaths can be prevented.
Physical therapy doesn’t just mean more healthy people, but more productive people who can
contribute to countries’ economies. Their services are provided in an atmosphere of trust and
respect for human dignity and underpinned by sound clinical reasoning and scientific evidence.
These are important messages that physical therapists want to convey to the world every day,
but especially on 8th September, World Physical Therapy Day. The message is clear: physical
therapists are the movement, physical activity, and exercise experts and a resource in the
battle against non-communicable disease that should never be overlooked.
This information may be freely reproduced if unaltered and attributed to Dr Marilyn Moffat, President of

1 comment:

Ashksngh said...

Physiotherapy consists of different techniques to help cancer patients. Hydrotherapy is useful techniques used in cancer treatment.
physiotherapist Dublin.