Exercise during Cancer Treatment

The majority of oncologists agree that exercise is beneficial, important and safe for patients with cancer during treatment. Benefits include improved physical functioning, body composition, cardiopulmonary system functioning, appetite, sleep, and health-related quality of life.  Exercise may also improve a myriad of treatment side effects (bone mineral density, fatigue, peripheral neuropathy, lymphedema, weight gain or loss).

Importantly, exercise may reduce the risk of recurrence and improve survival. Possible anticancer effects of exercise include improved immune function, reduction of oxidative damage, reduced inflammation, improved circulation in the tumour microenvironment, enhanced systemic therapy, reduction of visceral fat, and improved insulin sensitivity.

Guidelines

While research strongly supports that people with cancer should be physically active during and following cancer treatment, there is still a lack of guidelines on the optimal frequency, intensity, time, and type of exercise for each specific cancer, cancer therapy, or phase of survivorship. Fortunately, there are general guidelines that you can adapt to create an individualized approach.

It is important to consult your physician prior to exercising during cancer treatment and you should consider working with a trained rehabilitation or exercise specialist, such as an InspireHealth Exercise Therapist if you are at moderate to high-risk for adverse events with exercise (i.e., survivors with peripheral neuropathy, lymphedema, anemia, ostomy, lung or abdominal surgery, cardiovascular or musculoskeletal comorbidities). There are a number of exercise contraindications, including some specific to cancer, that underscores the importance of speaking to your doctor first.

There are various agencies that publish guidelines for cancer survivors (i.e., ACSM, ACS, ESSA). General guidelines recommend that you incorporate cardio, strength, flexibility, balance and coordination exercises into your program. It is important to avoid inactivity and return to normal daily activities as soon as possible following diagnosis. Supervised exercise is likely more beneficial than unsupervised exercise. Below are recommendations for each type of exercise.

Cardio Exercise

Include large muscle groups such those in the legs, back, arms, or core. Examples include walking, running, swimming, biking, or cardio-equipment.

• Frequency: Aim for at least 150 min of exercise per week or as much as your condition will allow. More may be better but listen to your body. Spread your exercise throughout the week and in congruence with your treatment plan. Daily exercise may be preferable for deconditioned patients who do lower intensity and shorter duration exercise sessions.
• Intensity: Generally should be moderate – depending on your current fitness level. Moderate intensity is an exertion level of about 3-5 out of 10 and is an intensity in which you can talk but cannot sing (talk-test). Recent studies have found vigorous exercise to be beneficial in some populations.
• Time: At least 10 minute bouts. Deconditioned patients or those experiencing severe side effects from treatment may need to combine shorter bouts (e.g. 1–5 min) with rest intervals.
• Progression: This may depend largely on your treatment and it is recommended to talk to your physician and an experienced kinesiologist before adding exercise progressions. For those going through repeated cycles of chemotherapy, it may be recommended to exercise lightly for the first week starting a day or two after receiving chemotherapy and then gradually increasing exercise workload until the next bout of chemotherapy. For those going through radiation, a gradual tapering off of exercise may be appropriate to accommodate increasing fatigue (note that exercise improves cancer-related fatigue).

Strength Training:

Resistance training may be comprised of machine-weights, free weights, body weight and/or elastic bands. Involve major lower- and upper-body muscle groups and include movement-based exercises.

• Frequency: 1–3 times per week, with minimum one rest day between exercising the same muscle group.
• Intensity: 50–80% of 1-repetition maximum or 6–12 repetition maximum.
• Duration: 6–10 exercises, 1–4 sets per muscle group. One set may be sufficient to maintain muscular strength and endurance or improved strength for deconditioned or elderly individuals.
• Progression: As described for aerobic exercise.

Flexibility:

Flexibility guidelines follow the Physical Activity Guidelines for Americans. Stretch at least two or three days each week and hold each stretch for 10-30 seconds to the point of tightness or slight discomfort. Repeat each stretch two to four times, for a total of 60 seconds per stretch. Static, dynamic, ballistic and PNF stretches are all effective. Warm-up (light aerobic exercise, hot bath) before stretching as flexibility exercise is most effective when the muscles are warm.

Additional considerations:

• Pelvic floor exercises may improve incontinence and urgency.
• Breathe throughout exercise – do not hold your breath. Diaphragmatic (belly) breathing is recommended.
• Pools and public areas may need to be avoided to prevent infection or irritation to sensitive skin areas.
• Activities of daily living count as physical activity and may bring similar health-benefits
• For information on exercise for those who have or are at risk of lymphedema, click here.

Main Conclusions if you are in Active Treatment:

• Speak to your physician before exercising as there are a number of contraindications and precautions
• Seek an exercise professional with experience in cancer, such as an InspireHealth Exercise Therapist
• Follow the recommended guidelines by incorporating cardio, strengthening, flexibility, balancing, and coordination exercises as much as your condition will allow
• Avoid inactivity whenever possible

Terry Heidt, MSc, BHK, is the Exercise Therapist and Clinical Director at InspireHealth in Kelowna.

 

References:

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