Can you still exercise when you have cancer?

MD Anderson Cancer Center
Date: 03-31-2014

 

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Lisa Garvin:  Welcome to Cancer Newsline a podcast series from the University of Texas MD Anderson Cancer Center. Cancer Newsline helps you stay current with the news on cancer research, diagnosis, treatment and prevention providing the latest information on the reducing your family's cancer risk. I'm your host, Lisa Garvin and today our guest is Carol Harrison, she's a senior exercise physiology technologist in the Department of Behavioral Science here at MD Anderson and we're going to talk about exercise and cancer. Of course we know that when we've talked before that exercise is a preventive measure for many types of cancer and an active lifestyle is always encouraged just in general but we're going to be talking about exercise for people with cancer. So once a person is diagnosed, say if they're an athlete and they've been diagnosed what sort of advice are they given with their exercise with respect to their disease?

Carol Harrison: As an athlete, well I wouldn't take that...we wouldn't see that as anything that would be necessarily taken into account assuming that they were physically active before okay, there may be during treatment that sort of thing as far as being able to having the need to back off what they're doing so to speak. It depends on the treatment, it depends on the type of cancer, it depends on when they need to get back into what they were doing and the type of athletic program they were involved with. There are several factors involved with that so it would very individualized.

Lisa Garvin:  Because I know even though people aren't professional athletes you have a lot of people who run dozens of miles a week, they go to the gym every day and I'm guessing once they get diagnosed with cancer the big question is can I still exercise and you say it's kind of individualized.

Carol Harrison: Yeah it is and we have to separate the two, an individual who was an athlete that makes a living at that, that has to stay in a tip top shape all the time, it happens quite often and the individual who exercises for health benefits, for longevity, for quality of life that type of thing, they are two individual...two separate situations there. For someone who's just interested for maintaining their style then the physical activity guidelines, say that you don't necessarily have to back off of what you are doing, you have to take special precautions though, during treatments especially because depending on the type of treatment as I was saying radiation treatment, surgery that type thing time after treatment a time to recover, the down time you may have based on the chemotherapy drug to which you were exposed, there are certain side effects that would prohibit certain things however it's just a matter of adjusting that exercise program to account for times when you're not feeling that well, the fatigue level may be higher. You may not be able to run as far as you could initially, then that you mean that not necessarily that you should stop doing the activity but maybe do it...maybe take it at a slower pace and ease yourself back into a level that you're comfortable with. That accounts for the discomfort you may feel from the treatment itself.

Lisa Garvin:   Because fatigue of course is reported by at least 75 percent of cancer patents in active treatment but I do know that we encourage here at MD Anderson at least that you should at least exercise a little bit because that does help with the fatigue. How do people cope with fatigue who want to exercise?

Carol Harrison: Yes that is a good question and it kind of seems like a paradox because we know that the fatigue level can at certain times be debilitating. I would not individual...we would not ask an individual to exercise during extreme fatigue. During extreme fatigue there is a possibility that they could possibly injure themselves yes that is true because the body is just not able to function on the level that it was able to function before, however exercise can be a benefit for fatigue. I would...we would ask that you exercise in smaller increments for instance if you're feeling fatigued then maybe if you are used to exercising 45 minute to an hour or running that five miles or two miles even maybe take a 10 minute bout, maybe a couple times a day or maybe 15 minute bouts maybe once a day in other words don't stop the activity do it at a level that your body can handle to ease back into where you need to be.

Lisa Garvin:   I would think that with some athletes they tend to want to push the envelope anyway, I'm wondering...

Carol Harrison: That's true.

Lisa Garvin:   How many people are saying oh I'm fine, I'm going go out and run my ten miles like I normally do, what is your caution against that kind of obsessive behavior?

Carol Harrison: My advice is what is the rush, what is the rush you must take this from a framework not from where you were but where you are right now. So if you want to be able to do this for the duration of your lifetime and you're looking at a long life span that's your goal a long life span then ease yourself back into it so that you can get to the level. People have had injuries and setbacks that will take them farther back than they were...further back than they were before they even started so think about it from that standpoint. You're looking at longevity, you're not in a rush, take the time, get back into it and set goals for yourself, I always say set the goals because if you set goals then you'll feel that sense of accomplishment that will keep you going, yes you were there, there was a pinnacle that you may have been at before all of this happened but think about getting back to a level that you can handle and reaching for that goal but doing it slowly and incrementally because once again this is your body, you only have one body take of it, there's not a rush. You're not...the only person you're competing against is yourself, set the goals for yourself and work toward that.

Lisa Garvin:   Now we've talked about of course chemotherapy is one of the usual suspects with fatigue and other side effects but say somebody has had surgery I mean there has to be a reasonable recovery time so they don't undo what was done or pop their stitches or whatever.

Carol Harrison: Yeah, yeah, yeah it's always recommended, we always recommend that before you start back on the exercise program that you do consult a physician, your primary care and the reason is that as you say there's wounds, there's infections that can occur, exercising in public places can be an issue, it's not advised to go to a public pool, that type thing. Because you can introduce an infection, there is...it can be up to 6 to 8 weeks of a recovery time depending on the type of surgery and the severity of the surgery. So but there are stretches, small stretches that you can do in the interim that can kind of keep the joints from getting too stiff. We recommend also that there maybe the possibility of accessing the physical therapist before because then they can prescribe certain exercises that can help the recovery period. So surgery does not necessarily mean no exercise it may mean that you have to delay starting back at full force until you are clear to exercise and the wound has healed.

Lisa Garvin:  Are there any issues with people undergoing radiation or proton therapy that might affect their exercise regimen?

Carol Harrison: We have to look and take into consideration it could be bone density is an issue, bone density is a huge issue, the radiation can be...radiation as far as fatigue is concerned is also a very big issue so radiation therapy does not necessarily mean stopping exercise, once again you have to play it day by day thing. It is a day by day thing, it is a goal setting thing so if...radiation doesn't necessarily mean you have to stop, it may mean you have to make an adjustment and there may be discomfort as far the surface where the treatment occurred also just the general discomfort from the fatigue level I must say, I keep going back to that because that's the major issue, it truly is. It's not necessarily that you cannot exercise but you feel that your body will not do what you want it to do and it's very...it can be very frustrating.

Lisa Garvin:   Are there any warning signs that people need to look for when they've gone back to exercise after treatment and maybe something doesn't feel right?

Carol Harrison: After treatment or during active treatment?

Lisa Garvin:   Either or.

Carol Harrison: Okay well let's say for instance on a breast cancer survivor after surgery they need to be aware of any shoulder or arm morbidities that may be present just as a result of that surgery itself, and watching that let's say I'm going to use breast cancer for an example because it's a very good example it is advised supervise exercise at least 16 weeks immediately following the surgery because you must start out slowly, very light exercise and that type of thing it can...not only does it get them back active but it also helps their self-efficacy level, it takes them to a level I can do this, but I have to do it slowly and once again I have to take into consideration the treatments that I've had. So certain treatments prescribed would mean certain precautions that we look out for. For instance as shoulder comorbidities, I'd say an ostomy in a colon cancer survivor. Contact sports may be an issue, that doesn't mean you cannot exercise but it means that you must be aware of contact sports that type thing, you need medical clearance before something like that, See endometrial cancer survivors or any type of gynecological cancers lower extremity lymphedema and with breast cancer survivor upper extremity lymphedema, a sleeve is necessary in terms of lymphedema because that is a precautionary measure that you would take.

Lisa Garvin:   A lot of people who are exercisers tend to push past the pain, now if they are a cancer survivor or in active treatment is that a good idea?

Carol Harrison: Pain is an indicator of something, especially in this population, if it causes...acute pain is also an issue this is even with the general population. Sudden onset of pain is something that you should take into consideration, if you exercise and there's pain then I would possibly lay off that particular exercise and possibly develop another exercise that can do the same job as far as strength training or aerobic exercise for instance if there's pain in the feet because of neuropathy then walking or running especially on a treadmill setting is not necessarily a good thing to do, however on a recumbent bike it can be a very good exercise. So if I have pain that is a result of neuropathy then I would maybe opt for an exercise bike or even an elliptical cross-trainer. Strength training, resistance training if there's pain in the joint from resistance training then it may be that you may be overdoing it, a lighter exercise something that's more compatible to what your physical ability at a particular point in time. So there are ways around it and ways to adjust it, there are ways to exercise such that you enhance your body as it is right now for longevity sake and ease yourself back to a level that you feel confident and that keeps you reaching for a higher goal.

Lisa Garvin:  I understand you're working on an exercise algorithm for cancer patients, can you tell us about that?

Carol Harrison: Well, basically it is an app that we're developing for a study that we're doing to encourage cancer survivors to exercise more, it gives them prompts it gives them information about...collecting certain information and that your exercise program is adjusted depending on what you're doing and it encourages you. But we found from focus groups that we have spoken to that a lot of individuals don't have an idea or knowledge of when they should stop or when they should consult a physician or is this normal or should I have this pain, do most individuals have this type pain, is it okay to do this or that. Especially breast cancer survivors have been told that resistance training is not good for them or shouldn't be done, we found from studies that is not necessarily true what we must do is start out slowly and incrementally. So that in itself was a revelation to a lot of individuals so this algorithm is...I'm developing this algorithm to help them assess where they are and they can follow kind of like a feedback answering yes or no to a question and it leads them to another box, well yes this is the case or no, shall I see a physician if I see these symptoms occur for this particular exercise I'm doing for the particular cancer that I've had. So the algorithm will lead them on a path to let them know what is I guess the best way to say this is acceptable pain and not acceptable pain.

Lisa Garvin:  So this is actually really I mean like I said we've always heard exercise is good it's kind of a blanket proclamation for cancer and cancer prevention so this is a way that to actually tailor exercise to the particular patient.

Carol Harrison: Yes, it can do that, it can very well do it, individualizing it because exercise in cancer survivors is very individualized, as I said earlier the treatment has a lot to do with it, that's one aspect of it being individualized but this gives them some type of avenue in which to assess themselves. And assessing themselves it gives them a little bit more control over their exercise program itself, so yes it does, it really does individualize the program for them.

Lisa Garvin:   When do you hope this app gets out to the public?

Carol Harrison: Well, we're hoping in the next few months, I can't give you a definite time but we're hoping very soon, I'll say in the next four to six months.

Lisa Garvin:   Great thank you very much for talking with us today.

Carol Harrison: Thank you.

Lisa Garvin:  If you have questions about anything you've heard today on Cancer Newsline contact askMD Anderson at 1 877 MDA-6789 or online at mdanderson.org/ask. Thank you for listening to this episode of Cancer News Line, tune in for the next podcast in our series.

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