exercise has played a significant role in helping me to combat the effects of fatigue. I therefore decided to write a short article in the hope that someone else may be able to gain some inspiration from my experience
Exercise helped me to cope with chemotherapy
I joined the gym in August 2009. I had previously been a member of gyms but found it very hard to stay focussed and motivated, and would find myself dropping out after a year. I wasn’t sure that this time round would be any different. I work full-time as a nurse, so started by going 3 times a week before or after a shift. Workouts would normally be 45 minutes before I would get bored and head for the door.
Two years on, I have run a half marathon, I’ve got bundles more confidence, and have met some great people through taking part in exercise classes, and using the gym. It’s no longer a chore to get up and exercise, it’s a part of my life.
In August last year I discovered a lump under my arm and 3 weeks later, just after my 30th birthday, I was diagnosed with Hodgkin’s Lymphoma (cancer of the lymph glands). Hodgkins is most common in persons of 20-34yrs of age, and older people, and like myself, most people don’t have any risk factors.
In the weeks that followed I had various hospital tests before starting a six month course of chemotherapy, during which I would not be able to work due to the risk of picking up virus/infections. The Clinical Nurse Specialist Nurse talked me through all the side effects of the treatment which included fatigue and nausea/vomiting. One of the burning questions I had was whether I could continue to exercise. I was relieved to have a positive response from my Haematology consultant, stating that people who exercise tend to experience less side effects of chemotherapy, although fatigue may impair my ability to carry out strenuous exercise.
From this point onwards, I threw myself into exercise in the lead up to chemotherapy. Having been a regular gym user, I had got to know the manager of the gym (Sam) fairly well, and I felt able to confide in Sam about my diagnosis. I felt sure that there would be many ‘do’s’ and ‘don’ts’ once treatment started and I was concerned that like family and friends, Sam may offer ‘take it easy’ warnings, when what I really wanted to hear was encouraging words that would give me some hope of being able to keep some normality in my life.
On the 16th September I had my first chemotherapy session. My treatments were once every two weeks, so I filled my time with socialising with family and friends, and exercise. I gave up circuits and spinning classes once chemo had started, as feared that it would be too hard. I felt very much like I had lost my way at times, but continued to feel fairly well during and after chemo sessions and exercise was my coping mechanism so was as determined as ever to keep it up.
In October, I was asked if I was interested in taking part in a Spinathon at my local leisure centre. Although it was only for a half hour period, my initial thought was that it would be too intense and I would struggle. I was reassured that I could have little or no resistance on the bike if I wanted. And so I signed up. I surprised my self that morning, I was able to maintain a good pace with resistance, and felt able to give Spin classes another go. From then onwards, I did 5-6 exercise classes a week, including spin classes, fitball (core stability classes) and fitness pilates. I informed instructors of my diagnosis for health and safety reasons, and the help and support I received from every one of them has been amazing. There were always days where fatigue kicks in and some exercises were a struggle. I learnt not to have such high expectations of myself, instead, tried to remain positive and realistic about what I was able to achieve. There were always bad days, but I think it’s important to not give up on something you enjoy.
I have now finished chemotherapy, and have signed up for a 10k run in May (2012) for cancer research. I am very lucky to have amazing support from family and friends, and am also very thankful to the fitness team at my local leisure centre, they may never know just how much they have helped me over the last few months. Exercise will always be a part of my life and I hope that later this year I will be able to run a half marathon.
The message I want to share with anyone else who enjoys exercise and has received a diagnosis of cancer, is that anything is possible if you put your mind to it, and seek the right help and advice from experts. I feel exercise played an important role in helping me to fight off colds/virus’, prevent weight gain, and has helped to lift my mood on days when my illness dragged me down. I have therefore researched the effects of exercise when undergoing chemotherapy and written a short article, and hope that someone else may benefit from reading this.
An exploration into the benefits
of exercise in during chemotherapy
Chemotherapy is the treatment used to treat many different types of cancer through the use of medicines that destroy cancerous cells. Drugs can also damage healthy cells within the body, and although these cells repair themselves after a period of time, this can result in several side effects such as: Fatigue, nausea and vomiting, anaemia, and a lowered resistance to infections.
Previous research suggests that the most common side effect of chemotherapy is fatigue, a general feeling of tiredness or lack of energy which can cause both physical and emotional exhaustion and the intensity of exhaustion may be dependant on the stage of cancer and illness progression (Watson et al 2004, Velthuis et al 2010). Fatigue is experienced by 70% of people undergoing chemotherapy treatment and can last for several months or years following treatment. In some cases, fatigue can cause difficulties in normal daily activities such as walking, and climbing the stairs. In the past cancer patients were frequently advised bed rest and avoid physical exercise, due to causing increased heart rate and breathlessness. However, this was found to cause muscle wastage and reduced cardio-respiratory fitness (Dimeo et al 2001).
Recent studies suggest that physical exercise during chemotherapy treatment can improve quality of life, and persons with cancer are now encouraged to remain active during treatment although guidance regarding exercise is rarely given. Safety is essential, and persons should begin at low intensity, and progress slowly depending on capabilities (Blaney et al 2010). Some of the benefits of exercise include: a reduction in stress/anxiety and a reduction in fatigue and weight gain. There is also research to suggest that exercise can lessen the risk of some cancers returning, however more evidence is needed (Macmillan Cancer Support 2010). The better an individuals fitness prior to illness, the quicker a person can recover from treatment (BreastCancer.org) and prevent further health problems.
A study conducted by Blaney et al (2010) explores the barriers thought to prevent persons from making exercise part of their daily routine. One of the barriers identified was the lack of guidance and support given by health professionals, and a lack of hospital and community based exercise programmes for patients experiencing fatigue. Exercise programmes could provide an opportunity for cancer patients to meet other cancer patients, and support one another.
Watson et al (2004) reports on a study carried out to investigate the affect of cancer-related fatigue on breast cancer patients in an outpatient department. The participants were split into 2 groups: control group and experimental group. The control group received no instruction regarding exercise, whereas the experimental group were given a low-moderate intensity programme which involved a 12 minute walking test. The study found that subjects in the experimental group experienced less symptoms of fatigue compared to the control group.
Exercise interventions can include resistance training, and aerobic exercise. Resistance training such as leg presses, abdominal crunches, lunges, and chest press is associated with an increased upper and lower body strength by 25-35%, and lean body mass. Aerobic exercise such as cycling and running/walking on a treadmill, have been found to improve anxiety, fatigue and quality of life. However, some patients may experience adverse events from aerobic exercise such as dizziness, weakness or nausea, although most people recover quickly from this (Courneya, KS 2007). Chemotherapy can affect the bone marrow which produces red blood cells, therefore reducing oxygen delivery to cells within the body causing these adverse effects. Therefore, general advice would be not to exercise if feeling unwell, and to stop if you experience dizziness, chest pain or shortness of breath (Macmillan Cancer Support 2010).
To determine your level of fitness and well-being prior to commencing exercise, advice can be sought from a trained professional who can tailor a fitness programme to meet individual needs, such as a Doctor, and fitness instructor/personal trainer. This is important due to the unpredictability of fatigue. It is important to participate in exercises that are not to strenuous, as this could be dangerous to a persons health (Lance Armstrong Foundation:www.livestrong.com/article). The main goal should be to stay as active as possible. Any amount of exercise is thought to be better than none. Swimming and cycling is considered as low intensity exercise, however, there are limitations to certain types of exercises, such as swimming, due to skin sensitivity, and compromised immune system which can cause an increased risk of picking up infections. Co-morbidities should also be taken into consideration before undertaking exercise, such as cardiovascular and cardio-respiratory illness which may contradict participation in exercise, and therefore high intensity exercise should be supervised in a practice setting (Waart, H et al 2010).
Blaney, J; Lowe-strong, A; Rankin, J; Campbell, A; Allen, J & Gracey, J (2010) The Cancer Rehabilitation Journey: Barriers to and Facilitators of Exercise Among Patients With Cancer Related Fatigue. Physical Therapy Vol 90 Number 8 1135-1146.
Breast Cancer Website: www.BreastCancer.org
Courneya, K; Segal, R; Mackey, J; Gelmon, K; Reid, R (2007) Effects of Aerobic and Resistance Exercise in Breast Cancer Patients Receiving Adjuvant Chemotherapy: A Multicenter Randomized Controlled Trial. Journal of Clinical Oncology vol. 25 no. 28 4396-4404
Dimeo, F; Fetscher, S; Lange, W; Mertelsmann, R and Keul, J (1997) Effects of Aerobic Exercise on the Physical Performance and Incidence of Treatment-Related Complications After High-Dose Chemotherapy. Blood journal vol. 90 no. 9 3390-3394.
Lance Armstrong Foundation:www.livestrong.com/article
Macmillan Cancer Support: www.macmillan.org.uk
Velthius, MJ (2010) Physical Activity during Cancer Treatment (PACT) Study: design of a randomised clinical trial. BMC Cancer 10:272
Waart, H; Stuiver, M; Harten, W; Sonke, G and Aaronson, N (2010) Design of the Physical exercise during Adjuvant Chemotherapy Effectiveness Study (PACES):A randomized controlled trial to evaluate effectiveness and cost-effectiveness of physical exercise in improving physical fitness and reducing fatigue. BMC Cancer Vol 10; 673.
Watson, T and Mock, V (2004) Exercise as an intervention for Cancer-Related Fatigue. Physical Therapy Vol 84: 736-743
I would like to gratefully acknowledge Sam Holmes (Gym Manager) for the support and advice given during and after chemotherapy treatment. And Rodney Ballantyne, for his words of encouragement during my treatment, and for his help in writing this article.
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