Exercise in Cancer Survivorship: Building Your Base

Spring came early throughout most of the country this year. Here in Wyoming, the grass has been green and the birds have been warbling for a couple of months. Now, with summer upon us, we’re starting to think about gardening and getting outside more, and cancer survivors are no exception. A common question from survivors and their families is, “How do I get back in shape without getting so sore and stiff?”  I love it when survivors ask physical activity questions, because exercise is the most important thing that a survivor can do to feel better.  In fact, I have written a great deal about the benefits of physical activity in reducing cancer-related fatigue, a common and distressing problem among cancer survivors.

Anna L. Schwartz, PhD, FNP, FAAN

My interest in cancer and exercise came from personal and professional experience. I was diagnosed with non-Hodgkin’s lymphoma when I was finishing nursing school. Not only did this set into motion a firestorm to live my life as fully as possible and do something meaningful with my life, but it also opened the door to possibilities I had never imagined. I started bicycling, went on to set three world records, and was invited to join the 2003 Tour of Hope team. We rode across the country with Lance Armstrong in 7 days to raise awareness for cancer research.  My personal experience certainly influenced my decision to pursue this research, which has become my passion and life’s work.

Needless to say, I’m a huge advocate of physical activity for cancer survivors in all phases of survivorship. Survivors reap numerous physical and emotional benefits such as improved muscle strength, aerobic capacity, body composition, self-esteem, and mood. Exercise actually reduces the risk of recurrence of some cancers and it reduces the risk of mortality from cancer and other diseases. We know that the long-term and late effects of cancer treatment increase risks for cardiovascular disease, overweight, diabetes, and other chronic illness, and there’s clear evidence that exercise reduces these risks. So, when cancer survivors want to exercise, I embrace their motivation. I suggest referring them to a LIVESTRONG at the YMCA program if possible; this is a research-based physical activity and well-being program designed to help adult cancer survivors achieve their health goals. Survivors work with Y staff trained in supportive cancer care to achieve their goals, such as building muscle mass and strength; increasing flexibility and endurance; and improving confidence and self-esteem.

VIDEO

Meet the author, Anna Schwartz, at the ONS meeting.

While the most important advice a nurse can give a patient is to avoid inactivity, it’s important to keep in mind that increasing one’s physical activity needs to be done slowly and steadily. If a person (regardless of being a cancer survivor or not) exercises too hard too soon, he or she will experience fatigue and muscle soreness that can haze the many benefits and pleasures of exercise-and this is a common reason that people stop an exercise program. In many of my studies, survivors who were randomized to the usual care control arm would start an aggressive exercise program of their own. They exercised so hard that at the 4-week follow-up, many of these control-group survivors were fitter and faster than their counterparts in the exercise-intervention group. But they went at it too hard at the outset, and by week 5 or 6 all had stopped exercising. It was too hard and too painful. The key is to slowly build an aerobic base before adding harder workouts.

Building a strong aerobic base allows survivors to gradually increase their exercise intensity and duration without feeling exhausted and muscle-sore. So, how can you help your survivors to build a base? They can start by keeping a record of daily activity-walking, cycling, taking an exercise class, lifting weights, working in the garden, or whatever the person enjoys doing. It’s critical not to go too hard; that is, advise the survivor to avoid exercising so intensely that it’s hard to breathe. Build the base before adding intensity. It’s also important to keep a good log of how many minutes are spent each day performing some type of exercise or physical activity. It’s helpful for survivors to record their daily level of fatigue, too. A simple 0- to 10-point scale of fatigue is quick and easy and doesn’t pose a burden. Survivors who see their fatigue levels increasing should cut back on their exercise routine, and maybe even take a rest day!

In the base-building phase, the goal for the survivor should be to exercise at a fairly steady aerobic level for several weeks while his or her body gets accustomed to the physical stress it has been put under. Ideally, your survivor should strive for a combination of aerobic and resistance, or strength-training, exercises that s/he can do through the full range of motion with correct form. Some examples of exercise are found in Cancer Fitness: Exercise Programs for Cancer Patients and Survivors (Simon & Schuster, 2004). It’s important to try to walk or do something physically active 15 to 30 minutes a week. If a survivor cannot exercise for 15 minutes, then break that exercise into shorter sessions during the day. Soon 15 minutes of continuous exercise will be possible. And if it’s recorded in the survivors’ exercise logs, they will be motivated by their improvements. The trick with exercise is individualizing the exercise program to the survivor and adapting it to his or her specific needs and even limitations. The ultimate goal is to improve quality of life by reducing disability, limiting or delaying complications, and restoring function.

In my next blog I will describe how to add some intensity to an exercise program, to reap more benefits out of exercise in a short period of time. It may seem counterintuitive, but more is not better in exercise. So, I’ll focus on how to help your survivor get the most out of exercise time.