Chemotherapy is a common treatment for cancer that involves using drugs to destroy cancer cells. While chemotherapy is one of the most effective tools in battling cancer, it can also cause side effects such as fatigue, nausea, weakness, peripheral neuropathy, and fluid retention. While traditionally patients undergoing chemo have been wrapped in cotton wool slightly and told to “take it easy,” research has shown that exercise during chemotherapy can have numerous benefits. As a fitness professional, it’s important to understand the benefits of exercise during chemotherapy and how you can support your clients who are going through treatment.
Does exercise help during chemotherapy?
Exercise has been shown to be beneficial for cancer patients in many ways. For example, it can improve overall physical fitness and muscle strength, reduce fatigue, and improve sleep quality, mood, and quality of life. During chemotherapy, exercise can also help to reduce the severity of side effects such as cardiotoxicity and muscle atrophy and improve treatment outcomes, making the chemotherapy more effective.
A study published in the Journal of Supportive Care in Cancer (1) found that breast cancer patients who participated in an exercise program while receiving chemotherapy had lower levels of fatigue and depression and better physical functioning than those who did not exercise. Another study published in the European Journal of Cancer Care (2) found that colorectal cancer patients who exercised during chemotherapy had better quality of life, less fatigue, and fewer symptoms of depression than those who did not engage in any physical activity.
What is the best exercise to do during chemo treatment?
The type of exercise that is best during chemotherapy will depend on the individual’s pre-treatment health and fitness level, as well as their personal preferences. In general, it’s best to choose low-impact exercises that are gentle on the body and don’t cause too much strain.
Some examples of exercises that may be suitable during chemotherapy include:
- Walking: Walking is a low-impact exercise that can be done almost anywhere. It’s a great way to improve cardiovascular fitness, build strength, and reduce stress. Other benefits of walking are that it is free, and it can be adapted as needed by increasing distance or speed or adding hills to make it more difficult. Some people choose to walk at a local shopping centre where they know it’s flat, well-lit, air-conditioned and there are always seats and bathrooms on hand if needed.
- Yoga: Yoga is a gentle form of exercise that can help to improve flexibility, balance, and strength. It can also help to reduce stress and anxiety. Yoga can either be done in a class with an instructor or even from the comfort of the living room with many yoga sessions available on youtube.com
- Resistance training: Resistance training involves using weights, resistance bands, or even your own body weight to build strength. It can be a great way to improve strength and prevent muscle wasting during chemotherapy.
- Swimming: Swimming is a low-impact exercise that is easy on the joints. It can be a great way to improve cardiovascular fitness, build strength, and reduce stress. If proper swimming is not appropriate, even walking in the pool or treading water is a great alternative.
Precautions for physical activity
- Resistance training should not be performed by anyone with low platelets (3) (the component of blood cells that cause clotting,) because of chemotherapy as it can cause increased bleeding and bruising
- Low haemoglobin can cause fatigue and breathlessness, activity should be adapted accordingly
- It is also important that if a patient has bone metastases, no resistance be applied through that limb as there is an increased risk of fracture (3)
- Patients experiencing peripheral neuropathy (numbness and altered sensation in hands and feet) may present with decreased balance and reduced fine motor skills. Care should be taken to prevent falls and monitor feet for blisters, cuts, or scratches which may pose an infection risk.
How much should you exercise during chemotherapy treatment?
Similarly, to the type, the amount of exercise that is appropriate during chemotherapy will depend on the individual’s health and fitness level. In general, it’s best to start with light exercise and gradually increase the intensity and duration over time, as tolerated.
The Clinical Oncology Society of Australia recommends that cancer patients aim for at least 150 minutes of moderate-intensity exercise per week (4). This can be broken down into 30 minutes of exercise, five days a week. However, it’s important to adapt each day depending on how the body is feeling, patients will fluctuate daily depending on their chemotherapy treatment cycles. It may be more manageable to tackle three “chunks” of ten minutes each day, instead of trying to do 30 minutes in one session. These 150 minutes of exercise should include aerobic exercise, flexibility training as well as resistance training at least twice per week.
It’s also important to consult with a healthcare provider before starting an exercise program during chemotherapy. A medical professional, exercise physiologist or physiotherapist can provide guidance on what exercises are safe and appropriate, and how much exercise is recommended. Having a letter from an oncologist listing any restrictions or limitations to physical activity will both cover a fitness professional legally and give valuable guidance for prescribing an exercise program. Due to the schedule of chemotherapy cycles, progress with exercise is rarely linear, it may be helpful for a trainer and client to discuss expectations to ensure both are on the same page.
A new way for health and fitness professionals to collaborate
Seeing the need for better pathways of communication and collaboration between health and fitness practitioners, Victorian-based podiatrist, Jenna Rogers developed the online platform, Medical Mecca. The web-based service aims to help allied health practitioners and fitness professionals in the local area of patients be easily found by GP’s and specialist doctors. Medical Mecca has a secure messaging feature that enables medical professionals to communicate confidential patient information securely, enabling the quick and secure delivery of referrals and treatment plans in real-time to provide the best outcome for the patient.
In summary, exercise can have numerous benefits for cancer patients during chemotherapy. It can help to reduce the severity of side effects, improve physical functioning and quality of life, and improve treatment outcomes. As a fitness professional, it is important to understand the benefits of exercise during chemotherapy and how you can support your clients who are going through treatment. By working collaboratively with healthcare providers and providing safe and appropriate exercise programs, you can help your clients to stay active and healthy during chemotherapy.
References:
- Dimeo FC, Thomas F, Raabe-Menssen C, Propper F, Mathias M. Effect of aerobic exercise and relaxation training on fatigue and physical performance of cancer patients after surgery. A. randomised controlled trial. Supportive Care in Cancer, 2004
- Courneya KS, Friedenreich CM, Quinney HA, et al. A randomised trial of exercise and quality of life in colorectal cancer survivors. European Journal of Cancer Care 2003
- Cancer Council Australia – Exercise for People Living with Cancer
- Clinical Oncology Society of Australia – COSA Position Statement on Exercise in Cancer Care 2018
Thanks to Caroline Jones for this article.
Caroline is a physiotherapist who is passionate about using exercise as medicine and getting patients moving, especially those living with chronic conditions.
She is currently undertaking postgraduate research, studying the effects of exercise on women following treatment for gynaecological cancer and consequent lymphoedema. She also holds a Level 3 Certificate in Personal Training, owns a CrossFit box with her husband, and enjoys being a below-average runner.
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