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Cancer Patients Benefit in Multiple Ways from Exercise

If you’re looking for a simple exercises that can be done anywhere to improve your quality of life before, during, and after cancer treatment, Jean Kozempel, DPT, has your answer. And it only takes about 20 minutes a day.

“More and more research demonstrates that moderate-intensity exercise has tremendous benefits for cancer patients at any stage of their journey,” said Kozempel, manager of physical medicine and rehabilitation at Fox Chase. “Patients who exercise have reduced cancer-related fatigue and stress, better side effects management, improved response to treatments, faster recovery of physical function, and, in some cases, a reduced risk for cancer recurrence,” she said.

One of the most distressing side effects of cancer is cancer-related fatigue (CRF). Different from fatigue that everyone has felt, cancer patients describe CRF as an overwhelming feeling that hits without warning and effects their daily life. A 2017 JAMA Oncology article reported that exercise and psychological interventions, such as psychotherapy, when done alone or in combination with each other, were more effective against CRF during and after treatment, while available medicines did not show the same level of improvement.

The key, said Kozempel, is developing an exercise approach that gives patients a moderate-intensity workout. Physical therapists can help people get started by assessing their capabilities and limitations to suggest safe exercises with modifications, if necessary, to build physical activity into their daily routine. For example, patients with cancer that has spread to their bones, or “metastasized,” are advised not to lift heavy weights. The clinicians also keep an eye on blood counts, particularly if patients are still undergoing treatment.

In addition, approaches like Fox Chase’s cancer-related fatigue group incorporate exercise into a wider educational program “We have a psychologist who talks about stress management, a pulmonologist who explains good sleep hygiene, and a dietician who advises about proper nutrition for cancer survivors,” Kozempel said.  “And, then, we exercise!”

Most programs start with walking, if the patient is able, and if not, then they can still get started with chair exercises that build up strength and endurance. Also, patients facing surgery may be advised to do “pre-hab” to improve post-op recovery.

The recommended target for physical activity for cancer patients is the same as for the general population: 150 minutes of moderate-intensity exercise a week is all it takes.

“Walking is easy to do because you don't need equipment and you can do it anywhere,” Kozempel said. “Then, we want to notch that up a little bit to get to a moderate-intensity level.”

With walking, that means moving fast enough so you are a little breathless but not short of breath. Patients learn to measure their “rate of perceived exertion” on a 1-10 scale, with 1 being sedentary, such as sitting in a chair and doing nothing, and 10 being the highest level of activity physically possible. Moderate intensity is around a level 4.

“We don’t recommend measuring your heart rate because patients undergoing treatment may have a higher-than-normal heart rate or they may have difficulty finding their pulse,” she said. “As long as you’re monitoring your breathing, know where you are on that scale, and are not in pain, you’re good.”

Weight-resistant exercises are suitable for patients who do not have low blood counts or metastatic bone disease. Equipment can be as simple as small weights or exercise bands, -even simple exercises that use the body’s own weight to build strength.

Moving exercises such as yoga and tai chi can reduce stress as well as build muscle strength, incorporate stretching, and improve balance, which can be an issue after surgery or treatment.

Kozempel offers a variety of tips for developing and sticking to an exercise program:

  • Start simply. Walk if you can; do chair exercises if you can’t. Start at whatever level you are now. Get rid of the “shoulds” and the “But I used to be able to (fill in the blank).” Be in the moment.
  • Get an exercise buddy. You’re more likely to exercise because you don’t want to let the other person down.
  • Find a class or a training program through YMCAs, fitness centers, and teachers who offer exercise programs and classes for cancer patients. There are even groups that help cancer patients train to do a marathon.
  • Set goals and gradually increase what you do each week.
  • Track your progress by writing down what exercise you did and how you felt. This helps motivate you to continue exercising.
  • If you missed yesterday, just start again today.
  • Give yourself credit for improving over time, even if your current exercise abilities don’t match up with what you used to be able to do.
  • Fit smaller exercise bursts into your day. If you are watching TV, get up and do something whenever a commercial comes on: march in place, do arm exercises, or stretch.
  • Over time, increase the intensity by, for example, bringing your arms over your head while you are marching in place. It can make a big difference.
  • Add stretching of your major muscle groups to your program. Stretch only as far as you can without feeling pain or tensing up. Plus, remember to breathe while you stretch.

“For most of us, if we learn to listen to our body, we will know what it needs,” Kozempel said.

“Any physical activity is good,” she added. “Human beings are meant to move. If we keep moving, we are more likely to keep moving in the future. Exercise can benefit cancer patients at any point along their journey.”