CURE

FALL / 2012

Exercise During Cancer Treatment Gives Some Patients a Boost

Sara L. B. Brown, an artist and mother of two in Colorado, didn’t exercise regularly before she received a diagnosis of metastatic breast cancer. But then her oncologist told her that patients who ran seemed to survive the longest.  

“I started running while recovering from chemo, first just short distances, then gradually going farther until I could make a mile without stopping,” Brown says. Exercising gave her more energy, and she found that the mental toughness gained from running—that effort required to keep going—helped her deal with long, sometimes unpleasant procedures as well. 

“When I get the shoes back on and exercise, it makes me stronger mentally and helps me recover faster physically,” Brown says. “Pushing myself helped me heal and get back to where I needed to be.”

Sara L.B. Brown says exercising during treatment improved her stamina. Photo by Kris Higgins.

In a report released in April by the American Cancer Society (ACS), a group of experts in nutrition, physical activity and cancer survivorship evaluated the scientific evidence and concluded that exercise is not only safe and achievable during cancer treatment, but also can improve quality of life in many ways.

An American College of Sports Medicine roundtable on exercise guidelines for cancer survivors, published in 2010, also concluded that exercise during cancer treatment is safe and can improve physical functioning, quality of life and cancer-related fatigue.

[New guidelines state nutrition and exercise can reduce cancer recurrence]

“The bottom-line message is avoid inactivity,” says Colleen Doyle, a registered dietitian and director of nutrition and physical activity for the ACS. Any kind of activity helps, she adds, referring to a study that showed a significant benefit from simply walking three to five hours a week at an average pace. Walking is simple, cost-free and can be done just about anytime, anywhere. 

Pushing myself just a little farther and a little faster, I learned to say ‘no’ to my body when it wanted to give up on me, and push on to where I had no idea I could be.

—Sara L.B. Brown

Mental Benefits

Gary T. Kimmel, MD, founder of Cancer Foundation for Life in Tyler, Texas, says there is compelling data on the benefits of exercise during cancer treatment. Some of the most important benefits may be psychological. 

“A major factor during and following chemo, demonstrated repeatedly, is the influence the cancer experience has on your mood and perspective,” Kimmel says. Exercise can be “just as effective as drug therapy in elevating mood and managing that aspect of the experience.”

“When someone gets a diagnosis of cancer and begins that journey, it’s all about what they are going to do to you,” he explains. “You depend on others to treat you and get you well.” But when patients hear that they can participate in their care, they begin to perceive themselves as survivors. 

[Find exercise program for cancer patients and survivors]

“Being active gives you a sense of self-control,” Doyle says. “It is great to have control over something during a trying, difficult time when there is such a sense of loss of control over so many things.”

Brown says exercise helped her develop perseverance. “Pushing myself just a little farther and a little faster, I learned to say ‘no’ to my body when it wanted to give up on me,” she says, “and push on to where I had no idea I could be.”

Anna L. Schwartz, PhD, a researcher at Idaho State University and a family nurse practitioner who specializes in oncology and pain management, says exercise also helps with body image, self-esteem and anxiety, as well as depression during treatment. “Exercise boosts endorphins. It’s recommended for healthy people who have mild to moderate depression and is known to decrease mild depression. It has the same effect in cancer patients.”

Physical Benefits

Exercise conveys a range of physical benefits, too. As Brown learned, it helps combat fatigue, which Kimmel says affects 70 to 80 percent of patients receiving cancer treatment. It also helps control weight gain, which he says sometimes happens during treatment, and may increase the chance of recurrence of certain cancers. Other side effects of treatment that may be favorably influenced by exercise, he adds, include nausea, deconditioning of heart and lungs, and loss of muscle mass and bone strength. 

“When you start exercising, you eat better and you feel better,” Kimmel says. “You may be able to tolerate chemo better. Your bones fare better. Your immune system is stimulated. Exercise treats everything, including the acute and chronic adverse effects of other comorbid diseases. To me, it is a panacea.”

Exercise maintains or improves aerobic function, even during treatment, Schwartz says. “Those who exercise can get stronger muscle-wise, which has benefits. They don’t gain the body fat that most survivors do. We also think it helps maintain bone density.”

According to Schwartz, a growing number of studies show that exercise may help reduce the overall risk for breast, colon and some other types of cancer, and may reduce recurrence as well. “Exercise is one of the most important things healthy people can do to prevent cancer,” she says, “and that patients can do to tolerate treatment well and increase chances for long-term survival.”

Overcoming Barriers

While there are plenty of reasons to exercise, some patients may need guidance and motivation, Schwartz says. One challenge is learning how to deal with treatment-related physical limitations (see sidebar). Ironically, another is healthcare providers who may be hesitant to prescribe exercise since it wasn’t encouraged in the past.

“All of our patients are physician-referred,” says Kimmel, “for the simple reason that, if you want someone to make a behavior change, one of the strongest motivators is their doctor. We just want doctors to recommend exercise in general [to their patients].” 

[What to know before you start an exercise program]

Expense can be a major hurdle for those who aren’t ready or able to exercise independently, says Kimmel, which is why his program doesn’t charge and doesn’t set a time limit—nor should others, he believes. “The American Society of Clinical Oncology has recommended exercise during and following treatment. It’s like someone said, we have a new drug available that works in many ways to improve the outcome of cancer patients, but it’s not being manufactured and we’re not going to pay for it.” 

People who didn’t exercise before they had cancer may especially need a structured, individualized program, Kimmel says. Having cancer and being told of the benefits of exercise often will be motivation enough to start, and once patients start an exercise program and see the benefits, they are empowered to continue.

“So many cancer patients don’t even know the importance of exercise,” Kimmel says. “The first few visits, we just want them to leave saying, ‘I can do this.’ Any exercise is awesome, whatever someone will do—swimming, biking, walking, golfing, gardening.” 

A friend who had gone through breast cancer treatment told me that one of the best things I could do to keep up my energy would be to try to stay active. Exercise had a huge impact on my ability to remain active, feel good and not miss work.

—Kim Utech

Kim Utech, a Milwaukee veterinarian, learned that was true when she received a diagnosis of stage 3C breast cancer in December 2010 at the age of 41. In 2011, she had 16 chemotherapy treatments, two surgeries and 31 radiation treatments.

“A friend who had gone through breast cancer treatment told me that one of the best things I could do to keep up my energy would be to try to stay active,” Utech says. “Exercise had a huge impact on my ability to remain active, feel good and not miss work.”

A little more than six months after whole-brain radiation, Brown is back to running. “Cancer tried to take away my physical body three times, but I kicked it in the behind and kept moving,” she says.  

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