★ Physical Activity and the Cancer Patient ★

Physical Activity and the Cancer Patient

 - American Cancer Society -

 

In the past, people being treated for a chronic illness ( such as cancer or diabetes) were often told by their doctor to rest and reduce their physical activity. This may still be true if movement causes severe pain, rapid heart rate, or shortness of breath.

Newer research has shown that exercise is not only safe and possible during cancer treatment, but it can improve physical functioning and quality of life.

Too much rest may result in loss of function, strength, and range of motion in the person with a chronic illness.

 

As a result, many cancer care teams are now urging their patients to be as physically active as possible during cancer treatment.

Regular exercise is an effective way to counteract the negative effects of inactivity in chronic illness.

 

※ Possible benefits of regular exercise during cancer treatment

1. keep or improve your physical abilities
2. better balance, lower risk of falls and broken bones
3. keep muscles from wasting due to inactivity
4. lower risk of heart disease
5. less risk of osteoporosis (weak bones that are more likely to break)
6. better blood flow to legs and lower risk of blood clots
7. less dependence on others to do normal activities of daily living
8. improved self-esteem
9. lower risk of anxiety and depression
10. less nausea
11. better ability to keep social contacts
12. fewer symptoms of fatigue
13. better weight control
14. improved quality of life

We still do not know a lot about the effects of exercise and physical activity on recovery from cancer and on the immune system. But regular moderate exercise has been found to have health benefits for the cancer patient. Moderate exercise is defined as activity that takes as much effort as a brisk walk.

 

While there are many reasons for being physically active during cancer treatment, each person's exercise program should be based on what is safe, effective, and enjoyable for that person.

Your exercises should take into account any exercise program you already follow, what you can do now, and any physical problems or limits you have.

You and your doctor should tailor an exercise program to meet your interests and needs.

The type of cancer you have; your cancer treatment; and your stamina, strength, and fitness level all affect your ability to exercise.

What may be of low or moderate intensity for a healthy person may seem like a high intensity activity for some cancer survivors. While some people can safely begin their own exercise program, many will have better results with the help of an exercise specialist, physical therapist, or exercise physiologist.

Be sure to get approval from your doctor first, and be sure that the person knows about your diagnosis and limitations. These specially trained professionals can help you find the type, frequency, duration, and intensity of exercise that is right for you.

 

※ Exercise safety and precautions for cancer survivors

Always check with your doctor before starting any exercise program. This is especially important if you are taking treatments that affect your lungs (such as bleomycin or radiation to the chest) or your heart (such as doxorubicin or epirubicin) or if you have risk of lung or heart disease.

• Do not exercise if you have anemia (low red blood cell count).  
• If you have low white blood cell counts or if you take medicines that may reduce your ability to fight infection, avoid public gyms and other public places until you are back at safe levels.
• Do not exercise if the level of minerals in your blood, such as sodium and potassium, are not normal. This can happen if you have had a lot of vomiting or diarrhea.
• If you are very tired and don't feel up to exercising, you can try to do 10 minutes of stretching exercises every day.
• Avoid uneven surfaces  that could cause a fall and injury.
• Do not use heavy weights or do exercise that puts too much stress on the bones if you have osteoporosis, cancer that has spread to the bone, arthritis, nerve damage, poor vision, poor balance, or weakness. You may be more likely to injure yourself or break bones.
• If you have numbness in your feet or problems with balance, you are at higher risk for falls. You might do better with a stationary reclining bicycle, for example, than a treadmill.
• Watch for swollen ankles, unexplained weight gain, or shortness of breath while at rest or with a small amount of exertion. Let your doctor know if you have any of these problems.
• Do not exercise if you have unrelieved pain, nausea/vomiting, or any other symptom that causes you concern. Call your doctor.
• Do not exercise above a moderate level of exertion without talking with your doctor. Remember, moderate exertion is about as much effort as a brisk walk.

 

 

§ Effective exercise

 

To make your exercise most effective, it is important that you work your heart. Pay attention to your heart rate, your breathing, and how tired your muscles get.

If you get short of breath or very tired, rest for a few seconds, and start back exercising as you are able.

Start slowly at first, and over the next few weeks, increase the length of time you exercise.

Be careful if you are taking blood pressure medicine that controls your heart rate. Your heart rate will not go up, but your blood pressure can get high. Ask your doctor, nurse, or pharmacist about this if you are not sure about your medicine.

The best level of exercise for someone with cancer has not been established. But the goal is to have your exercise program help you maintain endurance, muscular strength, flexibility, and level of functioning.

The more you exercise, the more your ability to exercise can improve and your ability to function can improve.

It is common for people who have exercised before they were diagnosed with cancer to need to reduce their intensity (make it easier and less taxing) and amount of exercise during treatment. Even if planned exercise stops, it is good to continue being active by keeping up your normal activities.

 

Things to think about when planning an exercise program

• Discuss any exercise with your doctor before starting.
• Start slowly with an exercise program. Even if you can only do an activity for a few minutes a day it will help you. How often and how long you do a simple activity like walking can be slowly increased. Your muscles will tell you when you need to slow down and rest.
• Try short periods of exercise with frequent rest breaks. For example, walk briskly for a few minutes, slow down, and walk briskly again, until you have done 30 minutes of brisk activity. You can divide the activity into three 10-minute sessions, if you need to. You will still get the benefit of the exercise.
• Try to include physical activity that uses large muscle groups. Strength, flexibility, and aerobic fitness are all important parts of an exercise program that works.
• Try to include some exercises that will help you keep lean muscles mass and bone strength, such as exercising with resistance or light weights.
• You might want to include exercises that will increase your flexibility and maintain the range of motion in your joints.
• Always start with warm-up exercises for about 2 to 3 minutes. Examples of warm-up exercises are shoulder shrugs, lifting arms overhead, toe tapping, marching, and knee lifts. End your session with stretching or flexibility exercises. Hold the stretch for about 15 to 30 seconds and relax. Remember to breathe when you stretch. Examples of stretching are reaching overhead, deep breathing, and bending over to touch your toes so that you relax all the muscle groups.
• Exercise moderately.

 

 

§ Too tired to exercise -- Fatigue in cancer

Most cancer patients notice a loss of energy. During chemotherapy and radiation, about 70% of patients have fatigue. For many, fatigue is severe and limits their activity. Inactivity leads to muscle wasting and loss of function.

An aerobic training program can help break this cycle. In research studies, regular exercise has been linked to reduced fatigue. It is also linked to being able to do normal daily activities without major limitations.

An aerobic exercise program can be prescribed as treatment for fatigue in cancer patients. Talk with your doctor about this.

Tips to reduce fatigue:

• Set up a daily routine that allows activity when you are feeling your best.
• Exercise regularly at light to moderate intensity.
• Get fresh air.
• Unless you are told otherwise, eat a balanced diet that includes protein (meat, milk, eggs, and legumes such as peas or beans) and drink about 8 to 10 glasses of water a day.
• Keep your symptoms such as pain, nausea, or depression controlled.
• To save energy, keep things you use often within easy reach.
• Enjoy your hobbies and other activities that give you pleasure.
• Use relaxation and visualization techniques to reduce stress.
• Balance activity with rest that does not interfere with nighttime sleep.
• Ask for help when you need it.

§ Keep it fun

The key is to keep your exercise program simple and fun.

Exercise and relaxation techniques are great ways to relieve stress.

Reducing your stress is a vital element in maintaining health.

 

Tips to enhance your interest in your exercise program

• Set short-term and long-term goals.
• Focus on having fun.
• Do something different to keep it fresh. Try yoga, dancing, or tai chi.
• Ask for support from others, or get friends, family, and co-workers involved in your exercise program.
• Use charts to record your exercise progress.
• Recognize and reward your achievements.

Beginning an exercise program can be a big task, even for a healthy person. It may be even harder for you if you have a chronic illness, more so if you were not used to exercising before your diagnosis. Start slowly and build up as you are able. If you were exercising regularly before you were diagnosed with cancer, you may need to reduce your intensity and length of exercise sessions.

 

Let exercise provide you with its benefits.

• helping prevent muscle wasting
• reducing the side effects of treatment
• improving your fitness
• improving your quality of life

 

Ways to add physical activity to your daily routine

Remember, only do what you feel up to doing.

• Take a walk around your neighborhood after dinner.
• Ride your bike.
• Mow the grass or rake the leaves instead of using the blower.
• Scrub your bathroom.
• Wash and wax the car.
• Play active games with the kids, like freeze tag, jump rope, and the games you loved to play when you were a kid.
• Walk a dog (one that can be controlled enough that you don't trip or get pulled off balance.)
• Weed your garden by hand.
• Take a friend dancing, or dance in your own living room.
• Use an exercise bike or treadmill or do arm curls, squats, lunges, and sit ups while watching TV.
• Walk to lunch.
• Park your car in the farthest parking space at work and walk to the building.
• Use the stairs instead of the elevator or escalator.
• Get off the bus several stops early and walk the rest of the way to work.
• Make appointments for yourself in your daily planner for 10-minute walking breaks.
• Form a walking club of co-workers to help you stay motivated to walk during the workday.
• Wear a pedometer every day and increase your daily steps.

Cancer survivors may need to exercise less intensely and increase their workout at a slower rate than people who are not getting cancer treatment. Remember, the goal is to keep up as much activity as possible. Keep it safe, keep it effective, and keep it fun.

 

 

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The benefits of exercise in cancer prevention and treatment in the medical literature have documented causal relationships between exercise and prevention and exercise and quality of life issues. However, specific dosage for exercise programs have yet to be established.

guidelines based on research in non-clinical populations offer clues for these exercise programs.

For example, detrimental effects on the immune systems in athletes provide the common-sense suggestion that the cancer population exercise at levels that are moderate, not intense.

The National Institute of Health (NIH) has recommended a program of moderate exercise, which includes such activities as walking, climbing stairs, and gardening, playing with children for non-clinical populations. These activities should be performed 6 - 7 days per week and can occur in 3 ten-minute sessions. The same moderate prescription is recommended for cancer patients.

The American College of Sports Medicine (ACSM) recommends for cancer patients undergoing treatment exercise programs that help patients meet the goal of maintaining cardiovascular endurance, muscular strength and level of functioning.

Scientific research has documented that walking or bicycling 30 - 45 minutes per session, 3 - 5 days per week produces the following benefits: decreased nausea, decreased fatigue, increased physical endurance and increased quality of life. The benefits are believed to come from effects on hormone levels, adiposity, gut transport time, and endorphins produced by exercise that are believed to affect mood.

Various types of aerobic and resistive exercises also improve the functioning of the heart/lung/circulation (cardiovascular system) and strength of the muscles. Aerobic exercise programs have added benefit of increasing the red blood cell count positively affecting the fatigue suffered by cancer patients undergoing treatment.

While receiving the various cancer therapies, minimizing deconditioning of the body is the main goal of exercise program. The better condition you can maintain your body, the better you will tolerate the side effects of chemotherapy, radiation and other invasive treatments. It will also be easier to do the required activities of daily living

If you have been inactive for a long period of time, your muscles will begin to atrophy; that is, they will shrink in size and strength. Having an arm or leg in a cast demonstrates this process well. The longer you lie in bed or sit in a chair, the longer it will take you to regain your normal muscle strength and return to more active living.

But you can start an exercise program that will build your muscle tone and stamina, no matter how limited your present physical condition.

Such an exercise program introduces activities gradually, starting first with passive and gentle limbering exercises. Even though the first series are done in bed, they will minimize joint and muscle deterioration, and will possibly prevent complications such as bone softening, blood clots, or even bedsores.

From this low energy program, you progress to sitting exercises which work against greater resistance, to build muscle tone. At this point you will be concentrating on the walking muscles. As you begin to spend a greater part of the day up and around, more active and vigorous exercises are brought into the program.

Exercising is enjoyable and can relieve the boredom and depression that often follows an extended stay in the hospital or confinement at home. Family and friends should be encouraged to learn the exercises with you. Exercising together, you will be more likely to stick to your program, and will feel more a part of the family again. Your companions will also get the satisfaction of directly participating, and helping you to return to more active living.

An important additional reason for their participation is safety. In the beginning, you may feel unsure of your ability to exercise, and may need them to help you into a comfortable position to start your exercises. They should be present, too, when you begin sitting or standing exercises, as you may feel dizzy when standing or bending over after a period of prolonged bed rest.

You may think that all useful exercises must be a part of a structured program which you do in one place at one time. While this may be true at first, later programs can use household chores, gardening, and sports activities as a means of exercising specific parts of the body. The more structured exercises can be done to prerecorded music and instructions. This helps organize and direct your daily exercise program, and makes it more pleasurable.

If you are recovering from a mastectomy, amputation, or other serious operation, special exercises would be added to the program, and alterations made where necessary.

 

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Exercise Therapy and the Cancer Patient

By Howard Stidwill

Depending upon the type and stage of cancer, as well as the treatment protocol, an appropriate exercise prescription should be seen as an important part of the treatment strategy.

This article will address several of the physical and psychological benefits of exercise and will assist cancer patients resume their daily living activities and a sense of normalcy.

In addition, an increased level of fitness will allow those going through the cancer experience to tolerate treatments more effectively with a greater adherence to the treatment schedule and possibly better results.

 

<Physical Benefits>

 

Aerobic Capacity

Aerobic activities utilize major muscle groups, are rhythmic in nature and are slow enough to allow the heart and lungs to supply oxygen to the exercising muscles.

They may be done as part of a warmup or lead in to other activities or more as a "stand alone" activity. As part of a warm-up, some form of aerobic activity should be done prior to flexibility and resistance exercises. Examples include walking, cycling and swimming.

The use of aerobic exercises approximately 20-30 minutes a day, several times a week have been shown to minimize the effects of fatigue, nausea and depression for many cancer patients. The increased circulation will also assist in the removal of waste products due to the effects of chemotherapy or radiation.

 

Balance

Balance exercises may improve balance that may be due to a loss of muscle mass or neurological damage such as neuropathy.

 

Bone Density

Moderate weight bearing exercise such as walking or lifting weights will minimize the loss of bone density that may result from metastasis to the bones or from the use of hormone therapy such as estrogen therapy for prostate cancer or tamoxifen for breast cancer.

 

Fatigue

Fatigue or what is known as cancer related fatigue (CRF) is very common occurence during the treatment and post treatment phase. A spiralling effect often occurs whereby an individual becomes less physically active and deconditioned. The individual therefore loses strength and does less. Aerobic and resistance exercises have been shown to intervene in this cycle with less fatigue on the part of the patient.

 

Flexibility

Flexibility is often lost as a result of scarring of the connective tissue or skin related to surgery or radiation, as well as the shortening of muscles due to inactivity. Stretching prior to exercise such as after a warm shower or a daily walk is suggested. Stretching at the end of an exercise session is also an ideal time as muscles have been warmed up and are more pliable. Stretch slowly not using too much momentum or bouncing types of movement when stretching. Lifting weights slowly through a complete range of motion will often increase flexibility.

 

Strength

Many cancer patients lose strength simply due to a lack of use. This is common in breast cancer where patients are afraid to lift objects with an affected arm. Moderate strength or resistance training will assist in maintaining strength which is essential in performing daily activities such as carrying groceries or raking the leaves.

 

Weight Management

Some cancer patients gain weight due to inactivity and hormone treatment. Those with advanced cancer often experience severe weight loss or cachexia due to the loss of fat and muscle. Aerobic activities will assist in the management of weight gain while light resistance exercise will maintain some degree of muscle mass for those experiencing cachexia. Exercise may also stimulate one's appetite which is often lost during chemotherapy.

Increased Tolerance of Treatment

While exercise will, unfortunately, not cure cancer its therapeutic effects will often allow for a greater tolerance of treatment. Greater adherence to one's treatment regimen may, in turn, increase the likelihood of recovery. A common mistake for those undergoing treatment is waiting to feel better before beginning to exercise or stated differently, "waiting to get better, to get better" thereby delaying the recovery process and a return to their former self

 

<Psychological Benefits>

 

Anxiety

Whether due to a "time-out" effect, biochemical changes or the increased body temperature of exercise exerting a calming effect, many symptoms of anxiety such as muscle tension or sleeplessness can be reduced or managed by moderate aerobic activity or by the slow meditative movements of the Eastern traditions such as Tai Chi.

 

Control

Loss of control and identity is commonly associated with cancer diagnosis. Many of the physical benefits of exercise enable one to perform activities of daily living (ADL) and gain a greater sense of control and identity.

 

Depression

Whether biochemical in nature or by gaining a measure of control, exercise has been shown to reduce depression that is commonly associated with cancer.