Battling Fatigue With Exercise Program and Good Nutrition

NEW YORK—Keeping fit and eating right is no easy task for the millions of Americans who are overweight and out of shape. For cancer patients, it requires specialized know-how as well as determination, according to experts who gave advice during a Cancer Care, Inc. teleconference on ways to battle fatigue.

Eileen Donovan, PT, MEd, manager of rehabilitation services, M. D. Anderson Cancer Center, and Marilyn Joyce, MA, RD, president of 5 Minutes to Health, Los Angeles, addressed exercise and nutrition, respectively, during the hour-long program.

Ms. Donovan urged patients to consult their physicians before starting an exercise program. If they have difficulty with basic activities such as bathing or have a specific heart, nerve, or muscle problem, she suggested that they also seek recommendations from a rehabilitation professional, such as an occupational or physical therapist.

"If you have disease in your bone, your doctor may want you to avoid certain activities," she said. "If you have loss of feeling or stress in your leg, you should see a rehabilitation professional and make sure that you can exercise without hurting yourself."

Cancer patients also need to assess what they want to do and why they are having difficulty, she said. For example, if a patient can’t carry groceries, the cause could be weak muscles or lack of stamina or both. Another common problem, shoulder tightness after surgery, usually requires exercises to restore flexibility rather than strength. If getting up from a low chair or commode is the goal, however, weakened leg muscles need to be strengthened.

Whatever the exercise regimen, Ms. Donovan recommended starting slowly and increasing the duration or the intensity of the activity over time, but not both at once.

A patient might figure out how far she can walk comfortably for 10 minutes at baseline, for example. After a week, she might try to walk farther in 10 minutes, or walk at the same speed for 11 or 12 minutes. Similarly, a patient might practice getting up from a chair that poses no difficulty, such as a dining room chair, several times a day for a week and then progress to chairs that are slightly lower.

Ms. Donovan warned against exercising while receiving intravenous chemotherapy unless directed to do so by a physician. She also advised against exercising when dehydrated, feverish, or experiencing severe nausea or diarrhea.

"You should stop if you have any new or increased bone or joint pain, if you notice any new muscle weakness, if you become nauseous during exercise, or you experience any shortness of breath or chest pain," she said, urging patients to consult with their physicians if they have any problems.

Role of Nutrition

Cancer patients need to eat foods that will help them produce energy, according to Ms. Joyce. One problem is that many patients can’t eat large amounts because of nausea. She recommended they super-blend raw fruits and vegetables into soups and drinks she called "smoothies" that can be sipped in small quantities throughout the day.

Cancer patients need energy-boosting nutrients such as vitamins B, C, and E, beta-carotene, selenium, and zinc, she said. Sprouts, seeds and whole grains, such as brown rice, whole-grain couscous, quinoa, millet, buckwheat, oats barley—"things you buy in a bag and cook"—are good sources, Ms. Joyce said, but most popular brands of cereal do not provide enough nutrients. Store-bought juices also come up short, she warned, estimating that 25% to 35% of nutrients are in the fiber lost during processing.

She recommended that cancer patients aim to eat 7 to 10 servings of vegetables a day and 3 to 5 of fruit. "If you aim for 5, you might get 2 or 3," she said, adding that produce should be fresh and organic, if possible. Similarly, Ms. Joyce urged that cancer patients drink 8 to 10 glasses of water daily, carrying a bottle of water wherever they go, so they can take small sips throughout the day.

Cancer patients should avoid foods that contain carcinogens, deplete energy, or support the growth of cancer cells, Ms. Joyce said. She called commercial salad dressings "death in a bottle" because they usually contain partially hydrogenized oils, and she warned against sugar, alcohol, caffeine, marijuana, white vinegar, pickled foods, commercial relishes, nitrites, red meat, coffee decaffeinated with methylene chloride, and smoked, barbecued, or burned meats.

She recommended eating types of fish that are high in omega-3 fatty acids three or four times a week. She said to avoid shellfish because they are apt to feed in polluted waters—and swordfish and shark, which tend to ingest more mercury than other fish. Other recommended foods include yogurt and lamb.