Research in the field of exercise oncology has created a large and consistent body of knowledge regarding the benefits of physical exercise throughout the cancer continuum. In this regard, several international organizations, in particular the American College of Sports Medicine® (ACSM), have published recommendations based on the existing evidence that justifies the need for appropriately programmed physical exercise for the prevention and management of cancer-related side effects such as fatigue, loss of function, or anxiety and depression.
These recommendations were largely based on studies that included patients without metastases. The exercise effects in people with metastases have not yet been extensively studied, and these patients are often excluded from clinical trials. In this context, the EFFECT study (NCT04120298) was conducted at centers in Europe and Australia to assess the effects of physical exercise on quality of life, fatigue, and other side effects in people with metastatic breast cancer. The exercise program was structured, individualized, progressive, and supervised. The program duration was nine months and included balance, resistance, and aerobic training two days per week for the first six months and one day per week from the seventh to the ninth month.
Over the course of the EFFECT study, we had a case, published in the October 2023 issue of Medicine & Science in Sports & Exercise®, of particular interest to exercise professionals. The case highlights the value of adding supervised exercise to the treatment of patients with metastatic disease.
One of our participants, a 75-year-old woman, had regularly attended the training program under the direct supervision of the same physical trainer. During the seventh month of training, the trainer noticed some subtle changes in the patient’s motor function. For example, the patient displayed issues during balance exercises, and she required longer rest intervals or a reduction in load during aerobic training. Additionally, the loaded movements that she had previously mastered, such as the bench press, became more uncoordinated. The trainer also noticed the patient had a slightly slower eyelid movement. However, the patient did not seem concerned about the changes, and when the trainer suggested she discuss these changes with her oncologist, the patient’s own indifference delayed this. Suspecting brain metastases based on the patient’s subtle deterioration in neurological functioning, and with the patient’s permission, the trainer herself spoke to the clinician, who immediately ordered an MRI scan, which confirmed the suspected brain metastases.
The primary lesson of this case is that exercise trainers by the nature of their profession can detect small but important changes in motor function that patients, relatives, or clinicians themselves may not be able to detect in the early stages of brain metastases. This highlights the importance of proper qualification and education, especially for supervising people with diseases like cancer, and the advantages of supervised exercise training. At the same time, it is necessary to create adequate channels of communication between the patient, trainer, and clinician to ensure that relevant information is conveyed in a timely manner. Although early detection of brain metastases does not result in prolonged survival in every patient, for some patients this can be the case and for others early treatment might prevent further loss of quality of life.
In summary, our case report adds another advantage to implementing supervised physical exercise as part of routine cancer care. It emphasizes the importance of skilled exercise trainers and the benefit of a close collaboration between the medical team and exercise professionals.
Acknowledgements: The EFFECT study is part of the PREFERABLE project and received funding from the European Union’s Horizon 2020 research and innovation program (grant agreement No. 825677). The study is also co-funded by the National Health and Medical Research Council of Australia (2028/GNT1170698).
Dr. Mireia Pelaez’s research focuses on the effects of physical exercise in special populations, specifically cancer (treatment-related side effects) and pregnancy (excessive weight gain and its consequences). She currently combines her teaching activity as an associate professor at the European University of the Atlantic in Santander, Spain, with her research activity as a project manager for GoNorte and freelance consultant. You can find Dr. Pelaez at Instagram or X: @mireia_pelaez.
Dr. Anne May is a professor of the clinical epidemiology of cancer survivorship and director of research at the Julius Center at the University Medical Center Utrecht in the Netherlands. She investigates the effects of lifestyle on treatment-related side effects and prognosis as well as in the underlying mechanisms, with a special emphasis on physical activity and exercise. Dr. May has served on lifestyle- and cancer-related guideline panels (ACSM/ASCO/WCRF) and is the principle investigator for several large national and international exercise RCTs, including Preferable (h2020preferable.eu) and Preferable II (preferable2.eu). You can connect with Dr. May at X: @annemariamay and follow PREFERABLE at X: @preferable_mbc.
