by Kathleen Ambach, R.N., B.S.N.
In the past, cancer patients were often advised to rest and avoid physical activity. This may still be true if activity produces pain, breathing difficulty, or rapid heart beat. But for many people with cancer, regular exercise can prove very beneficial. Too much rest and inactivity may result in loss of function.
Scientific evidence shows that a program of moderately intense activity can improve the quality of life for many patients undergoing active cancer treatment as well as for cancer survivors. Improved immune system functioning, improved physical conditioning, prevention of muscle wasting from inactivity, prevention of osteoporosis, improved blood flow, reduced risk of blood clots, improved bowel functioning, improved sleep patterns, and reduced fatigue are among the benefits.
A significant number of cancer patients experience muscle weakness, decreased functional capacity, and fatigue that prohibits many exercise activities. Patients often feel more tired during chemotherapy and/or radiation therapy treatment cycles. This is certainly normal and indicates that both the body and the cancer are being affected by the treatment.
So it is important to tailor an exercise regimen based on safety, effectiveness, and most of all, enjoyment. Before starting to exercise, patients should consult with their doctor on the types of exercise appropriate for them.
Current recommendations on frequency, intensity, and duration of exercise sessions during cancer treatment are largely based on symptom response. Remember: exercise during your most “energetic” part of the day and always stop if fatigue or other symptoms increase. Because certain types of chemotherapy can impact heart or lung function, it can be very important to exercise regularly to maintain functional capacity. Other cancer treatments, including surgery or radiation therapy that affects the lymph nodes, can put patients at risk for a type of swelling called lymphedema. For these patients it is important to do light activities because strenuous exercise may worsen the condition.
The goal of an exercise program is to help maintain endurance, muscle strength, flexibility, and level of functioning. The more you exercise, the more your ability to exercise improves, and your ability to function improves.
Plan an exercise program that includes activities using large muscle groups. Try walking, swimming, cycling, dancing, stepping, and Tai Chi. Exercise need not be intense to derive benefit. Exercise moderately. Moderate activity is anything that produces a slight increase in heart rate and breathing, but you need not break a sweat. This means exercising 3-5 times a week, each time for at least 30 minutes. However, daily exercise for a shorter duration may be preferable for deconditioned patients or those just starting an exercise program. On this, consult your doctor.
If you are only able to do limited activity, start with 5 minutes of exercise 3 times a day and add 1 minute to each interval until you are able to exercise for 10 minutes at a time. Try to work up to 20 minutes to 30 minutes 3-5 times a week. Progress slowly, paying close attention to any untoward symptoms.
If you feel you have a normal activity level, start with 20 minute to 60 minute sessions 3-5 times a week. Begin with 15 minutes at a time and gradually increase the time until you reach 20 minutes to 60 minutes a session. If this seems too difficult, try short increments of activity with frequent rest breaks. If you are walking, for example, walk briskly for a few minutes, slow down, walk briskly again, until you have done 30 minutes of activity. Or, divide the activity into three 10-minute sessions. You still get the benefit of the activity.
Most patients tolerate an exercise program both during and after cancer treatment quite well. However, patients experience numerous side effects to varying degrees during cancer treatment. These can range from mild to severe and may hinder exercise regimens. Fatigue, or loss of energy, occurs in about 70% of patients undergoing cancer treatment. Because both physical and psychological factors contribute to fatigue, it is considered one of the foremost cancer treatment-related challenges. Fatigue may be positively impacted by exercise due to the mood elevation it often produces.
If you find you are experiencing inordinate fatigue that interferes with your exercise regimen, make a bargain with yourself by setting a realistic goal with the promise that you can stop and rest when you reach it. Other tips to reduce fatigue include sticking to a daily routine, getting some fresh air, eating a balanced diet that includes 8 glasses of water a day, maintaining a regular bedtime, and adequately managing any pain you may have.
Although exercise may be an effective intervention for many cancer patients, some factors may make exercise unwise. If your blood counts are low, you may be at risk for infection or bleeding. If you are anemic (low number of red blood cells) you may become more short of breath while exercising. If you have bone pain or bone disease, avoid impact activities that may lead to falls or fractures. Do not exercise if you experience unrelieved pain, nausea, vomiting, dizziness, blurred vision, or swelling. You should always contact your doctor with any questions.
Making the effort to engage in any type of fitness activity is a great investment in your health, state of mind, and quality of life. There are countless benefits and reasons why everyone can benefit from exercise. Most important, keep it safe, keep it effective, and keep it enjoyable.
Kathleen Ambach, R.N., B.S.N., who cared for oncology patients for more than 20 years, is a member of the advisory board of the BioSynchronistics Institute, the national training arm of Quality Physical Therapy/BioSynchronistics, which has offices in Sturbridge on Main Street and in Charlton on Worcester Street. Recently, an office was opened in Barre as a convenience for both patients and referring healthcare professionals in nearby communities. Rehabilitation treatment is also done at all three offices. The practice’s website address is www.BioSynchronistics.com. You are invited to email article ideas to Info@BioSynchronistics.com.