By Jennifer Green, B.S.
 |
| Jennifer Green, NCHPAD Visiting Information Specialist |
In the past, people being treated for chronic illnesses, such as cancer, were often told by their doctors to rest and reduce their physical activity. This advice may still hold true if movement causes severe pain, rapid heart rate, or shortness of breath; however, new research has shown that exercise is both safe and feasible during cancer treatment. Physical activity has been shown to improve physical functioning and quality of life, while too much rest may result in loss of function, strength, and range of motion. Regular physical activity is a great way to combat the negative effects of inactivity in chronic illness.
When creating exercise prescriptions for individuals with cancer, there are several important aspects to keep in mind. The first is that treatment for cancer may involve surgery, radiation, chemotherapy, hormones, and immunotherapy. In the process of destroying cancer cells, some treatments also damage healthy tissues. Patients may experience side effects that limit their ability to exercise during treatment and afterward, both immediately and long-term. Furthermore, overall physical functioning is generally diminished due to loss of aerobic capacity, muscle tissue, and range of motion. According to the American College of Sports Medicine, "Even among cancer survivors who are 5 years or more post-treatment, more than half report physical performance limitations." Given this knowledge, it is important to remember to prescribe appropriate exercise in terms of intensity and duration for these individuals.
There is insufficient evidence for precise recommendations regarding the optimal components of exercise prescription for cancer patients, as there are many different cancer types. However, we can follow the general principles recommended by the American College of Sports Medicine as well as the American Cancer Society (ACS). The ACS Nutrition and Physical Activity Guidelines suggest that adults choosing to adopt a physically active lifestyle should engage in at least 30 minutes of moderate to vigorous physical activity on 5 or more days of the week, with 45 to 60 minutes of intentional physical activity being preferred. This recommendation is very similar to that of ACSM, which suggests aerobic activity 3 to 5 days per week for 20 to 60 minutes per day, resistance exercise 2 to 3 days per week consisting of 1 to 3 sets of 8 to 12 repetitions with at least 48 hours of recovery between sessions, and flexibility exercise 2 to 7 days per week consisting of 4 repetitions of 10 to 30 seconds per stretch. Exercises can be accumulated in shorter bouts if necessary.
As mentioned before, intensity is important to consider in this population due to high rates of fatigue. Although some clients may be exceptions to the rule, general guidelines suggest aerobic exercise be performed at 40% to 60% oxygen uptake reserve (VO2R) or heart rate reserve (HRR). This portion of an exercise program should include prolonged, rhythmic activities such as walking, cycling, swimming, etc., focusing on large muscle groups. Resistance training should range from 40% to 60% of a one-repetition maximum test (1-RM) and involve a combination of weights, resistance machines, and weight-bearing functional tasks. Finally, flexibility exercise should be 'slow and static to the point of tension,' and include both stretching and range of motion activities addressing particular areas of joint or muscle limitation that may have resulted from treatment with steroids, radiation, or surgery.
Once you have created an appropriate exercise prescription focusing not only on the guidelines above but also the personal goals of your client, it is important to review the special considerations for this population. As stated before, fatigue is a major factor when training with an individual who is fighting cancer, yet there are other considerations as well. High-impact activities and contact sports should be avoided to minimize fracture risk. Because bone is a common site of metastases in cancers such as breast, prostate, and lung, bones, specifically in the vertebra, pelvis, femur, and skull, can be fragile. Cachexia, which can consist of weight loss, muscle atrophy and weakness is also prevalent with some forms of cancer and can limit exercise depending on its extent. Finally, individuals who have had bone marrow transplants and low white blood cell counts may want to avoid exercising in public places to decrease the risk of microbial contamination.
In all, exercise has been shown to improve physical function and the quality of life in those who are fighting cancer. When creating an exercise prescription, it is important to follow the guidelines set by the American College of Sports Medicine as well as those set by the American Cancer Society. However it is also important to listen to your clients, understand their conditions and goals, and find creative, fun ways to work around obstacles that may arise. Remember to always have your clients fill out a medical history and talk to their doctors before starting a program. With the proper techniques and understanding of disease, exercise professionals can play an important role in the treatment as well as prevention of this condition.
By: Jennifer Green, B.S.
Sources:
Doyle, C., Kushi, L. H., Byers, T., et al. (2006). Nutrition and physical activity during and after cancer treatment: An American Cancer Society guide for informed choices. CA Cancer J Clin, 56, 323-353.
Physical activity and the cancer patient. (2008). Retrieved February 1, 2010, from
The complete guide-Nutrition and physical activity. (2008). Retrieved February 1, 2010, from http://www.cancer.org/docroot/PED/content/PED_3_2X_Diet_and_Activity_Factors_That_Affect_Risks.asp
Thompson, W. R., Ph.D., FACSM, Gordon, N. F., MD, Ph.D., MPH, FACSM, & Pescatello, L. S, Ph.D., FACSM (Eds.). (2010). ACSM's guidelines for exercise testing and prescription (8th ed.). Baltimore: Lippincott Williams & Wilkins.
Please send any questions or comments to Jennifer Green at green1jn@uic.edu.