Alberta Innovates- Health Solutions

Statistics indicate that people are living longer with cancer and that in many cases, they are enjoying a better quality of life.

A big part of that has to do with medical research and technological advances that allow more targeted and effective therapies. But another part of it is a growing consciousness that nurturing all parts of a person's life, not just the physical aspect, will help people live with cancer, not in spite of it.

This holistic approach to cancer forms the basis of Heritage-supported researcher Dr. Kerry Courneya's research. Based in the University of Alberta's Faculty of Physical Education, Dr. Courneya is trained in kinesiology, the study of human movement, a field usually associated with excellent health. He was, however, always interested in health psychology, which led to a collaboration with Dr. Christine Friedenreich, a cancer epidemiologist at the Alberta Cancer Board in Calgary. The two conducted a literature search into the role of exercise in the lives of cancer patients, which showed that very few studies exist on the subject.

"The literature review led me to my current research question: what is the potential role of exercise both during and following treatment in cancer patients," says Dr. Courneya. "I'm approaching it from a quality-of-life perspective which includes the heart, mind, body, and soul. Medical outcomes like disease progression, disease recurrence, and survival rates are research goals further down the road." Carrying groceries, shovelling the walk, gardening, walking the dog when we can do these and other normal activities with minimal effort, we are enjoying functional well-being. It's a different story when we become injured or ill. Many cancer patients undergo major surgery, followed by courses of chemotherapy and/or radiotherapy. It can take months to recover from treatments, by which time patients are weak, out of condition physically, and unable to get back into their daily routine.

Dr. Courneya's research has revealed that current therapies for cancer patients do not address what patients are most concerned about, functional well-being. "The literature showed most interventions target emotional and social well-being, so we're doing really well in addressing these components of quality of life in cancer patients. But physical functioning is addressed only through physical rehabilitative therapy to help with specific range of motion."

Dr. Courneya, in collaboration with Dr. Friedenreich, Dr. Tony Fields of the Cross Cancer Institute, and Dr. Art Quinney of the University of Alberta, has set up a study involving patients newly diagnosed with colorectal cancer, a disease that affects both genders equally. These volunteers are given a baseline test of overall physical fitness and a quality-of-life assessment. Some participants immediately begin a home-based exercise regime, tailor-made to their needs, which they follow during the whole course of cancer treatment. Other participants do not receive the exercise program right away. At the four-month point, the time most adjuvant therapies are completed, both groups are tested again and the control group is given the exercise regime. The first fitness test of the group, of which the average age is about 65, showed a below average fitness level, based on what is considered normal for age and sex. This lower fitness level might be due, in part, to the sedentary lifestyle that often results from disease, surgery, and treatment.

The study examines a number of issues unique to cancer patients. Dr. Courneya comments, "We want to look at whether it is even feasible for cancer patients to exercise during treatment. About 75% of the participants in our study are going through chemotherapy and/or radiotherapy, so we want to identify the psychosocial and medical factors that affect their ability to follow the program. And we want to see if early intervention helps people cope with treatment better rather than waiting till after treatment to rehabilitate."

Although the idea of physical activity during cancer treatment contradicts medical advice which often urges patients to take it easy, Dr. Courneya's preliminary results show that people can do a lot more than was previously thought, even while in a gruelling chemotherapy regime. He has found much encouragement from both the patient volunteers and the healthcare professionals at the Cross. "We couldn't have gotten this study off the ground without the enthusiasm of the patients and the active involvement of cancer specialists. We needed a multidisciplinary team to try and address the issue of the potential role of exercise during cancer treatment. I see cancer rehabilitation being where cardiac rehabilitation was 30 years ago in terms of thinking about the potential role of physical exercise."

Dr. Kerry Courneya received a major equipment grant from AHFMR and also receives support from the Health Research Fund, administered by AHFMR on behalf of Alberta Health. He is in the University of Alberta's Faculty of Physical Education. The project is co-funded by the National Cancer Institute of Canada.