Chemotherapy is a powerful tool, but it brings with it a vast array of challenges, both during your cycles and after. For those undergoing chemo treatment, exercise might be the last thing on your mind. But perhaps it shouldn’t be…

The plain and simple fact is that there is a growing body of evidence that shows tailored exercise during chemotherapy can reduce unwanted side effects, limit de-conditioning, AND has even been found to aid treatment.

So, is it possible to stay active whilst undergoing chemo, and why on earth would you want to?

Benefits of exercise for chemotherapy

1. Exercise reduces cancer related fatigue

Chemotherapy is associated with a crippling fatigue. It is also psychologically draining as it often means you are unable to do the things you love, and can impose a financial burden due to missed days as work. There are hundreds of studies that show that exercise reduced fatigue levels, and it’s yet another reason why should factor exercise into your chemo treatment.

2. Exercise creates an attenuation in chemotherapy related neuropathy symptoms

Neuropathy is a relatively common side effect of chemotherapy. Essentially, it effects the hands and feet, creating symptoms like numbness, tingling and pain, cramping, difficulty handling small objects, and issues with gait and balance. Unpleasant! Multi-modal exercise, such as resistance exercises coupled with low to moderate intensity aerobic exercise like walking, can modify both the severity and prevalence of neuropathic symptoms.

3. Exercise reduces de-conditioning

Chemotherapy tends to effect how you function physically. It can lead to a reduction on both muscle size and strength. So, it’s no wonder people undergoing chemo may feel fatigued. Luckily we have a treatment for that! Specific resistance training has shown to minimise this loss of this strength. Completing targeted strength training means everyday activities, like carrying your children, doing the shopping, or even getting out of the car, don’t seem so challenging. It is also important to note that those with advanced cancers tend to lose more muscle mass and as such may find exercise just as beneficial or more

4. Exercise reduce risk of cardiovascular disease

Due to the direct toxic effects of anti-cancer therapies as well de-conditioning, people undergoing chemotherapy have a risk of developing cardiovascular diseases such as heart failure, stroke, and coronary heart disease. A study in 2016 found that post-diagnosis exposure to exercise was associated with substantial reductions in newly diagnosed cardiovascular diseases or cardiovascular related death.

5. Improved completion rates of treatment

Oncologists provide treatment doses based on what they think will create the best chance on achieving the treatment goal. However, completion can depend on how well you can withstand the treatment and its side effects. So, given that exercise therapy can reduce general pain levels, cancer related fatigue, and neuropathy, it makes sense that it allows more people to fully complete treatment. This can give you the best chance of survival!

6. Exercise reduces risk of death

If you exercise when diagnosed with cancer, you will reduce your chance of dying. I know that is a massive statement, but a review of 71 studies found that exercise was linked to reduced mortality in breast, colorectal, and prostate cancers. In one of those studies they found mortality reduced by 24%, 32%, 39% and 40% when individuals participated in low, moderate, vigorous and very vigorous activities respectively. This essentially means there is a dose response relationship with exercise and mortality. In a nutshell – some exercise is better than none, and more is better than less.

Things to consider before you start exercising

Before you start exercising, you need to talk to both your oncologist and an Accredited Exercise Physiologist. There are always caveats to exercising while undergoing chemotherapy, so it’s important to speak to an expert.

An exercise physiologist will tailor exercises to the current functional status and capacity of each individual patient. These exercises will then be progressed and regressed based on the treatment cycles. Some things to remember include:
• Overstretching areas around catheters should be avoided.
• Stoma’s should be cleaned before and after sessions and if you are feeling feverish.
• It’s important to monitor acute changes in your pain levels, gastrointestinal disorders (nausea, vomiting diarrhoea etc), heart rate, blood pressure and breathing rates.

What type of exercise & how much?

As mentioned, exercise prescription must tailored to the current functional status and capacity of each individual patient. Typically you can exercise directly after each chemotherapy dose but usually once side effects really hit, intensities will need to be modified.

For the same reported feelings of exertion, your exercise may change from being able to jog around the block, to being able to walk to the mailbox. Then, as you progress through your cycle, your intensity can increase. Just remember, exercise may sometimes feel like the last thing you want to do, but just like any good medicine, it will help when prescribed appropriately!

To find an Accredited Exercise Physiologist, ask your doctor for a referral or click here to find one near you.

Holly Evans is an Accredited Exercise Physiologist at iNform Health and Fitness Solutions, and is currently completing a PHD in Exercise Oncology.

References

1. Meneses-Echavez JF, Gonzalez-Jimenez E, Ramirez-Velez R. Effects of supervised multimodal exercise interventions on cancer-related fatigue: systematic review and meta-analysis of randomized controlled trials. Biomed Res Int. 2015;2015:328636.

2. Kleckner IR, Kamen C, Gewandter JS, Mohile NA, Heckler CE, Culakova E, Fung C, Janelsins MC, Asare M, Lin PJ, Reddy PS. Effects of exercise during chemotherapy on chemotherapy-induced peripheral neuropathy: a multicenter, randomized controlled trial. Supportive Care in Cancer. 2018
Apr 1;26(4):1019-28.

3. Coletti D. Chemotherapy-induced muscle wasting: an update. European Journal of Translational Myology. 2018 Jun 4;28(2).

4. Jones LW, Habel LA, Weltzien E, Castillo A, Gupta D, Kroenke CH, Kwan ML, Quesenberry Jr CP, Scott J, Sternfeld B, Yu A. Exercise and risk of cardiovascular events in women with nonmetastatic breast cancer. Journal of Clinical Oncology. 2016 Aug 10;34(23):2743.

5. Li T, Wei S, Shi Y, Pang S, Qin Q, Yin J, Deng Y, Chen Q, Wei S, Nie S, Liu L. The dose–response effect of physical activity on cancer mortality: findings from 71 prospective cohort studies. Br J Sports Med. 2016 Mar 1;50(6):339-45.