31 Oct Exercise Right for Brain Cancer
Being diagnosed with brain cancer is a terrifying experience, and exercising is probably the last thing on your mind. But perhaps it shouldn’t be… Some research has shown that exercise both during and after treatment can help cope with the side effects of a brain cancer diagnosis.
A brain tumour is a mass of unnecessary and abnormal cells growing in the brain. Brain cancer is a brain tumour that is malignant. There are many types of brain cancers, but the common types include medulloblastomas, astrocytomas, oligodendrogliomas, glioblastomas and mixed gliomas.
People can be diagnosed with primary brain tumours, which start in the brain and almost never spread elsewhere in the body, or metastatic brain tumours, which is caused by cancer that start elsewhere in the body and spreads to the brain. This chapter will focus on primary brain cancer.
Although everyone’s treatment and experience with brain cancer may be different, common treatments for brain cancer may include surgery, radiotherapy, oral or intravenous chemotherapy, corticosteroids, and anti-seizure medication.
WHY IS EXERCISE IMPORTANT?
Brain cancer and its treatment can cause significant side effects affecting people physically, cognitively and emotionally. These important changes caused by different treatments can affect how people function and how they complete their day-to-day activities. Some studies (1,2) have shown that cardiovascular fitness and muscular strength decrease during treatment for brain cancer, but exercise during treatment can prevent some of these declines: strength training is helpful for bone and muscle health, whilst aerobic activity is helpful for improving cardiovascular fitness.
Another common side effect of treatment is fatigue, which can fluctuate during and after treatment. Exercise during treatment in particular, can be very helpful to manage fatigue. Following treatment, balance, aerobic and resistance exercise can help patients regain some of the function lost during treatment and improve overall function.
TYPES OF EXERCISE RECOMMENDED
There are no exercise guidelines specifically for people with brain cancer and the evidence for exercise in this specific cancer group needs to be developed further. However, below are some examples of practical advice that can be adapted for each individual living with brain cancer and their circumstances.
It is common for the amount of exercise or physical activity undertaken to change during and after treatment. During treatment, it is likely that the presence of symptoms will interfere with how much exercise one can do and maybe even what type of exercise can be done. The important thing to remember is to ‘keep moving’ and to do something enjoyable.
Exercise should include aerobic (cardiovascular) and resistance (strength-based) activity at a moderate intensity (or higher) during and after treatment. If someone is just starting to exercise or hasn’t exercised in a while, it’s recommended to start by doing something they know they can do (e.g., walking or using a stationary bike) at moderate intensity for 10-15 minutes (or less if unable to last for this duration at a moderate intensity). Then they can progress gradually from there by slowly increasing duration (e.g., if previous session was ‘easy’ increase next session by 5 minutes) and/or intensity.
There is also the option to break up activities into shorter blocks. This is particularly helpful when someone is struggling with fatigue. For example, instead of walking for 30 minutes in one session – this could be broken up into 3 sessions, each lasting 10 minutes duration.
The general recommendations are to do 2-3 sessions per week of strength training. Depending on one’s level of function, it’s best to start with ‘body-weight’ exercises or light exercise bands, and progress to more challenging exercises using weights.
IMPORTANT THINGS TO REMEMBER
Corticosteroids (e.g., dexamethasone)
Some people are prescribed steroids during their treatment to manage brain swelling. Some side effects of steroids include weight gain, changes in bone density, muscle strength, and mood. Exercise may help to prevent weight gain and will help keep bones and muscles strong while taking this treatment. Both aerobic and resistance exercise are important.
Balance and neurological deficits
Depending on the area of the brain that is affected and what treatment has been given, some people experience problems with balance, speech, movement or seizures. Balance exercises like standing on one leg or walking may be helpful in preventing falls.
It is important to exercise in a ‘safe’ environment. If there is difficulty with movement or balance, care needs to be taken when completing balance exercise – this should always be done either supervised and in a safe environment (e.g., having a chair as support). Safety should also be monitored when exercising outdoors – making sure the footpath is in good condition to avoid any trips is a good example. Choosing to exercise with someone may be helpful if one is feeling “wobbly” on their feet.
People find that as they progress through their treatment cycle, their symptoms may fluctuate. It’s ok to reduce exercise when symptoms are ‘flared’. Similarly, exercise activities should be gradually increased when feeling a bit better.
Speak to an exercise expert
Accredited Exercise Physiologists (AEPs) can be a wonderful help to get started with exercise or to ensure safety after a brain cancer diagnosis. AEPs will ensure the exercise is safe and can help provide an understanding on how to achieve exercise goals while accommodating functional ability and fluctuating side effects.
There’s over 5,000 AEPs around Australia… To find one near you, click here.
Expert Contributor: Carolina Sandler, Accredited Exercise Physiologist, Lecturer, Queensland University of Technology