When I first began conducting research in exercise oncology, I was one of a very small group of people in the world. For the first few years, I had no idea. I thought that everyone who had cancer had the opportunity to receive specialized exercise training – just like it was with cardiac rehab!
It wasn’t until about 2006, when I first moved to Dayton and wanted to continue the research I had been doing by volunteering at our local hospitals, that I learned this wasn’t the case.
Not only were there NO exercise oncology programs in my area, but I was even lectured by a health care professional about the dangers of exercising during cancer. He advised that the increase in blood flow might cause cancer cells to spread throughout the body.
Luckily, I knew better. When I was getting my doctoral degree at the University of Northern Colorado, I had the opportunity to conduct research on people as they went through cancer. We would measure changes in hormones, fitness parameters, cortisol levels, and heart function.
In addition, I also had the opportunity to work as a Research Assistant in our animal research lab for two years. As part of my job, I spent all day in our lab exercising our animals (which were rats….and I did grow quite fond of those little guys!), as they underwent chemotherapy.
We had a treadmill with lanes built into it so we could exercise up to 20 rats at a time! We also had several rats with wheels in their cages, which allowed us to see how much they would run during a chemotherapy regimen, that would have been typical for a human to receive. Amazingly, these rats would voluntarily run miles and miles each day!! Even on chemo days – they would still run 5 miles!
As a part of each study we did, we measured cardiac function. Basically, we would compare the hearts of the rats who exercised and received chemotherapy treatment with those who did not exercise and received the same amount of chemotherapy. We also had saline-treated rats (both exercise and sedentary) for controls.
What was amazing to me – and what truly made me a believer in the field of exercise oncology – was the difference between the hearts of the exercise trained rats and the sedentary rats.
A rat heart is only about the size of your big toe, but you could literally see the difference. Physiologically, the differences were astounding. The exercise trained hearts had a much higher developed pressure than the sedentary hearts. Basically, this means that the exercised hearts could beat with significantly more force…..even though they were exposed to the same amount of chemotherapy as the sedentary group. Even though they lived in the same conditions and ate the same food. Even though they were administered a type of chemotherapy that was known to limit cardiac function!
It didn’t matter what kind of exercise regimen they followed. The results were the same whether it was 12-weeks of training, voluntary wheel running, or even one single bout of exercise. Every single protocol was protective against the detrimental effects of the chemotherapy.
These findings weren’t limited to my own research. In fact, more than two decades of research – thousands of published articles – support a link between a physically active lifestyle 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.
That is why I knew the well-meaning, albeit wrong, physician who tried to steer me away from exercise oncology was wrong. That is also what led me to establish Maple Tree and advocate for exercise to become a part of the national standard of cancer care.
Physical Activity Guidelines
Now that I’ve convinced you, it is important that you understand exactly how much exercise is beneficial during cancer. This is important because the type and degree of the physiological response is dependent on the type and dose of exercise.
There are a number of recommendations for exercise during cancer treatment, based largely on observational epidemiologic research linking exercise and cancer risk. The most current recommendations for prevention and survival come from the World Cancer Research Fund, American Institute for Cancer Research, American Cancer Society, and American College of Sports Medicine.
More research has been provided discussing benefits of exercise with a risk reduction in cancer diagnosis. Little research, however, has been done on the benefits of exercise with cancer survivorship, so current recommendations reflect prevention guidelines with some treatment- and disease-specific modifications.
Both guidelines include moderate physical activity (such as a brisk walk) for at least 30 minutes every day, as well as strength training and stretching of major muscle groups a minimum of 2 days each week.
Ideally, for an individual undergoing cancer treatment, the prescription will include a whole-body workout that targets all the major muscle groups. This is the principle we follow at Maple Tree.
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 change from day-to-day during treatment.
Each exercise training session should consist of the following components:
- Warm up: Each session should begin 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: 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. 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.
We would love to help you get started on a program! If we are in an area where you live, please give us a call. If we are not yet in your town, try one of our online programs!! We have several designed to meet you right where you are and help you progress!