Making exercise a priority
If you ask me about my top pearls of wisdom for optimising your cancer recovery – I will say ‘get the right advice on MOVING YOUR BODY’. For many patients, exercise is the key that unlocks a faster and smoother recovery.
I see exercise as a super tool! During and after treatment it has been proven to help patients to reduce the symptoms of nausea, peripheral neuropathy, fatigue, poor sleep and low mood. Long term, exercise is understood to reduce the risk of a cancer reoccurrence. If you can implement a solid and supported exercise plan, many of the other cancer ‘hurdles’ will become far easier to jump.
My return to exercise
After my bowel cancer surgery, I was linked in with a great Accredited Exercise Physiologist (AEP). We focused on rebuilding my core strength with a home exercise program. After having two babies in two years, still carrying around an 18 month old, and a recent large abdominal surgery, my core needed quite a lot of TLC. I left my appointment with my exercise plan in hand, with good intentions!
Fears, fears and more fears
Initially I started off reasonably well and stuck to the home plan. Unfortunately soon after I developed a lot of fears around exercise, and in all honestly I had also lost motivation. This was unusual for me. Before my diagnosis I was relatively fit. I had been a member of a gym consistently for the past 20 years and ran 20-30km most weeks prior to having my boys.
During my recovery I had a lot of apprehension around exercise. Although I was grateful to my body for alerting me to my cancer, I was beginning to loose trust in my physical abilities.
I was living a nausea, fatigue, fibre intolerance, diarrhoea ground-hog day. The bare minimum of daycare drop offs and pick-ups, short grocery shops, occasional cooking, and regular medical appointments had already absorbed every skerrick of energy that I had available. There was… NOTHING LEFT!
There was also the added anxiety of my constant need to be close to a toilet. I had decided that the possibility of worsening my diarrhoea with exertional exercise was too great. I could not add public faecal incontinence to my list of bad shit to deal with. Ha! A ‘normal’ busy gym environment just wasn’t right for me at that stage… well, so I told myself.
As if that wasn’t enough, I was also worried about loosing more weight. I had already lost quite a lot of weight and was starting to look gaunt. I knew that I couldn’t afford to loose any more. Another fear to add to the list.
I wish I had known
Exercise (or lack of) didn’t really come up in my medical appointments. I do remember my surgeon recommending to me to be as active as possible before my operation. However it didn’t really feature as a discussion point during my future medical reviews.
Had I have known what I do now, I would have appreciated that exercise is an amazing healer and can be done safely and gradually built up over-time. I wish I had told myself: that a little each day is a fantastic start, to find an expert who can help me to feel confident and trust my body again, there is no downside when exercise is done safely with the right support, exercise will absolutely improve your quality of life….so stop with the excuses and get moving!
Always remember – All big goals are made up of tiny steps!
What Cancer Patient’s Say
“I didn’t receive any information about exercise, so I asked my Oncologist if it was a good idea”.
“I tried to walk daily through my recovery from ULAR and through my chemo treatment. Some days it was just ten minutes or two ten minute walks, others up to half an hour. It was a priority regardless of how exhausted and fatigued I was”.
“I’m 51 yo and have always been active eg exercise moderate to high intensity 5-6 times per week, approx 1.5 hrs each session… In March this year was diagnosed with stage 4 cancer and had operation on colon and liver…I do feel exercise is assisting my mindfulness, allows me my ‘own time’, self-care, and believe it’s assisting my body in coping with the drugs and the tiredness”.
“I tried to exercise (walking) everyday during chemo – I had advice from a friend it helped with chemo side effects. Sometimes I would get 10 minutes, sometimes half an hour”.
“…losing weight is an uphill battle. Post-treatment menopause and the struggle with depression continue to make this difficult. (I) exercise a lot now which is good for my mind but side effects of treatment are problematic”.
(Thank-you to all of the women who so generously shared their feedback. All comments shared with permission).
Since this is such a crucial topic in cancer management, I have invited the fabulous Dr Meegan Walker to share a little more about the importance of exercise in cancer recovery. Dr Walker contributes to teaching and research at the University of the Sunshine Coast. She teaches in the clinical exercise physiology program with a special interest in exercise for cancer care. Her research focus is cardiovascular adaptations to exercise and vascular control of blood flow.
If this doesn’t get you moving, nothing will!
Exercise is Medicine for Cancer Patients
Written by Dr Meegan Walker, Accredited Exercise Physiologist and Academic
This information is intended to supplement the information provided by your health care team. Please note, when undertaking exercise, special consideration is needed for patients who have bone cancer or bone metastases.
When someone is diagnosed with cancer and the oncology team says that chemotherapy is going to be the best thing to treat it, people rarely ask, “are you sure?” But there are still plenty of people who will question whether someone who is going through cancer treatment should be exercising.
Exercise is medicine for cancer patients. It is important and beneficial at all stages of cancer treatment and throughout survivorship.
We have a substantial and growing collection of high-quality evidence informing our understanding of the role of exercise in cancer treatment. The five topics I’m going to cover are how exercise makes cancer treatment more effective, how exercise improves quality of life for cancer patients, how it reduces the negative side-effects associated with treatment, how it protects long term physical health, and, finally, how exercise is empowering while it reduces anxiety and depression.
Recent studies with thousands of cancer patients demonstrate an inverse relationship between level of physical activity and cancer-related mortality.
The explanation is related to some specific benefits of exercise, including enhanced myokine release, increased blood flow, reduced oxidative stress, improved immune function, and more successful surgeries.
Myokines are potent anti-cancer chemicals produced by muscles. Each time the muscles are stimulated with exercise, they release myokines, which fortify the immune system and supress tumour growth. For this reason, the current recommendation for cancer patients is to do shorter, more frequent bouts of exercise, as this creates regular bursts of myokines. This strategy is more protective than doing longer duration bouts of exercise less often.
During chemotherapy, exercise can enhance treatment effectiveness by increasing the rate of blood flow throughout the body. Chemotherapy drugs are delivered to cancerous cells through the blood stream and exercise increases blood flow, thereby increasing contact and uptake of chemotherapy agents by the cancerous cells. There is now clear evidence that exercise can make chemotherapy treatment more effective.
Another aspect of treatment effectiveness for which there is growing evidence is that regular exercise reduces inflammation, reducing oxidative stress in the body. Oxidative stress is created by reactive oxygen species, which are volatile little molecules that cause several problems. One problem is that they attack DNA, causing cell mutation which can both initiate cancerous growths and promote the spread of cancer. Regular exercise reduces reactive oxygen species, reducing the frequency of cell mutation, while it also helps to inhibit growth factors for cancerous cells.
Regular exercise is also linked to the improvements in immune function, specifically, regular exercise increasing white blood cell count, which improves both surveillance (the ability to detect abnormal cells) and the capacity to fight abnormal cell growth.
There are three ways that regular exercise leads to better surgical outcomes. First, tumours are better contained in people who exercise regularly. This increases the likelihood of removing the whole tumour, making the surgery more effective. Secondly, people who exercise tend to have less adipose tissue, and surgical access is easier in leaner people. Finally, recovery time following the surgery is better for people who exercise. Being fitter going into surgery means quicker recovery.
Quality of Life
Regular exercise improves the efficiency with which the body can deliver oxygen to working muscles by building the oxygen carrying capacity of the blood and expanding the capillary network that facilitates oxygen uptake by the muscles. Regular exercise also improves muscle strength and stamina, increasing the amount of physical work the body can do.
This increased capacity carries over into the things that need to be done in daily life. Cancer treatments commonly cause fatigue and weakness, and this can impact ability to work, get groceries, maintain a house, or keep up with kids or grand kids. In turn, this can create a loss of independence and may lead to feelings of frustration and helplessness. Regular exercise increases physical capacity to achieve activities of daily living and, hopefully, recreational activities too. This is one way that exercise improves quality of life.
The most well researched side-effects of cancer treatment are persistent fatigue, nausea, and pain. There are a significant number of studies that compare individuals receiving chemotherapy treatment with and without simultaneously participating in regular exercise. These studies convincingly indicate that fatigue, nausea, and pain are reported less by people who exercise regularly.
Fatigue, in particular, is common during cancer treatment and it can be disabling. It’s experienced in a personal way and hard to measure for the purposes of scientific studies, but according to the Australian Cancer Council (and numerous international cancer agencies), exercise is the best approach for managing cancer-related fatigue.
If we take the opposite viewpoint, we can confidently say that regular exercise will not increase fatigue. We know it will do no harm, and it is likely to improve the quality of sleep, which may help to reduce fatigue.
Another important theme in the research on exercise in cancer care is that completion rates for treatment are higher among those who exercise. Often the chemotherapy dose must be reduced or treatment has to stop because the body isn’t coping. Sometimes the side-effects become unmanageable, or the body is too depleted or immune-suppressed. Exercise, by reducing the intensity of side-effects and making the body stronger, improves the physical ability to tolerate the cancer treatment, improving the likelihood that the prescribed course of treatment can be completed. Enduring the full course of treatment gives a better chance of eradicating the cancer.
Long term health
Cancer treatment causes a decline in the health of bones, muscles, and metabolism. Chemotherapy, radiation, and hormone therapies each, in their own way, cause a decline in the integrity of the bone structure, leading to osteopenia and osteoporosis. This can be reversed with exercise. Loading the bones with resistance exercise, or impact loading (hopping or skipping), directly stimulates the body to strengthen the bones, preventing osteoporosis.
Chemotherapy drugs deplete muscle, reducing strength and stamina. The primary movers, the big muscles that move the legs and arms, are the ones that are often noticed first and targeted with resistance training exercise. This is beneficial, however the focus should be on functional strength. Functional strength is the strength needed to do daily activities with a minimum of assistance and it includes the muscles required to hold good posture. Postural muscles are important to maintaining balance and preventing falls. One very simple exercise for posture involves standing against a wall and taking a moment to feel what parts of the body are touching the wall, then focus on holding the head up high and pressing the shoulders back so they touch the wall.
Cancer treatment often takes a toll on metabolic health too. Exercise helps maintain good glucose control (reducing the chance of developing type 2 diabetes), reduces adipose tissue, and it has beneficial anti-inflammatory effects. Reducing inflammation is a recurring theme – it was mentioned above (recall: a reduction in inflammation was linked to a reduction in DNA mutation, increased white blood cells, and enhanced immune function). Other important reasons to reduce inflammation (and the associated reactive oxygen species) is that they are directly linked to the accumulation of atherosclerotic plaque in the blood vessels, and they promote arthritic changes in the joints.
Another long-term health theme that emerges in the research is that cancer recurrence rates are 30 – 40% lower in people who exercise regularly. This seems to be related to a few things, including myokine production, reduced oxidative stress, increased immune function, and positive hormonal changes.
The benefits of exercise aren’t limited to physical well-being. Cancer is a confronting diagnosis. Many aspects of cancer treatment are not within the patient’s control, and this can lead the patient to feel like a victim caught up in a rapidly escalating process.
Exercise is a choice – when you do it, you own it. From the perspective of the patient, session-by-session, day-by-day, they are doing what they can to help themselves, to reduce side-effects, and to feel in control of the outcomes. This is empowering.
For everyone, with or without cancer, exercise is considered medicine for mental well-being. There are now hundreds of high-quality research studies demonstrating that regular exercise reduces anxiety, reduces depression, alleviates stress, and it contributes to positive self-esteem and mood. It is beneficial for all of us.
Regular exercise makes cancer treatment more effective in a range of ways. Frequent bouts of exercise causes regular release of protective myokines, enhances circulation of chemotherapy drugs to the target tissues, reduces oxidative stress, and improves surgical outcomes.
For each individual the optimal type, intensity, and duration of exercise will be different. Some exercise is better than no exercise, and generally, more is better than less. An accredited exercise physiologist is an allied health professional, trained in exercise prescription for cancer patients: www.essa.org.au
Dr Meegan Walker email@example.com
While pondering this fantastic content from Dr Meegan Walker, I know that you are going to want to start your exercise routine today. Whether you are reading this piece as someone newly diagnosed with cancer, if you have been on the cancer road for a while, or you are simply interested in living as long and as healthily as you can – your journey to wellness will be supported through regular exercise.
For a little more inspiration I highly (REALLY REALLY) recommend the Cancer Survivor Guide Podcast Series. The episode on exercise is a must listen for patients, and health and wellness professionals alike. I also wanted to share this link to the ‘Cancer at 30’ blog for another perspective on the benefits of exercise from a fellow bowel cancer survivor.
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