The Regulation of the Metastatic Cascade by Physical Activity: A Narrative Review

The purpose of this narrative review is to provide an overview of the currently available knowledge about the mechanisms by which physical activity may affect metastatic development. The search terms exercise [Title/Abstract] AND metastasis [Title/Abstract] returned 222 articles on PUBMED on the 10 February 2019. After careful analysis of the abstracts, a final selection of 24 articles was made. Physical activity regulates the levels of metastatic factors in each of the five steps of the process. Moderate intensity exercise appears to prevent tumor spread around the body, among others, by normalizing angiogenesis, destroying circulating tumor cells, and decreasing endothelial cells permeability. Contrarily, high-intensity exercise seems to favor cancer dissemination, likely through excessive stress, which can be somewhat counteracted by an appropriate warm-up. In conclusion, chronic adaptations to moderate-intensity endurance exercise seem the most effective way to achieve a preventive effect of exercise on metastases. Altogether, the data gathered here reinforce the importance of encouraging cancer patients to perform moderate physical activity several times a week. To limit the undesired events thereof, a good knowledge of the patient's training level is important to establish an adapted exercise training program.