cancer research

Back from the wilderness – and the journey must continue…

Ola! It has been a while since I have posted last, and as much as I would like to say it’s because I was busy training for a marathon, this is not the case. I’ve been getting stuck into a new job and writing research papers that I’ve worked on over the last few years. I will be going through my papers in the next few weeks to provide not just motivation, but scientific evidence behind why it is safe and beneficial to exercise during/after treatment.

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So I thought I would start with a link to an article I was asked to write for the Oncology Newsletter about my experiences promoting physical activity for women with ovarian cancer who were undergoing chemotherapy. (Click the link below!)

http://oncologynews.com.au/movement-the-key-to-reducing-side-effects-of-chemotherapy/ 

Just as a recap of where I’ve been MIA over the past year or so:

* I have started a job at the Kids Cancer Centre at the Sydney Children’s Hospital, where I run clinical trials for kids with all sorts of cancers. We are also working on a few lifestyle projects to increase activity of kids during and after treatment (as there is early evidence that it helps the kiddies too!)

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(oh, here is the day I got to dress up as Batman for Superheroes day, where the entire hospital staff dressed up!! I think I had just as much fun as the kids!)

* My thesis works were finally published! I was able to get my two main studies published in the International Journal of Gynecological Cancer (which I’ll discuss in subsequent posts), which gave me some sleepless nights, but it is great to get word out there of what the amazing ladies in my studies were able to achieve

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* Always trying myself to get out and keep fit whether its playing soccer or touch football. I try to run for 40-50 minutes from time to time and I even went for a 15km cycle for the first time in 5 years on the weekend! I was slightly uncoordinated but it was still great fun!

Remember to aim for the American College of Sports Medicine’s 150 minutes/week of moderate intensity exercise i.e. getting your heart rate up a bit from a challenging activity

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* Lastly, I have also gotten back into music, which I love playing the drums and it is a great outlet for me. I have joined the Kids Hospital band and we are working towards a range of fundraisers to come up in the next few months, as well as playing for the kids in wards when I’m able to.

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So I really look forward to getting the website and community back up and active. I encourage you to share a personal experience with your exercise journeys and ask any questions that you may have. Please share this with somebody you feel could use the encouragement and as always, keep moving forward, one step at a time!

Your Exercise Physiologist

David

Stretching for cancer survivors is helpful to maintain muscle health – particularly after surgery [A how-to guide]

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Stretching is essential for many reasons in maintaining health & wellness. It can be done by anyone, at any time – and is very easy to do, and it is alright if you are unsure as I will show you how in this post. In general, the main benefits attained from stretching include:

  • Increased flexibility or Range of Motion (ROM)
  • Reduced likelihood of injury
  • Improved benefits when completing aerobic & resistance exercise

Before I go on, I would just like to let you know, I have created a new Facebook page called Exercise Cancer Community: Health & Wellness, to create a supportive environment for people to share their experiences. Please visit the page, click the Like button on the side of this page or on the FB site and pass it on.


Now, stretching is important for basically anybody to maintain or improve their physical health, but it is particularly important for cancer survivors who have undergone treatment such as a surgery. For example, women with breast cancer who have undergone a mastectomy tend to experienced reduced should flexibility, strength & mobility due to muscle and tendon tissue damage. In fact, here is a great article by Dr Robert Kilgour displaying that home-based stretching can assist in reversing these results, as published in the Journal of Breast Cancer Research Treatments. By engaging in stretching exercises (and eventually resistance training exercises), you will be able to achieve a level of health pre-surgery, or even greater. But if not, simple daily tasks around the house such as reaching into cupboards above the head, discomfort whilst driving or picking up a baby may become challenging.

Here is an example of a "spider-crawl" or "wall walk", where you slowly raise your arm up the wall to the level of your range (not to pain)

Here is an example of a “spider-crawl” or “wall walk”, where you slowly raise your arm up the wall to the level of your range (not to pain)

Before I show you individual stretches, here are the guidelines for stretching:

  • Stretches can be done daily or most days of the week (can do them up to 3-5 times/day)
  • Hold each stretch for 15-30 seconds
  • Repeat each stretch 1-3 times on each side
  • Have a deep breath in when commencing the stretch
  • Only complete the stretch to the full range of your joint (and not to a painful point)
  • Stretching is most effective when the muscles are warm, so after a walk is perfect

Here we go: If you are only a few weeks post surgery (1-3 weeks), you may consider doing “range of motion” exercises, that is just moving your joints to their point, and not pushing further.

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Above: Shoulder flexion & extension

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Above: Shoulder abduction

If these are simple, then lets move on to more stretches for the upper body:

Chest stretch:

  • Arm at 90 degrees against a wall, with forearm on the wall
  • Rotate body away from wall & hold

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Shoulder stretch:

  • Arm across the body
  • Other hand presses the elbow closer to the body & hold

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 Triceps stretch (only if your flexibility allows you to do so):

  • Arm above and behind your head, with elbow in the air
  • Hand above your opposite shoulder
  • Using your other hand, pull the elbow across your body & hold

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 Biceps & forearm stretch:

  • Arm directly in front, with fingers facing downwards
  • Using opposite hand, pull the fingers back & hold

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Do you see how simple some of these are? Definitely can be done at the office, in an elevator or at home! I constantly will be doing stretches to help aid my training sessions in the gym and at soccer around the office. Now here are some lower body stretches to do for the lower body:

Calf stretch:

  • Place hands on the wall
  • Take a step backwards with one leg, with foot placed flat on the ground
  • Bend the front leg, straighten the back leg and feel the stretch

With both feet flat, act as if you are trying to push the wall down. You should feel this in the back of your behind leg

Hamstring stretch:

  • (seated or on a yoga mat) put one leg out as straight as you are able to
  • Lean towards your foot, with your hands together
  • Aim to keep your back straight
  • Point your toe backwards for a greater stretch
  • Resistance bands can also be used for a greater stretch
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If less mobile, use a chair for support

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If you are more mobile and have progressed your flexibility, try a greater stretch using a resistance band

 Quadriceps stretches:

  • Find a stable object for support (wall, table, exercise bike!)
  • Grab your foot of the leg you are stretching
  • Keep legs in-line with each other and pull until you feel a stretch
  • You can also use a resistance band or rope around your foot to assist if you have limited flexibility

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Remember, every day you can partake in stretching, and before you know it, you will be improving your flexibility in no time. Combine this with your aerobic and resistance exercise and you are on your way to achieving a fantastic lifestyle.

Keep up the great work and please remember to provide encouragement to those in need, pass this resource on and keep continuing to send me questions and personal experiences.

 

Your Exercise Physiologist,

David

“Live in the peace of the moment; on your bike!” – an inspirational journey

Usually when you talk about cancer, or hear about somebody being diagnosed with cancer, we are instantly jumping to negative thoughts. However, we often miss the rest of the cup, the cup that can be half full if we wish it to be – the cup can even be three quarters full if we wanted it to be! 

Today I will speak of my encounter with Helene O’Neill. Helene is definitely a glass is three-quarters full kind of woman. A few weeks ago I presented my research at the Australia and New Zealand Gynaecological Oncology Group (ANZGOG) annual scientific meeting in Canberra, Australia – a meeting for the latest in women’s cancer research. It was a great day with some amazing oncologists presenting their research, interesting debates but also an initiative to have volunteers who assist with patient support groups enlighten us of their experiences. This is powerful because at the end of the day, I, along with others have passion for the health industry to help each individual person.

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Now Helene, a Uterine cancer survivor, did not sound like anything could get her down, and would rather take life by the horns. She spoke with such confidence and pride. She had strength that needed to be witnessed, as she is an inspiration for cancer survivors around the country, and this is evident with her passion for exercise and the community work she does with ANZGOG. I needed to find out more from her and her story, to share it, and assist in inspiring and motivating others so I asked her a few more questions….

Helene was diagnosed in 2007 around the same time her hometown of Newcastle flooded, which included her house. Her mother-in-law also passed away around the same time so it was a particularly sensitive period to say the least. Her oncologist, Dr Geoff Otton removed a grapefruit-sized tumour from her, performed a hysterectomy and removed lymph nodes, but she did not require radiation therapy.

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(above – The 2007 Newcastle floods were not going to hold Helene back)

I asked Helene how she felt physically and emotionally right after her treatment. She said “I was extremely tired in the early part and did suffer a loss of confidence with things like exercise”, which is completely understandable, right? “My bike is my friend and I remember the first time I went for a ride after the operation – a trip that normally takes 10 mins took me 30 mins – I was paranoid !! My quality of life was affected as the fear of lymphedema scared me but I attended a clinic and learnt a lot about the condition so I could get on with life.”

So the tasks usually simple to Helene were suddenly much more of a challenge, and that is where it is important to take the necessary steps to regain your fitness, be inspired and get back your lease on life. Helene was always healthy and physically active and her cancer diagnosis was not going to stop her. At first she feared she may have to stop exercising, but put that behind her as being active made her feel healthy and happy.

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(above – Helene getting back on the bike)

The self-proclaimed “super-competitive” former gym instructor is keen to try any form of exercise. Happy to avoid gyms, Helene likes to run, row, ride bikes and swim. She also enjoys sports – tennis, badminton and coaching soccer! Now, I thought I was super-sporty, but she is giving me a run for my money!!

I asked what a typical week of exercise looked like for her just to put into perspective:

Weekdays:

* Most mornings – mixture of running, riding, rowing and swimming – 1 hour

* Cycle to work (and also on the job) – about 1 hour

Afternoon/evening walk – 45 mins

* Sport: Tennis on Mondays (1 hour), Soccer on Tuesdays (1.5 hrs) and Badminton on Fridays (2 hrs)

Weekends:

* Variety of surfing, bush walking and paddle skiing

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(above – for those who don’t know paddle skiing, it is a water sport requiring a great amount of core abdominal strength, and is also very fun!)

I’ve spent much time talking in previous posts of the benefits of exercise in scientific research, but what also matters is how each individual feels. So how does being active make Helene feel? “I love the adrenalin rush. I also know that exercise is one aspect of my life that I am in control of. I like to exercise on my own so I can vary the activity, the pace and the duration and use the time to get to know myself better.” She is in the minority of people who requires little encouragement to exercise, so she definitely doesn’t need me running around telling her she is doing a great job, considering she has been a representative sports athlete since she was 5 years old. Even sometimes her husband tells her to slow down, as she “refuses to let age and health get in her way“. Amazing!

However, it is not without its challenges, the risk of lymphedema and infection remain a possibility, but she is willing to meet those challenges head on.

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Now as an ambassador for ANZGOG and to patients in rural areas, I asked Helene if she could provide a few words of inspiration to survivors who may be newly diagnosed or struggle for motivation. I often think these words are way more powerful from somebody who has had these experiences and bounced back, rather than a health professional like myself, who cannot speak of cancer first-hand – and this is what she said:

“Support comes in many forms but the one person I can rely on is myself. I encourage patients to steer away from the excuses, listen to their body and view exercise as one of the means to get well. There’s the adage ‘that cancer isn’t a sentence’. Basically it’s an opportunity to discover a ‘new’ you. Whilst everyone has a different cancer trip, it’s better to live in the present and enjoy every day to the max. I love to share my story – not the cancer journey – but the day-to-day highlights that I enjoy. Sure you reflect on the past but that’s not going to change – live in the peace of the moment. On your bike !!!”

I really hope you have found Helene’s story inspirational, as I have. Pass this story to somebody who you care about, a friend or a family member who can benefit from the support. Share on Facebook or Twitter to keep growing a community. Follow this blog for more posts, provide any comments or questions, join an e-mail list and like me on Twitter. Any questions, feel free to get in touch as well by e-mail.

Your Exercise Physiologist

David Mizrahi

E-mail: d.mizrahi@unsw.edu.au

Twitter: @Davemiz_EP

 

My 2013 adventures around the world talking about the benefits of exercise at cancer conferences

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2013 was a big year for me. I managed to present my research involving ovarian cancer patients at 3 conferences, I spoke at 5 different hospitals in Sydney as well as 3 patient support groups. I am 100% happy to put my work aside so I can take these opportunities, as it is very important for patients, clinicians, families, nurses and the general public to be aware of how something as simple as walking can actually help a cancer patient.

The year started off with a trip to Adelaide, Australia for the Flinders Centre for Innovation in Cancer Survivorship conference. This was a great opportunity and and interesting mix. Half of the delegates were medicos (doctors, nurses, allied health staff) whilst the other half were cancer survivors/patients/advocates – So all in all it was a really nice dynamic. This was my first conference presenting this research, so naturally I was a little bit nervous. The main points of the poster above were:

* ovarian cancer patients undergoing chemo were asked to achieve 90+ mins/week of exercise for 12 weeks – They could do it!

* Their sleep improved

* Their fatigue reduced

* Their quality of life increased

* Their muscular strength increased

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I actually got some great exposure from this conference. I had oncologists from around Australia asking me what they should be encouraging their patients to do, and also some amazing cancer survivors telling me of their experiences with trying to remain active. I simply encouraged them, keep up what you are doing and every week try and out-do what you did last week. “A little bit longer in duration, a little bit higher in intensity and you will reap the benefits.”

Next stop – Liverpool, United Kingdom – the home of the Beatles, Liverpool or Everton Football Club (depending who you are speaking to), lack of sun and many a pub.

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The European Society of Gynaecological Oncology Conference. What an experience this was. Over 3000 medical folk, a handful of Australians, in which I did not know any and a lot of great research presentations from top European doctors. This conference was interesting for me, as the majority of topics were related to drug or surgical administration, and minimal on complementary medicines such as exercise, diet or psychological interventions – which are all extremely valuable to the well-being of each patient. This was a good thing for me, as my work was more unique, and again I had decent interest from people around the world. So many European doctors were telling me they didnt have the funds to employ an exercise physiologist or a physiotherapist in their hospitals. My response – educate the patient on the importance on remaining active during and after treatment. They will listen to you. That is it, a couple of sentences will provide encouragement.

Image(my abstract at the bottom underneath all the very complex medical trials)

In this conference I spoke about the relationship between physical activity and sleep quality for ovarian cancer patients undergoing chemo. Firstly, they dont sleep well at all. So i monitored them with this high tech GPS device to track their sleep quality for a week. Turns out, of the participants who were more active than the others, they actually slept better. This is important because more sleep -> less fatigue -> more energy -> less anxiety -> higher quality of life = good news.

However, it was a great experience and a lot of hard work. Hard work means hard play – so naturally, being on the other side of the world, I thought it was only fair I could have some down time

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Image(me enjoying delicious Manchester pub lunch, visiting the Cavern in Liverpool – where Beatles played their gigs, giving a fake press conference at Arsenal’s Emirates Stadium and seeing Arsenal play vs Chrystal Palace at Selhurst Park, London).

Back on a long plane ride to Sydney (26 hrs) and straight to Adelaide again for the Clinical Oncology Society of Australia conference.

ImageNow this picture was taken of me in front of my poster during the networking function, in which a couple of glasses of wine were consumed compounded with my jetlag from the UK and I guess I was just being silly.

Nonetheless, this was another great conference for me. This time I spoke about what were the reasons holding patients back from exercising – the barriers. In a nutshell, the main reason for not exercising for fatigue. Now, I get that. But when there is evidence showing engaging in exercise will reduce your fatigue, you would wish to give it a go. The patients who were exercising more in this study, reported less fatigue again. A trend appears to be going on. Other reasons for not exercising was that it was not a priority and procrastination was an issue. If you have read my previous articles showing exercise can increase life expectancy, reduce recurrence risk and improve countless symptoms, I think it IS a priority and I dont think procrastination should be a word in your vocabulary anymore.

These were amazing experiences. Now i set up 2014 with a more meetings, conferences and patient support group talks ahead of me, I am full of excitement for what this year has to come. If I have an audience of 1 person or 150 people, it does not matter to me, as long as the message gets through. You can do it, one step at a time.

David

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

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.

“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.