When you’re not feeling at your best, exercise is often the last thing you want to do, and this can certainly be true during cancer treatment and recovery. But research shows it could make all the difference to how you feel, and heal. Valion Health Exercise Physiologist, Emma Sansalone explains how exercise can help boost your energy levels, minimise the side effects of treatment and even improve your recovery.

Far-reaching benefits

Exercise is increasingly being included as standard practice in cancer care and for good reason. Emma says that people living with cancer should not only think of it as medicine during their recovery but also as a preventative measure, helping to reduce your risk of another cancer diagnosis and other chronic health conditions associated with ageing.

“If someone gave you a pill and said ‘take this five days a week and your chance of the cancer coming back is 40 per cent less and your chance of dying from that cancer is 35–50 per cent less’ you’d likely take it. Exercise is medicine for cancer patients,” she said.

This view is supported by the Clinical Oncology Society of Australia who recommend that exercise be embedded as part of standard practice in cancer care and be viewed as a supportive therapy to help counter the adverse effects of cancer and its treatment[1].

Exercise at every stage

Emma says that exercise offers a range of benefits before, during and after the active cancer treatment phase. Engaging in appropriate exercise can also help to prevent deconditioning and improve your overall strength and balance during your cancer recovery.

“Exercise offers physical and psychological benefits during the treatment and recovery phases of cancer and has been shown to improve a patient’s quality of life.

“Patients who are able to exercise throughout treatment and into the recovery phase have a better prognosis, as well as a reduced risk of the cancer returning at a later stage,” she said.

This is supported by the World Health Organisation which says exercise reduces cancer mortality[2] and may lower the risk of cancer returning[3].

One size doesn’t fit all

What’s important to highlight here is appropriate exercise. Emma says that people often make the mistake of thinking that one size fits all, but everyone is different and your exercise plan should be tailored depending on the type of cancer you have and which phase of cancer treatment you’re in.

“No two people with the same cancer will experience the same symptoms or side effects of treatment. Not only do we need to consider the type of cancer and treatment being given, but also other medical conditions and/or injuries.

“It’s important that an exercise prescription be based on an individual’s needs and abilities and is specific to them,” said Emma.

Don’t overdo it

Another mistake people often make when it comes to exercising is overdoing it, which Emma says is especially common in the recovery or post-treatment phase.

“Often cancer survivors think that once treatment is completed, they can return to normal levels of activity. It’s important to remember that cancer treatment is very demanding on the body and takes time to recover from.

“Exercise needs to be started slowly and increased gradually to allow the body time to adjust without making symptoms worse. It’s important that an exercise program is tailored to meet your individual goals and each session should be adjusted based on how you’re feeling on the day,” she said.

What type of exercise is best?

Exercise and Sports Science Australia’s (ESSA) position statement on Exercise medicine in cancer management says that people with cancer should aim to complete at least moderate intensity exercise, unless you have certain risk factors (like recent surgery for your cancer, medical factors like very low immunity or increased bleeding risk, or nausea related to higher intensity activity)[4].

Doing some form of aerobic exercise (which is any activity that gets your heart beating faster, such as walking, swimming, dancing or cycling) on most days of the week is recommended. If you can reach 20 minutes or more of continuous exercise then try to aim for exercise on most days of the week. If 20 minutes is too challenging, then break it up into manageable chunks but aim for some exercise on every day of the week.

Resistance or strength training (which aims to increase the size and load capacity of your muscles and includes everything from bodyweight exercises like squats through to dumbbells and machine weight exercises) two to three times per week is also recommended, with at least 48 hours of recovery before exercising the same muscle group again. Resistance exercise can be done at home using light hand weights, resistance bands or just your bodyweight.

Emma says that a combination of aerobic and resistance training can help you to improve your physical fitness as well as your overall strength and balance in the recovery phase.

Fight the fatigue

One of the most frustrating side effects of cancer treatment is fatigue, even after a good night’s sleep. It’s experienced by 70–100% of people diagnosed with cancer[5] and can affect every aspect of your daily life, from physical activity to social relationships and mental health. Extreme cancer-related fatigue can even affect your chances of remission or recovery[6] as it can reduce your desire to continue with treatments such as chemotherapy.

So, what’s the answer? You’ve guessed it, exercise! Exercise has been found to reduce cancer-related fatigue[7] both during and after cancer treatment. It’s even been proven that doing no exercise at all can actually make your feelings of fatigue worse[8].

Emma said that many of her patients are scared to exercise if they’re experiencing fatigue as they’re worried that exercise will make it worse.

“There’s been a lot of research into cancer related fatigue and exercise and the results have shown that exercise is effective for managing it and that the right exercise doesn’t make it worse. In fact, a graduated exercise program can reduce levels of fatigue over time and improve your energy,” she said.

On the days where you’re feeling especially exhausted, Emma recommends short bouts of high intensity aerobic or resistance exercise where you don’t need to maintain intensity for long periods.

Combating other side effects

Fatigue isn’t the only side effect of cancer and cancer treatment that a tailored exercise plan can help to improve. It can also reduce the risk and/or severity of the physical side effects, including:

• long-term heart problems after chest therapy (radiation and chemo)
• loss of bone strength
• lymphedema (swelling) after lymph node treatment
• anaemia
• nausea
• pain
• peripheral neuropathy (nerve damage that affects the hands and feet).

Good for the body AND mind

Emma says that in addition to the physical benefits, regular and tailored exercise can also improve your cognitive capacity (specifically attention and memory) and emotional regulation.

“Exercise, particularly aerobic exercise such as walking, is well known for reducing stress and reducing your risk of, or the symptoms of, anxiety and depression. Moderate exercise is also a really great way to support your emotional regulation,” she said.

Three short steps to a regular routine

Even though the benefits of exercising are well known, it can be hard to get started. When you’re in the recovery phase of your cancer journey, try to:

1. Move every day – it can be as simple as walking to your letterbox and back
2. Stand up from a chair without using your hands
3. Use technology to support you (like reminders on your phone or tracking your steps).

Remember to start small – some exercise is always better than none, and making physical activity part of your everyday routine may be simpler than you think! Set yourself an achievable target and try to increase your daily steps by 10–20 steps every few days.

Be kind to yourself

Emma says it’s common to have a bad day when it comes to exercise, especially in the cancer recovery phase, because side effects can last for several months after you’ve finished treatment. That’s when ‘setback days’ can be useful.

“Some days exercise is just too much and that’s okay! If you’re experiencing high levels of fatigue or don’t have the energy to exercise, give yourself a setback day where you rest or do some gentle stretching and breathing exercises. Once fatigue levels settle, then get back to your exercise plan.”

Don’t go it alone

Having supportive people on hand can make all the difference in your exercise journey! Whether you choose family members, friends, health professionals or an exercise physiologist, ask someone to help make you accountable for your exercise program (or keep you company!). They can help to motivate you on those days you feel extra tired, as well as celebrate your progress when you reach a new milestone.

An exercise physiologist can help you to understand what kind of exercise is best for you and why, work on prioritising your health issues and overseeing your progress throughout your recovery, all while helping to keep you motivated. They can be your own personal cheerleader, with all the knowledge to help you achieve your goals.

Remember any time’s a good time to start an exercise program!

Don’t forget to check your Teachers Health Extras cover for benefits towards exercise physiology. The Healthy Lifestyle benefit can also help with the cost of gym memberships and more!

References:
1 cosa-position-statement-v4-web-final.pdf
2 The dose-response effect of physical activity on cancer mortality: findings from 71 prospective cohort studies - PubMed (nih.gov)
3 The Impact of Exercise on Cancer Mortality, Recurrence, and Treatment-Related Adverse Effects - PubMed (nih.gov)
4 The Exercise and Sports Science Australia position statement: Exercise medicine in cancer management - Journal of Science and Medicine in Sport (jsams.org)
5 RACGP - Exercise for cancer fatigue
6 RACGP - Exercise for cancer fatigue
7 Comparison of Pharmaceutical, Psychological, and Exercise Treatments for Cancer-Related Fatigue: A Meta-analysis - PubMed (nih.gov)
8 The Exercise and Sports Science Australia position statement: Exercise medicine in cancer management - Journal of Science and Medicine in Sport (jsams.org)

Valion Health supports eligible Teachers Health members through the Cancer Support Program.