Exercise During & After Treatment

Physical activity vs. exercise – what’s the difference?

Physical activity is defined as bodily movement and energy expenditure, whereas exercise is planned, structured, repetitive and has a purpose aimed at what you’re trying to achieve.

Exercise comprises:

• Cardiovascular endurance
• Muscle strength and endurance
• Body composition
• Flexibility

Exercise recommendations for cancer patients

During treatment (as individually tolerated)

• Strength training + Aerobic activity – 90 mins/week, comprising 3 x 30-minute sessions of moderate intensity aerobic exercise

After treatment (as individually tolerated)

• Strength training + Aerobic activity – aiming to build to standard exercise guidelines of 150-300 minutes per week, with 2 sessions of structured strength training per week

If you feel confident you can achieve more, don’t limit yourself to these recommendations. Remember, more exercise equals greater benefits for you and your body.

The role of muscle mass

Lower skeletal muscle mass is associated with decreased oncology outcomes and higher levels of side effects to treatment.

Higher muscle mass reduces inflammation and increases immunity and helps boost immunotherapy treatments and greater survival outcomes.

Overcoming treatment side effects through exercise

The predominant side effect in melanoma patients is cancer-related fatigue, followed by weight gain and compromised sleep.

Exercise is one of the best medicines for side effects, including cancer-related fatigue. It has also been reported to help overcome nausea, loss of appetite, anaemia, depression and anxiety, weight changes and loss of muscle mass.

Fatigue – Many patients report feeling extreme tiredness, or fatigue, during or after cancer treatment.

It’s important to be aware of the deconditioning cycle, where treatment causes fatigue, so we reduce activity levels, deconditioning then occurs and fatigue increases, then the cycle continues. Even low intensity exercise can help stave off the deconditioning cycle.

Exercise helps overcome fatigue by releasing natural endorphins, a great antidote for cancer-related fatigue.

Lymphoedema – Regular exercise has been shown to lower the risk of developing lymphoedema or reducing the severity and symptoms of existing lymphoedema.

Your immunity – Our immune system can be compromised by some cancers and treatments. A low white blood cell count can lead to an increased risk of infection, so at this time, it’s important to avoid physical contact with other people and wipe clean any shared equipment before you use it.

Avoiding Anaemia – Another common side effect of treatment is low red blood cell and/or haemoglobin count. Through good nutrition and exercise, we can help avoid or improve anaemia. Low intensity exercise is recommended, however, if your count is very low, consult your doctor first.

Improving balance & coordination – If your balance of coordination has been compromised by treatment, it’s advisable to exercise with a training partner or coach, and avoid outdoor cycling, using a treadmill or lifting free weights on your own, as these activities require balance and/or coordination.

Goals of exercise for cancer patients

• Avoid inactivity
• Restore and or improve physical activity, aerobic capacity, strength and flexibility
• Improve cardiorespiratory, endocrine, neurologic, muscular, cognitive and psychosocial function
• Improve quality of life and body image
• Improve treatment tolerance
• Reduce the risk of reoccurrence and development of other cancers, however, this is not always the case
• Prevent and mitigate long-term and late effects of treatment
  Improve the ability to cope with current or future cancer treatments

Tips to increase physical activity

Always check with your treating medical team before commencing physical activity or an exercise program

• Ask a friend to walk with you or join a walking group
• Wherever possible, skip the lift or escalator and take the stairs instead
• Try getting off the train or bus a stop early or park your car further from your destination, then walk to your destination
• Activities around the home, such as vacuuming, gardening and lawnmowing are great physical activities with the added incentive of a positive end result
• If you need to sit behind a screen for long periods, stand up every half hour
• Try a new activity – join a yoga, stretch, dance, Pilates or tai chi class
• Join your local gym
• Play with your children or grandchildren, hit or kick a ball around the yard or park
• Chat to your GP about an exercise program
• Consult with an exercise physiologist about tailoring a program to your needs

When exercise may go wrong

It’s important to take precautions before starting a new exercise program – Talk to your treatment team first. If you’re overdoing exercise, indicators may include any abnormal symptoms such as pain, excessive breathlessness or dizziness, which indicate you need to pare back the intensity of the exercise. Beware of boom-bust behaviours, such as doing too much when you’re feeling good and not enough when you’re feeling poorly.

How to get started/where to get help

1. Discuss your plans with your GP/doctor or those involved in your care plan
2. Consult an exercise physiologist via your GP, they will develop a plan to suite you and provide any additional support you may require
3. Make an exercise plan, including a commitment to the start date

What an exercise physiologist does

An exercise physiologist is a university qualified allied health professional who has the knowledge, skills and competencies to design, deliver and evaluate safe and effective exercise interventions. They embrace and use exercise as medicine to help manage disease and improve wellbeing.

An exercise physiologist can help you by:

• Assessing your medical history, oncology history, treatments, side effects and impact
• Testing your physical capacity
• Educating you on the importance of exercise
• Developing a tailored exercise program, which may be supervised or unsupervised
• Conducting regular check-ins to monitor your progress
• Making adjustments in alignment with your symptoms, progress or setbacks

Useful Resources

• Cancer Council Victoria
• Peter Mac – Diet, Exercise & Lifestyle