comscoreASCO Issues Guidelines on Exercise, Diet, and Weight Management During Cancer Treatment

ASCO Issues Guidelines on Exercise, Diet, and Weight Management During Cancer Treatment

Doctors should recommend regular aerobic and resistance exercise for people receiving cancer treatment.
May 26, 2022.

Doctors should recommend regular aerobic and resistance exercise for people receiving cancer treatment, according to new guidelines from the American Society of Clinical Oncology (ASCO).

The guidelines were published online on May 16, 2022, by the Journal of Clinical Oncology. Read “Exercise, Diet, and Weight Management During Cancer Treatment: ASCO Guideline.”

ASCO is a national organization of oncologists and other cancer care providers. ASCO develops guidelines for doctors to follow that are supported by highly credible research and experience.


Exercise, diet, and breast cancer

Not exercising and having poor eating habits contribute to excess weight and may lead to higher levels of inflammation in the body — both of which are linked to a higher risk of more than a dozen types of cancer, including breast cancer.

Regular exercise is an important part of being as healthy as you can be. More and more research shows that exercise can reduce the risk of:

  • breast cancer developing in people who’ve never been diagnosed

  • breast cancer coming back (recurrence) in people who’ve been diagnosed

For people living with cancer, regular exercise also has been shown to:

  • improve physical function

  • reduce anxiety

  • ease depression

  • lessen fatigue

  • improve quality of life

There are three basic types of exercise:

  • Aerobic exercise uses the large muscles in your body in rhythmic, repetitive motions; examples are walking, running, bike riding, and dancing.

  • Flexibility exercise stretches your muscles to keep them elastic and to keep your joints moving freely; examples are yoga, Tai Chi, foam rolling, and stretching.

  • Resistance exercise uses weight or resistance to make your muscles work harder; examples are weight lifting, resistance band exercises, pull-ups, and push-ups.

A number of organizations, including the American Cancer Society (ACS) and the American College of Sports Medicine (ACSM), have published exercise recommendations for people living with and beyond cancer. Still, most people who have been diagnosed with cancer don’t exercise regularly.

In many cases, people receiving cancer treatment — especially treatment for advanced-stage cancer — don’t exercise because they, along with their doctors, are concerned that exercise may not be safe for them.

Although there are fewer studies on diet and cancer, we know that eating a healthy diet full of nutrient-dense fruits, vegetables, and protein and limiting or avoiding processed and sweetened foods can help you maintain a healthy weight, with little or no excess fat.


Guideline recommendations

When developing the exercise and diet guidelines for adults receiving cancer treatment, ASCO experts reviewed many studies. The most common types of cancer the experts looked at were:

  • breast cancer

  • prostate cancer

  • lung cancer

  • colorectal cancer

The guidelines say:

Doctors should recommend regular aerobic and resistance exercise to people receiving treatment for non-metastatic cancer. Non-metastatic breast cancer means that the cancer has not spread outside of the breast area. (Metastatic cancer means that the cancer has spread to areas in the body that are away from the initial site.)

Doctors may recommend exercises before surgery for people diagnosed with lung cancer.

The experts also say there currently isn’t enough evidence to make a recommendation for or against a number of different diets or ways of eating to ease side effects or improve quality of life, including:

  • ketogenic diet

  • low-carbohydrate diet

  • low-fat diets

  • fasting

  • functional foods

There also wasn’t enough evidence to make a recommendation for or against trying to lose weight while receiving cancer treatment.

The guidelines also say that neutropenic diets — specifically diets that exclude raw fruits and vegetables — aren’t recommended to reduce the risk of infection in people receiving cancer treatment because the risks likely outweigh the benefits. Still, the experts did point out that there isn’t much quality research on the subject. People on neutropenic diets follow strict food safety guidelines and avoid foods that are likely to expose them to microbes and bacteria, including processed and cured meats, raw fish, and frozen fruits and vegetables.

“The guidelines tried to call to attention that there are areas such as weight management that had very limited quality evidence,” Sami Mansfield, founder of Cancer Wellness for Life and one of the guidelines’ authors, told Mansfield is also an oncology exercise specialist who leads BUILD, a functional exercise program for cancer survivors.

“While we were not able to make concise recommendations in this guideline, these topics should continue to be studied with quality clinical trials to provide additional future evidence.”


What this means for you

If you’re receiving treatment for non-metastatic breast cancer, these guidelines support and encourage you to exercise regularly, at an intensity level you’re comfortable with.

If you’re receiving treatment for metastatic breast cancer that has spread to the bones, research published in August 2021 found that you can safely participate in supervised exercise programs.

Exercise can ease certain side effects of breast cancer treatment, including fatigue, anxiety, and depression, as well as improve overall quality of life.

Because cancer treatments can change how you move and function, it makes sense to talk to your doctor before you start a new exercise program and ask if there are certain things you shouldn’t do.

It also makes sense to start slowly, especially if you’ve never exercised before. You may want to start by walking for 15 to 20 minutes a day and gradually increasing the amount of time you walk. Slow bike riding or gentle stretching is also a good way to start.

“It’s very beneficial for anyone who is resuming or starting an exercise program to start with short duration, moderate intensity, full-body movements, using only their body weight,” Mansfield explained. “You can do things at home with minimal equipment. For example, you could go from sitting in a chair to standing up. Or you can sit in a chair and do leg lifts and pull-backs holding a can of soup in each hand. Focus on controlled settings, using balance assistance as needed, and emphasize good posture and full range of motion. If you’re uncertain of where to start, talk to your doctor about a referral to a trained cancer physical therapist for an evaluation and a plan.”

Learn more about Exercise.

To talk with others about the benefits of exercise and to share exercise tips and get encouragement, join the conversation on Working on Your Fitness in our community.

Written by: Jamie DePolo, senior editor

— Last updated on June 16, 2022, 9:23 PM

Reviewed by 1 medical adviser
Brian Wojciechowski, MD
Crozer Health System, Philadelphia area, PA
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