Cancer Treatment and Exercise 101

Cancer, by definition, is a group of diseases characterized by the uncontrolled growth and spread of abnormal cells resulting from damage to DNA by internal and/or environmental factors. There are a variety of treatment options, some more invasive then others. Surgery, radiation, chemotherapy and immunotherapy are some of the most widely known and used treatment plans. During these types of treatments, patients may feel that their overall physical function is diminished because of loss of aerobic capacity, muscle tissue breakdown and decreased range of motion.

However, several studies have shown that exercise may have a positive impact on the patient while undergoing treatment and may also improve outcomes. Anyone undergoing cancer treatment needs to obtain approval from their oncologist before starting an exercise program. Cancer affects people differently. Therefore, each cancer patient should exercise at their own level of intensity.

How exercise can help:

Both aerobic exercise and resistance training have been shown to help individuals undergoing treatment by decreasing fatigue, muscle wasting and nausea, while improving body composition, blood flow, bone density, cognitive response, self-esteem and overall quality of life. A study by Kerry Courtneya, Ph.D., professor and Canada Research Chair in Physical Activity and Cancer at the University of Alberta, showed that women with breast cancer participating in a resistance-training program during chemotherapy had dose reductions and fewer delays in their chemotherapy treatments. According to Dr. Courneya, “higher levels of physical activity are associated with a reduced risk of the cancer coming back, and a longer survival after a cancer diagnosis.”

Following is the American College of Sports Medicine (ACSM) exercise prescription guidelines.
Remember: The patient should gradually increase exercise workload depending on energy and skill level. Start slow and build to tolerate exercise.

Frequency:

• Aerobic exercise: 3-5 days per week.
• Resistance exercise: 2-3 days per week with 48 hours of recovery between sessions.
• Flexibility: 2-7 days per week.

Intensity:

• Aerobic: 40 percent – 60 percent heart rate reserve (age-predicted max heart rate, resting heart rate or 12-13 on the Borg Rating of Perceived Exertion [RPE] scale).
• Resistance: 40 percent – 60 percent; 1-RM (rep max).
• Flexibility: Slow static stretching; be mindful of range of motion restrictions due to surgical treatments and/or radiation therapy.

Time:

• Aerobic: 150 minutes per week (short bouts of 10 minutes at a time if necessary).
• Resistance: Start with 1 set of 8-12 repetitions, increasing number of sets over time and ability.
• Flexibility: 4 reps of 10-30 seconds per stretch.

Type:

• Aerobic: Walking, cycling, swimming, rowing, etc.
• Resistance: Free weights, machines or weight-bearing functional tasks (such as sit-to-stand or wall push-ups) targeting all major muscle groups.
• Flexibility: Stretching or range-of-motion exercises for all major muscle groups, also addressing specific areas of joint or muscle restrictions.

When Not to Exercise:

• No exercise on days of intravenous chemotherapy or within 24 hours of treatment.
• No exercise before blood draw.
• Severe tissue reaction to radiation therapy.
• Platelets less than 50,000.
• White blood cells less than 3,000.
• Hemoglobin less than 10g.Dl-1.
• Bone, back or neck pain of recent origin.
• Unusual muscle weakness.
• Unusual or extreme fatigue.
• Poor functional status.
• Acute infections.
• Fever greater than 100F.
• Severe nausea.
• Vomiting or diarrhea within 24-46 hours.
• Dehydration.
• Poor nutrition consumption.
• Inadequate fluid intake.
• Chest pain.
• Resting heart rate greater than 100 bpm (beats per minute) or less than 50 bpm.
• Resting SBP (Systolic blood pressure) greater than 145 mm Hg and/or DBP (diastolic blood pressure) greater than 95 mm Hg.
• Resting SBP less than 85 mm Hg.
• Irregular heart rate.
• Swelling of ankles.
• Severe shortness of breath.
• Coughing, wheezing.
• Significant decline in cognitive status.
• Dizziness or lightheadedness.
• Disorientation.
• Blurred vision.

About the Author
Jennifer Oestreich has a bachelor’s degree in health education and a
master’s degree in health promotion and human performance. She is a staff member at the Wellness Center at Mariners Hospital.