Exercising Cancer Patients? Some considerations to exercise prescription

Speck et al performed a systematic review of controlled physical activity in cancer survivors. The study reviewed 82 research works and showed a significant effect of exercises in cancer survivors, during and after treatment. A large effect was shown on upper and lower body strength and a moderate effect on fatigue and breast cancer-specific concerns.

Similarly, Orsini et al study found that walking or cycling an average of 30 minutes per day has been associated with a 34% lower rate of cancer death and a 33% improved cancer survival.

World Health Organization recommends 150 minutes of moderate-intensity aerobic physical activity a week which can reduce the risk of breast and colon cancers. The same amount of exercise can also reduce the risk of diabetes and heart disease.

Per the International Agency for Research on Cancer: “Physical activity is one risk factor for non-communicable diseases which is modifiable and therefore of great potential public health significance. Changing the level of physical activity raises challenges for the individual but also at societal level.”

The physiotherapist can help to maximize recovery of cancer patients. However, we, physiotherapists need to consider few things to minimize the risk of potential adverse effects or injuries while exercising cancer patients.

• Cancer patients must be screened for any physical limitations before starting any sort of physical exercises. An exercise program should be modified and designed per individual disease condition, physical and mental state and as per patient’s specific needs.
• Cancer treatments can adversely affect normal cardiac response. So, heart rate monitoring is the must throughout the physical activity.
• Some contraindications to exercise in cancer patients are;
  • Cardiovascular insufficiency, for example; uncontrolled symptomatic heart failure, acute myocarditis, and recent myocardial infarction.
  • Hemoglobin <10g/dl
  • Absolute Neutrophil count- less than 0.5×10 ⁹μl
  • Platelet count less than 50×10⁹μl
  • White blood cell count less than 500/mm³
  • High fever over 38 degree Celsius
  • Exercise within two hours of chemotherapy or radiation therapy
  • Intravenous chemotherapy within previous 24 hours
  • Acute infectious diseases and metabolic diseases like thyrotoxicosis, myxedema
  • Mental or physical impairment leading to inability to exercise.
  • Acute onset of nausea during exercise and vomiting within previous 24-36 hours
  • Unusual fatigability or muscular weakness, disorientation, blurred vision, faintness, pallor, night pain or pain not associated with injury
  • Indwelling catheter – avoid resistance exercise of muscle in the area to avoid dislodgement of catheter
  • Significant peripheral neuropathies.
• Risk of possible metastasis. Exercise should be modified to avoid pressure on bony structures.
• Risk of fall injuries. Cancer patients are prone to poor balance and thus care should be taken during dynamic exercises like running on a treadmill, stepping exercises, balance exercises etc.
• Risk of fatigue and poor posture. Cancer patients can fatigue easily and thus show a lot of compensatory movements during exercise. So, exercise should be progressed very slowly and focussed on proper alignment, technique, and posture.
• Adequate hydration is the key to reduce the risk of fatigue and low blood pressure. So, patients should be monitored and encouraged to maintain their hydration level regularly.
• Risk of lymphedema. A number of studies have shown the significant effect of exercise in reducing lymphedema. However, too aggressive exercises have shown the opposite reaction resulting in aggravation of lymphedema in cancer patients.
• Risk of infection. Cancer patients have poor immune systems and thus are prone to get infections. Hence, exercise environment should be well maintained to minimize the risk of infection.
• Risk of sudden onset of symptoms. Cancer patients should always be closely monitored throughout the workout as any sudden onset of symptoms like shortness of breath, cardiac symptoms, severe pain, abdominal pain, excessive sweating, dizziness, vomiting, fainting etc should be addressed by emergency medical assistance.