The Benefits of Exercise during Radiotherapy for Breast Cancer

After receiving an overwhelming response for my recent post “Exercise to increase overall survival and reduce disease recurrence”, I was able to get in touch with some amazing people who were implementing positive healthy behaviours into their journey.

I would like to commend one poster, who during radiotherapy, despite having leg muscle impairments, was exercising 30-45 minutes daily, doing weights, yoga, physio and meditation – and feeling great!! Great inspiration. She gave me the idea to speak about exercise during radiotherapy (RT).

Common side-effects of RT are fatigue, pain, shoulder instability, cardiac damage and reduced quality of life. The majority of these I have previously mentioned will be improved by engaging in aerobic physical activity. An article published in 2008 by Ji Hyi Hwang in South Korea worked with breast cancer patients after surgery, who were about to commence RT.

Protocol:

Exercise consisted of 3x 50 minute sessions a week for 5 weeks

Each 50 minute session consisted of:

10 minute warm up

30 minutes exercise (treadmill walking, cycling, strength exercises, shoulder stretching)

10 minute cool down (relaxation)

The main results were as follows:

 

Exercise RT

 

On each figure, the left bars indicate the non-exercising control groups – who experienced reduced quality of life, increased fatigue and worse pain

The right bars indicate the exercising group – who experienced IMPROVED quality of life, IMPROVED fatigue and HIGHER pain threshold. This is a two-fold swing right here. Furthermore, the exercising group had better upper arm flexibility – which is vital to be able to continue doing normal activities at home – driving, washing, going to shops, lifting things etc!

Here is the link below to the article:

http://synapse.koreamed.org/Synapse/Data/PDFData/0069YMJ/ymj-49-443.pdf

If you or somebody you know is undergoing or about to undergo radiotherapy, provide support, ask them to go for a walk with you. Go at their pace, doesnt matter how fast, it is better than nothing. Once confident and building endurance, then you can start to go faster and you will start embracing some of the great benefits. Walking is safe and does not require supervision. If you wish to have a weights program prescribed to you, consider speaking with your physiotherapist, or certified exercise physiologist

As always, please comment, ask questions, go for a walk, share this blog with a friend or family member, follow me and stay positive.

David

Your exercise physiologist – Exercise Oncology Australia

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Exercise to increase overall survival and reduce disease recurrence

I’d like to speak today about a great article published in 2006 in the Journal of Clinical Oncology, one of the top ranking oncology journals titled “Impact of Physical Activity on Cancer Recurrence and Survival in Patients With Stage III Colon Cancer” by Jeffery Meyerhardt. The study used patients with Stage 3 Colon cancer 6 months after chemotherapy treatment.

The study first asked patients how much activity they were engaging in per week. Each type of activity has an intensity, where a higher intensity allows for more energy exertion. The terminology used is called a MET or metabolic equivalent – so when we are resting, we exert 1 MET, brisk-walking is 4.5 METs or swimming is 7 METs.   I’ve included a table from the article below:

MET exercise intensities

As I’ve mentioned previously, “more is better than less and some is better than none”. This is a good place to start. Once you can get into a rhythm of regular exercise, it is time to train for longer and add in some challenging sessions.

What this study found was really interesting, and is a reason why there is more research in exercise oncology studies. Patients who engaged in at least 18 MET-hours/week (approx 6 hrs of normal pace walking or 1.5 hrs of running or 2.5 hrs of tennis per week) had a 47% improvement on disease-free survival than inactive patients. This is HUGE! The table below shows the survival rates by different levels of activity

reduced mortality

Personally, I think this is really ground breaking, with more and more oncologists now wishing to have their patients participating in exercise studies. There is emerging hard evidence, this isnt just fluff and games. Get out there and start to move, walk, shake that body. One step at a time. You can do it.

Here is the link to the article:

http://jco.ascopubs.org/content/24/22/3535.full.pdf+html

As always, please feel free to comment, share, like, follow me, ask questions or just go out for a long walk after reading this. 

Exercising during chemotherapy – you can do it!!

From what i’ve seen and heard from patients, chemotherapy is one of the toughest parts of cancer treatment. 6 months of hospital visits, sleepless nights, nausea, fatigue and uncertainty. Then walks into the clinic David, the Exercise Physiologist, every week to see if there are any new patients he can ask to come and join his studies..

Every week for all of last year, I would visit 2 hospitals in Sydney, each on two mornings per week to see if there were any patients eligible to recruit into my trials. Women with recurrent ovarian cancer undergoing chemo to be precise. This is a group of patients who’s cancer has returned and spread, requiring higher doses of chemo and as a result, having worse side-effects of treatment. This was the first study to date to include this patient group – so it was very challenging but exciting at the same time to try and assist these patients throughout treatment.

Here are some things we do know during chemotherapy:

* Patients (and their families) tend to  withdraw themselves during chemo (6 months of inactivity!)

* You may become weaker during this time, along with additional side-effects of treatment

* Recent exercise studies have displayed safety, as well as countless psychological and physical benefits

* Reaching recommended physical activity guidelines can decrease your risk of cancer recurrence and all-cause mortality by more than a third!

Back to my recruitment. I would speak with numerous patients about their lifestyles, the majority not doing anything due to excessive fatigue – with nearly all of them not knowing how exercise can help them. I had about a 50% uptake rate, which is about normal for studies such as these, with many women not willing to commit to a 3 month study. However I did not mind, I still provided them with advice and encouragement to walk whenever they can and build up their endurance during chemo.

Now to the ones that did join the study, firstly I did baseline health checks, with most of them having physical and mental function, low muscle strength and excessive fatigue – not surprising. Everyone received a different exercise program tailored to their needs and goals, but started at 90 minutes/week (about 15-20 mins/most days of the week). This would be a combination of aerobic exercise (mainly walking and gym cycling) and resistance training (gym weights and resistance bands). It was not without its challenges for these amazing women. Here is an example week for one:

Monday – walk 20 mins (including hills)

Tuesday – theraband resistance session – 25 mins

Wednesday – chemo day – light morning walk – 15 mins

Thursday – rest day (feeling ill)

Friday – rest day (feeling ill)

Saturday – rest day/light walk 15 mins

Sunday – resistance exercises and walk – 30 mins

No week would really be the same depending on how they responded to the treatment, but i’ll tell you this now, if they hadnt been exercising, they would be feeling a whole lot worse. Im very happy with a week looking like this if possible.

If you’re undergoing chemo – you can do it. Don’t aim for a marathon, set a realistic aim at giving it a go – because you can achieve that. 10 minute walks around the block will assist in alleviating the fatigue and sets a platform to increase this. Some is better than none and more is better than less. The aim is 150 minutes a week of moderate intensity exercise (increased breathing rate). But if you can only achieve half of this amount, that is more than fine, it is a start. You cant progress if you haven’t started. If you havent started your journey, let it start now….one step at a time.

I hope these posts provide support, motivation and guidance. Feel free to ask any questions or comments and again please forward to a friend or family member undergoing the cancer experience.

So you or somebody you know has been diagnosed with cancer – When do you start to exercise?

So you’ve been diagnosed with cancer and you want me to exercise?! I heard this frequently when I approached ovarian cancer patients in chemotherapy clinics to participate in my research. I would sometimes sit for hours in the waiting rooms just to wait for a two minute conversation with a patient, in the hope to assist them to become more active.

I have no doubt that being diagnosed with cancer and having treatment is one of the most challenging things a person can ever go through, and without having cancer myself, i cannot act like I know what they are going through. However, what I do know – an emerging field of exercise oncology – the majority of patients, families and a lot of doctors do not know about. More and more support has been given by oncologists to tell their patients to be active and get moving, when in the past they were wrapped in cotton wool and told to rest. In fact, this has been shown in prospective studies for patients when asked how much they exercised, the ones who engaged in more, lived for longer.

Now going back to the original theme of when do you start to exercise? before or after surgery? during chemo? after chemo?

The answer is now.

Think of it this way – the healthier your body is from being active, the better you will recover from surgery, the stronger you will be during chemo and the more likely you will be back and feeling normal after treatment.

I’ve spoken with oncologists from around Australia and the world and I have told them exactly that. There have been studies for patients before surgery, during chemo and radiotherapy and after treatment, all showing benefits from increased aerobic activity (walking, cycling, aqua aerobics etc) and resistance training (weights).

The time to be active is now.

A 5 minute walk around the block a day to start your regime. Next week aim at 10 minutes a day. The week after aim at 15 minutes. Before you know it, you have a larger endurance capacity, more energy and vitality again. Believe you can do it, because you can.

In my next post, I will give some insight to my work with women with ovarian cancer, who were involved in an exercise study whilst undergoing chemo. Ovarian cancer generally has a really tough outlook, but with some great courage and determination, I was able to work with a lot of amazing people who were able to reach some fantastic goals.

Please feel free to pass this blog onto any cancer survivor.

“Some is better than none, more is better than less”

It is common for cancer patients to reduce their physical activity during and after cancer treatment. It is also common for many patients to experience side effects such as debilitating fatigue, poor sleep, anxiety and reduced quality of life. However, emerging research has shown that the type and amount of exercise will influence what benefits are possible. The most common type is aerobic exercise, anything getting the heart rate higher. This could be walking, cycling, jogging or aqua aerobics.

Generally, the harder you work, the fitter and healthier your heart and other organs become. Resistance training is a type of exercise that promotes muscle and bone health by lifting against force. Types of resistance exercise can be with body weight (squats, pushups etc.), resistance bands or weights. Resistance training is very important for re-gaining strength during a time when there has been a large decline. The American College of Sports Medicine recommends 150 minutes a week of moderate intensity aerobic exercise (30 minutes on most days of the week) and two sessions of resistance exercise.

I will write posts on exercise oncology studies by cancer site, today I will go over a few studies completed in patients with breast cancer:

Post menopausal breast cancer survivors improved their cardiac function and quality of life by cycling 3 times a week for 40 minutes in a study in 2008 by Kerry Courneya. A walking intervention during radiation therapy by Mock in 1997 demonstrated reductions in fatigue and anxiety, as well as improvements in sleep quality. Another study by McNeeley in 2006 of patients during chemotherapy showed that aerobic training improved self esteem and reduced body fat, whilst resistance training improved self-esteem, muscular strength and lean body mass. Lymphedema was not worsened in any of these studies, in fact there was even mild improvements in the condition. This is not the first study of patients exercising during chemotherapy and radiation therapy, with more and more emerging every year showing not only that exercise is safe, but there are numerous benefits.

At a recent cancer conference in Adelaide in which I presented a study I ran for patients with advanced ovarian cancer, I met another researcher, Dr Sandi Hayes from Queensland University, who does some amazing work with patients around Australia. I remember she mentioned a quote that really stuck with me that she has used to help motivate patients who are enduring tough times. Some is better than none, more is better than less. Not reaching the recommended guidelines is not the be all and end all, but any amount of physical movement is a start and something to build up on. A 5 minute walk in the morning, 5 minutes at night – not a whole lot, but something to build on. Some is better than none, more is better than less. Remember it next time.