Chemotherapy is prescribed to do a great number of things: to cure, aid other treatments, control the cancer, and help with symptom relief. It is a powerful tool, but as everyone knows, it brings with it a vast array of challenges, both during your cycles and after. But where does tailored exercise fit into this? Is it possible to stay active whilst undergoing chemo, and why on earth would you want to?
The plain and simple fact is that there is a growing body of evidence that shows tailored exercise during chemotherapy can reduce unwanted side effects, limit de-conditioning, AND now it is also being found to aid treatment. So, why are we not prescribing exercise like a drug? Why are we still not using it to its potential? Well, let’s talk about the benefits first…
1. Exercise creates a reduction in chemotherapy related neuropathy symptoms
Neuropathy is a relatively common side effect of chemotherapy. Essentially, it effects the hands and feet, creating symptoms like numbness, tingling and pain, cramping, difficulty handling small objects, and issues with gait and balance. Unpleasant! Multi-modal exercise, such as resistance exercises coupled with low to moderate intensity aerobic exercise like walking, creates significant reductions in both the severity and prevalence of neuropathic symptoms. Now that sounds to me like a pretty useful treatment!
2. Exercise reduces cancer related fatigue
Chemotherapy is associated with a crippling fatigue, known as cancer related fatigue. This can have a sudden onset and can impose a significant physical burden. It is also psychologically draining as it often means you are unable to do the things you love, and can impose a financial burden due to missed days as work. There are now hundreds of studies that show that exercise reduced fatigue levels. If you would like to know more, read my previous blog “Cancer related fatigue: Does exercise help or hinder?”
3. Exercise reduces de-conditioning
Research has shown that the loss of rapid muscle mass is accelerated 24-fold during chemotherapy in comparison to healthy people. It is no wonder people undergoing chemo feel fatigued when they lose so much muscle, so quickly. Luckily we have a treatment for that! Specific resistance training has shown to minimise this loss of strength. Completing targeted strength training means that carrying your children, doing the shopping, getting out of the car doesn’t become so fatiguing. That has to improve your quality of life.
4. Exercise reduce risk of cardiovascular disease
Due to the direct toxic effects of anti-cancer therapies as well de-conditioning, people undergoing chemotherapy have a risk of developing cardiovascular diseases such as heart failure, stroke, and coronary heart disease. A study in 2016 found that post-diagnosis exposure to exercise was associated with substantial reductions in newly diagnosed cardiovascular diseases or cardiovascular related death. That is massive!
5. Improved completion rates of treatment
Now, oncologists provide treatment doses based on what they think will create the best chance on achieving the treatment goal. However, completion can depend on how well you can withstand the treatment and it’s side effects. So, given that exercise therapy can reduce general pain levels, cancer related fatigue, and neuropathy it makes sense that it allows more people to fully complete treatment. This can give you the best chance of survival!
6. Exercise reduces risk of death
If you exercise when diagnosed with cancer, you will reduce your chance of dying. I know that is a massive statement, but a review of 71 studies in 2015 found that exercise was linked to reduced mortality in breast, colorectal, and prostate cancers (those were the only cancers these studies focused on). In one of those studies they found mortality reduced by 24%, 32%, 39% and 40% when individuals participated in low, moderate, vigorous and very vigorous activities respectively. What they essentially found was that there was a dose response relationship with exercise and mortality. Therefore, some exercise is definitely better than none and more is better than less. It depends on personal side effects of your chemotherapy treatment.
7. There are always caveats to exercising whilst undergoing chemotherapy
It is important to be aware of the caveats to exercising while undergoing chemotherapy. Exercise must be tailored to the current functional status and capacity of each individual patient and then must be progressed and regressed based treatment cycles. Overstretching areas around catheters should be avoided. Stoma’s should be cleaned before and after sessions and if you are feeling feverish. It is also important to monitor acute changes in your pain levels, gastrointestinal disorders (nausea, vomiting diarrhoea etc), changes in heart rate, and blood pressure and breathing rates.
As we mentioned, exercise prescription must tailored to the current functional status and capacity of each individual patient. Typically you can exercise directly after each chemotherapy dose but usually once side effects really hit, intensities will need to be modified. For the same reported feelings of exertion, your exercise may change from being able to jog around the block, to being able to walk to the mailbox. Then, as you progress through your cycle, your intensity can increase. Just remember, exercise may sometimes feel like the last thing you want to do, but just like any good medicine, it will help when prescribed appropriately!
If you have any questions regarding how and when you can use exercise, please feel free to contact Holly on 8431 2111.
About the Author
Can we use Strength Training for depression?
Any keen gym goer would have heard of the film “Pumping Iron” – and the subsequent revolution of Bodybuilding. Besides from being built like Hercules and having a positive-B sample, Strength Training has a lot of wonderful benefits for men and women. But what about Strength Training for depression?
Well, a recent meta-analysis published in the journal: JAMA Psychiatry may have just eluded some neat findings for Strength Training as an adjunct for reducing depression. The meta-analysis included: 33 clinical trials, with 1,877 participants. Gordon and colleagues found: “resistance exercise training was associated with a significant reduction in depressive symptoms.”
Promising news. However, there are limitations to consider… “total volume of resistance exercise training, health status and strength improvements were not associated with an antidepressant effect”.
So what could be some potential hypothesis that are contributing to the antidepressant effects experienced by the participants?
Filling in the gaps for using Strength Training for depression
First and foremost – we are born to move! When are ancestors became bipedal – moving to find food, water and shelter was essential.
And what happens when there is an unexpected reward? Dopamine is released, which causes a surge (reward dependent) of this wonderful catecholamine increasing the likelihood that the behaviour will be repeated – such as moving to find more resources, or more dumbbells!
Secondly, Strength Training has noteworthy benefits in the release of particular growth hormones and hypertrophic increases in muscle tissue. It would be plausible that an increase in testosterone, along with bigger muscles, would most definitely increase motor behaviour (going to the gym), along with libido (I will leave you with your own imagination). Which would equate to more energy being utilized, while also affecting higher cognitive regions in the frontal lobe improving: attention, motivation and reduced impulsiveness. The same areas of the brain that are inhibited by depression!
Lastly, although are ancestors missed out on dubstep, listening to music whilst exercising greatly activates many brain regions, along with an endogenous release of natural opioids that increase euphoria. I can see Hippocrates prescribing dubstep for his melancholic patients…
So hopefully I’ve filled in some missing gaps in the aforementioned meta-analysis that would be difficult to quantify.
Key take home points when using Strength Training for depression:
- Work with an accredited Exercise Physiologist/Scientist – to move with confidence. While also being guided about specific exercise prescription for your current goals, or medical condition.
- Make a sweet as music-playlist to increase baseline mood when Strength Training. Creating your own playlist will likely increase adherence to Strength Training along with enjoyment and motivation.
- Lastly, always consult your GP – if you are currently inactive, and wanting to increase your physical activity levels. The team at iNform can assist you from there onwards.
About the author
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.
NCCN 2016, Cancer-Related Fatigue, https://www.nccn.org/professionals/physician_gls/pdf/fatigue.pdf
Before we begin, I just wanted to pop these stats in front of you….
· 34% of Australians (over 18) are have high blood pressure (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.