Strength Training Benefits Cancer Survivors

A study published this November reviewed the results from 13 other studies that looked at strength training in cancer patients and survivors.  It showed that incorporating strength training into an exercise programme makes a positive a difference.

The resistance training helps by increasing muscle strength, physical function and by reducing fatigue.   All of these contribute to improving quality of life during and after treatment.

Increasing muscle mass is particularly important in cancer survivors as many treatments lead to loss of muscle, which is linked to overall strength and physical function.

CanMove – exercise for all cancer patients, includes resistance exercises that are tailored to each individuals abilities and progressed gradually.   Strength exercises can be done at home, a gym or outdoors and can be done using a variety of readily available equipment such as resistance bands, dumbbells and body weight exercises.    

If you are unsure about what exercises are right for you seek professional advice before proceeding.

When you feel to tired to exercise

It is common to feel a loss of energy during cancer treatments in particular as a result of chemotherapy or radiotherapy.  This loss of energy or fatigue can be severe and limit activity which leads to muscles wasting and losing their ability to function.

It has been shown that a good, regular aerobic exercise programme can help reduce this fatigue, which in turn allows you to do more of your normal daily activities with less limitation.

You can start the aerobic exercise programme during or just after treatment.  Just ensure that you progress gradually and listen to how you are feeling.

It adds up

Over the space of a year the smallest nutritional indiscretions can add up and lead to a small gradual increase in weigh and waistline.  Just one slice of sponge cake a week will add up to the equivalent of 2.5kg of fat or nearly 20,000 calories in a year.  Which means you would only have to walk about 200 miles to burn it off, which is equivalent of walking from St Peter Port to Paris. Over 10 years a weekly cake would provide enough energy to walk to Cairo.  If you don’t fancy wither of these expeditions but still want your cake and eat it, do a little bit every day.  About 900m a day would burn off the cake or a walk from the main road, past the model yacht pond, past castle cornet, out to the light house and back every other day.  If you do this, and do not have your cake and eat it you will lose the 2.5kg a year.  

Benefit of exercise for Cancer Patients

What effect will cancer have on exercise?

Depending on the stage of cancer and what treatment the individual has undergone they can experience some physical limitations when it comes to exercise. For example tumours in the lungs can result in breathlessness, pain is common for cancer in the musculoskeletal system; seizures can be a side effect when tumours are affecting the central nervous system and brain; and anaemia is common when the bone marrow is affected.

Certain side effects of treatments may impact exercise, but may also be a reason for continuing exercise. For example, some treatments may cause pain, fatigue, weight loss or gain, nerve damage, loss of flexibility or bone loss. Exercise can help decrease the severity of the side effects from these treatments.

The benefit of exercise:

Many studies have shown the benefit of individualised prescribed exercise programs during cancer treatment and recovery. For people going through cancer treatment the main goal is the maintain strength, endurance and a level of independent functioning. For cancer survivors, exercise has the goal of returning them to their previous level of functioning within society.

Benefits of exercise:

·       Reduced levels of fatigue	·       Less side effect severity
·       Improved body satisfaction	·       Improved fitness levels (aerobic capacity)
·       Maintenance of body weight	·       Higher quality of life
·       Improved mood, reduced levels of depression	·       Improved balance, bone remodelling and reduced muscle weakness
·       Improved shoulder range of motion; especially for those receiving treatment of the upper limb and chest region where muscle and skin can tighten in response to some forms of treatment	·       Improved flexibility & strength ·       A greater sense of control

Exercise and Cancer

Research shows that exercise is not only safe, but also helps with the outcomes of a variety of cancers including the most common types, i.e. breast, prostate and bowl cancer.  Exercise helps during (and after) treatment, by counteracting many of the side effects caused by the treatment such as muscle loss, weight gain, fatigue, depression, anxiety and decreased immunity. Research also shows that exercise improves quality of life, and that regularly exercising patients are more likely to complete their chemotherapy cycles, which leads to better long term outcomes.

Exercise during this time should be under the counsel of an expert exercise physiologist who will prepare a specialised program unique to you and your disease management. This will be more effective than undertaking a program on your own. The first step should be consulting your treating oncologist or GP. Your program will be individually tailored to your needs and could range from a walking program to a vigorous gym program.

The cost/benefit of cancer rehabilitation

Due to improved screening, earlier detection and more effective treatments cancer survival rates are increasing and now sit at about 50% for all cancers.

This means that one can estimate that about 4-5% (4-5 out of 100) of the population will be cancer survivors by 2015.  Many of these survivors do not return to their pre diagnosis levels of health, with about a third never returning to work.  They may suffer from a variety of ongoing effects, such as fatigue, depression, lymphoedema, and anxiety.  These issues mean, not only is a survivor’s quality of life diminished, but their ongoing health care costs are greater.  Many studies have shown that multidisciplinary rehabilitation (more than one type such as exercise and psychological support) provide physical and psychological improvements, which lead to a better quality of life. 

A recent article, in The Oncologist medical journal, has also shown that physical rehabilitation alone and multidisciplinary rehabilitation provide greater economic benefits than usual treatment. 

In summary, not only is it good for the cancer survivor to have access to multidisciplinary rehabilitation, but it also saves healthcare costs and social care costs.

What better reasons could you have to make multidisciplinary rehabilitation available to cancer patients?

Reference: The Oncologist 2012;17:1581–1593 www.TheOncologist.com

From clinic to athlete

You may think that there are few similarities between the two extremes of my client base, which range from people in ‘end of life care’ through to elite athletes who represent Great Britain.  However, I have found that they have the following common factors that are vital for everyone wishing to achieve a new goal.

1.                       Needs – both groups need programmes tailored to their needs, goals and available support to give them a chance of completing their goal and succeeding.

2.                       Mindset – both groups need to have coping mechanisms that help them determine their response to a stressful situation.

3.                       Training – benefits are not going to be seen unless they push through the monotony of training and maintain focus on the goal, whether it be symptom relief or a gold medal.

4.                       No pain no gain – the level they work at needs to feel at least moderately hard, which means it will probably feel uncomfortable.  Whether this is chair stands or high intensity interval work.

5.                       Back on the Wagon – if they have a result that has put them back, they will show the determination to restart without thinking ‘I failed last time, so I will fail this time.’

Try using some of these strategies to help you achieve your health and fitness goals and you will succeed.

Achieving your goals

One of the best ways of making sure your new healthy habits stick is by setting SMART goals:

·    Specific

·    Measureable

·    Achievable

·    Realistic

·    Timed

Within this, ensure you set both a long-term target and smaller, more short-term targets.  Write the goal down and put it somewhere you will see it whether that be the fridge, your diary or on the bathroom mirror.  Then, also take some time to think of the supports or barriers you that you may have and how they will help or hinder you achieving your goal.  Write these down along with ways that you will use the supports and overcome the barriers.

Then when you achieve the smaller targets, take time to reward yourself. Pick anything that you enjoy, from a meal out to a family day out. This stepping stone approach prevents the long-term target from being too daunting, and keeps you from throwing in the towel.

Go on set a goal and achieve it, whatever it is, it will feel great when you celebrate!

Multidisciplinary rehabilitation post treatment

Following a cancer diagnosis, patients often enter a protracted treatment period that can last many months.  During this time, they will be having regular appointments with medical specialists, nursing staff and allied health professionals.   Eventually their treatment cycle, a combination of chemotherapy, radiotherapy, immunotherapy, surgery or other targeted therapies, will end. Suddenly they are out in the world again with only a follow up appointment in 3-6 months time.

Many of my CanMove clients have said that this is an incredibly tough time and that there is a lack of direct support from health professionals during this time.  The post treatment period often leaves patients with ongoing psychological and physical side effects that can last years.  Fatigue has been reported to last up to 5 years.    

Not every patient needs follow up care, but it has been reported that about 1 in 3 would benefit from, amongst others, physical, nutritional, or psychological support.   A study that evaluated a rehabilitation programme in Belgium concluded that multidisciplinary programme should become part of cancer patients total care plan.  These programmes should become standard care as they have been for cardiac or pulmonary rehabilitation since the late 80s. 

How old is the knowledge?

It is surprising to hear that the first scientific article showing that vigorous exercise could influence certain components of the immune system was way back in 1902. 

To show this, R.C. Larrabee took blood from four competitors in the 1901 Boston Marathon both before the race and again within 5 minutes of completion. He found that all began the race with no abnormalities, but that the end tests all showed evidence of leucocytosis (that's a white blood cell count above the normal range in blood to you and me). 

With his conclusion stating that a marathon is a "violent, prolonged, exhausting work" and earlier mentioning that "...the winner...covered the distance in less than two and one-half hours. This is about ten miles an hour, about as fast as an ordinary man rides his bicycle for pleasure", perhaps we can conclude that R.C. Larrabee wasn't into his running! (FYI - the 2012 Boston Marathon winner came home in 2 hours 12 minutes.)

See 'Leukocytosis after violent exercise', The Journal of Medical Research for more info.

The first report linking physical activity and cancer risk dates back to 1922, where it was observed that men involved in physically active occupations experienced lower cancer mortality rates than their fellow men engaged in less strenuous jobs.

Cherry, T. (1922). A theory of cancer. Medical Journal of Australia, 1, 425–438. 

Since this report, more than 190 reports from epidemiological studies and over 10 reviews have examined this relationship. This body of evidence is still growing.

Using exercise as therapy goes back even further to 1796, with an early exercise machine superbly called "The Gymnasticon" (see image) invented to 'give and apply motion and exercise, voluntary or involuntary, to the limbs, joints, and muscles of the human body'. 

What's the point?

In my job as an Exercise Physiologist, I frequently work with cancer patients. Over the years they have repeatedly told me how daunting the concept of exercising or being active is after a cancer diagnosis, and indeed, how difficult it can be to regain some control of an exercise regime afterwards.

Should you exercise at all, especially when undergoing treatments? If it's ok, how much? Is it safe? Will it help? And then after treatment, can I get back to my old levels of exercise? What about my body’s changes, like scarring or surgeries?

Well, like all things, the answers to these questions vary from person to person, and situation to situation. In my clinics I can offer my clients personalised exercise programmes according to their cancer, their physiological state, and their ability. 

Here I hope to provide a 'go-to' site for safe, evidence-based information to help people exercise through cancer. More and more scientific studies support the benefits of safe exercise during cancer treatments, including:

•                decreasing fatigue

•                decreasing anxiety and depression

•                improving quality of life

•                improving function

•                decreasing pain

•                improving body composition

•                improving strength and fitness

I also provide weekly group exercise classes in my local area, specifically for people undergoing or recently completed cancer treatments. In a short time, these classes have doubled and I now have a waiting list. 

I will be bringing my knowledge from these classes to you, and what my clients have to say about their journey of exercise through cancer. 

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 A few testimonials from my current clients:

‘My time might be limited but the time I put into exercising gives me more energy to enjoy the remaining time with my family and friends’

‘The class is proving to be a huge boost to my recovery’

‘The programme improved my life enormously’