Many people resolve in the new year to get more exercise. Today we are delighted to provide information from Karen Wonders, Ph.D., FACSM, a member of the Triage Cancer Speakers Bureau and Executive Director of Maple Tree Cancer Alliance.
Cancer and its associated treatments often result in long-term physical and psychological side effects that impact the survivor’s quality of life. More than two decades of research support the efficacy of exercise and positive physiological and psychological changes in cancer survivors. These include improvements in VO2 max, which in turn improve heart and lung function and promote a healthy blood pressure, blood volume, and gas exchange. In addition, improvements in quality of life, muscular strength and endurance, fatigue reduction, anxiety, depression, body image, immune function and emotional well-being have been reported. In response to this overwhelming research, organizations like the National Comprehensive Cancer Network, Commission on Cancer, and American Cancer Society have recommend that exercise serve as an integral part of an individual’s cancer care plan.
Patients should talk with their health care team prior to starting an exercise regimen. Once clearance is obtained, the ideal exercise program would be individualized to uniquely meet each patient’s strengths and weaknesses. Each person responds differently to treatment, and it is important for the cancer exercise trainer to understand and identify limitations that could hinder patient progress. The overall goal of the exercise program should be to minimize the general de-conditioning that often results from cancer treatment so that the cancer treatments are better tolerated. In general, the exercise prescription should include a slow progression and demonstrate adaptability to changes in the patient’s health status, which frequently will change from day-to-day during treatment.
Each exercise training session should include a whole-body workout that targets all the major muscle groups, and consist of the following components:
- Warm up: Begin each session with a 5- to 10-minute warm-up that stimulates blood flow to the working muscles. Warm-up activities may include walking or jogging to increase the body temperature and other physiologic responses, as well as decrease the chance of injury. Warm-up activities are also important to help ensure that the muscles and cardiovascular system are prepared for the activities to come in the training session.
- Aerobic Component: ACSM recommends aerobic training 3-5 days each week, for 20-60 minutes each session. Appropriate modes of aerobic exercise include walking, cycling, or swimming (if infection is not a concern). During the aerobic component of exercise, it is important to frequently monitor blood pressure and heart rate. If the patient is on a medication that effects heart rate, the Borg Scale of Exertion may be used to monitor intensity. Based on this scale, a light-to-moderate intensity (RPE of 11 to 14) should be encouraged. If dizziness, nausea, or chest pain occurs, all exercise should be stopped. Frequent short breaks are sometimes encouraged to accommodate therapy-related fatigue.
- Resistance Training: The type of resistance exercise performed will depend on the patient’s range of motion, tissue removal, and wound healing. Ideally, the patient should strive for 2-3 days/week of 1-3 sets, 8-12 reps per exercise. Appropriate modes include free weights, machines, resistance bands, as well as traditional body weight exercises. ACSM recommends at least 48 hours of rest between each resistance training session. Therefore, it may be advisable to plan a whole-body approach to resistance training, where all major muscle groups are targeted in one day. If the patient is unwilling or unable to participate in traditional modes of strength training, Yoga or Pilates may serve as an alternative form of strength exercise.
- Flexibility Training: Aerobic exercise should be followed up by static stretching and range of motion exercises for all major muscle groups. Muscles should be stretched to the point of mild discomfort and held for 10-30 seconds per stretch.
- Cool Down: Cool-down activities provide a reduction in injury risk occurring after an intense bout of exercise. The cool down should consist of less intense exercises and stretches to relax and lengthen the muscle and promote range of motion. The cool-down allows for a gradual reduction in the level of metabolic activity achieved during exercise training.
Initially, the intensity of exercise will depend on the patient’s functional status and exercise history prior to cancer diagnosis. Typically, previously active cancer patients may continue their exercise regimen, although intensity may need to be decreased during treatment. Progression should consist of increases in frequency and duration rather than intensity.
Maple Tree Cancer Alliance is a national organization with a growing platform that can help patients get started with an exercise program. For more information about our programs, check out our website: www.mapletreecanceralliance.org.
With the right support in place, the patient will be encouraged to adopt an active lifestyle for life!