Eat better, move more, weigh less, live longer! It is the modern concept of healthy life, and it should be a special pursuit for tumor patients. The first three articles are the means, the latter is the end. Large-scale studies have confirmed that physical activity is both an effective primary and tertiary preventive measure against tumors. The World Public Health Recommendations and Health Promotion Activities recommended three effective tumor prevention measures worldwide, namely diet modification, tobacco control, and physical activity. Studies have found that physical activity in healthy people has a clear preventive effect on breast, colon, prostate, lung, and endometrial cancers, and the mechanism of action involves improving metabolic status, sex hormone levels, immune function, inflammatory response, and oxidative stress. The direct preventive effects on other tumors are less well studied and no definitive conclusions are available. According to the World Health Organization’s Global Recommendations for Physical Activity for Health and the U.S. National Physical Activity Program, active participation in physical activity is recommended for any individual over 6 years of age to help improve physiological function, enhance physical performance, and optimize body composition. The physical activity requirements for normal healthy people can be implemented by referring to the standards of the U.S. National Physical Activity Program, please refer to my previous blog post “Physical Activity” for details. Tertiary prevention of tumors Physical activity is safe and beneficial for patients with tumors and is widely applicable to patients with different diagnosis, gender, age, stage (stage I to IV), and treatment measures (surgery, radiotherapy, chemotherapy). A recent meta-analysis of randomized controlled studies published in the British Medical Journal by Fong DYT et al. showed that a mean of 13 weeks (3-60 weeks) of physical activity reduced insulin-like growth factor 1 levels, improved supine weight lifting, leg press, depression, fatigue and quality of life; improved body weight, BMI, right hand grip strength, 6-minute maximum walking distance, peak oxygen consumption, peak cardiac output. In conjunction with other studies, physical activity in oncology patients may also improve reproductive hormones, metabolic hormones, adipokines, growth factors, prevent obesity, reduce central adiposity, enhance immune function, increase lean mass, and reduce body fat; lower blood glucose levels, insulin levels, and IGFBP-3 levels; reduce oxidative DNA damage; reduce toxic side effects of chemotherapy and radiotherapy; and promote post-surgical recovery. It is suggested that physical activity of tumor patients can improve the physiological function, immune function, body composition, organism function, psychological status and quality of life of patients. Tumor-related fatigue, anorexia, early satiety, bloating, and constipation are the most common causes of quality of life in oncology patients, and research has demonstrated that physical activity is the best non-pharmacological approach to treat these symptoms, and is a routine clinical measure recommended by the Oncology Nursing Society (ONS). Physical activity can alleviate tumor-related symptoms in many different settings and stages, and is often effective in patients with end-stage palliative care. The more common causes of death in oncology patients are coexisting diseases such as cardiovascular disease, diabetes, and osteoporosis, rather than the tumor itself. Physical activity indirectly extends the survival time of oncology patients by reducing the risk of death from coexisting diseases. Physical activity also significantly reduces the incidence of second primary tumors, which in turn indirectly extends the survival time of tumor patients. Physical activity directly prolongs the survival time of tumor patients by reducing tumor recurrence and metastasis, and this effect has been demonstrated in many studies for breast, colon, and prostate cancers. Recent studies have reported that physical activity can reduce the risk of death by 30-50% in breast and colorectal cancer patients, an effect that cannot be achieved with any type of drug therapy. Physical Activity Requirements In 2010, the American College of Sports Medicine recommended that oncology patients engage in moderate to vigorous physical activity at least five times a week for 30-60 minutes each time. However, depending on the patient’s physical status and tumor stage, at least 30 minutes of moderate intensity physical activity at least once a week is the minimum requirement. Basic physical activities of daily life are low-intensity physical activities. The effect of low-intensity physical activities on tumor has not been confirmed, therefore, basic physical activities of daily life cannot replace the medium-intensity and high-intensity physical activities described in this article. For adult oncology patients, at least 5 times a week, 30-60 minutes of moderate-intensity and high-intensity physical activities are recommended in addition to physical activities of daily living. For adult oncology patients, at least 5 times per week, 30-60 minutes of moderate and vigorous physical activity in addition to daily physical activity is recommended. For pediatric and adolescent oncology patients, at least 5 times a week, 60 minutes of moderate and vigorous physical activity is recommended in addition to daily work and life physical activities. Also reduce the time spent in front of screens (e.g., computers, game consoles, TV) to no more than 2 hours per day. The NCCN guidelines recommend that patients start with low-intensity, short-duration exercise and gradually transition to the recommended intensity and duration of exercise, adjusting the exercise program as often as necessary based on the patient’s condition. The minimum requirement for starting exercise is 20-30 minutes, 3-5 times per week. Physical activity for oncology patients is not the longer the better or the more intense the better. Some studies have shown that high intensity exercise of more than 60 minutes per day will in turn increase patients’ fatigue and thus reduce their quality of life. Types of physical activity Moderate intensity physical activity: such as brisk walking (≥3 mph), dancing, horseback riding, lawn mowing, yoga, golf, work-related walking, lifting, tai chi, table tennis, tennis doubles, bicycling (<10 mph). High-intensity physical activities: such as race walking, jumping rope, running, fast cycling (>10 mph), soccer, hill skiing, heavy labor (e.g., logging, construction), basketball, tennis singles, round-trip swimming, backpacking fulfillment. The type of physical activity for oncology patients should be selected in the context of the actual condition of the oncology patient and environmental conditions. Before implementing physical activities, professional assessment is required to carefully evaluate which type of exercise is the most beneficial for the patient. Patients with osteoporosis, tumor metastasis, etc. are at high risk of fracture and should not engage in weight-bearing and strenuous physical activities, such as dancing, running, ball games, athletic sports, etc. However, they can choose slow-paced physical activities such as tai chi and swimming. Patients with bone metastases, leukopenia, reduced platelets, anemia, and fever should weigh the pros and cons and exercise with special care for these patients. Patients with leukopenic tumors should avoid sports and exercise environments with a high risk of infection. Gymnasiums, swimming pools, etc. are crowded and have a high risk of infection. The simplest but very effective exercise for the majority of oncology patients is brisk walking after dinner. The most important meal of the nation is dinner, which is the best and the most eaten, so choose after dinner. The basic requirements of walking after dinner are two: one is fast, ordinary walking is not useful, or not very useful; second is long, the time can not be shorter than 30 minutes, otherwise it will not achieve the effect. The study found that physical activity combined with physical and mental relaxation is more effective for oncology patients. 269 patients with chemotherapy for 21 types of tumors (except bone and brain metastases) with an average age of 47 years were randomly divided into exercise/relaxation group and conventional care group, and 235 patients completed the follow-up. The exercise/relaxation group received guided cardiovascular activity, counteracting exercise, relaxation training (muscle relaxation, 30 min/4 times/week), physical arousal and recovery training (e.g., yoga, Pilates mind training, 90 min/week), and massage (30 min, 2 times/week), and the results showed that patients in the physical activity plus physical and mental relaxation group had significantly improved vitality, physical fitness, physical fitness, stress, and mental health, and reduced fatigue; whereas patients in the usual care group had significantly reduced fatigue. The results showed that the patients in the physical activity plus relaxation group showed significant improvement in vitality, physical performance, physical fitness, stress and mental health, and fatigue; while the conventional care group showed no significant improvement. Relaxation of body and mind is one of the advantages and a characteristic measure of traditional medicine in China, such as qigong, taijiquan, acupuncture, tui na, massage, hypnosis and so on. Tumor patients may want to have relaxation therapy after physical activities, which can help improve the fatigue after physical activities as well as improve the prognosis of tumor. Why not? I sincerely wish all tumor patients move more, live longer!