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  • Daniel Rockman

Exercising with cancer

Cancer is an umbrella term for over 200 diseases and is defined as the abnormal growth of cells. Normally, cells multiply by cell division, but as the body gets older the "instructions" for the division process can be damaged and accidentally create cancer cells. Cancer cells differ from normal cells as they are programmed to ignore cellular signals to stop dividing and, if allowed to, will spread into other parts of the body, impacting the function of the healthy cells.


Due to a large variety of diseases classified under the term cancer, an individual's symptoms and treatment can vary greatly depending on the type. Over the years, cancer has been the focus of a large body of research, which has improved how we treat the disease medically and increased our chance of survival. Some cancers, such as prostate and breast cancer, have a survival rate of 95%, while the average survival rate of all cancers is 69%. Some cancers, such as pancreatic and lung cancer still have a very low survival rate.


Exercise as a treatment for cancer has only become scientifically mainstream in the past century, but has quickly become part of gold standard care recommended alongside all cancer treatments. This is because people who exercise regularly following a cancer diagnosis experience fewer and less severe side effects. Due to the large variability in presentations, the Clinical Oncology Society of Australia (the peak organisation for cancer healthcare professionals) has recommended referral to an Accredited Exercise Physiologist to create an individualised exercise plan.



Treatment side effects

Cancer doesn't cause hair loss, the treatment does.

Once diagnosed with cancer, there are multiple treatment options depending on the type and stage of cancer. You may undergo radiotherapy, hormone therapy, immunotherapy, chemotherapy or surgery to combat the cancer.


Because these therapies are targeting fast dividing cells, they can often have widespread effects on the whole body (as the whole body is constantly dividing). As you can imagine, this leads to widespread side effects such as fatigue or hair loss. Did you know, it's not actually the cancer that causes the signature effect of hair loss, It's the treatment?


Below is a list of side effects from all the various treatment options. The main take away? It's a tough time on the body, regardless of the approach!


Some common side effects of cancer treatments include:

  • Increased risk of subsequent cancers

  • Fatigue

  • Pain

  • Increased cardiovascular disease risk

  • Cognitive changes

  • Body weight changes (more fat mass, less muscle mass)

  • Decreased bone health

  • Impaired sexual function

  • Impaired immune system

  • Impaired stomach function

  • Low mood


So, with all these side effects going on, why on earth would you want to exercise?


Why exercise after a cancer diagnosis?


Exercise directly treats the symptoms of cancer therapies.


Exercise will help:

  • Decrease the risk of secondary cancers

  • Decrease fatigue

  • Decrease pain

  • Decrease cardiovascular disease risk

  • Encourage cognitive improvements

  • Encourage muscle mass growth and discourage fat mass growth

  • Improve bone health

  • Improve sexual function

  • Improve immune function

  • Reduces nausea and vomiting

  • Improve digestion and reduce constipation

  • Improve the patient’s mood


But, the biggest reason to exercise after a cancer diagnosis, according to cancer patients, is because it provides a sense of control over their treatment. The other therapies are passive treatments, in that you don't actively participate in any of it, you sit back and let the doctors decide which approach you take. With exercise, you get to take control of your own treatment. That can have a huge impact on your mental health.


Recommendations


According to Australia's peak exercise professional body (ESSA), everybody is different when it comes to exercise prescription, it all depends on the type of cancer, treatment and other individual factors.


In general, ESSA recommends every person with cancer should aim to complete at least moderate intensity exercise (a little bit of huff and puff but still able to keep a conversation) unless there are certain risk factors such as a recent surgery. A combination of resistance and aerobic exercises should be utilised where possible.


For aerobic exercise: if 20 continuous minutes can be reached, then it's recommended to aim for exercise most days of the week. If it's a struggle to reach 20 minutes, then it's recommended to break exercise up into manageable chunks but aim for every day of the week. This can be as simple as walking but can include anything from working out on an elliptical machine to dancing.


For resistance exercise: should be performed at least twice per week, with around 48 hours of recovery before exercising the same muscle group to avoid excess fatigue. Resistance exercises should target large muscle groups and follow the same principles as for a healthy population.


Exercise works best in conjunction with social support. Whether that's an exercise physiologist or a walking group, the more people you can get involved the more likely the exercise treatment is to be enjoyable (and therefore, successful).


Considerations


Fatigue


One of the most common side effects of treatment is fatigue. The body is expending loads of energy in trying to deal with the treatment, leading to a decrease in total capacity. Exercising is obviously going to take up a large amount of this in-demand energy, but this is for the best in the long run. That's right, exercise will actually improve the symptoms of fatigue. This can be especially hard to convey to family members who will want the patient to get "plenty of bed rest", but that can actually make matters worse. It's important when exercising to progress slower than usual and allow plenty of time for recovery after exercising.


Side effect fluctuations


Most of the side effects mentioned earlier will be of a fluctuating manner, either due to treatment timelines or just body processes. This means that while one day might be riddled with fatigue, the next might not be. It is wise to use a pacing strategy, as this can help avoid a "boom-bust" approach. It's important to keep track of these side effects using a symptom diary to ensure that exercise (or other lifestyle changes) aren't causing flare ups.



Psychological factors


A cancer diagnosis carries a large psychological burden for not only the patient, but those around the patient, such as friends and family. Feelings of depression and anxiety can be quite common for all those involved, and this can have an impact on exercise adherence. Look for cancer support groups in your area for help with coping during this stressful time. Remember, even though you may not feel like it at the time, exercise can reduce feelings of depression and anxiety, so make sure you have a form of exercise you can perform even when you're feeling down.




Exercise helps prevent cancer

"Prevention is better than cure"

In addition to treating the symptoms, exercise has been shown to lower the likelihood of contracting the disease in the first place. The higher the levels of physical activity, the greater the reduction in risk of cancer.


There is strong evidence that physical activity can reduce the risk of: breast, colorectal kidney, bladder, oesophageal, stomach and bowel cancer. There is moderate evidence that physical activity can reduce the risk of prostate cancer, and a small body of evidence that it can reduce the risk of lung and endometrial cancer.


Why does physical activity reduce the risk of cancer?


There are multiple theories as to why physical activity can help. It might be due to improved digestion, better blood lipid levels, improved hormone control, enhanced immune function or improved antioxidant mechanism (the process that delays aging). Essentially, it all boils down to improving the cellular function within the body.




So, what are you waiting for? Get out there and take control of your health.


If you're searching for an exercise physiologist who specialises in cancer, use this simple tool: www.essa.org.au/find-aep/


Stay strong.

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