Chances are somewhere along the way you have personally been touched by cancer. Either someone close to you or you yourself have heard the frightening words: “you have cancer”. Cancer does not discriminate between nationality, race, age or gender. For many confronted by a cancer diagnosis, the mind races ahead to thoughts of chemotherapy, fatigue and what the future may hold.

In most recent times, there has been a focus on the role of regular exercise in the prevention and treatment of cancer. But what about cancer and exercise? Is it safe? And even if it is safe, is it recommended?

There are major therapeutic roles that exercises plays in the treatment of cancer. Physical inactivity is a known risk factor for developing certain cancers, hence the role that exercise has in primary prevention. Exercise is now becoming an adjunctive treatment to counter commonly reported symptoms such as fatigue and muscle weakness. In addition to this, preliminary data is showing an increase in the benefits of exercise in reducing cancer recurrence, cancer specific mortality and all-cause mortality.

 

 

The Data

Data shows that higher levels of physical activity is associated with lower overall cancer mortality. For the non-smoker, dietary and physical activity interventions are the most important modifiable determinants of cancer risk.

– 48 studies with 40,000 patients demonstrated a 10% to 70% reduction in colon cancer in physically active individuals.

– 41 studies including 108,321 women evaluated breast cancer and possible risk reduction with physical activity.

– 26 studies demonstrated that both occupational and leisure time activity reduce breast cancer risk by as much as 30%.

 

Considerations

It is important to determine a few things before commencing exercise whilst undergoing cancer treatment. Firstly, it is important to become familiar with the type of therapy/therapies you are receiving. Secondly, you should listen to your body and determine how well you are tolerating therapy. Communicating this information to your Exercise Physiologist is paramount in developing a safe and suitable exercise program tailored to your needs.

 

Here at Restart…

Personally, I have a number of clients whom I have been fortunate enough to help either before, during, or post-chemotherapy treatment. One of which, Rachel aged 34, recently completed radiation treatment following a bout of chemotherapy, during which she maintained weekly individualised gym appointments with myself.

For the purpose of this blog, I asked Rachel a few questions regarding exercise and how it helped her during her cancer treatment. These are her words:

– “Initially I researched into the benefits of exercise and cancer treatment with regards to tolerating chemotherapy and reducing fatigue.

– I wanted supervised sessions with an Exercise Physiologist to provide professional guidance as not to exacerbate any of my symptoms and maintain muscle mass during treatment.

– When it came to tolerating chemotherapy, a lot of people undergoing treatment at the same time as me would miss treatment sessions due to low blood cell counts and thus have their dosage altered. I managed to get through the whole bout of chemotherapy without missing any sessions or changing any chemo doses.

– During chemo I did get a lot of muscle soreness, and stretching with my Exercise Physiologist helped reduce these symptoms, especially lower back pain.

– I believe that exercise helped in reducing my fatigue levels during chemotherapy, however I would still have to take it easy. Interestingly, I noticed that people that were not engaging in regular exercises appeared to be more fatigued than I was during the course of the treatment. This helped solidify my reasoning behind making the effort to regularly get to the gym and see Craig.”

 

 

 

Developing an exercise plan!

Currently there is no evidence to support a different training response to exercise in a patient with cancer from that in the general population. Therefore, a combination of aerobic, resistance and flexibility based training protocols is recommended. The initial exercise intensity level should be based upon:

1. Active treatment versus survivorship phase,

2. Response to treatment,

3. Pre-existing co-morbidities (Heart disease, Osteoarthritis),

4. Current level of activity,

5. Fatigue level.

Starting off at a lower intensity and slowly progressing is preferred; incorporate exercises such as walking and cycling to initially improve aerobic capacity and exercise tolerance. Free weights, machine weights and resistance bands to assist in maintaining lean muscle mass as well as flexibility based exercise to reduce the risk of musculoskeletal injuries is also recommended.

Fatigue is a common side effect associated with cancer treatment. Regular exercise counteracts many of the potential causes of fatigue, and studies show promise regarding exercises ability to mitigate the side effects of chemotherapy both during and following treatment. Aside from fatigue, studies in patients with cancer have also shown exercise to reduce side effects such as nausea and pain.

While the goal for all cancer patients is to progress gradually to 150min/wk of moderate intensity aerobic training, one has to consider that the path to this goal is not linear. There may be times in which exercise has to be reduced or ceased completely, but adjusting exercise programs accordingly and seeking guidance from a health professional is of utmost importance throughout the cancer journey.

Craig James

 

References

Clinical Exercise Physiology (2014), Jonathan K. Ehrman, Paul M. Gordon, Paul S. Visich, Steven J. Keteyian 3^rd Edition.