Physical activity for cancer patients during COVID-19 pandemic: A call to action
Open accessAbstract
Self-isolation is strongly recommended for cancer patients during the COVID-19 pandemic, but may lead to physical inactivity and prolonged sitting time. The benefits of physical activity for cancer patients are manifold, such as reduced anxiety, fewer depressive symptoms, less fatigue, better quality of life, and improved physical function. In the last decade, several oncology-related organizations have provided guidance and summarized the evidence on the role of physical activity for cancer survivors. In this comment, we provide a brief summary of these recommendations and benefits of physical activity for cancer patients; and we recommend that oncologists and health practitioners should promote an active lifestyle for these patients during the pandemic and thereafter. Suggestions for implementing these actions in the clinical settings are also provided.
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Cites
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Claims the paper makes
0 of 14 cited sources checked · 0 supported · 0 flagged
- Premisecitation
In Brazil, only 45% of people with cancer meet physical activity guidelines.
“In Brazil, only 45% of people with cancer meet physical activity guidelines [11].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [11] Azevedo e Silva G, de Rezende LF, Gomes Fda S, de Souza Junior PR, Szwarcwald CL, Eluf Neto J (2016) Lifestyle among former cancer patients in Brazil in 2013. Cien Saude Colet 21:379–388 source
Not checked in the free run.
- Premisecitation
In the USA and UK, only about one third to 45% of cancer patients accumulated at least 150 minutes of moderate-to-vigorous physical activity per week.
“Data from USA and UK cancer patients suggested that only approximately a third to 45% of the patients accumulated at least 150 min of moderate to vigorous physical activity per week [7].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [7] Campbell KL, Winters-Stone KM, Wiskemann J et al (2019) Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable. Med Sci Sports Exerc 51:2375–2390 source
Not checked in the free run.
- Premisecitation
Physical activity, especially after diagnosis, is associated with better survival from breast, colon, and prostate cancers.
“The comprehensive literature review of the ACSM Multidisciplinary Roundtable on Exercise and Cancer also suggested that physical activity, particularly postdiagnosis, is associated with improved survival from breast, colon, and prostate cancers [7].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [7] Campbell KL, Winters-Stone KM, Wiskemann J et al (2019) Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable. Med Sci Sports Exerc 51:2375–2390 source
Not checked in the free run.
- Premisecitation
Scientific evidence is unclear about the best type or domain of physical activity for people with cancer.
“Of note, scientific evidence is not clear about the best type or domain of physical activity for people with cancer [8]; thus, guidelines suggest to include physical activity as part of everyday life [6].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [8] Friedenreich CM, Stone CR, Cheung WY, Hayes SC (2019) Physical activity and mortality in cancer survivors: a systematic review and meta-analysis. JNCI Cancer Spectrum 4:pkz080 source
Not checked in the free run.
- Premisecitation
In cancer survivors, high versus low physical activity before diagnosis is associated with improved overall survival (HR 0.82, 95% CI 0.79-0.86).
“High vs. low physical activity prediagnosis (hazard ratio 0.82; 95% confidence interval 0.79–0.86)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [8] Friedenreich CM, Stone CR, Cheung WY, Hayes SC (2019) Physical activity and mortality in cancer survivors: a systematic review and meta-analysis. JNCI Cancer Spectrum 4:pkz080 source
Not checked in the free run.
- Interpretationcitation
Reverse causation is unlikely to entirely explain the protective association between physical activity and survival in cancer survivors, based on preliminary randomized trial results.
“While it is likely that reverse causation contributes to some of the association (i.e., those with better health and prognosis are more able to exercise), preliminary results from randomized trials showing the effect of exercise on survival suggest that bias is unlikely to entirely account for the protective association [9, 10].”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [9] Wiskemann J, Kleindienst N, Kuehl R, Dreger P, Schwerdtfeger R, Bohus M (2015) Effects of physical exercise on survival after allogeneic stem cell transplantation. Int J Cancer 137:2749–2756 source
Not checked in the free run.
- cites [10] Hayes SC, Steele ML, Spence RR et al (2018) Exercise following breast cancer: exploratory survival analyses of two randomised, controlled trials. Breast Cancer Res Treat 167:505–514 source
Not checked in the free run.
- Premisecitation
Prediagnosis and postdiagnosis physical activity are associated with lower cancer-specific and all-cause mortality in breast and colorectal cancer survivors.
“Reductions in cancer-specific mortality and all-cause mortality were also observed for prediagnosis and postdiagnosis physical activity in breast and colorectal cancer survivors [8].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [8] Friedenreich CM, Stone CR, Cheung WY, Hayes SC (2019) Physical activity and mortality in cancer survivors: a systematic review and meta-analysis. JNCI Cancer Spectrum 4:pkz080 source
Not checked in the free run.
- Premisecitation
Most oncology organizations recommend that cancer survivors engage in at least 150 minutes per week of moderate-to-vigorous aerobic physical activity.
“Most of the oncology organizations recommend cancer survivors to engage in regular 150 min per week of aerobic, moderate to vigorous intensity physical activity.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [6] World Cancer Research Fund/American Institute for Cancer Research (2020) Continuous Update Project Expert Report 2018. Survivors of breast and other cancers. Available at dietandcancerreport.org
Not checked in the free run.
- Premisecitation
In cancer survivors, high versus low physical activity after diagnosis is associated with improved overall survival (HR 0.63, 95% CI 0.53-0.75).
“postdiagnosis (hazard ratio 0.63; 95% confidence interval 0.53–0.75) were associated with improved survival outcome for all-cancer combined [8].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [8] Friedenreich CM, Stone CR, Cheung WY, Hayes SC (2019) Physical activity and mortality in cancer survivors: a systematic review and meta-analysis. JNCI Cancer Spectrum 4:pkz080 source
Not checked in the free run.
- Classified as probably not a substantial claim. 1
- May combine two claims. 3
Probably not a substantial claim: may not pass S4 (based).
Interpretationnone givenThe COVID-19 pandemic and its social distancing and isolation policies have created a sedentaryogenic environment that makes meeting physical activity guidelines especially challenging for people with cancer.
“The COVID-19 pandemic and its social distancing and isolation policies have created a “sedentaryogenic” environment where meeting physical activity guidelines becomes especially challenging for people with cancer.”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-isolation may lead to physical inactivity and prolonged sitting time in cancer patients.
May combine two claims.
PremisecitationPhysical inactivity and prolonged sitting are highly prevalent among cancer patients.
“Physical inactivity (not meeting the physical activity guidelines) and prolonged sitting time are highly prevalent among cancer patients, partially due to persistent symptoms such as fatigue, which may contribute to these behaviors in addition to self-isolation measures.”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [7] Campbell KL, Winters-Stone KM, Wiskemann J et al (2019) Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable. Med Sci Sports Exerc 51:2375–2390 source
Not checked in the free run.
- cites [11] Azevedo e Silva G, de Rezende LF, Gomes Fda S, de Souza Junior PR, Szwarcwald CL, Eluf Neto J (2016) Lifestyle among former cancer patients in Brazil in 2013. Cien Saude Colet 21:379–388 source
Not checked in the free run.
May combine two claims.
PremisecitationPhysical activity is safe and effective for reducing anxiety, depressive symptoms, and fatigue, and for improving quality of life and physical function in cancer survivors.
“The benefits of physical activity for cancer patients are manifold, such as reduced anxiety, fewer depressive symptoms, less fatigue, better quality of life, and improved physical function.”
- Also stated in: § Main · boosted
“In summary, strong scientific evidence supports the safety and efficacy of physical activity to address several health benefits for cancer survivors, including reduced anxiety, fewer depressive symptoms, less fatigue, better quality of life, and improved physical function [7].”
- Also stated in: § Main · boosted
“Strong epidemiological evidence supports the safety and efficacy of physical activity to address important health outcomes for cancer patients [7].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [7] Campbell KL, Winters-Stone KM, Wiskemann J et al (2019) Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable. Med Sci Sports Exerc 51:2375–2390 source
Not checked in the free run.
- Also stated in: § Main · boosted
May combine two claims.
PremisecitationPatients with cancer have a higher risk of ICU admission, invasive ventilation, or death from COVID-19 than patients without cancer, due to immunosuppression from the disease and its treatments.
“Patients with cancer have higher risk of being admitted to intensive care unit requiring invasive ventilators or dying from COVID-19 than patients without cancer due to their systemic immunosuppressive state induced by the disease and its pharmacological treatments [5].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [5] Liang W, Guan W, Chen R et al (2020) Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol 21:335–337 source
Not checked in the free run.
The paper relies on this without support.
Self-isolation may lead to physical inactivity and prolonged sitting time in cancer patients.
“Self-isolation is strongly recommended for cancer patients during the COVID-19 pandemic, but may lead to physical inactivity and prolonged sitting time.”
“Physical inactivity (not meeting the physical activity guidelines) and prolonged sitting time are highly prevalent among cancer patients, partially due to persistent symptoms such as fatigue, which may contribute to these behaviors in addition to self-isolation measures.”
The paper relies on this without support.
Social isolation policies have reduced follow-up visits for regular pharmacological cancer treatment and adherence to non-pharmacological recommendations such as physical activity.
“At the same time, however, social isolation policies have reduced follow-up visits for regular pharmacological cancer treatment, as well as adhering to non-pharmacological recommendations such as physical activity.”
The paper relies on this without support.
Cancer patients are less likely to attend follow-up visits during the COVID-19 pandemic, which reduces opportunities to discuss physical activity.
“In addition, cancer patients are less likely to attend follow-up visits during the COVID-19 pandemic, which further reduces the opportunities to discuss the importance of physical activity during and after treatment.”
“During COVID-19 pandemic, people with cancer are less likely to attend follow-up visits, which might reduce the opportunities for evidence-based counseling.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
A negative consequence of self-isolation was physical inactivity and prolonged sitting, as well as increased anxiety, depressive symptoms, and increased fatigue.
“A negative consequence of self-isolation was physical inactivity and prolonged sitting, as well as increased anxiety, depressive symptoms, and increased fatigue [28].”
From The Effect of Vinyasa Yoga Practice on the Well-Being of Breast-Cancer Patients during COVID-19 Pandemic (2023) · cites this paper as [28]
The Abstract says self-isolation may lead to physical inactivity and prolonged sitting among cancer patients. The Main section says physical activity can reduce anxiety, depressive symptoms, and fatigue, but it does not say self-isolation increased those symptoms. The citing sentence also omits the paper’s cancer-patient context. (LLM, conf=0.85)
Experimental — accuracy not yet measured
Cites
Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China
Liang, W., Guan, W., Chen, R., Wang, W., Li, J., Xu, K., Li, C., Ai, Q., Lu, W., Liang, H., et al. (2020) · The Lancet Oncology · doi:10.1016/s1470-2045(20)30096-6 · Cited by 4,384 · see citing works
Body Fatness and Cancer — Viewpoint of the IARC Working Group
Lauby-Secretan, B., Scoccianti, C., Loomis, D., Grosse, Y., Bianchini, F., & Straif, K. (2016) · New England Journal of Medicine · doi:10.1056/nejmsr1606602 · Cited by 3,596 · see citing works
CAMPBELL, K. L., WINTERS-STONE, K. M., WISKEMANN, J., MAY, A. M., SCHWARTZ, A. L., COURNEYA, K. S., ZUCKER, D. S., MATTHEWS, C. E., LIGIBEL, J. A., GERBER, L. H., et al. (2019) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000002116 · Cited by 2,988 · see citing works
Exercise is medicine in oncology: Engaging clinicians to help patients move through cancer
Schmitz, K. H., Campbell, A. M., Stuiver, M. M., Pinto, B. M., Schwartz, A. L., Morris, G. S., Ligibel, J. A., Cheville, A., Galvão, D. A., Alfano, C. M., et al. (2019) · CA: A Cancer Journal for Clinicians · doi:10.3322/caac.21579 · Cited by 789 · see citing works
Physical Activity and Mortality in Cancer Survivors: A Systematic Review and Meta-Analysis
Friedenreich, C. M., Stone, C. R., Cheung, W. Y., & Hayes, S. C. (2020) · JNCI Cancer Spectrum · doi:10.1093/jncics/pkz080 · Cited by 453 · see citing works
Effects of physical exercise on survival after allogeneic stem cell transplantation
Wiskemann, J., Kleindienst, N., Kuehl, R., Dreger, P., Schwerdtfeger, R., & Bohus, M. (2015) · International Journal of Cancer · doi:10.1002/ijc.29633 · Cited by 96 · see citing works
Exercise following breast cancer: exploratory survival analyses of two randomised, controlled trials
Hayes, S. C., Steele, M. L., Spence, R. R., Gordon, L., Battistutta, D., Bashford, J., Pyke, C., Saunders, C., & Eakin, E. (2018) · Breast Cancer Research and Treatment · doi:10.1007/s10549-017-4541-9 · Cited by 82 · see citing works
Modos de vida entre pessoas que tiveram câncer no Brasil em 2013
Silva, G. A. E., Rezende, L. F. M. D., Gomes, F. D. S., Souza Júnior, P. R. B. D., Szwarcwald, C. L., & Eluf Neto, J. (2016) · Ciência & Saúde Coletiva · doi:10.1590/1413-81232015211.24722015 · Cited by 13 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 1
- Ferlay J et al (2018) Global cancer observatory: cancer today. International Agency for Research on Cancer, Lyon. Available from: https://gco.iarc.fr/today. Accessed 8 May 2020
Cited by
Sorted by citations
Zok, A., Matecka, M., Zapala, J., Izycki, D., & Baum, E. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20043770 · Cited by 12 · see citing works
“, hypertension, diabetes, and cardiovascular disease) associated with a worse prognosis in COVID-19, reinforcing the importance of self-isolation efforts in these patients [28].”
Background
- Authors
- Rezende, L. F. M., Lee, D. H., Ferrari, G., Eluf-Neto, J., & Giovannucci, E. L.
- Affiliations
- Universidade Federal de São Paulo (BR)
- Harvard University (US)
- Brigham and Women's Hospital (US)
- Corresponding author
- Rezende, Leandro F. M.
- Venue
- Cancer Causes & Control
- Published
- 2020-11-16
- Volume
- 32
- Issue
- 1
- Pages
- 1-3
- ISSN
- 0957-5243 (ISSN-L)
- 1573-7225
- PMC
- PMC7668288
- OpenAlex
- W3102692092
- Cited by
- 20
- References
- 9
- Citations by year
- 2026: 1 · 2024: 4 · 2023: 5 · 2022: 7 · 2021: 3
- FWCI
- 1.35
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Cancer Causes & Control (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Fundação de Amparo à Pesquisa do Estado de São Paulo (2018/23941-9)
- Conselho Nacional de Desenvolvimento Científico e Tecnológico (442658/2019-2)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Oncology › COVID-19 and healthcare impacts
- Keywords
- physical activity, cancer patients, COVID-19 pandemic, self-isolation, physical inactivity, prolonged sitting, cancer survivors, anxiety, depressive symptoms, fatigue, quality of life, physical function, clinical guidelines, active lifestyle promotion
- MeSH terms
- Cancer Survivors, COVID-19, SARS-CoV-2, Anxiety, Fatigue, Humans, Life Style, Neoplasms, Quality of Life, Exercise, Pandemics
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