Exercise during cancer treatment improves quality of life

Guidelines from the American College of Sports Medicine strongly recommend individuals with cancer, as well as cancer survivors, incorporate exercise into their daily routines.

Although the guidelines recommend patients and survivors — if physically able — strive to meet federal physical activity guidelines, the primary recommendation is for them to avoid inactivity.

This is sound advice, even if all a person feels they can do is take a 5-minute walk or perform simple stretches, according to Colleen Doyle, MS, RD, managing director of nutrition and physical activity for the American Cancer Society.

HemOnc Today spoke with Doyle about the benefits of exercise during treatment for cancer, as well as the beneficial effects exercise can have for cancer survivors.

Question: How important is exercise during cancer treatment?

Answer: Exercising during treatment can be beneficial from a number of perspectives, including improving physical functioning, reducing fatigue and improving quality of life — particularly from the perspective of reducing stress. It can also help improve post-treatment adverse effects on bone health and muscle strength.

Having said that, there are some precautions to consider:

Individuals with severe anemia should delay exercise, other than activities of daily living, until the anemia is improved;
Those with compromised immune function should avoid public gyms and public pools until their white blood cell counts return to safe levels. Survivors who have completed a bone marrow transplant are usually advised to avoid such exposures for one year after transplantation;
Someone suffering from severe fatigue from their therapy may not feel up to an exercise program, so they may be encouraged to do 10 minutes of light exercises daily;
Individuals undergoing radiation should avoid chlorine exposure to irradiated skin, such as in swimming pools;
Those with indwelling catheters or feeding tubes should be cautious or avoid pool, lake or ocean water or other microbial exposures that may result in infections, as well as resistance training of muscles in the area of the catheter to avoid dislodgment;
People with multiple or uncontrolled comorbidities need to consider modifications to their exercise program in consultation with their physicians; and
Someone with significant peripheral neuropathies or ataxia may have a reduced ability to use the affected limbs because of weakness or loss of balance. They may do better with a stationary reclining bicycle, for example, than walking on a treadmill.

Additionally, patients should talk to their health care team about the safety of exercise for themselves and their current condition, also taking into account if they were active prior to treatment.

Q: Is exercise during treatment something that is discussed up front by the cancer care team?

A: Ideally yes, but in reality, many times it is not. Because of the many benefits, the care team should be encouraging some level of activity — again, taking into account the individual, the type of cancer, resulting treatment and activity level prior to treatment. Individuals receiving treatment who are already active should be advised that they may need to exercise at a lower intensity and/or for a shorter time period than they are used to. For those who were sedentary prior to treatment, low-intensity activities — such as gentle stretching or brief, slow walks — may be a good place to start, and they can progress from there. For those who are older and for those with bone metastases or osteoporosis, or for those with signiﬁcant challenges like arthritis or peripheral neuropathy, careful attention should be given to balance and safety to reduce the risk for falls and injuries. The presence of a caregiver or exercise professional during exercise sessions can be helpful. If someone experiences periods of bed rest, reduced fitness and strength and loss of lean body mass are likely to result. It may therefore be helpful for the team to recommend physical therapy to help maintain strength and range of motion.

Q: Is there a particular study suggesting the benefit of exercise during cancer treatment that you refer to most often?

A: In a 2011 meta-analysis by McMillan and colleagues, researchers looked at whether exercise impacted fatigue and whether it was able to improve physical capacity. The study findings suggested aerobic exercise reduced fatigue, and that exercise improved aerobic and musculoskeletal fitness compared with control groups. I prefer looking at this type of study because it looks across a variety of studies on the same topic to pool results.

Q: What are some of the challenges a patient may experience with exercise during cancer treatment?

A: There can be a number of challenges. Certainly there may be days when an individual just does not feel well and does not feel like doing much of anything, and that is OK. I encourage people to be active during treatment because of the benefits, but to also not “beat themselves up” if they do not feel like doing much on a given day. There could be treatment effects that present challenges like neuropathy, which can result in balance problems. Therefore, riding a stationary bike or walking on a treadmill where you can hold on may be in order.

There may be ports placed in areas like the chest that may make it difficult to do particular exercises involving upper body strength training, for example. It could be that they are concerned about exercise and need some guidance. The American College of Sports Medicine and American Cancer Society developed a Cancer Exercise Trainer certification and health/fitness experts with a specialty certification for working with people undergoing treatment or post-treatment can be found at certification.acsm.org/acsm-cancer-exercise-trainer.

Q: Can exercise during treatment have a ripple effect in terms of survivorship?

A: There has been a number of studies that suggest exercise post-diagnosis reduces breast cancer deaths by 34% and recurrence by 24%. For colon cancer, exercise reduces deaths and recurrence by up to 50%. There is also evidence that activity is associated with reduced recurrence of prostate and ovarian cancers. So, encouraging and supporting exercise among people who have been diagnosed with cancer is important for so many reasons, and it is something that health care teams should take an active role in doing.

Q: Can exercise prevent cancer?

A: Regular activity is directly associated with a reduced risk for breast and colon cancer, and possibly endometrial and advanced prostate cancer. It is also indirectly associated with a reduced risk for those cancers that are impacted by excess weight, including breast cancer in postmenopausal women, colon and endometrial cancers, and cancers of the esophagus, kidney and pancreas. Our recommendation for both prevention and survivorship is to be moderately active for at least 150 minutes per week or 75 minutes or more of vigorous activity, or some combination thereof. To give you a sense of what’s “moderate,” think about walking one mile in 15 minutes.

Q: Is there anything else you would like to add about exercise during cancer treatment?

A: After a cancer diagnosis, there can be such a sense of “loss of control” among many individuals, with so much happening and decisions to be made about treatment. Setting a goal to be active each day — even if it’s just a very short walk — can help empower an individual and help them feel that they are able to have a sense of control in an important area. For individuals who may not have been active before their diagnosis but made activity an important part of their treatment plan and recovery, I would encourage them to keep it up after treatment ends. Setting healthy lifestyle goals post-treatment is important for overall health and well-being, and it may help reduce the risk for recurrence and reduce the risk for developing a different type of cancer. – by Jennifer Southall

For more information:

Colleen Doyle, MS, RD, can be reached at American Cancer Society, 250 Williams St., Atlanta, GA 30303; email: colleen.doyle@cancer.org.

Disclosure: Doyle reports no relevant financial disclosures.