A healthy dose of exercise is good medicine, even for lymphoma patients receiving chemotherapy, according to Kerry Courneya, Canada Research Chair in Physical Activity and Cancer in the Faculty of Physical Education and Recreation at the University of Alberta.
The Healthy Exercise for Lymphoma Patients (HELP) trial, a three-year study led by professor Courneya, , found that a regimen of aerobic exercise training produced significant improvements in physical functioning and overall quality of life benefits in patients with lymphoma.
Researchers recruited 122 patients with Hodgkin's and non-Hodgkin's lymphoma, then stratified participants by disease type and treatment status; whether they were undergoing chemotherapy at the time or receiving no treatments. Participants were randomly assigned to an exercise program designed to maximize cardiovascular fitness or to usual care, which did not include an exercise component.
"The exercise program consisted of interval training," explains Courneya. "We had patients ride the bike at a modest intensity interspersed with high-intensity bouts of exercise, where they would go full out, exerting maximal effort for a minute or two at a time, then rest for a few minutes before doing it again. That type of interval training has really been shown to maximize improvements in fitness."
Exercisers trained three times a week for 12 weeks and were encouraged to stay the course with behavioural support techniques that included perks like free parking, a well-equipped gym, flexible exercise schedules, variation in exercises, follow-up phone calls reminders and positive reinforcement by staff.
Lymphoma patients who received the exercise intervention reported significantly improved physical functioning, overall quality of life, less fatigue, increased happiness, less depression and an improvement in lean body mass. In fact, cardiovascular fitness in the exercise group improved by over 20 per cent. "That's considered a fairly large improvement over a 12-week period," says Courneya, adding that the group receiving chemotherapy benefited as much as the group that was off treatments.
Says Courneya, "That's important because we know that fitness improvements are related to improvements in how cancer patients feel both functionally as well as emotionally.
"What's equally important is that we know that cardiovascular fitness is a strong predictor of mortality in other patient groups. There is some thinking that even with cancer patients, an improvement in fitness might be linked to longer survival. We haven't looked at that yet but certainly from other patient populations we know that the fitter people are the longer they live."
Courneya also found that the vigorous intensity exercise program did not interfere with lymphoma patients' ability to complete their chemotherapy treatments or benefit from the treatments.
"The improvements in fitness and in how they felt were really important. The most important finding from a safety perspective is that the patients were able to complete their chemotherapy as scheduled," he says.
"In addition, we found some suggestion that the group that did the exercise had a better response to their treatment. In the exercise group we found that 46 percent of patients had a 'complete response.' That means the tumour has gone and there's no evidence of disease, compared to only about 30 percent in the usual care group.
"The study wasn't really designed to look at that but it's a very provocative finding and suggests that perhaps this type of exercise training program during treatment might allow patients to respond better to the treatments and get better disease control."
Initiatives like Wellspring, which is establishing cancer patient support groups all over the country, and organizations like the Canadian Cancer Society, the YMCA and others, are forging ahead in developing supportive care interventions that include exercise programs.
"Ultimately," says Courneya, "it's important that we get the information out to those groups, so we can inform cancer patients, and help them access this type of exercise program."
The study, "Randomized Controlled Trial of the Effects of Aerobic Exercise on Physical Functioning and Quality of Life in Lymphoma Patients," was published in the Sept. 20, 2009, issue of the Journal of Clinical Oncology.
Dr. Courneya's Behavioural Medicine Laboratory: http://www.behaviouralmedlab.ualberta.ca/
Watch a video with Dr. Courneya talking about the HELP trial findings.