Exercise and cancer

September 18, 2012 David Zucker, MD, PhD

There is plenty of research—and it is increasing every day—showing that exercise is beneficial for cancer survivors, whether during or after treatment. In a recent study published in the Journal of Pain and Symptom Management, Dr. Andrea Cheville, an onco-physiatrist (cancer rehabilitation physician) and colleagues at Mayo Clinic interviewed 20 patients with advanced lung cancer about exercise, its relationship to their symptoms, and the role of their oncology team in counseling them about exercise (video). Not surprisingly, participants considered their usual everyday activities as "exercise". While important in helping to maintain function, everyday activities generally do not reach the threshold to help maintain or improve overall fitness. In Dr. Cheville’s study, exercise was defined as "a systematic way of stressing the body to increase flexibility, stamina, and strength.”

Systematic and regular exercise causes biochemical changes in the body, not unlike medicine. The route of administration however, is different. You can't take an "exercise pill", you have to actively participate. The changes that exercise brings are beneficial. For example, exercise can help reduce fatigue. While this may seem counterintuitive, especially while living with cancer, taking it easy can actually increase fatigue. This is because the body becomes "deconditioned"—the less the body does, the less it can do. Add the fatiguing effect of chemotherapy, and you have a recipe for reduced whole body strength and fitness. Enjoyable and regular exercise is a powerful antidote to the fatiguing impact of cancer and treatment.

In our cancer rehabilitation programs, we often hear survivors express fear that exercise might cause physical harm. Some of the participants in Dr. Cheville's study expressed a similar concern. When exercise is done with a good understanding of what is too much, what is too little, and how to modulate its intensity during cycles of treatment, exercise not only enhances physical and mental well-being, but also helps to reduce symptoms related to cancer and its treatment. In addition to fatigue, these symptoms include shortness of breath, pain, insomnia, malaise and reduced endurance.

The study showed that survivors strove to “self-regulate” their activities so as not to trigger uncomfortable symptoms. While well intentioned, it was pointed out that such "patterns of avoidance" carried out over long periods of time inevitably lead to deconditioning and can increase, rather than decrease, uncomfortable symptoms. It's often a revelation to cancer survivors to recognize that much of the suffering and many uncomfortable symptoms are not related to cancer, but to deconditioning and, further, that these experiences can be lessened by something as simple and enjoyable as regular physical exercise activity.

Dr. Cheville's participants often cited lack of direction in how to reap the benefits of exercise as sanction not to initiate a program of conditioning exercise. We are fortunate that our physician team at Swedish Cancer Institute includes not only cancer surgeons, medical oncologists, and radiation oncologists, but also an onco-physiatrist who, like Dr. Cheville, is a specialist in cancer rehabilitation medicine. Our physician team is augmented and supported by a dedicated team of physical therapists who serve as "personal trainers" and help to optimize fitness, well-being, and to increase abilities to participate in cherished everyday activities.

Our team is here to help survivors initiate and maintain a good physical exercise program, whether living with advanced disease or not.


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