Physiotherapy exercise is clinically effective
Size of the problem
- 2 million people in the UK are living with or after cancer (1,2)
- 60% have unmet physical or psychological needs following treatment (9)
- 1.6 million cancer survivors are not active at levels recommended by the UK's Chief Medical Officer (1)
Cancer and its various treatments are associated with a wide range of distressing physical and psychological symptoms, which can affect patients for many years following the end of treatment.
Exercise can improve quality of life for cancer patients, regardless of the type and stage of their disease.(1) Inclusion of physiotherapy-led exercise within cancer pathways can reduce and prevent disability.(2)
Specialist physiotherapy can also alleviate distressing symptoms such as lymphoedema and fatigue, which debilitates 75-95 per cent of all cancer patients.(1-3)
Evidence shows that exercise reduces the risk of cancer recurrence and mortality.
Mortality can be reduced by 50 per cent,(4) 40 per cent(5) and 30 per cent(6) in bowel, breast and prostate cancer respectively.(1) In addition to this, disease progression was reduced by 57 per cent in men with prostate cancer who engaged in three hours a week of moderate intensity exercise.(7)
Excessive weight gain and loss can be a problem for many patients, depending on their treatment, stage and type of cancer. Specialist physiotherapists are vital for maintaining healthy weight and preventing muscle-wasting in cancer patients.(8)
More on cancer and physiotherapy:
Physiotherapy reduces future health complications, improves body image(3) and can improve an individual’s ability to return to work.
Some cancer treatments can reduce bone quality leading to osteoporosis, increased risk of fragility fractures, pain and disability. Physiotherapy exercise can reduce bone loss and the likelihood of falls in patients with poor bone density.(10)
Patients with cancer may present with problems managing pain – physical, psychological and spiritual in nature.(3) Pain can lead to a vicious cycle of fear, inactivity and further disability as a consequence and therefore increase length of hospital stay.(11) Physiotherapy has been shown to reduce the length of inpatient stays –with fewer nights as an inpatient representing better quality of life and cost savings to the NHS.(1)
Case study: Breast cancer rehabilitation service at Bart's Hospital, Bart's Health NHS Trust
Find out the facts about physiotherapy's effectiveness with our range of evidence-based briefings
This specialist out-patient service provides rehabilitation for all patients who undergo treatment for breast cancer. It is based on best available evidence and recommendations from the national Cancer Action Team breast rehabilitation pathway:
- Patients are assessed by a specialist physiotherapist in the post-operative phase for the main sequelae, including loss of shoulder mobility. Education and advice on self-management and referrals for ongoing physiotherapy are provided here as required.
- Ongoing physiotherapy care includes manual treatment, exercise and advice on self-management and return to work
- Patients are re-assessed at key stages in the cancer pathway including during chemotherapy/radiotherapy and at end of treatment, when a six-week group education programme is available to ease the 'transition'
This service has resulted in:
- fewer delays to radiotherapy due to poor shoulder mobility
- improved self-management
- early identification and management of consequences of treatment
Survivorship and work
- In England, the estimated cost to the economy, from the loss in work productiity of cancer survivors in 2008, was £5.3 billion.(12) Physiotherapy exercise is signifcant in managing the longer term side effects, helping people return to work, reducing recurrence following remission and increasing survival and quality of life (1)
- A Cochrane review reported exercise and patient education or counselling led to higher return-to-
work rates than usual care (odds ratio = 1.87), bringing significant economic benefits (13)
- Cancer survivors are 1.4 times more likely to be unemployed than matched controls. Exercise
programmes can result in a significant reduction in medium-term economic burden associated with unemployment and long term sick leave (14)
- In the UK over 300,000 people are diagnosed with cancer annually; half are of working age.(1)
More resources for GPs:
1. Support MC. The importance of physical activity for people living with and beyond cancer: a concise evidence review. Macmillan Cancer Support; 2011.
2. Headley JA, Ownby KK, John LD, editors. The effect of seated exercise on fatigue and quality of life
in women with advanced breast cancer 2004: Onc Nurs Society.
3. Rankin J. RK, Murtagh N. Rehabilitation in Cancer Care. Chichester: Wiley Blackman; 2009.
4. Meyerhardt JA, Giovannucci EL, Holmes MD, Chan AT, Chan JA, Colditz GA, et al. Physical activity and
survival after colorectal cancer diagnosis. Journal of clinical oncology. 2006;24(22):3527-
5. Holmes MD, Chen WY, Feskanich D, Kroenke CH, Colditz GA. Physical activity and survival after breast cancer diagnosis. JAMA: the journal of the American Medical Association. 2005;293(20):2479-86.
6. Kenfi eld SA, Stampfer MJ, Giovannucci E, Chan JM. Physical activity and survival after prostate cancer diagnosis in the health professionals follow-up study. Journal of clinical oncology. 2011;29(6):726-32.
7. Richman EL, Kenfi eld SA, Stampfer MJ, Paciorek A, Carroll PR, Chan JM. Physical activity after diagnosis and risk of prostate cancer progression: data from the cancer of the prostate strategic urologic research endeavor. Cancer research. 2011;71(11):3889.
8. Ingram C, Courneya KS, Kingston D, editors. The effects of exercise on body weight and composition in breast cancer survivors: an integrative systematic review 2006: OncNurs Society.
9. Initiative NCS. Consequences of cancer treatment: the challenge. MacMillan Cancer Support; 2012 [cited 2012 28th August]; Available from: http://www.ncsi.org.uk/what-we-are-doing/consequences-of-cancer-treatment/
10. Kashyap A, Kandeel F, Yamauchi D, Palmer JM, Niland JC, Molina A, et al. Effects of allogeneic bone marrow transplantation on recipient bone mineral density: A prospective study. Biology of Blood and Marrow Transplantation. 2000;6(3):344-51.
11. Kinetics SCDCCSEacrH. Exercise and cancer recovery. Champaign, USA: Human Kinetics Publishing; 2003.
12. Featherstone H, Whitham L. The cost of cancer. Policy Exchange Research Note. 2010.
13. Gordon LG, Scuffham P, Battistutta D, Graves N, Tweeddale M, Newman B. A cost-effectiveness analysis of two rehabilitation support services for women with breast cancer. Breast cancer research and
14. Satariano WA, DeLorenze GN. The likelihood of returning to work after breast cancer. Public Health Reports. 1996;111(3):236.
The CSP would like to thank: Chiara De Biase (Macmillan Information & Support Manager), Kate Jones (Clinical Specialist physiotherapist, the Royal Marsden), Joyce Craig (Craig Health Economics Consultancy Ltd), Hannah Young (Clinical Specialist, University Hospitals of Leicester), Ruth McGuiness (Clinical Specialist, the Royal Marsden).