Tuesday 16th December 2014
Mac Voice, the magazine for Macmillan professionals: Winter 2014
Dr Anna Campbell on the delivery of physical activity programmes for people affected by cancer
I have been undertaking research into physical activity and cancer survivorship for 14 years. I am interested in finding out why exercise appears to have a protective effect, and also how we can get more people living with cancer to engage in beneficial physical activity programmes.
A recent study that I was involved in found that a community-based group exercise intervention, undertaken during treatment for breast cancer, provided significant short-term and long-term physical and psychological benefits. At the end of the 12-week programme, the women randomised to the exercise group were more active, had a higher level of cardiovascular fitness, better range of shoulder movement and a more positive mood. We followed up these women six months later when they had finished treatment and found that in addition to the above, their quality of life had improved and their levels of fatigue and depression were reduced.  Five years later, we re-contacted the women in the study and reassessed their physical and psychological well-being. Interestingly, the women in the exercise group were still undertaking almost two and a half hours more activity than the women who had been randomised to the control group, and they still recorded a more positive mood than those who did not get the 12-week exercise programme during treatment. 
There have been a number of reviews of all the studies on the effects of exercise on people with cancer and survivors. A review by Speck et al  of 82 studies showed a large effect of physical activity interventions post-treatment on upper and lower body strength and moderate effects on fatigue and breast cancer-specific concerns. The review suggested that physical activity interventions during treatment had a moderate positive effect on physical activity undertaken, aerobic fitness, muscular strength, functional quality of life, anxiety, and self-esteem. With few exceptions, exercise was well tolerated during and after treatment without adverse events.
So, we now know that being active during and after cancer treatment improves both physical and psychological cancer outcomes and reduces isolation. However, we also know that many people with cancer may be unsure about how much physical activity is safe and may lack confidence in how to get started. We are also aware that the lack of suitable activities in local areas is preventing people from getting out and moving more.
Macmillan has developed Move More Scotland to provide practical support, and to help those affected by cancer to remain active both throughout their cancer treatment and afterwards.
To ensure there is something for everyone, there are four programmes to choose from, all of which have been designed specifically for people affected by cancer.
- Classes of Chi Gung, an ancient Chinese practice aligning breathing, physical activity, mental and spiritual awareness, which can be done seated, making it accessible for people of all ages and abilities.
- Walking groups, which are led by a trained volunteer and are low level, short, sociable walks, just requiring a comfortable pair of shoes.
- Gardening groups, allowing people to complete light gardening tasks to growing fruit and vegetables.
- Circuit-based classes delivered in leisure centres by highly-trained fitness instructors with specialist cancer and exercise training.
All of these programmes are led or supported by volunteers and there has been a huge amount of support for the Move More Scotland programme from external organisations. We are already delivering programmes in Glasgow and Fife, with Aberdeen and Edinburgh soon to follow.
Working in partnership with local authorities has allowed us to deliver Move More within local community libraries and venues.This has helped to deliver the programmes in an environment that is local, trusted, and non-judgemental. It has also ensured that the classes and groups are accessible and welcoming to all - some can even be attended by carers and family or friends.
Case study: how walking has benefited Patrick
'In January, I discovered that I had prostate cancer. I went for a few tests and found out I also had cancer in my spine. So I had radiotherapy and was on steroids, and when I came out of the hospital, I found it very difficult to walk. I visited the Macmillan Day Care Centre in Dundee and they gave me walking sticks and helped to get me mobile.
What really got to me was not being able to get out and attend football games. So I decided I needed to take the bull by the horns and set myself goals. The first one was walking to the hotel down the road. It's a bit of a distance for someone who is disabled. I had a go and made it to the hotel, had a cup of tea and then walked back. I kept doing that and setting myself slightly further distances each time. With help from a Macmillan Physiotherapist I eventually got myself mobile and set myself a bigger goal. On the 20th September I intend to walk two and a quarter kilometres across the Tay Bridge.
Walking has given me more confidence. I can get on a bus now, whereas before I needed help from my wife. I can go to town on my own. Macmillan has really boosted my mobility and my confidence. Without help from Macmillan, I would probably be sitting in a chair and feeling depressed.
You have to build yourself up gradually. It really does you good. My advice is to pick a route and walk where people recognise you, so if you ever run into difficulties, you can ask for help easily.
I met other people in the Macmillan Day Care Centre who are in similar positions to me, and I now have new friends. Dundee Football Club, who I support, have been helpful and given me free tickets to some games. So IÕm planning to make it to those.'
1 Mutrie N, Campbell AM et al. Benefits of supervised group exercise programme for women being treated for early stage breast cancer: pragmatic randomised controlled trial. BMJ. 2007. 334(7592): 517.
2 Mutrie N, Campbell AM et al. Five-year follow-up of participants in a randomised controlled trial showing benefits from exercise for breast cancer survivors during adjuvant treatment. Are there lasting effects? Journal of Cancer Survivorship. 2012. 6(4): 420-430.
3 Speck RM, Courneya KS et al. An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. Journal of Cancer Survivorship. 2010. 4(2) 87-100.