Friday 31 May, 2013

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On this page: Why exercise?  | Who should exercise? | Overcoming common side effects | Who to talk to | Exercise equipment | Choosing a program | Reviewers  

Why exercise?

Much of the research to date on exercise and cancer has focused on cancer prevention. Recently however, research has started to examine the effectiveness of exercise for people with cancer.

The current evidence suggests exercise is beneficial for most people during cancer treatment. The evidence also shows there's little risk of harm if care is taken and professional exercise advice is followed closely.

Australia's National Physical Activity Guidelines for Adults recommend everyone should aim to put together at least 30 minutes of physical activity on most, preferably all, days of the week. People with cancer should be as physically active as their abilities and condition allow.

Cancer treatment causes a range of side effects that are different for different people. Exercise has been shown to help people cope with many of the side effects of cancer treatment, including:

  • fatigue
  • feeling sick (nausea) and loss of appetite
  • anaemia (low red blood cell and/or haemoglobin count)
  • depression and anxiety
  • body weight and composition (muscle and fat) changes.

Who should exercise?

Most people being treated for cancer are able to participate in an exercise program. Some people may need a modified program and others may have to delay starting a program. 

Talk to your doctor before starting if you have any of the following problems, as you may need a modified exercise program:

  • lymphoedema
  • fatigue
  • anaemia
  • shortness of breath
  • low platelet count
  • radiation therapy burns
  • compromised immune function
  • damage to nerves (peripheral neuropathy)
  • primary or metastatic bone cancer.

You'll need to delay the start of an exercise program if you have severe anaemia, fever or severe weight loss.

Try to avoid being physically inactive. Some days will be harder than others but even a few minutes of light exercise is better than no exercise at all.

Overcoming common side effects

  • Lymphoedema: Starting an exercise program early in treatment may lower the risk or severity of lymphoedema. Stretching programs and range-of-motion (ROM) exercises are recommended for people with lymphoedema. Appropriate aerobic and resistance training should not increase lymphoedema.
  • Fatigue: Carefully monitoring your condition and making adjustments to the exercise intensity and volume can help manage fatigue. It's important to keep doing even a light amount of exercise during times of excessive fatigue. By stopping all activity you risk losing fitness and strength, which can make the fatigue worse. Stretching, range-of-motion (ROM), yoga and tai chi style activities may be better tolerated during periods of fatigue.
  • Anaemia: Low red blood cell and/or haemoglobin count is another common side effect of cancer treatment. Symptoms of anaemia include unexplained tiredness and fatigue. If anaemia is severe, it's recommended that exercise is delayed. If anaemia is less severe, you should participate in a low intensity exercise program, with gradual increases. Aerobic activity has been shown to improve anaemia. Good nutrition is also important.
  • Compromised immunity: Some cancers and treatments stop the immune system from working properly. When this happens the immune system is compromised and there's an increased risk of infection. A modified exercise program can improve immunit without overloading the immune system. When white blood cell (neutrophil) count is low it's important to reduce the risk of cross-infection by limiting physical contact with other people and by cleaning any shared equipment before use. When immunity is severely compromised (neutropaenia), gyms, swimming pools and training venues should be avoided.
  • Skin irritation: Areas of skin affected by radiotherapy can be extremely sensitive and often uncomfortable. Choose activities that limit rubbing of clothing around affected parts of the body. If you're having radiotherapy, avoid water-based exercise programs.

Who to talk to

Before taking part in any exercise program, either during or soon after your treatment, it's important to talk with your oncologist or general practitioner (GP) about any precautions you should take.

If it's been a while since you've been active or your fitness level is low, start slowly and build up gradually.

Starting an exercise program can be overwhelming. You may have lots of questions. Exercise professionals, such as exercise physiologists and physiotherapists, are specifically trained to give advice on exercise. Medicare or your private health fund may provide some limited cover for visits to an accredited exercise physiologist or physiotherapist. Ask your GP for a referral to an exercise professional or use the Exercise & Sports Science Australia website.

Your exercise physiologist can work with you and your doctor to develop an exercise program tailored for you. Many structured exercise programs offered at places such as gyms will ask you for a medical clearance before starting.

Exercise equipment

You don't need expensive equipment or clothing to exercise or be physically active. Appropriate shoes are vital and help prevent injury later on. A podiatrist or reputable shoe shop can help you select the right shoes.

Wear loose, comfortable clothes, such as shorts and a t-shirt, when you're exercising. Other equipment, such as heart rate monitors and home-gym systems can be useful, but aren't necessary.

Most exercises can be done without the need for any additional equipment.

Wear sunscreen and a hat if exercising outside. Wherever you choose to exercise, it's important to consider your comfort, health and safety.

Choosing an exercise program

There are many ways that you can be physically active without too much cost or inconvenience. What you choose will depend on your current fitness level, what you want to do and what your doctor says is safe for you to do. It's also important to find a routine that suits you. If you enjoy an activity, you're more likely to stick with it. Many people enjoy the social aspects of exercise, so consider inviting a friend or family member to join you.

Exercise at home

Home-based and outdoor exercise are excellent ways to include exercise in your daily routine. You can try aerobic activities such as walking, cycling or swimming, or try some resistance exercises. If you're unsure about what to include in a home-based program, ask your GP for a referral to an exercise professional for advice.

Group exercise program

Many gyms and fitness centres run group exercise programs. When joining, ask about the level and quality of the supervision provided. Fitness professionals should hold current registration with Exercise & Sports Science Australia.

Let your gym know that you have cancer, and ask if they can modify programs and equipment if necessary. Check if your program will be designed and run by an accredited exercise physiologist. They've completed a four-year university degree, and are the most appropriate exercise professional to help design and supervise programs for people affected by cancer.

An exercise program usually includes an initial consultation and functional assessment. You'll receive an exercise program designed specifically for your abilities and condition, and consisting of aerobic, resistance, and flexibility exercises.

To find a group exercise program you can ask your GP, visit Fitness Australia or call Cancer Council on 13 11 20.

Mix it up

You might choose a mix of exercising at home and attending a group exercise program. The structure and safety of a supervised program can be a great place to start exercising, and including home-based or outdoor activities on other days during the week can keep things interesting and help you reach your goals. 

Reviewed by: Dr Prue Cormie, Senior Research Fellow, Edith Cowan University Health and Wellness Institute WA; Steve Pratt, Nutrition and Physical Activity Manager, Cancer Council WA; Kate Aigner, Cancer Information Consultant, Cancer Council ACT; Simone Guise, Exercise Physiologist, Cancer Council WA; Christine Hygonnet, Education & Information, Cancer Council SA; Dr Amanda Horden, Bayside Healthy Living, VIC; Jenny Mothoneos, Publishing Editor, Cancer Council NSW; and Andrew Murnane, Exercise Physiologist, Peter MacCallum Cancer Centre, VIC.
Updated: 31 May, 2013