Have you ever been too tired to walk up your stairs, eat, or even go to the toilet? Welcome to the life of individuals with cancer related fatigue.
Fatigue is one of the most common and debilitating side effects of cancer treatments that presents itself before, during, and after treatment. A 2007 study found that 80-90% of people undergoing radiotherapy and chemotherapy reported experiencing incapacitating fatigue. Of those, approximately 91% felt they could not lead a normal life, participate in social activities or perform simple intellectual tasks. 75% had to change employment status and 65% needed their caregivers to take at least one day off per month. Worse still, many of these people can suffer similar symptoms long after the treatment has ceased.
What is cancer related fatigue?
Cancer related fatigue is unlike anything the apparently healthy individual has usually ever felt. The sense of utter exhaustion that you feel is disproportionate to the amount of effort produced. For a once fit individual, that can mean that a walk to the letter box produces the fatigue levels that are only imagined after completing an Ironman event (1 x 3km swim, 1 x 180km bike ride topped off with a marathon). The most disconcerting thing about cancer related fatigue is that rest or sleep does not always help alleviate symptoms. On top of that, because the causes are not well understood, treatment is not always straight forward.
If that is that case, shouldn’t I rest rather than exercise?
Well this is where it gets interesting! Research has now shown that exercise should be used as part of a patient’s oncology treatment schedule. Not surprisingly, results show an increase in strength and capacity, especially in cases of breast, prostate, haematological, and colorectal cancer. However, one of the unexpected outcomes of these studies has been the effect of exercise on fatigue levels. It was first measured due to concern that exercise would exacerbate cancer related fatigue levels, BUT the results proved very interesting… It in fact showed the opposite!
A systematic review from South Australia showed that out of the 47 studies identified relating to exercise and cancer related fatigue, 32 found exercise to significantly reduce cancer related fatigue! In fact, there were no significant studies that didn’t favour an exercise intervention for improving cancer related fatigue.
So… exercise reduces your levels of cancer related fatigue!!
How exactly can exercise help?
As there is still no single definitive cause of cancer related fatigue, determining the physiological reasons as to why exercise is so effective is pretty difficult. When you begin treatment, just the thought of exercise would probably make you feel exhausted. However, if we look at the flip side, we know that without a doubt inactivity leads to increased fatigue. Exercise reduces the distance you can walk without puffing and also the amount you can lift. So therefore, movement allows you to complete all those activities quicker and for a longer period of time.
There are also theories around surmising that resistance training can prevent the dysregulation of our immune system and helps maintain our energy currency (ADP). All of which can be disrupted when we begin muscle wastage. Big words I know! The main take away message is that moderate exercise can increase your capacity to function, improve your quality of life, decrease risk of depression and anxiety, and decrease cancer related fatigue!
What exercise should I do to reduce fatigue levels?
Before we answer this question, I would like to make a caveat… The definition of exercise (and its intensities) is very broad. What a healthy individual calls exercise can be different to what someone undergoing treatment or who is now a survivor does. Also, no two cancers are the same and so no two exercise prescriptions are the same. It should be based on factors such as your cancer diagnosis, side effects, and treatment type, timing and trajectory. Plus your age, current activity levels prior to diagnosis and previous injuries and illnesses.
With all that in mind, research has shown that a combination of both types of training is recommended for you during and post treatment. So far the evidence says that best case scenario is twice a week progressive (60-80% 1RM) resistance training (lifting/moving heavy objects). Adding to two-four times of moderate aerobic (huff and puff) exercise (40-60% max). If you have just undergone a chemo cycle that may be 2 x 5 minutes of a home-based program. This may include sit to stands, wall push ups and a single leg dead lift. If you are feeling strong that maybe 2 x 45 minutes of supervised gym using weights.
Do I need to train throughout my whole treatment?
Interestingly, timing and duration of the activity may be important since one of the biggest effects on fatigue was observed when the exercise intervention lasted until the end of the treatment. So, ensuring you move throughout the entire treatment period/s can decrease your cancer related fatigue by up to 50%. That could mean the difference between getting to the toilet, being capable to watch your children play sport, or even feeding yourself.
If you are unsure about how to begin or keep exercising as you undergo treatment, please feel free to give us a call or an email and we are happy to chat!
Brown 2010, Efficacy of Exercise Interventions in Modulating Cancer-Related Fatigue among Adult Cancer Survivors: A Meta-Analysis. The Journal of Cancer Epidemiology and Biomarkers
Curta et al 2000, Impact of Cancer-Related Fatigue on the Lives of Patients: New Findings From the Fatigue Coalition. The Oncologist vol. 5 no. 5 353-360
Maloney, L 2016, A summary of meta-analytic evidence on the impact of exercise on cancer related fatigue: An umbrella review.
Osteoporosis is a global disease in which the remodelling process (replacement of new bone for the old) results in an excessive loss in bone mass. This issue here is that it leads to an increase in our fracture rate (and severity), musculoskeletal impairment and mortality.
Why should we care about Osteoporosis?
By 2022, it is estimated there will be 6.2 million Australians over the age of 50 with osteoporosis or osteopenia. That is a 31% increase from our 2012 figures! Improving our lifestyle factors such as eating a well balanced diet, not smoking, minimising alcohol consumption and engaging in regular exercise are the easiest and most cost effective treatments in reducing our risk. Although osteoporosis is determined primarily by genetic factors, our environmental and lifestyle choices can modify around 30% of ourbone mass,
Women have higher risk of osteoporosis than men. Why the gender gap?
Did you know that women start with a lower bone density than their male counterparts. This becomes especially evident in postmenopausal women due to the decreased levels of estrogen production. This is because estrogen helps regulate a woman’s reproductive cycle as well as plays a role in maintaining bone density.
So what is actually happening in our body?
Human bones are constantly changing, our old bone cells are being replaced with new cells. The removal of old bone is controlled by cells called osteoclasts, while the formation of our new bone is controlled by cells called osteoblasts. Like a simple mathematical equation, bone growth is achieved when there is higher activity of osteoblasts. This is present in children up to early adulthood, where it peaks by 20 years of age. From our 30’s this process starts to reverse, which is why it’s so important to maintain bone strength through proper diet and physical activity.
The role of exercise in osteoporosis is well known, especially in promoting calcium intake, maintaining bone mass and strengthening the functionality your bone. Regular exercise is believed to be the most important factor to increase or maintain bone mineral density (BMD). Basically the mechanical forces placed in the skeletal system when you exercise stimulate bone size, shape and strength.
So what about Osteopeania then?
Osteopenia refers to a decreased BMD, but not low enough to be classified as osteoporosis. Having osteopenia means that there is a greater risk that you may eventually develop osteoporosis.
Well the good news is that osteopenia is reversible. A balanced diet and regular resistance based physical activity will help slow the loss of bone density and delay or better prevent osteoporosis. So lift some weights, get some sun and eat healthy to give yourself the best chance of maintaining a healthy BMD and decreasing the risk of fracture.
Trying to put cancer into words is beyond difficult. It is more than just a series of statistics; it is a ruthless disease is something that has devastated us all in one-way or another, whether we have personally been affected or we have seen loved ones go through the battle.
In stark contrast, the aim of exercise is to build up the human body and make it more resilient to what life throws at it. It can increase our aerobic capacity, strength, endurance, immunity, mental health, metabolism, and the list goes on.
So, why is there is a still a longstanding misconception that once diagnosed with cancer that individuals should generally rest and recover?
Research and clinical practice have both proven unequivocally that appropriately prescribed exercise is safe during and after treatment. Much more than that, appropriately prescribed exercise can be used to make treatment more effective, decrease adverse acute side effects, and minimize the long-standing consequences of the brutal regimes it is put through.
In fact, 62% of people with cancer are sedentary. 75-90% of those with cancer don’t perform any strength based exercise. It is important to caveat this blog with the understanding that side effects of treatment can leave the body unable to do what it used to. But! And here is the big BUT! As Robert Newton (a leading exercise oncology professor) states “some activity is better than none, more is better than less.” Patients may not be able to go for that 6 km long hike or run like they used to, but what ever stimulates change and growth within the body will be effective. More importantly, it gives people the chance to do something positive with their bodies rather than just constantly be broken down!
This blog begins a series of cancer specific articles taking an in depth look at the how’s and the why’s exercise oncology, so keep a look out! If you ever have any questions or queries, please feel free to have a chat with me.
My final thought is this… Exercise has now been proven to be a drug, which should be prescribed appropriately and individually in those undergoing cancer treatments… so why are we not using it!
Before we begin, I just wanted to pop these stats in front of you….
· 34% of Australians (over 18) are have high bloodpressure (BP) – that’s about 6 million people
· 4.1 million Australians have uncontrolled or untreated hypertension
So, let’s answer a few commonly heard questions around iNform: 1)How does a bout of exercise affect my BP? A single episode of exercise is able to reduce BP post exercise. The magnitude (−2 to −12) and duration (4 to 16 hours) vary considerably between individuals as the environment, exercise prescribed, duration of exercise and genetic components can all affect change.
Let’s get scientific for a second: Systolic BP (the first number) refers to how much pressure goes through the arteries as the heart is contracting. We would love it to be around 120. Diastolic BP (the second and typically smaller number) refers to the arterial pressure during the relaxation phase of the heartbeat. The recommended value is approximately 80.
When we begin exercising our systolic BP increases because we need to pump more blood around the body to deliver oxygen and get rid of waste products. Our heart rate increases and the overall amount of blood moving through the arteries increases. Therefore the pressure the blood creates on the arteries also increases. However BP does not usually fly off the charts because our arteries dilate to allow the extra blood through and as such the resistance (and the pressure) decreases. Think of it like opening doors wider to allow more people to shop during the post-Christmas sales. So we would tend to expect a gradual increase in systolic BP until we hit a plateau at our exercise peak. Interestingly our diastolic does not often change much except in static exercises like wall sits.
How does it work? This happens through a variety of ways including increased hormonal activity, decrease in heart rate and nerve activity (sympathetic – due to decrease in circulating catecholamines).
However, given the many factors in our body that help regulate our BP, it is still proving difficult to identify a single mechanism for this drop. What is important though is the beneficial effects on the body!
2)Can regular exercise help me control my high BP The big new is yes! Regular physical exercise has been recommended for the prevention and treatment of hypertension. We have had a range of clients who begin to exercise regularly, decrease their BP and thus the decrease or even cease the medication they are on (based on GP’s clinical decision).
3) What exercise is best for individuals with high BP? Decrements in BP have been widely found in a majority of aerobic exercise including walking, running, cycling. Resistance training is a little more controversial is it tends to exhibit greater BPs during the exercise, however it does exhibit post exercise BP decrements. Each training mode produces different effects on the body so it highly encouraged to completing both modes.
4) How long should I exercise for? The acute decrease in BP has been observed after as little as 10 minutes and as long as 170 min of exercise, although the majority of studies have used exercise lasting between 20 and 60 min. So if time is a factor, you still gain benefits from a short bout of exercise.
To make long term changes, research shows that there seems to be a positive association to 3-5 days of exercise for approximately 30-60mins at greater than 65% intensity levels. However, just remember any type and duration will have a positive response when compared with no exercise.
5) What is the best way to work out my BP response to exercise? Here at iNform, if we feel it is required we measure BP pre and post (sometimes during). This happens over a course of sessions and allows us to monitor the responses to the exercise prescription. It also allows us to change intensity, duration and mode to see how these effect individuals. We find different individuals respond better to different modes so we take an individual approach to determining it.
6)What risks are there of exercising with high BP? Both aerobic or resistance training can increase systolic BP, so ensuring that this rise does not exceed approximately is important. If systolic BP rises greater than 250 mmHg and/or diastolic BP >115 mmHg during exercise, the training session should be terminated.
Ways to decrease risk: a) Ensuring steady breathing during exercise is important to decrease build-up of pressure in arteries. This is especially evident in resistance training b) Completing dynamic movements rather than static exercises (such as wall sits) are important to decrease risk of excessive BP c) Upper body exercises tend to lead to an increase BP when compared to lower body exercise, however this is not saying no upper body exercise (just be mindful). d) Ensuring a progressive build-up of intensity during warm up and slow down when cooling down to reduce risk of sudden drops or increases.
As the nation goes through a messy haze, filled of negativity biases left right at your doorstep or television screen. It feels refreshing to promote psychology week.
In between all the Trump & Clinton concoctions, horrific weather and so-forth. Psychology week, promoted by the Australian Psychology Society is another wonderful intervention to promote health and well being. One is going to discuss the power of social connection; and the importance on combating disease and social isolation.
One is in awe of all the Facebook love; to promote the awareness of mental health. With all the ‘likes’, sharing and so forth (bless our nucleus accumbens!). The second Thursday of September 2016 marks “Are you OK day?”. One doesn’t need to explain the definition.
But; Perhaps flip the coin, directing attention on the self. Why the self?. When was the last time you got in touch with your inner meta-cognitive dialogue? I will touch on reaching out at the end….However, placing emphasis on the self first, can then enable the opportunity to reach out to others.
To be vulnerable, one must surrender shame. When shame is surrendered, one can be ready to show compassion. When feeling numb, self cannot connect, because self is dis..connected. The same can be said with mental health. Mental health is much more than depletion of neurotransmitters & a lottery of SSRIs & MAOIs!
To further delve, please do follow the links above to find out more…
Let’s say that self is ready to reach out to others in need. Trying to say/think of the right words can be incredibly difficult, especially if the topic is sensitive. However; listening, reading facial expressions, feeling ones pain (without taking on the burden) and touch (within respect), are all powerful non-verbal tools, which can assist the compassionate empath…YOU!
My dream for the future, is that humanity won’t need a day of recognition to remind us all to be self compassionate, emotionally intelligent, empathetic… Friend, husband, wife, brother, sister, colleague and neutral.