Exercise Prescription For Cancer


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10 Question Exam (sent via email)

One common symptom of cancer is fatigue and loss of exercise tolerance.

Unfortunately, the only way to reverse this is to exercise. To deal with this difficulty you must do frequent, brief and low intensity exercise within a range that is tolerable for you.

Our initial goal is to reverse exercise intolerance, improve mood, and improve quality of life.

Program Design

Carefully evaluate how the patient feels, particularly in regard to their cancer therapy and motivation to exercise.

Keep careful watch for sudden loss of exercise tolerance, increased shortness of breath with or without exertion, or increase in anxiety or depression as manifested by difficulty in falling asleep or sleeping through the night, loss of interest in social contacts and/or sudden changes in nutritional status or loss of appetite.

You will also need to be aware that the degenerative effect of cancer can result in other disorders like Cardiovascular Disease, Osteoporosis, etc., can also effect the patients’ ability to exercise and exercise tolerance.

Exercise is the best medicine for the treatment, care and prevention of cancer and all chronic disorders, but you have to find the correct dose. Your goal should be to reach a level of moderate intensity.

Low intensity activity may not provide the dose the patient needs to provide the many improvements to the immune system and other physiological systems of the body.

High intensity exercises can be exhausting and that may temporarily depress the immune system and other physiological systems of the body. Your Aerobic and Strength Training Exercise Modes (Types) should be at Moderate Intensity, or an RPE of 11 to 14 on the 20 RPE Scale.

The very deconditioned patient will benefit from “Interrupted” exercise sessions. Instead of continuous exercise sessions, the patient exercises for a few minutes and then reduces or stops exercise activities for a period of time that will vary until the patient feels comfortable resuming exercise.

Tailor the exercise session to the needs of the patient.

You should always be supportive, not pushy; motivating, but not demanding.

One successful technique is the “50 Rules”. Ask the patient how far or how long they think they can walk before becoming tired, and then have them walk 50% of that distance or time.

Cancer-related fatigue (CRF) is the most common side effect of cancer.

It is defined as sustained physical, emotional, or cognitive exhaustion experienced during and after adjuvant cancer treatment is not proportional to recent activities and interferes with usual functioning.

Because CRF is debilitating, it is associated with reduced compliance to treatments, particularly exercise treatments. Causes of CRF may include emotional distress, sleep disturbance, anemia, nutrition, comorbidities, and a decrease in physical activity.

Lack of physical activity results in depression of the endocrine system, which results in loss of production of anabolic hormones with an increase in stress hormones and catabolic hormones. Lack of physical activity also results in loss of mitochondrial activity which results in a decrease in energy from lack of ATP Production. The body cannot produce energy without physical activity.

In simplest terms: “What you don’t USE, You LOSE!”

Therefore, it is critical   that the Doctors’ Fitness Center (DFC) Protocols are executed by IFPA Certified Medical Fitness Specialist (MFS) who understand the impact our exercise prescriptions have on ALL the physiological symptoms of the body, not simply the CV and Skeletal-Muscular Systems that is the focus of a Personal Trainer.

Aerobic Exercise

  • Frequency: 3-5 times/week; preferably: every day and when necessary shorter periods: 3-5 times/day
  • Intensity: RPE 11 to 14 on the RPE 20 Scale
  • Time: Progress to 150 mins/week on Moderate Intensity exercise (RPE: 11-14)
  • Type: Walk, Recumbent Bike, Swim, Water Aerobics, Bike, etc.

Strength (Resistance) Training

  • Frequency: 2-6 times/week; increased Frequency provides important ACUTE Exercise Effects.
  • Intensity: Initially: Light-Moderate: 8-15 Reps: Not to Failure.
  • Time: Initially: One Set of each exercise
  • Type: Initially: Machines or Associated Exercise: One Exercise/Body Part

Pick one exercise appropriate for your patients’ level of conditioning/CRF.

Muscle/Group – Exercise: Low Conditioning – High Conditioning  

  • Quadriceps: Chair Squat – Leg Extension – Squat
  • Hamstrings: Leg Curl
  • Chest: Chest Press – Push-Ups
  • Back: Lateral Pull Down
  • Shoulders: Side Lateral Raise – Overhand Press
  • Biceps: Bicep Curls
  • Triceps: Tricep Extension
  • Calf: Heel Raise
  • Abdominal: Crunch
  • Forearm: Wrist Curls

Start with the above program 2-3 days/week. Program can progress to 4-6 days/week with appropriate body part splits, i.e.: 4 days On, and one day Off:

  • Day 1: Chest & Back
  • Day 2: Legs
  • Day 3: Arms & Shoulders
  • Day 4: Cardio
  • Day 5: Light or Light Cardio & Flexibility

Or 6 days/week:

  • M,W,F: Upper Body
  • Tu,Th,Sat: Lower Body
  • (Note: The purpose of increased Frequency is simply to increase the many benefits of acute exercise.)

Flexibility Exercise 

  • Frequency: Every day, can be performed 2-3 times/day
  • Intensity: Very Low! Stretch to the point of “Tight”, never to the point of Pain!
  • Time: Stretch for 30 secs, feel the muscle elongate to a slightly larger stretch, more to a deeper stretch (Tight! Never Pain!) and hold for an additional 30 secs.
  • Type: Static Stretches (always following a proper CV warm-up) or PNF when an IFPA Flexibility Training Specialist is available.
  • Exercise:  Use the exercises appropriate to your patients’ condition in the IFPA Personal Trainer Textbook.
  • (Note: Motivation, Encouragement, Understanding, and your ability to communicate the necessity for exercise are the keys to success!)

Components of the Immune System

Innate Immune System: Nonspecific Response: nonspecific killing of tumors cells by phagocytosis and cytolysis.

  • Monocytes
  • Macrophages
  • Neutrophils
  • Natural Killer (NK) Cells

Acquired or Adoptive System: Antigen- Specific Response: requires tumor antigens in association with class I major histocompatibility antigens.

  • Immune System
  • Cytotoxic T. Lymphocytes

Effects of Exercise on the Immune System: Innate Immune System

Component: NK Cells

  • Effect Of Acute Exercise: Immediate increase in cell count and cytolytic activity
  • Effect of chronic exercise: NK cell count and activity increase both in blood and (depressed for 2-24 h post-exercise) in spleen

Component: Macrophages

  • Effect Of Acute Exercise: Immediate increase in monocyte and macrophage count. Adherence unchanged Increased phagocytosis with moderate activity.
  • Effect of chronic exercise: Response is unclear. Resting monocyte is count unchanged. May cause adaptations that alter exercise response.

Component: Neutrophils

  • Effect Of Acute Exercise: Large and sustained increase with moderate exercise. Most PMN function decrease significantly after strenuous exercise.
  • Effect of chronic exercise: Function is suppressed during periods of strenuous activity.

Effects of Exercise on the Immune System: Acquired Immune System

Component: T. Lymphocytes

  • Effect Of Acute Exercise: Moderate activity enhances cell proliferation, with depressed levels 30 min post-exercise. Vigorous activity causes a transient decrease in proliferation.
  • Effect of chronic exercise: Regular, moderate exercise enhances cell proliferation.

Exercise Testing

  1. Maximal Cardiovascular
  2. Submaximal Cardiovascular
  3. Muscle Strength and Endurance
  4. Flexibility
  5. PAR-Q

Contraindications to Exercise for Patients with Cancer

  • Hemoglobin <10.0g •dl-1
  • White Blood Cells <3,000/ml
  • Neutrophil count <0.5 •109•ml-1
  • Platelet Count <50•109•ml-1
  • Fever >38°C (100.4°F)
  • Unsteady gait (ataxia)
  • Cachexia or loss of >35% of premorbid weight
  • Limiting dyspnea with exertion
  • Bone pain
  • Severe nausea
  • Extensive skeletal metastases

Good Luck,

Dr. Jim Bell


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