#MyPTArticleOfTheMonth – what is Lou James reading?

Lou James (MNZM) is a New Zealand physiotherapist with expertise in oncology. The number of people surviving or living longer after a cancer diagnosis is increasing and is projected to rise to 21.7 million by 2029. While cancer treatments are lengthening lives, they are also creating a whole host of new problems that can affect a person’s ability to work, their emotional and social well-being, and their long-term health. In response to this, Lou founded PINC & STEEL International in 2008 to develop a world-class program for cancer survivorship. In collaboration with international experts she has created the PINC & STEEL, Next Steps and PaddleOn cancer rehabilitation programs plus the Cancer Rehabilitation Physiotherapy Education Program. The programs are now available in 12 counties and have supported thousands of people. In 2017 Lou was recognised for her pioneering work in this field, being appointed a Member of the New Zealand Order of Merit (MNZM) for services to people with cancer.

Lou’s rehabilitation and education programs are based on the rapidly expanding body of high-quality clinical research evaluating the effects of exercise for people with cancer. Lou has recently read two articles on the topic.

Cormie P, et al. The impact of exercise on cancer mortality, recurrence, and treatment-related adverse effects. Epidemiol Rev 2017;39:71-92

This article reports the results of two systematic reviews. The first included 32 cohort studies and four randomised controlled trials that evaluated the impact of exercise on cancer mortality and recurrence. The second included 40 meta-analyses and 23 randomised controlled trials that assessed the impact of exercise on cancer treatment-related adverse effects. The cohort studies indicate a reduced risk of cancer mortality and recurrence in people who exercise more. This was not supported by the randomised controlled trials, but the trials were not designed or powered to evaluate mortality and recurrence. Some of the randomised controlled trials concluded that exercise participation reduced cancer treatment-related adverse effects (including bone health, cognitive health, bowel and bladder function, and hot flushes and anaemia). The included systematic reviews indicated that exercise reduces fatigue and psychosocial distress. Lou says: “This article supports the view that exercise is an important adjunct therapy in the management of cancer. This is significant for physiotherapists as many people affected by cancer are not meeting physical activity guidelines and this has implications for not only their quantity, but also their quality of life.”

Hilfiker R, Exercise and other non-pharmaceutical interventions for cancer-related fatigue in patients during or after cancer treatment: a systematic review incorporating an indirect-comparisons meta-analysis. Br J Sports Med 2018;52(10):651-8

Cancer-related fatigue is a common problem (prevalence 25% to 99%) and can persist for years after completion of cancer treatment. This large (245 randomised controlled trials) network meta-analysis evaluated the impact of exercise and other non-pharmacological interventions on cancer-related fatigue during or after cancer treatment for any type of cancer. The types of exercise evaluated included aerobic (34 trials), combined aerobic and resistance (23), yoga (10), resistance training (10), multimodal training (exercise and psychosocial combined; 6), and dance (2). All forms of exercise reduced fatigue compared to the control conditions. For example, aerobic exercise reduced fatigue compared to control by a standardised mean difference of 0.53 (95% confidence interval 0.26 to 0.80) during cancer treatment, and by 0.33 (0.16 to 0.51) after cancer treatment. Lou says: “This is important for physiotherapists as we have a significant role in addressing fatigue management for the individual’s impacted. We can have a really positive impact on the management of fatigue symptoms and improving functional status and quality of life for people diagnosed with curable or incurable cancer.”

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