Exercising with Cancer

“If the effects of exercise could be bottled, it would be the most widely prescribed medication” (Dr. Linn Goldberg). In a recent publication titled “Evaluation of a cancer exercise program: patient and physician beliefs” by Peeters et al. surveyed doctors who reported that the majority of oncologists have insufficient time to discuss exercise in their practice.  However, it has been proven in multiple studies that participation in an exercise intervention during cancer treatment diminishes the side effects associated with cancer therapies. Exercise boosts your immune system and helps it to fight cancer. It helps normalize your body weight and get rid of excess fat, a known risk factor specifically for breast cancer. Exercise gets the blood and lymph fluid circulating and helps the body get rid of toxins and it lifts your spirits, which helps with depression and anxiety. With the known benefits it’s confusing to understand how doctors like the ones from the study have such time constraints that limit them from educating their patients. I feel it’s necessary and personally important too me to educate individuals on the benefits of properly prescribing an exercise intervention and the results that can follow.

This topic has had a direct effect on my life. My father was diagnosed with esophageal cancer in January of 2012. He noticed that he was having pains in his chest and feared he might be having heart problems. After many examinations the doctors concluded his heart was fine. On his last visit the doctor decided to check his esophagus by performing an endoscopy. When the camera reached the sphincter between his esophagus and stomach he saw the growths in the area and performed a biopsy. Later he came back to deliver the news to my dad that he indeed had cancer in this area. His cancer was diagnosed in stage 3 III. I did my own research and found that the survival rate was not good.  After a few days I spoke to a professor of mine and he told me that the only thing I can do is to use my education and prepare him for what was ahead. I became motivated. I had already learned a great deal about exercise for cancer survivors and those in treatment and knew of the benefits that he could gain.

I attended my father’s doctor’s visits at the University of Wisconsin-Madison. The doctors wanted to be very aggressive with him and discussed his chemo and radiation therapy timeline. They discussed drugs he would receive and the effects of all of them. In a study by Murane, et al. 71% of cancer patients wanted information about exercise during treatment.  89% of the surveyed patients said they would participate in a personalized, home based physical fitness program. I asked my father in a series of Q&A’s, “What directions did the doctor give you in regards to physical activity during treatment”. His response was that the doctors said to do whatever he was capable of doing and wanted to do. He had to ask about physical activity because none of the doctors volunteered any direction or information on the benefits of exercise or on exercise program considerations. Macmillan Cancer Support’s chief medical officer, oncologist Dr. Jane Maher, said in a written statement that health care professionals need to undergo a “cultural change” and make exercise an integral part of cancer care. Macmillan’s “Move More” report found over half of general practitioners, oncologists, and nurses don’t tell their patients the benefits of physical exercise.

As well, doctors are hindering their patients in the fact that pre-habilitation through exercise before surgery could eliminate functional decline after an operation to remove the cancerous areas. Surgery often compromises different areas of your body, and you may need to rely on your muscular strength and endurance to help you with your daily activities. After surgery it is challenging to perform routine activities like sitting up, getting dressed or using the bathroom. The doctors that performed the procedure on my father had to reform his lower esophagus out of his stomach once the cancerous area was removed. His surgery took 10 hours and they had to go through both his left and right sides of his chest along with through his front abdominal area. Having one of the best thoracic surgeons in the world does help, but she contributes his workout regime and preparations to the main reason he only spent 4 days in recovery before leaving the hospital.

One relevant aspect of exercise concerns its effect on the immune system, which is frequently compromised in cancer due to stressful effects of chemotherapy, radiation and other aspects of the overall experience of cancer. Exercise is a potent stressor, and under certain circumstances may compromise immune system functioning, although normally this effect is limited to relatively high exercise intensity levels. On the other hand, there is evidence that exercise can strengthen the immune system and reduce susceptibility to disease under some circumstances. The key appears to be determining an optimal exercise ‘dosage’ that minimizes disease susceptibility while maximizing immune system functioning.

Furthermore, in considering those who do want to participate in exercise, a strong education and background in proper exercise prescription is a necessity for anyone prescribing exercise into a cancer patient’s.  The American College of Sports Medicine recommends “to the extent they are able, cancer patients and survivors should adhere to the 2008 federal Physical Activity Guidelines for Americans, which recommend at least 150 minutes per week of moderate-intensity aerobic activity. Similar guidelines state, walking and cycling are recommended as safe and generally well tolerated exercise modes involving large muscle groups, with a recommended frequency of 3-5 times per week. More deconditioned patients should begin with daily sessions of shorter duration and lower intensity. In general, moderate intensity exercise (50-75% HR reserve, RPE 11-14) sessions of between 20 and 30 minutes duration are recommended, with modifications as needed, including very short exercise bouts (3-5 minutes) followed by rest periods. Knowing your patient, what they are capable of doing, there work capacity, and preferences of exercise are all areas that must be taken into consideration when programming an exercise plan. Not knowing one of these variables could lead to injury, set back in treatment schedule, or making the experience not enjoyable, leading to a lack of motivation to participate.

Exercise recommendations should be tailored to the individual cancer survivor to account for exercise tolerance and specific diagnosis. For example, cancer patients with weakened bones may be advised to avoid heavy weight training in order to avoid fractures. Other exercise options can be walking, gardening, playing with grandchildren, riding bikes, or light strength training.  My father asked me to help him decide on a workout program. We decided on working his major muscle groups doing push ups, squats, rowing activities, and lunges to increase his strength and hopefully develop as much mass as possible. He continued to stay active aerobically by walking his dog around the neighborhood and walking on his treadmill.  He went above the recommended aerobic activity time set by the ACSM and maintained his workouts as long as he was physically able too.

Exercise is proven to be beneficial, but doctors and hospitals are not giving it enough attention. Exercise is not a final solution to healing cancer, however, if the results from an exercise intervention equal what prescription drugs can do then we must educate the population on it.