As Lance Armstrong said after recovering from cancer, “We have two options medically and emotionally: give up, or fight like hell.”
The bicycling champ’s attitude should be taken during treatment, as well, based on research on cancer and fitness. Radiation, chemotherapy and stress can make patients weak, but medical experts say exercise can reduce side effects of treatment, enhance self-confidence, reduce depression and stress, improve sleep patterns and maintain feelings of independence.
The American Cancer Society updated its recommendations regarding exercise in 2003, reporting “cancer patients who exercise benefit from reduced pain and nausea, improved cardiovascular endurance and muscular strength, reduced pain and fatigue, and improved ability to work outside the home and perform day-to-day duties; they are less likely to suffer from depression and anxiety, and benefit from social interaction in exercise.”
Unless activity or movement causes distress such as severe pain, rapid heart rate or uncomfortable breathlessness, exercise is not only safe but also improves the quality of life and general ability to function physically.
Granted, it is the rare person who comes home from chemo or radiation therapy who wants to — or can — do anything but rest. But as soon as they feel up to it, people who stay active — or get active — feel like they have more control over their recovery and just feel better overall.
“A diagnosis of cancer is shocking, distressing and overwhelming, but after the patient adjusts to all of the new information and the treatment schedule, we explore exercise options,” says Dana McCroskey, a former personal fitness trainer and now a physician assistant for the Rocky Mountain Cancer Center in Aurora. McCroskey recommends exercises classes or 30 minutes of walking a day.
The American Cancer Society also suggests dance therapy, qigong, tai chi, yoga and various bodywork therapies. While none should be construed as treatments for cancer, they are helpful in other ways.
Mary Phillips, an ovarian cancer survivor, lifted weights a couple of times a week with a trainer, did yoga and walked about 10 miles a week before learning she had cancer. After her diagnosis, which required major abdominal surgery, she had to take two months off from exercise. As soon as she was able, however, she got back into her regimen but added massage, acupuncture, meditation and qigong halfway through her five months of chemotherapy.
Stress is bad for cancer patients, says Phillips, a retired lawyer who volunteers with the Colorado Ovarian Cancer Alliance and other groups. Exercise, she says, helped ease that stress.
Exercise is also important for filling the void that occurs after chemotherapy ends. “When you get to the end of chemo, you suddenly feel like you are doing nothing but waiting for the other shoe to drop,” Phillips says. “Meditation, visualization, qigong, and regular exercises such as weightlifting and walking make you calmer and stronger so your body is in a better position to fight off any cancer that may try to come back.”
Carole Schneider, an exercise physiologist and professor at the University of Northern Colorado, went through radiation therapy for cancer in 1994. The treatments brought on debilitating fatigue, which did not abate after a year. So she began to weigh the negative effects of cancer on the body against the positive effects of exercise and realized “they are mirror imates of each other.”
In 1996, Schneider and her physician, Dr. Susan Carter, started the Rocky Mountain Cancer Rehabilitation Institute to do research the effects of exercise on cancer recovery, teach and work with patients.
With a grant, they built the 10,000- square-foot Ben Nighthorse Campbell Center on the UNC campus in Greeley.
As there was no model for this research, they created one. Students come from all over the world to attend workshops and complete internships.
Among their findings was that the most effective prescription for cancer patients is to exercise for an hour, three times a week, for three months. Whole-body workouts at a moderate intensity integrating muscular strength and endurance, flexibility, range of motion, and cardio- respiratory components during and following cancer treatment produced the best results.
The medical community and cancer treatment centers are starting to catch on to the viability, need and urgency of physical activity’s role during and after treatment.
Dr. Tim Byers, professor of preventative medicine at the University of Colorado School of Medicine, has spent the past 30 years studying the roles nutrition and physical activity play in affecting one’s risk of getting cancer, as well as recovery after cancer. He has also helped the American Cancer Society write guidelines on nutrition and physical activity for cancer prevention.
“The norm in oncology is not to focus on exercise and nutrition because we are so intensely focused on saving lives with surgery, radiation and chemotherapy,” Byers says. “What is becoming increasingly apparent, now that we are saving so many more lives, is that many people come out of cancer treatment in very bad shape regarding nutrition and fitness.”
The research has proved the relationship between poor diet, inactivity, obesity and a high cancer risk. “Typically, people come into cancer treatment already at low levels of physical activity and fitness, then our efforts to cure the cancer make them sicker and less fit,” Byers says. “More physical activity early in treatment helps people feel better faster, sleep better, recover quicker and stay well longer.”
Byers would like to see research focus on whether increasing physical activity and reducing levels of obesity post-treatment can reduce one’s risk of recurrence of cancer. He suspects the answer to that question is yes. “I think that five years from now, cancer patients will be routinely assigned to fitness programs as part of their treatment and recovery, just as is now the norm in cardiology.”
Gentle movement eases cancer treatment, recovery
1. Dance therapy. The use of rhythmic, dance movements to treat mental and physical disease began as a therapy in 1942. The American Dance Therapy Association was formed in 1956, maintaining very high standards for registered dance therapists. Dance therapy has been found to be effective for improving self-esteem and feelings of well- being while reducing stress, anxiety and depression. Dance is good for overall fitness, enhancing circulation and respiration, as well as helping maintain muscle and bone mass.
2. Qigong and tai chi. Qigong is a form of traditional Chinese medicine and has been practiced in China more than 7,000 years; tai chi is an ancient Chinese martial art developed in the sixth century B.C. Both involve slow, deliberate movements, meditation and breathing, with improved health, fitness and well-being being major objectives. In China, qigong is part of health care programs. Because of the gentleness of the movements, qigong has been found to be very useful in relieving stress and anxiety, reducing pain for a short time, improving coordination and enhancing quality of life.
Tai chi has been found to promote relaxation, agility and help circulation. Research suggests that tai chi improves posture, flexibility, muscle tone and balance. It is considered a relatively safe physical activity, but joints and muscles are involved. Because of this, speak to your physician before beginning any program.
3. Yoga. Yoga can help with relaxation, as well as improved physical fitness. First practiced in India more than 5,000 years ago, research has shown that yoga can reduce stress, increase feelings of relaxation and help elevate the mood. Yoga has also been found to increase strength and stamina, improve sleep, reduce blood pressure and enhance feelings of well-being. Because yoga involves holding postures that can stress joints and muscles, those undergoing cancer treatment should speak to a physician before beginning.
4. Bodywork. Examples include Rolfing, massage, posture therapies (like the Alexander Technique, Feldenkrais Method, Trager Approach), acupressure and reflexology. The idea is to relieve pain and stress, and promote circulation and relaxation.
Exercise safety and precautions
1. Always check with your doctor before starting any exercise program. This is especially important if you are taking treatments that affect your lungs or your heart, or you have risk of lung or heart disease.
2. Do not exercise if your blood counts are low and you are at risk for infection, anemia or bleeding. Your cancer care team will be checking your blood counts during your treatment, so check with them about the best time for exercising.
3. Do not exercise if the level of minerals in your blood, such as sodium and potassium, are not normal. This can happen if you have had a lot of vomiting or diarrhea. Ask your doctor about your blood tests. If it’s OK with your doctor, be sure to drink plenty of fluids.
4. If you have severe fatigue and don’t feel up to exercising, you can try to do 10 minutes of stretching exercises every day.
5. Avoid uneven surfaces or excessive weight-bearing exercises that could result in a fall and injury.
6. Do not use heavy weights or do excessive weight-bearing exercise if you have osteoporosis, cancer that has spread to the bone, arthritis, nerve damage, poor vision, poor balance or weakness. These problems increase your risk for falls and injuries. You might do better with a stationary reclining bicycle, for example, than a treadmill.
7. Watch for swollen ankles, unexplained weight gain or shortness of breath while at rest or with a small amount of exertion. Let your doctor know if you have any of these problems.
8. Watch for bleeding if you are taking blood thinners. Avoid any activity that increases your risk for falls or injury. If you notice swelling, pain, dizziness or blurred vision, call your doctor immediately.
9. Do not exercise if you have unrelieved pain, nausea/vomiting or any other symptom that causes you concern. Call your doctor.
10. Do not exercise above a moderate level of exertion without talking with your doctor. Remember, moderate exertion is what you would experience during a brisk walk.
American Cancer Society
Tips for maintaining interest in your exercise program
Cancer survivors may need to exercise at a lower intensity and progress at a slower rate than those not undergoing treatment. The goal is to maintain as much activity as possible. Keep it safe, keep it effective and keep it fun.
1. Set short-term and long-term goals.
2. Focus on your enjoyment.
3. Perk up your activity with variety to keep it fresh. Try yoga or tai chi.
4. Recruit support from others or get friends, family and co-workers involved in your exercise program.
5. Use charts to record your exercise progress.
6. Recognize and reward your achievements.
American Cancer Society
Resources
ORGANIZATIONS
American Cancer Society, 800-227-2345,
American Dance Therapy Association, Rocky Mountain Chapter, contact: Riitta Ojala, current president: 303-506-0092
Tai chi and qigong: The Tai Chi Project, 303-744-7676,
Colorado School of Traditional Chinese Medicine, 1441 York St., No. 202, 303-329-6355,
Navitas Cancer Rehabilitation Center, 303-426-4633,
Rocky Mountain Cancer Centers, 888-259-7622,
BOOKS AND MAGAZINES
“Cancer Fitness: Exercise Programs for Cancer,” by Anna L. Schwartz (Simon and Schuster, 2004, $13)
“Exercise and Cancer Recovery,” by Carole M. Schneider, Ph.D., Dr. Susan Carter. (Human Kinetics, 2003, $67)
“The Healing Power of Movement: How to Benefit,” by Lisa Hoffman, (Amazon.com, $15)
Nexus, Colorado’s Holistic Journal, 303-442-6662,
Linda J. Buch is a certified fitness trainer in Denver; linda@LJbalance.com
