cathy-skinnerIn response to emerging research, more healthcare organizations are recommending exercise for cancer patients. As a result, cancer patients and survivors are looking for ways to build upon the healing foundation initiated by their physicians and physical therapists and carry it forward to their lives after treatment.

Even with the same cancer diagnosis and treatments, people have different outcomes. Individuals respond uniquely to their cancer, to the treatments, and to exercise. As a result, cancer survivors need a program that can be customized and constructed to meet their needs. This adaptability keeps survivors engaged and moving forward. Many people embark on an exercise routine with good intentions; however, they become derailed by exercises that are not appropriate for them or do not fit their complex health concerns. When a patient considers a cancer recovery exercise program, I encourage them to find one that inspires preventative wellness as a key part of recovery, empowering them to develop lifelong, sustainable habits of self-care and wellness.  

Exercise Overview

Cancer patients should plan to exercise three to six days per week. To begin an exercise session, a warm-up of at least 5 minutes is recommended; however, any patient who suffers from irregular vasomotor symptoms (i.e. overheating, hot flashes, etc.) should extend their warm-up to 10 minutes. Warm-up options include walking, jogging, rowing, biking, dynamic stretching, and other activities. Patients are encouraged to do strength training that follows a three days per week routine on nonconsecutive training days. On alternating days, participants are encouraged to be physically active for at least 20 minutes with activities that build their cardiovascular system such as walking, biking, jogging, etc.

Exercise Barriers

For many cancer patients and survivors, the greatest barrier to exercise is fatigue—the mind-numbing, life-altering, unimaginable fatiguethat frequently accompanies diagnosis and treatment. It may appear counterintuitive, but movement and exercise have been shown to decrease feelings of fatigue.[1]Exercise releases hormones such as endorphins and serotonin which trigger the brain and body to feel elated, energized, and happy.[2]For decades, physicians treating cancer patients encouraged them to rest during and after treatment. However, with the evidence generated by research and greater understanding of the debilitating effects of treatment, such as the loss of muscle mass, bone density, neuropathy,cognitive function, and digestion problems, physicians are now recommending that patients get moving. In fact, the American Cancer Society advocates that cancer patients “avoid inactivity.”[3]

Another barrier to exercise is fear. Even if a survivor was an exerciser prior to diagnosis, fear can be a byproduct of not knowing what to do after treatment. Survivors may ask: What are my capabilities? What are my limits? Where did I get this body and how does it work? Will I be able to perform at the same level? Will I experience the same benefits? Some people take the cancer diagnosis as a death sentence and rationalize that they need not or cannot devote any more time or energy to their physical well-being. 

If a survivor did not exercise before the diagnosis, concerns may arise about moving forward with exercise in safe and appropriate ways. There is a certain level of body awareness that comes with a history of exercise. Those who exercised before diagnosis already understand how to activate muscles, how to coordinate movements, and how to trust their body to do the work. If exercise is new to a person, he or she will have to grow to understand what a sore muscle feels like versus what an injured muscle feels like. This becomes particularly complicated when cancer survivors are also scanning their body for signs of more canceror for treatment efficacy, even as they continue to try to comprehend the whole cancer journey. Furthermore, if people have negative associations with exercise, there may be additional mental and emotional hurdles to overcomebefore getting started. 

Closely linked to fear is depression. Often survivors experience significant feelings of loss and grief for the body, abilities, and life once possessed. Survivors have suffered many losses: perhaps hair, a body part, identitysexuality, a sense of power and control, and life as once was known. For some, antidepressants can be valuable tools to move through a difficult time. Exercise also can act as an antidepressant; used alone or together with medication, it can have powerfully positive results

Cancer Side Effects

Some treatments, such as chemotherapy, can cause neurological damage that resembles Post Traumatic Stress Disorder or brain damage. According to the American Cancer Society,[4]percent of people who had chemotherapy experience a side effect called “chemo brain.”
This mental fog includes impairments such as short-term memory loss, the inability to multitask, diminished word recall, the inability to finish tasks in a timely manner, and trouble concentrating. The term chemo brain may be misleading. Researchers at the Mayo Clinic propose that there are other cancer-related factors (besides chemotherapy) that affect mental function.[5]While more research is underway, it is believed that some of these effects are reversible. Exercise can assist in rewiring the neurological system and help the body and brain find new ways to function. According to studies at MD Anderson Center at the University of Texas, even five minutes a day of moderate aerobic activity can improve mental function in cancer patients.[6] 

Sometimes side effects created by or exacerbated by cancer treatments impose limitations. Patients can have balance and gait issues, mobility and stability limitations, bladder and bowel problems, and chronic pain. When I work with clients either one-on-one or in small groups, I often ask, “Do you have any pain or weirdness?” I ask the “weirdness” question because I want to know if the participant has any pain beyond their daily experience of pain. For those who live with chronic pain, exercise can still be a part of their treatment. However, through reflection and self- assessment, those with chronic pain can discern if the exercise creates more or less pain and if they feel safe to move forward.  

Costs of Cancer v. Benefits of Exercise 

The fear of a recurrence of disease or secondary complications makes survivors think twice about how to spend their money. Some view exercise as a luxury and an extravagant expense. I recommend cancer survivors look for an exercise program that requires very little equipment and can be started with a few simple exercises in a survivor’s home. More importantly, find a program designed for survivors to grow in self-efficacy and empowerment; thus, creating a sustainable, healthy lifestyle. There is nothing more effective at reducing cancer costs than maintaining one’s health

[1]New Guidelines Strongly Recommend Exercise for Cancer Patients, Survivors.” ACSM In The News (1 Aug. 2011): n. pag. Web.

[2]Oncology Rehab Partners: Your Source for Developing a Comprehensive Cancer Rehabilitation Program.” Advertisement. N.p., 2013. Web.

[3]www.cancer.org

[4]Chemo Brain.” American Cancer Society (30 May 2012): n. pag. Web

[5]Cheville, Andrea L. “A Home-based Exercise Program to Improve Function, Fatigue, and Sleep Quality in Patients with Stage IV Lung and Colorectal Cancer: A Randomized Controlled Trial.” N.p., May 2013. Web.

[6]Chemo Brain.” MD Anderson Center (2013): n. pag. Web.

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