Earlier this year, the Clinical Oncology Society of Australia (COSA), issued formal guidelines recommending exercise as part of cancer treatment, for all cancer patients. Among the recommendations they said that: "Best practice cancer care should include referral to an accredited exercise physiologist and/or physical therapist with experience in cancer care."
Yet, in Ireland, physiotherapy-led exercise rehabilitation services for cancer patients are still extremely limited. So why is exercise so beneficial during and after cancer treatment?
To start with, chemotherapy is one of the most common treatments for cancer. It is a non-targeted treatment and therefore affects the whole body and not just the tumour cells.
During a chemotherapy cycle, patients will experience good days, where they feel like they can function as normal, and bad days, where it is a struggle just to get out of bed.
So how do you prescribe exercise to suit when you hit the bad days?
Firstly, exercise goals should be adjusted accordingly. On bad days your goal may be simply to move, to get out of bed and walk to the end of the hall. On good days your goal might include a longer walk, a Pilates class, or a light weights session.
Exercise during chemotherapy should be aimed at maintaining as much physical fitness as possible. You should exercise to tolerance but not to a point where you feel wiped out.
Everybody should be exercising, but you should consult an appropriately trained healthcare professional with specific cancer rehabilitation training for an individual programme.
1 Exercise helps your mental health...
Exercise is one of the most effective ways to improve mental health. It helps to relieve stress, improve self-esteem and reduce symptoms of anxiety and depression.
When we exercise, the brain releases endorphins. These endorphins are chemicals that help to elevate mood.
Anxiety, or feelings of worry and fear, is the number one issue reported by patients during cancer treatment. Due to the endorphin uptake during exercise, simple activities such as going for a walk or completing an exercise class can help this.
2 It can also reduce pain...
A cancer tumour may cause pain by pressing on bones, nerves, soft tissues and other organs in the body. Endorphins released during exercise can act as an analgesic and reduce the perception of pain.
3 It reduces fatigue...
Cancer related fatigue is a common and debilitating side effect of cancer treatment. It is a feeling of tiredness that is not relieved by sleep or rest. It is multifactorial and can be physical fatigue, cognitive fatigue and emotional fatigue.
Studies show that a progressive exercise programme significantly improves cancer-related fatigue. This might be a cycling programme where the resistance level or distance cycled is progressed week by week. Alternatively, it may be a resistance programme where the weight or the number of repetitions gradually increase.
4 It improves sleep quality...
Sleep disturbance is another common problem faced by patients during chemotherapy. Getting a full night's sleep is vital to allow the body to heal and recover. Physical activity triggers an increase in body temperature. After exercise, the body temperature drops. This change in body temperature may help promote sleep and reduce feelings of anxiety and depression.
5 It improves physical function...
Maintaining physical ability levels and good physical function is tremendously important during chemotherapy.
Preserving as much muscle as possible during treatment will enhance recovery rates after treatment is completed. This can be achieved with resistance exercises, incorporating weights or performing bodyweight exercises.
It is important to note that people undergoing chemotherapy are at increased risk of infection. Therefore, it is important to ensure that weights and gym equipment are adequately cleaned prior to use. It may be advisable to exercise in a private or home environment rather than at a public gym while your immune system is compromised.
6 It increase effectiveness...
There is new preliminary evidence that exercising during chemotherapy may result in improvements in completion rates of chemotherapy and return to work. Exercise results in increased blood flow in the body. Chemotherapy is transported via the blood stream.
Therefore, exercising during treatment may result in the drug itself being delivered faster and more effectively to the affected cells.
People who perform aerobic exercise or resistance training during treatment have been found to tolerate the prescribed dose and number of cycles of chemotherapy better when compared with a group of people who did not exercise during treatment. This could mean getting back to normal life or full fitness weeks or months sooner if you exercise during treatment.
7 It helps with balance...
Chemotherapy may cause a feeling of numbness, pins and needles in the hands or feet, or both; this is called peripheral neuropathy. Peripheral neuropathy can affect balance as well as the ability to complete manual tasks using your hands.
Completing balance exercises during treatment may improve these symptoms, as well as reducing the risk of falling. If you are experiencing changes in balance, you will need some guidance on how to safely perform exercise from an appropriately trained healthcare professional.
For example, a recumbent bike may be more suitable instead of using a treadmill or static bike for aerobic exercise. If your grip is affected, machine weights or body weight exercises may be more suitable.
7 Maintains your bone density...
Chemotherapy causes increased bone resorption and results in reduced bone mineral density. This loss may be increased further if treatment is combined with hormonal therapy.
Studies show that bone loss can be reduced and reversed when resistance exercise is performed two to three days a week in conjunction with a healthy diet.
8 It improves memory ...
"Chemo brain" is a term used to describe the thinking, concentration and memory issues that patients experience while undergoing treatment and after treatment. Personalised exercise programmes have been found to significantly improve these symptoms of cognitive impairment.
10 Quality of life improves...
Chemotherapy drugs can affect the heart, lungs and other organs in the body. It can increase your risk of developing cardiovascular disease and lung conditions. Cardiovascular disease is one of the leading causes of death in cancer survivors. Aerobic exercise strengthens the heart and lungs and can help reduce and prevent development of these significant secondary conditions. Exercise therefore helps people to live longer and with a higher quality of life.
One size does not fit all. Every person's cancer treatment is individual. Each person will experience different symptoms and side effects. Each person will have unique physical limitations and strengths, different previous exercise experience, and personal exercise related interests and goals.
All of these factors need to be taken into consideration when prescribing exercise during chemotherapy.
Aoife McGovern is a Chartered Physiotherapist at Total Physio in Sandyford. You can check out totalphysio.ie for more information.