Exercise and Cancer: Growth, Treatment Response & Managing Side Effects
Featuring: Lee Jones, PhD
In short
Cancer researcher Lee Jones, PhD, from Memorial Sloan Kettering shares what science currently knows about exercise and cancer — including how chemotherapy can cause the equivalent of 10–15 years of physical aging in just a few months, and how carefully dosed exercise may help slow that decline, support immune function, and potentially influence cancer progression. The content is grounded in ongoing clinical trials and is useful for patients actively in treatment or in recovery who want to understand the role exercise can realistically play.
- •Chemotherapy can cut your fitness by 5–20% in just three months — ask your care team about starting a supervised exercise program during treatment to help limit that decline.
- •Exercise dose matters and is not one-size-fits-all: your cancer type, treatment stage, and personal fitness level should shape your plan, so ask for a referral to an exercise physiologist who works with cancer patients.
- •A cardiopulmonary exercise test can measure your current fitness baseline — this gives your team concrete data to build a safe, personalized exercise prescription rather than guessing.
- •There is currently no randomized evidence that exercise prevents cancer, but ongoing phase 3 trials are actively testing whether it reduces recurrence and improves survival — so findings in this area are still emerging.
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“When we measured individuals going through standard chemotherapy, we found that fitness could decline anywhere from 5% to 20% over a period of three months. ’ Typically, you see a 10% decline in somebody's fitness level over a decade; your fitness will decline 1% per year. You see 10 to 15 years of aging in just three to six months of chemotherapy.
” – Lee Jones, PhD “I work on thinking from a biological perspective, a translational perspective, how exercise can influence cancer.
Meeting Summary
While medical researchers have made significant advances in cancer therapies, these are far from perfect and complementary approaches are needed that are non-toxic and may also help lower your risk of progression and improve your outcomes. Exercise is an intervention you can use to control or offset your cancer and the side effects of therapies.
You may wonder which exercise and other lifestyle approaches you should adopt after your cancer diagnosis that are grounded in scientific research. Lee Jones, Director, Exercise-Oncology Program, Member and Attending Physiologist, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Professor, Weill Cornell Medical College, is uniquely qualified to talk about the latest research on exercise and cancer development and progression.
His academic career has focused on a near patient translational approach on the effects and mechanisms of highly controlled exercise in health and disease with an emphasis on cancer. His team was among the first to adopt traditional and molecular epidemiological approaches to investigate the link between post-diagnosis exercise and clinical outcomes in patients with cancer.
Building on these efforts, they leveraged established as well as novel mouse model systems to uncover whether and how exercise alters tumor growth kinetics and biology at the cellular and molecular level. , prevention to advanced disease).
Adhering to a rigorous translational development pipeline, they are conducting the first ever phase 1 trials to evaluate the tolerability and tissue / tumor biological efficacy of exercise therapy in persons with and at-risk of cancer.
To enhance conduct of these trials, they have pioneered a decentralized, patient-centric approach called the Digital Platform for Exercise (DPEx) which permits all study procedures to be conducted remotely inpatient’s homes. Why is exercise important for cancer patients?
•Mitigate treatment side effects : can help prevent the significant decline in fitness during cancer treatment; you can lose 5-20% of your fitness in just three months of chemotherapy.
•Counteract accelerated aging : can help slow or reverse the process of rapid physiological aging – feeling like you’ve aged 10 years in just a few months.
•Slow cancer progression : can influence cancer progression, potentially preventing recurrence or slowing cancer growth, according to emerging research.
•Improve overall physical function : can help maintain muscle mass, strength, and cardiovascular health during and after treatment.
•Support your immune system : can enhance immune surveillance, potentially helping the body detect and control damaged or mutated cells.
•Improve therapy response : can improve response to certain cancer therapies. What is the emerging scientific evidence connecting exercise and outcomes for cancer patients, including potential benefits?
•Observational studies suggest exercise may lower risk of 13 different cancer types, potentially reduce cancer mortality (especially in breast and colorectal cancers), and mitigate physiological aging during and after cancer treatment.
•Current research focuses on understanding exercise as a potential cancer treatment strategy, in addition to a symptom control intervention.
•Ongoing phase three trials (studies that test safety and how well a new treatment works compared with a standard treatment) are investigating exercise's impact on cancer recurrence and overall survival. There is no randomized data suggesting that exercise lowers the risk of any form of cancer.
•Preliminary research shows promising findings, e.g., in a prostate cancer study, 225 minutes of weekly exercise was feasible (i.e., achieved good compliance) and showed promising biological activity in tumor markers.
•Challenges remain: more rigorous research is needed to definitively prove exercise's anti-cancer effects, treating it more like a "drug" with careful dosing and patient selection. What is general advice on exercise?
•Aim for 225 minutes of exercise per week, spread across 5 days. (This is only for prostate cancer. We don’t know if it applies to other tumor types yet.)
•Personalize your prescription of exercise based on your fitness level and what your target is: body composition vs. fitness vs. cancer control. There is overlap, but the goal is to match your prescription with your goal and not just “one size fits all”.
•Consult with qualified exercise physiologists or oncology teams to develop a personalized exercise plan How should you personalize your exercise?
•Consider your current treatment stage, cancer type, physiological capacity, and potential risk of over-training to create a precise, adaptable exercise plan. Vary intensities and session lengths within the same week. In the future you will also base your exercise prescription on other characteristics, such as treatment type, tumor biology, etc
•Conduct a cardiopulmonary exercise test to determine your baseline fitness level
•Monitor your compliance and physiological adaptation and modify your program based on your progress; focus on finding your "sweet spot" of exercise dosage How can you learn more?
•Reach out to Lee Jones for discussions and questions and to get links to his papers at lee.jonesphd@gmail.com
•Review previous Cancer Patient Lab discussion on exercise, including:
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•Adding Exercise for Everyday Life and Developing a Medical Device to Personalize Cancer Treatment
•“Exercise as a Countermeasure to Hormone Deprivation Therapy Side Effects and for Bone and Mental Health” The information and opinions expressed on this website or platform, or during discussions and presentations (both verbal and written) are not intended as health care recommendations or medical advice by Cancer Patient Lab, its principals, presenters, participants, or representatives for any medical treatment, product, or course of action. You should always consult a doctor about your specific situation before pursuing any health care program, treatment, product or other course of action that might affect your health. For the video recording of this conversation, please see here. Meeting Notes KEYWORDS Exercise oncology, cancer treatment, exercise physiology, fitness decline, biological aging, exercise trials, phase three trials, exercise prescription, cancer recurrence, exercise benefits, resistance training, aerobic training, inflammation, hormesis, exercise compliance. SPEAKERS Lee Jones (79%), Cindy Ness (5%), Brad Power (5%), Richard Anders (4%), Roger Royse (2%), Chris Apfel (2%), Alexander Lalov (1%), Rick Davis (1%), Jim Ward (1%) CHAT CONTRIBUTORS Robb Owen, Alane Watkins, Roger Royse, Se, Alexander Lalov, David Plunkett, Cindy Ness, Rick Davis, Jim Ward, Chris Apfel, Richard Anders SUMMARY Lee Jones, a PhD researcher on exercise and cancer, discussed his career trajectory and current research at Memorial Sloan Kettering. He highlighted the lack of evidence in the early 1990s on the feasibility and benefits of exercise in cancer patients, leading to his first studies in colorectal, breast, prostate, and lung cancers. Jones emphasized the importance of rigorous exercise trial design, including phase one studies to identify optimal doses and feasibility. His recent work found that 225 minutes of exercise per week was the most effective dose for prostate cancer patients, with higher doses showing no additional benefits. Jones also discussed the challenges and benefits of a decentralized exercise trial model. OUTLINE Introducing Lee Jones
•His journey has been from the UK to Canada to the US.
•His early career was in Edmonton, Alberta, where he worked with Kerry Courneya on the first studies in exercise for individuals with cancer.
•He moved to Duke University in North Carolina, where he started his lab and received grants for his research.
•He joined Memorial Sloan Kettering (MSK) in 2014, where he established the exercise oncology program with a team of 32-33 people.
•He recently accepted a new position at City of Hope in East LA, starting on July 5, where he will start a new research program in exercise oncology. Initial Research and Findings
•His initial focus was on behavioral exercise intervention, studying how to initiate and maintain exercise in individuals with cancer.
•There was a lack of evidence in the early 1990s to suggest that exercise was feasible or beneficial for individuals with cancer.
•His first studies in colorectal, breast, prostate, and lung cancers showed the feasibility and tolerability of exercise during and after therapy.
•He became interested in the physiological adaptations and consequences of cancer and cancer treatment, using exercise physiology tools to measure organ function during stress. Impact of Cancer Treatment on Fitness
•There is a significant decline in fitness levels during cancer treatment, with a 5-20% decline in fitness over three months.
•There is accelerated physiological aging, where individuals feel like they have aged 10 years in just three to six months of chemotherapy.
•His research aimed to recover fitness levels to pre-treatment baselines and prevent dysfunction during treatment.
•You need to understand the optimal dose and timing of exercise to mitigate the physiological side effects of cancer treatment. Transition to Exercise as Cancer Treatment
•He shifted focus to whether exercise can influence cancer outcomes, either as a prevention or treatment strategy.
•His current research at MSK aims to understand how exercise can affect cancer progression and response to treatment.
•Rigorous development of exercise interventions is important, from discovery epidemiology to definitive clinical trials. Challenges in Exercise Research
•There are challenges in designing and conducting phase three trials of exercise in cancer, including the lack of evidence and the need for a rigorous development framework.
•Ongoing phase three trials are few, such as the Challenge Trial in colorectal cancer and the Interval Trial in metastatic prostate cancer.
•It’s important to understand the right dose and patient selection for exercise interventions. Decentralized Exercise Trials
•A decentralized approach to exercise trials, using technology to deliver exercise prescriptions and monitor compliance, is better.
•The decentralized approach to exercise trials involves sending treadmills and other equipment to patients' homes.
•The approach allows for more efficient recruitment and longer trial durations, beyond the typical 12-15 weeks.
•The non-linear exercise prescription includes different intensities and durations to elicit specific physiological responses.
•The approach has been used in various cancer settings, including high-risk individuals and those with cancer. Phase One Trial in Prostate Cancer
•There was a phase one trial in localized prostate cancer, which aimed to identify the optimal dose of exercise for anti-tumor activity.
•The trial recruited 53 non-exercising men scheduled for surgery, who were assigned to six different exercise doses ranging from 90 to 450 minutes per week.
•The trial found that 225 minutes of exercise per week was the recommended phase two dose, based on feasibility and biological activity.
•The results showed that higher doses did not provide additional benefits, and 225 minutes was deemed the optimal dose. Discussion on Exercise Prescription
•Exercise prescriptions should be tailored to each patient's physiological response.
•A non-linear approach to exercise is needed, which includes different intensities and durations.
•He offered to provide more detailed guidance on exercise prescriptions and to review individual cases.
•You should understand the right dose and patient selection for exercise interventions. Aging, the Use of Oxygen, and the Impact of Exercise on Cytokines and Natural Killer Cells
•There are challenges in measuring biological aging
•Fitness is important as an integrative measurement.
•The use of biomarkers in current studies are important for understanding the physiological effects of exercise.
•Rigorous development and testing of exercise interventions is needed to prove their efficacy. Invitation to Discuss
•Dr. Jones encouraged participants to reach out to him for further discussions and to stay informed about his research.
Full transcript
Brad Power This is the Cancer Patient Lab, and our weekly webinar series. We're honored to have Lee Jones with us, who's beaming to us from San Diego, where he's in transition, I gather, moving between things. He's with Memorial Sloan Kettering, and he's a PhD researcher on exercise and cancer, and he's going to share with us some of his research findings before we get started. This is for information purposes only. This is not medical advice.
We try to arm patients and caregivers with information they can take to their medical team. We are a 501(c)(3) nonprofit, and we depend on the kindness of people making donations. So if you're inspired to donate to support our activities like this webinar, you can do that very easily with the Donate button on our website.
Lee Jones
When I first started in this research area, which is probably 25 years ago, this area of exercising and cancer didn't exist. I don't know how much you know about my background, but you can probably hear by my accent that I'm not originally from San Diego or New York. I'm originally from the UK. That's where I did my undergrad.
I then moved to Canada to do all my graduate training, first in northern Ontario, before moving to Edmonton, Alberta, at the University of Alberta. That is important in my career trajectory because I started working with somebody named Kerry Courneya there. Kerry was a young professor at the time, and was just starting some of the very first studies about exercise in individuals with cancer, specifically colorectal cancers as it happened.
I was his first PhD student, which meant that I was doing everything. I was the clinical coordinator. I was the exercise physiologist. I was the person doing all the exercise prescriptions and every session with individuals undergoing treatment or afterwards.
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