There are more than 120,000 new cases of cancer diagnosed yearly in Australia. The burden of cancer is well known in Australia with current predictions indicating that 1 in 2 men and 1 in 3 women will be diagnosed with cancer by the age of 85 years. For many cancers the current survival rates exceed 90% due to advances in treatment. However, the cost of these advances in treatment leave common side-effects during cancer survivorship which include symptoms of fatigue, pain, impaired immune function, negative changes in body weight and composition, worsened bone health, lymphoedema and gastrointestinal changes.
Cancer related fatigue (CRF) affects over 10 million people worldwide and does not resolve with rest and rarely presents as an isolated symptom. CRF is multidimensional and often is a cluster of symptoms including sleep disturbance, pain and emotional stress. CRF is categorised as either central fatigue originating from neurological impairments within the cerebrum or peripheral fatigue originating from impairment within the musculoskeletal system.
There is now strong compelling evidence to recommend exercise as a first line intervention for CRF. The benefit of exercise to reduce CRF may be associated with a ‘positive sense of fatigue’ derived from peripheral factors Vs the ‘negative sense of fatigue’ related to central fatigue. ‘Positive sense of fatigue’ after exercise correlates with a perception of increasing strength, energy level and a state of well-being.
The Benefits of Exercise
The benefits of exercise during and after treatment include improvements in:
• Muscle strength, mass and power
• Physical functioning
• Range of motion
• Immune function
• Chemotherapy completion rates
• Body image, mood and self esteem
Furthermore, reductions are seen in:
• Duration of hospitalisation
• Psychological and emotional stress
• Depression and anxiety
• Number and severity of symptoms and side effects reported (pain, fatigue and nausea)
Exercise Recommendations for cancer survivors
An exercise program needs to be individualised to meet past and current fitness levels, previous and planned cancer treatment, disease and treatment-related risk factors, presence and severity of symptoms and the general interest of modality of exercise.
The aim is to have exercise engagement meet the recommended current physical activity guidelines for general population. These guidelines may however be too unrealistic for some people due to recent surgeries or other associated treatments. Therefore, encouragement of the following is a good starting point remembering ‘some exercise is better than no exercise’.
• Limit sedentary behaviours such as prolonged sitting/laying down
• Maintain or gradually return to activities of daily living (ADL’s)
• Gradually introduce planned aerobic-based exercise (walking, cycling, swimming) aiming to build to 150 minutes of moderate-intensity (puffing) exercise weekly.
• Engage in 2 sessions weekly of resistance-based exercise (weights, body weights, therabands) for all major muscle groups. Allow 48-hours recovery between sessions.
Is exercise safe for cancer survivors?
Exercise is considered safe when commenced at an appropriate level and progressed gradually. There are standard guidelines that should be followed particularly for people who have heart and lung problems. There is some extra care and considerations that must be addressed for some cancer survivors whom may be at higher risk of heart attack or cardiovascular events. Also, consideration must be given for chosen exercise modalities, prescription and the location of exercise engagement particularly for those with suppressed immune systems.
Contraindications and barriers to Exercise
Contraindications to exercise for cancer survivors are the same as for the general population. Cancer survivors face the unique challenge of the risk of cancer recurrence and development of chronic diseases. Common side effects associated with cancer survivorship such as pain, nausea and fatigue make regular exercise adherence difficult. A well-designed program should take into consideration these struggles. An accredited Exercise Physiologist (AEP) can help address common barriers to exercise, assist with goal-setting and appropriate program prescription, ensure contraindications are addressed, assist to manage risk factors of chronic disease development, supervise to ensure exercise is done safely and potentially assist to find you a supportive group exercise environment where you can engage in regular physical activity with other cancer survivors.