Should doctors prescribe exercise?

“Although the data vary by different cancer types, there is a consistent trend suggesting that moderate daily exercise has a beneficial effect on preventing certain cancers. If you are a reasonably healthy adult, your should exercise regularly.” 

Let’s look at the relationship of exercise and selected cancers. The American Society of Clinical Oncology (ASCO) has done a nice job of summarizing:

Breast Cancer

While the amount of risk reduction varies among studies (20-80%), most suggest that 30 to 60 minutes of moderate to high-intensity exercise per day lowers breast cancer risk. Women who are physically active throughout their life appear to benefit the most, but those who increase physical activity after menopause also fare better than inactive women.1

Colon Cancer

Research suggests that people who increase their physical activity can lower the chance of developing colon cancer by 30 to 40% relative to sedentary adults.1,2 A decrease in colon cancer risk can be achieved regardless of body mass index (BMI) and people who are most active benefit the most. There is insufficient evidence of a protective effect of physical activity on the risk of rectal cancer (a protective effect was seen in some case-control studies, but not in cohort studies).3

Endometrial, Lung and Ovarian Cancer

A handful of studies have suggested that women who are physically active have a 20-40% reduced risk of endometrial cancer compared to those who don’t exercise.1 Higher levels of physical activity seem to also protect against lung cancer (up to 20% reduction in risk), particularly among men.1Although less consistent, research suggests that physical activity possibly reduces the risk of ovarian and prostate cancer.

What about Other Cancers?

While observational data on the benefits of exercise for prevention of the types of cancers listed above are fairly consistent, evidence of the effects of exercise on prevention of any other type of cancer either is either insufficient or inconsistent.2,4

Prostate Cancer

Prostate cancer is one disease in which the data are not consistent, however prostate cancer is a heterogeneous disease and risk factor associations for total non-aggressive disease are different from aggressive / lethal disease. Most population based studies show similar findings, with little effect of exercise on overall incidence of prostate cancer but lower risk of aggressive prostate cancers for those with the highest levels of VIGOROUS activity (rather than any type of activity). In the Health Professionals Follow-up Study men 65 years or older who engaged in vigorous physical activity, such as running, jogging, biking, swimming or tennis at least three hours per week  had a 67% lower risk of advanced prostate cancer and 74% lower risk of fatal prostate cancer.5

Conflicting data for other malignancies

For example, one recent study found no association between physical activity and risk of developing gastric, rectal, pancreatic, bladder, testicular, kidney and hematological cancers.4 In contrast, a pooled analysis of data from prospective trials with 1.4 million participants found that physical activity was linked to lower risk of 13 cancers: esophageal, lung, kidney, gastric, endometrial, myeloid leukemia, myeloma, colon, head and neck, rectal, bladder, and breast.6Interestingly, leisure-time physical activity was associated with a higher risk of melanoma (presumably due to time spent outdoors) and prostate cancer, although it is not clear from these data whether that association was with nonaggressive or aggressive prostate cancer.

While we wait for confirmation and clarity on the role of exercise in preventing all the 200+ types of cancer – should doctors prescribe exercise? The answer is simple: yes, because evidence of the protective role of exercise is already strong for some of the most common cancers.

References

  1. Lee I, Oguma Y. Physical activity. In: Schottenfeld D, Fraumeni JF, editors. Cancer Epidemiology and Prevention. 3rd ed. New York: Oxford University Press, 2006.
  2. Slattery, ML. Physical activity and colorectal cancer. Sports Medicine 2004; 34(4): 239–252.
  3. Pham NM, et al. Physical activity and colorectal cancer risk: an evaluation based on a systematic review of epidemiologic evidence among the Japanese population. Jpn J Clin Oncol. 2012 Jan;42(1):2-13.
  4. Friedenreich CM, Neilson HK, Lynch BM. Eur J Cancer. State of the epidemiological evidence on physical activity and cancer prevention. 2010 Sep;46(14):2593-604.
  5. Giovannucci E, Liu Y, Leitzmann MF, et al. A prospective study of physical activity and incident and fatal prostate cancer. Arch Intern Med. 2005; 165(9):1005-1010.
  6. Moore SC, Lee IM, Weiderpass E, et al. Association of Leisure-Time Physical Activity With Risk of 26 Types of Cancer in 1.44 Million Adults. JAMA Intern Med. 2016 Jun 1;176(6):816-25.
  7. http://www.asco.org/about-asco/press-center/asco-resources-media/cancer-perspectives/should-cancer-doctors-prescribe?et_cid=38723632&et_rid=463715101&linkid=Read+more

I’m Dr. Michael Hunter. Of course, the disclaimer: Do not begin an exercise program without input from an appropriate medical professional. Many can simply start with a brisk walk for 30 minutes daily, 5 days per week. Have a wonderful day!

Light-emitting e-readers Before Bedtime Adversely Impact Sleep

What You Need to Know: Use of a light-emitting electronic device (LE-eBook) in the hours before bedtime can adversely impact overall health, alertness, and the circadian clock which synchronizes the daily rhythm of sleep to external environmental time cues.

“We found the body’s natural circadian rhythms were interrupted by the short-wavelength enriched light, otherwise known as blue light, from these electronic devices,” said Anne-Marie Chang, PhD, corresponding author. “Participants reading an LE-eBook took longer to fall asleep and had reduced evening sleepiness, reduced melatonin secretion, later timing of their circadian clock and reduced next-morning alertness than when reading a printed book.”

Background: Previous research has shown that blue light suppresses melatonin, impacts the circadian clock and increase alertness, but little was known about the effects of this popular technology on sleep. The use of light emitting devices immediately before bedtime is a concern because of the extremely powerful effect that light has on the body’s natural sleep/wake pattern, and may thereby play a role in perpetuating sleep deficiency.

The Study: During the two-week inpatient study, twelve participants read LE-e-Books on an iPad for four hours before bedtime each night for five consecutive nights. This was repeated with printed books. The order was randomized with some reading the iPad first and others reading the printed book first.

  • IPad readers took longer to fall asleep, were less sleepy in the evening, and spent less time in REM sleep. IPad readers had reduced secretion of melatonin, a hormone which normally rises in the evening and plays a role in inducing sleepiness.
  • IPad readers had a delayed circadian rhythm, indicated by melatonin levels, of more than an hour. Participants who read from the iPad were less sleepy before bedtime, but sleepier and less alert the following morning after eight hours of sleep.

Although iPads were used in this study, BWH researchers also measured other eReaders, laptops, cell phones, LED monitors, and other electronic devices, all emitting blue light.

“In the past 50 years, there has been a decline in average sleep duration and quality,” stated Charles Czeisler, PhD, MD, FRCP, chief, BWH Division of Sleep and Circadian Disorders. “Since more people are choosing electronic devices for reading, communication and entertainment, particularly children and adolescents who already experience significant sleep loss, epidemiological research evaluating the long-term consequences of these devices on health and safety is urgently needed.”

My Take: These findings are important and should be considered, given recent evidence linking chronic suppression of melatonin secretion by nocturnal light exposure with the increased risk of breast cancer, colorectal cancer and prostate cancer. I’m Dr. Michael Hunter, and I no longer use any blue light-emitting devices in the hour before bedtime.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad: Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Journal References

  • Anne-Marie Chang, Daniel Aeschbach, Jeanne F. Duffy, and Charles A. Czeisler. Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness. PNAS, December 22, 2014 DOI: 10.1073/pnas.1418490112
  • Brigham and Women’s Hospital (Harvard). “Light-emitting e-readers before bedtime can adversely impact sleep.” ScienceDaily. ScienceDaily, 22 December 2014. <www.sciencedaily.com/releases/2014/12/141222131348.htm>.