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BY GUEST BLOGGER | JUNE 6, 2010
Survivors may soon get their very own exercise prescription, following new guidelines presented today at the American Society of Clinical Oncology's annual meeting.
Prior guidelines aren't specific enough, said Kathryn Schmitz, PhD, of the University of Pennsylvania School of Medicine, during a session on physical activity in cancer survivors. Plus, scientific evidence about cancer and exercise has grown greatly in the past few decades, as has the number of cancer survivors, which has jumped from two million to 12 million since the 1970s. Considering the increasing number of exercise programs for patients and survivors that are popping up all around the world, Schmitz said better guidance was needed not only for fitness instructors but also for physicians who need to get past the idea that patients shouldn't push themselves during treatment.
Schmitz headed up a panel of experts brought together by the American College of Sports Medicine to develop new recommendations for exercise during and after cancer treatment. Published studies in five cancer types--breast, prostate, hematologic, colon, and gynecologic--were used to develop the recommendations.
Although Schmitz noted there are circumstances in which a patient or survivor should receive a medical assessment before starting an exercise program, she said it shouldn't be the norm. In fact, the panel concluded that in order to reduce barriers to starting an exercise program, requiring medical assessment for all survivors is not recommended. "We chose to do this because we felt that the small risk in a small body of patients was probably less than the amount of risk that is induced by telling people that they shouldn't exercise until they're cleared," she said during the session, adding that the risk of inactivity for the large majority of patients at low risk for problems is probably greater than the small risk of putting someone in harm's way.
The first and most important guideline, Schmitz said, is that patients and survivors must avoid inactivity. They must continue their normal activities during and after treatment, and resume daily life as soon as possible after surgery. Other specific recommendations include:
> Over the course of one month, it's safe to build sedentary patients up to 150 minutes of moderate-intensity aerobic exercise per week
> It's safe for patients undergoing stem cell transplant to exercise every day, but these patients should reduce intensity and progression of intensity because of the effects on the immune system
> For patients suffering from weight loss, resistance training can help build strength
> For those with prostate, hematologic, and colon cancers, twice-weekly resistance training is recommended: one exercise for each major muscle group for eight to 10 repetitions, and one to three sets per exercise
> Women with breast and gynecologic cancers should start with a supervised resistance training program given the risk for lymphedema
> Given side effects such as incontinence and sexual dysfunction, floor exercises should be added to an exercise routine for men with prostate cancer
> Colon cancer patients with an ostomy should avoid excessive intra-abdominal pressures
The full guidelines will be published in the July 1 issue of the journal Medicine and Science in Sports and Exercise, and are expected to be made available on the ACSM website at www.acsm.org.
Check out CURE's 2010 Cancer Resource Guide to learn more about exercise and recovery, including where to find a cancer-certified trainer or a cancer exercise program near you.
Melissa Weber is the former managing editor of CURE and is covering the annual meeting of the American Society of Clinical Oncology.
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It would be very helpful to have specific guidelines and even "prescriptions" for aftercare. I say prescriptions for two reasons....it makes it more "real" for patients, and family members then understand how important aftercare is and can support the doctor's prescription! Not just exercise, but diet recommendations as well as complementary like massage, acupuncture etc.
- Posted by Wendy 6/7/10 10:07 PM
Kathryn Schmitz in this article and others, that I have read of hers, knows her stuff. An excercise physiologist who is to be listened to. Anything she writes and tells of her research I want to read about. No, I do not know her, but had the opportunity to email a bit with her on excercise w/risk of Lymphodema, in reference to her clinical trial on that. A special PHD. that really cares!
- Posted by Debbie 6/21/10 3:15 PM
I like the idea posted by Wendy - "Prescriptions" for exercise. So many times exercise seems to be the "throw-away" activity, when it facts it's a very important component of preserving health.
- Posted by Sheryl 6/29/10 11:23 AM
My only recommended exercise when I went home from the hopital after radiation and chemotherapy (given together), came from a nurse. She said get up and walk as far as you can around the house every hour on the hour. Whatever, don't become sedentary.
Fifteen months after being diagnosed with Stage IV, inoperable, non-small cell lung cancer, I began to go to a gym three times a week. Each visit I use an elliptical
walker for 20-30 minutes, then I switch to 30 minutes of weight/resistance exercises.
My diagnosis was eight years ago. I just had my 70th birthday and looking forward to many more.
However, it would have been helpful to know if I were doing the correct exercises. I could not find any information at the time that would have been helpful.
It would still be encouraging to know what is effective and healthy for one having had lung cancer.
Thanks,
Pattye Lester
- Posted by Pattye Lester 6/29/10 4:08 PM
Pattye -- you're my hero! I also have been diagnosed in April with Stage IV lung cancer and am dealing with it ok...been doing radiation and chemo for 8 weeks now, set to go on a 3-week chemo schedule now. I am 47 and otherwise in excellent physical shape -- a bit of a gym rat actually for years! So I am itching to get back to the gym and regain some strength, but I also highly recommend walking as much as possible! I have walked home from my doctor or hospital (just under 2 miles, in a big city) and while it's not lifting weights and my usual workout it's been good. Worst thing to do I think is lie around in bed and get weaker and weaker! But I hope to follow in your footsteps and survive this thing as best as I can! :) Jeff
- Posted by Jeff Coudriet 7/11/10 12:38 PM
I'm probably going to make a lot of people angry by saying this, but I have good reason to believe that personally, none of those regimens will "take". My reason is, they never have. I've always exercised inconsistently. I would try workouts in the latest gym, ride my bike (until I had knee replacement, and that went out the window) - you name it, I tried it. No matter what level of enthusiasm I had at the onset, in the end, I bailed.
But knowing how important exercise is to keeping the cancer from coming back (I was diagnosed stage 4 in 2005), I devised a fool-proof solution. I dumped my car. And I live in Los Angeles, so I knew I was going to pay. And here's the payoff, if I want food I have to walk a mile down a mountain and bring it home, then carry it up the 75 steps to my front door.
I started slow, but within months I was making this trip every day, sometimes carrying up to 20 pounds on the way home. It was the only way. If I started any of the suggested programs, I would have only followed my life's pattern with exercise. So I'm strongly suggesting that anyone who, like me, has failed at exercise, devise a foolproof method of accomplishing the healthy results we need to stay alive. You just have to leave yourself no alternative.
I'm cancer free, and intend to stay that way.
- Posted by Elaine Jesmer 12/11/10 4:23 PM
I am an American Council on Exercise certified personal trainer. As my clients and I are getting older, cancer is a part of more and more of our lives.
Before I became a trainer I had chemo and radiation for lymphoma and did not know how I would ever recover from the horrible affects and become "normal" again, but I received a gift membership to Degerberg Academy martial arts in Chicago and started showing up twice a week for workouts. I was pathetically weak and probably scared my instructors somewhat but I just kept going back and it was indeed good medicine for me because I was literally fighting for life. Extremely positive experience. As each year passed, I was surprised by my body's willingness to be stronger and healthier.
Prescriptions for aftercare would be great. Current guidelines for fitness professionals rely on the doctors' recommendations. It's troubling how many recently treated clients' doctors gives them unrestricted okay "as tolerated" to resume their regular activity. I think it sets them up for feeling bad when they can't go right back to their old routine as quickly as their doctors suggest. I want to know how best to help my clents care for their unique recovery needs.
From my experience and knowledge, regular exercise is the key to good health. And nutrition. Yelling and hitting and kicking some heavy bags helped me alot with the emotional release.
Congratulations to everyone who knew they had to pull themselves up by their own bootstraps and did it!!!!
- Posted by Nancy Trock 2/22/11 4:11 PM
I have had breast cancer twice. I think staying flexible in the upper torso and arms was VERY important. I threw a ball, a stick, whatever my dog would fetch and I did it within a week of surgery, both times. I was gentle and used a Chinese exercise web site that gave me motions to do as I walked to my mailbox each day. I felt soooo good and getting my blood pumping surely improved my mood and outlook. I never had a problem pulling shirts on over my head. I think massage also helped the first time. Just don't be inactive. It'll kill your spirit! But I sure think chemo messes with one's metabolism. Shedding actual # was HARD HARD HARD. I dropped that goal and just exercised to feel good. I won!
- Posted by linda goertzen 5/12/12 12:48 PM