Cancer patients that undergo surgery, radiation or chemotherapy, commonly suffer from physical fatigue, weakening of the body, psychological trauma and a subsequent decrease in quality of life.
The usual lack of physical activity during treatment may exacerbate the levels of fatigue observed during and after cancer treatment. Patients may often not be motivated to exercise due to chronically feeling tired, low self-esteem and lack of encouragement from family and friends, and may mistakenly assume they need further rest.
Several studies examining the role of physical activity during and after cancer treatment have shown positive effects on decreasing fatigue, enhancing physical performance and improving quality of life. The majority of studies have looked at the effects of aerobic exercise on cancer patients, while fewer studies to date have examined the effects of resistance training. Many of the studies have been carried out on patients with breast cancer, while fewer studies have examined the effects of exercise, particularly resistance training, on patients with other types of cancer, such as colon or prostate cancer. However, the results reported have been very promising.
Resistance training is highly effective in increasing strength and lean muscle tissue, both in athletes as well as in untrained, older adults. Therefore, one may assume that resistance training may also offer considerable benefits to cancer patients that suffer from fatigue as well as loss of strength, muscle mass and bone mineral density, even if the intensity (difficulty of workout), volume (length of workout) and frequency of training (number of sessions per week) may be very low in the beginning.
Exercise guidelines for cancer patients
The American Cancer Society recommends that cancer survivors commit to these actions:
- Take part in regular physical activity.
- Avoid inactivity and return to normal daily activities as soon as possible after diagnosis.
- Aim to exercise at least 150 minutes per week.
- Include strength training exercises at least 2 days per week.
In Australia, the Clinical Oncology Society of Australia (COSA) has gone so far as to issue a formal guideline on exercise for cancer survivors. Its recommendations are:
- Exercise should be embedded as part of standard practice in cancer care and viewed as an adjunct therapy that helps counteract the adverse effects of cancer and its treatment.
- All members of the multi-disciplinary cancer team should promote physical activity and help their patients adhere to exercise guidelines.
- Best practice cancer care should include referral to an accredited exercise physiologist and/or physical therapist with experience in cancer care.
Exercise has numerous medicinal and health-promoting properties. It is not surprising that the chairwoman of the COSA committee, Dr. Prue Cormie, has compared the benefits of exercise to medication:
“If we could turn the benefits of exercise into a pill it would be demanded by patients, prescribed by every cancer specialist and subsidized by government. It would be seen as a major breakthrough in cancer treatment.”
Cancer recurrence and long-term survival
Exercise may not only impact the recovery from treatment, but may also influence the rate of cancer recurrence and long-term survival. Over 20 studies of people with breast, colorectal, prostate, and ovarian cancer have suggested that physically active cancer survivors have a lower risk of cancer recurrence and improved survival compared to those who are inactive. Further benefits of regular exercise include reductions in anxiety, depression and self-esteem as well as increased happiness in cancer survivors.
Due to the repercussions of their treatment, cancer patients may need to commence their exercise programme at a very moderate level of intensity. Although the recommendations are to exercise 30min daily, patients may start with short bursts of 6-10min at a time and gradually increase their exercise duration as their stamina increases. Some type of resistance training (strength training) should be included in the routine to exercise muscles that may have weakened during therapy. To go about this in the right way, patients are advised to seek the advice of an experienced exercise professional or physical therapist. Exercise recommendations may vary from patient to patient, depending on their physical condition, fitness and degree of recovery. In the beginning, bodyweight exercises or resistance bands can provide more than adequate resistance, meaning that sophisticated gym equipment is not required. Appropriate aerobic exercises for the initial stages of an exercise programme may include walking, swimming and indoor cycling on a stationery bike.