The Benefits of Breaking a Sweat
Exercise is helpful against side effects but questions remain about the specifics.

By Joe Mullich & Kathy LaTour

When Sandy Elson was diagnosed with breast cancer, she immediately changed her lifestyle. She took up walking, improved her diet and joined a gym. “On those days when I felt bone tired and wanted to stay in bed, I forced myself to get up and walk around the block,” she says. “It was difficult, but I felt so much better afterward.”

The benefits of exercise have been heralded for years as a way to prevent some cancers, but now research is showing exercise can improve quality of life for those going through treatment as well as aid in the relief of some side effects. No longer are doctors saying, “You’re sick, take it easy.” Instead they are saying, “Let’s evaluate what you can begin doing and how soon you can get up and moving.”

Exercise has been shown to improve not only issues such as fatigue, nausea and depression, but also the function of the immune system and stress reduction. Also, by controlling weight gain and reducing the percentage of body fat, exercise can influence the risk of cancer recurrence and survival.

Indeed, in its recommendations for home care for the person with cancer, the American Cancer Society recommends the recovering patient remain as physically active as possible to keep muscles functioning and prevent problems associated with long-term bed rest, such as stiff joints, breathing problems, constipation, skin sores, poor appetite and mental changes.

This doesn’t mean you should begin training for a marathon, but it does mean keeping in touch with your physician about what you should and should not do and looking out for warning signs that may indicate
problems.

Exercise as Symptom Management

“In the future, exercise will probably be a core element in cancer rehabilitation,” says Karen Mustian, PhD, an exercise psychologist and assistant professor of radiation oncology at the University of Rochester Medical School James P. Wilmot Cancer Center. This, she notes, is a complete reversal of the typical advice cancer patients have previously received.

Dr. Mustian cautions that exercise is very individual and before beginning any kind of exercise regimen, patients need to check with their physician.
“Many physicians encourage walking and low-level activity based on the patient’s history,” Dr. Mustian says. “If you were an active exerciser before treatment, you should continue, but the first step is to discuss it with your physician. They may also be able to direct you to an existing program in the community or at your cancer center.”

Cancer-related fatigue, which remains a frequent and distressing side effect of cancer treatment, is one area where a number of studies show improvement when the patient exercises. A small study reported in the journal Cancer looked at aerobic exercise in cancer patients recovering from high-dose chemotherapy and stem cell transplantation. Shortly after completing treatment, one group of patients participated in an aerobic exercise program, while a second group served as a control group with no exercise. After seven weeks, researchers found that maximum physical performance and hemoglobin concentration were significantly higher in the training group. The study’s investigators concluded: “To reduce fatigue, this group of patients should be counseled to increase physical activity rather than rest after treatment.”

Research suggests aerobic exercise of a low to moderate intensity done three to five days a week for 30 minutes or more each session can improve mental and physical health, including depression, fatigue, aerobic function and strength.

Dr. Mustian has been studying exercise in post-treatment patients for a number of years. In one study she found cancer patients received more physical and emotional benefits from tai chi exercise than from a support group. “The tai chi improved quality of life and fatigue and functional capacity. They gained in aerobic capacity and muscle strength and range of motion.”

Dr. Mustian says one outcome that could not be documented was the gratefulness of participants who began to take an interest in life again.
The limited amount of research has focused almost exclusively on breast cancer patients, so doctors are hesitant to generalize whether those findings are applicable to other types of cancer.

What, When and How Much

Doctors are a long way from being able to answer specific questions about what forms of exercise are best for specific types of cancer, what intensity levels provide the biggest benefit and at what point in treatment exercise should begin. But doctors can say that people who have undergone surgery, radiation and chemotherapy might have some physical limitations that affect their choice of workout.

There are, of course, disease-specific issues related to the kind of tumor and the treatment that will affect not only the person’s ability to exercise but also the kind of exercise. If a patient experiences fever, dizziness, bone pain, nausea or extreme muscle weakness, it may be something the physician needs to interpret.

But most researchers agree moderate exercise helps and recommend existing programs to their patients or creating programs within their cancer centers.
Some of the biggest questions at the moment revolve around the kind and intensity of exercise patients should do during treatment. While moderate levels can improve the immune system, heavy doses can have the opposite effect. For this reason, doctors recommend cancer patients begin slowly and escalate gradually until they find comfortable levels.

“However, be aware that sometimes when you are not feeling well, a little bit of activity can reverse the cycle,” Dr. Mustian says. A slow walk around an indoor track at the gym or just walking around the block can lift spirits and push away depression even if it doesn’t improve cardiovascular fitness.

Jeff Berman was an active athlete in high school and college before being diagnosed with chronic lymphocytic leukemia. During his first course of chemotherapy, he felt so seriously debilitated that he stopped exercising altogether and gained 35 pounds in three months.

During his next two courses of chemotherapy, he saw exercise during treatment as a balancing act. “I try to maintain as much fitness as possible without weakening myself,” he says. “I’ve found it’s important to know my body and to pay close attention to it. I try not to overdo it on a good day, because I end up paying for it the next.”

Berman also found it was important not to have preconceived notions of how he would feel any given day during treatment or how much exercise he could do. “Some days I didn’t feel like getting out of bed, and I allowed that to happen,” he says. A key, he discovered, was telling his oncologist he wanted to maintain an active lifestyle during treatment and adjust treatment whenever possible to allow that.

Some people prefer individual, home-based exercise, but others benefit from group sessions designed for cancer survivors. Dr. Mustian remembers one active woman in a focus group who was concerned about returning to the gym after breast cancer surgery, fearing others in the locker room would notice her prosthesis. “This is not an issue when you are in a group of 15 other women with breast cancer,” she says. “You have an immediate bond and support for things like where to find fitness clothes that fit when you have a prosthesis.”

Dr. Mustian recently gathered preliminary results of a study involving a home-based walking and resistance-training program for men and women undergoing radiation treatment for breast and prostate cancers.

“We gave patients a pedometer, three resistance bands and an exercise manual that explained what to do. We oriented them for 45 minutes, and they did the exercise regimen while going through treatment.”

All patients received a baseline assessment and some were randomized to standard care. Dr. Mustian says the exercise intervention group experienced improvement in fatigue, sleep, quality of life, aerobic capacity and muscle strength. The standard care group had declines in those areas, she says. In addition, those in the exercise program had decreased fat mass and improvement in muscle mass.

While researchers work to determine the best method and intensity of exercise to prevent cancer or control treatment effects, the bottom line is that exercise is valuable before, after and perhaps even during cancer treatment.

“This field is very young and we are seeing benefits, and it’s time for us to look at other outcomes,” says Dr. Mustian. “Can exercise affect survival and secondary prevention or prevent recurrence? Those studies are still to come.”