Excercise During Cancer Treatment

If you've been diagnosed with cancer, exercise may be one of the last things on your mind. But there are plenty of reasons not to ignore it, even while you're in treatment.

Not convinced? Listen to an expert on the subject, Anna Schwartz, FNP, PhD, FAAN, explain the health benefits that can be enjoyed by people doing the right types of activities. Schwartz is professor of nursing and Scottsdale Healthcare Cancer Research Endowed Chair at Arizona State University, and adjunct professor of nursing at the University of Washington. She's also an avid cyclist and a 20-year survivor of non-Hodgkin lymphoma.

Note: It抯 a good idea to talk with your cancer care team about your plans before beginning any exercise program.

Q: Why should a person who is going through cancer treatment try to exercise? It seems a rough time to push yourself to get moving.

A: If you talk to patients, they have endless reasons for why they exercise and how it makes them feel better. More and more, health-care professionals recognize exercise as a very important part of the cancer care plan.

It helps people stay with treatment, feel better about life. It gives them feelings of control and hope. You抮e going to be more able to interact with your family and friends better and do the things that are meaningful for you. One of the big things we're seeing is that it radically reduces fatigue both during and after treatment.

Q: How does exercise fight fatigue? Won't it just make people more tired?

A: Most people with cancer think they need to go home and rest in order to take care of themselves, and that can mean being very inactive, lying on the couch. When they do that, their body becomes more and more debilitated. They lose muscle strength and cardiovascular fitness and it becomes harder to do any physical activity. By having people exercise during treatment, they maintain or even increase their fitness. You get your blood circulating and reinvigorate your body when you're exercising, even if it's just walking around the house or up and down the driveway. When people exercise, they tell me the most important time to exercise is when they feel worst.

Q: When should people with cancer start an exercise program?

A: I think they should start exercising the day they're told they have cancer . . . [but] it's going to vary depending on age, what kind of surgery they've had, their physical limitations. It抯 really about learning to work around your limitations, looking at the positive aspects, and saying, 揟hese are the things I can do.?

People who start slowly and don抰 overextend . . . feel better right away. You usually feel benefits in the first or second session. Particularly emotionally, it makes you just feel better about life. When people start to feel better, it makes them want to keep exercising. ?Anna Schwartz, FNP, PhD, FAAN

Q: Are some people too old to exercise during cancer treatment?

A: With older people, it抯 probably much more important to exercise, because they get debilitated [lose physical strength or ability] more quickly than others.

Q: Who should a patient talk to about beginning an exercise program during cancer treatment?

A: I think some patients may want to ask their doctor for a referral to a physical therapist, particularly if they've had surgery and are worried about lymphedema or are worried about surgery affecting the way they walk, or if they already have problems walking. Physical therapists are really good at saying, "OK, you have this problem, but here are these other things we can do," and showing a lot of different aerobic exercises and [moves to] strengthen the weakened areas.

For people who are already active, they can start or continue exercising, but they may need to reduce the intensity or volume of exercise.

More and more cancer centers have exercise rehabilitation programs. And we're now developing cancer exercise specialist certification programs, so by the end of this year people who want to help cancer patients with exercise will be [able to get] certified.

Be sure any trainer you use works with your medical team so they know how to protect you.

Q: What should people with cancer know or do before they exercise?

A: People should start off slowly . . . way slower than what they think they should be doing. Most people think back to when they were 18 or 20 and think they抣l just go back to the kind of exercise they did then. They push themselves beyond what they can do. They get sore and more tired from it, so they quit.

Q: How much exercise would you suggest for a person who's starting chemotherapy?

A: I generally tell people to exercise at least every other day for at least 15 to 30 minutes . . . That's the amount of time that hugely reduces fatigue. It also [improves] your quality of life, bone strength, and body composition (the body's balance of fat to muscle). People are generally able to exercise that much, and it helps both physically and emotionally. I also tell people, "If you抳e got a dog or small children or grandchildren, take them with you. Make them your exercise partners."

Q: Do you have different advice for someone starting radiation therapy?

A: No. The research shows that it抯 basically the same thing, start very slowly and be very patient. I really think people should keep an exercise log so they can see their progress over time, when they think they抮e not getting better. The only thing with radiation therapy is if a person gets a lot of skin breakdown, they抮e not going to want to do anything that makes them really sweaty. But most people don抰 exercise to that extent anyway.

Q: Don't you have to get sweaty to see the benefits?

A: No. Definitely not. It doesn抰 need to be a really intense, painful workout. What I tell most patients to do is to get out and go walking. That抯 what keeps you independent . . . and, it抯 safe. The chances of getting hurt are pretty slim. Most people can do it out their door, or they can go to the mall.

Q: When should people with cancer avoid exercise?

A: I tell people not to exercise if they抮e really having bad side effects from chemo, if they抮e getting sick from it梡ain, nausea, fever, dizziness, shortness of breath, low blood counts, or heart problems. Otherwise people can exercise. Even in a hospital bed, they can use giant rubber bands called Thera-bands, to keep their muscles strong . . . . Even though it doesn抰 help your cardiovascular fitness, it keeps your muscles strong so you can get up and walk out of the room. The situations mentioned above are really the only times to avoid exercise. If there are some limitations from a recent surgery, we adapt an exercise program around what the person抯 limitations are.

Q: What about balance training -- like yoga, Pilates, or tai chi -- for people who are weak but able to get up a little bit?

A: I抎 rather see [these] people . . . walking, because if they lose that ability, they lose their independence. A physical therapist can work with a person using Pilates to improve hip girdle and upper leg strength, and core strength. There are some benefits . . . but it needs to be really focused.

Q: How can people stay motivated?

A: An exercise log really helps with motivation. After 2 or3 weeks, when you think you抮e not getting anywhere, you can look back and say, 揥hen I started I could barely walk across the living room, and now I walk to the end of the block and back.?Keep yourself surrounded by positive people and your dog or your kid. Also, you have to do something you like.

Q: Are there types of exercise that patients should avoid?

A: If you are only choosing one type of exercise, aerobic exercise (such as walking, biking, swimming, or dancing) is better than resistance exercise (weight lifting or strength-building). Ultimately, if somebody had time to do a little resistance training and a little more aerobic training, that would be ideal. If you抮e up walking or riding your bike or doing an activity that you like梱ou抳e got to do something that you like梱ou抮e going to get stronger and keep doing it.

Q: Can exercise help with chemo brain, the memory and thinking problems that some cancer patients notice?

A: If you look at healthy people, exercise definitely helps brain function, but it抯 too early right now to say if it does the same for people in cancer treatment. Early evidence suggests that it might. There's a slowly accumulating body of knowledge in that area. We're beginning to understand that some of [the chemo brain] is truly related to the drugs and changes in brain activity. But the chemo brain that is related to fatigue undoubtedly will be reduced by exercise. It helps you think more clearly.

Q: What do you know about exercise for breast cancer patients and survivors?

A: We're beginning to appreciate that people who exercise are less likely to gain weight and are better able to maintain their body weight than are sedentary patients and survivors, particularly in the breast cancer setting. This has positive consequences as far as risk for recurrence or development of a new breast cancer.

Article date: July 6, 2007