Before beginning any program of exercise or physical activity, cancer survivors should undergo a complete health assessment to develop an individualized plan that maximizes the benefits of physical activity while reducing risks of injury.
Regular physical activity is associated with reduced risk of colorectal cancer, coronary heart disease, osteoporosis, and diabetes mellitus,71,72 and may be beneficial for the prevention of other cancers as well, including breast cancer.71-73
The impact of physical activity on the prognoses of people with cancer is less clear.74-77 Physical activity levels tend to decrease after cancer diagnosis and treatment, but increased levels of physical activity can improve overall quality of life, and result in less fatigue, lower levels of anxiety, increased energy, and a renewed sense of vitality.78-94
Increased physical activity has been shown to have beneficial effects on heart rate, lean body mass, and respiratory capacity among cancer survivors, effects that are similar to those observed in individuals without cancer.78 Thus, consistent with other recommendations regarding regular physical activity, cancer survivors and their family members should be encouraged to engage in moderate regular physical activity.
There have been only a few studies of the effect of physical activity on survival of people with cancer, and most involve only small numbers of subjects.78 Researchers in this emerging field have not been able to determine whether activity can prevent recurrence of cancer or slow the progression of disease, but studies have shown that regular physical activity can reduce anxiety and depression, improve mood, boost self esteem, and reduce symptoms of fatigue, nausea, pain, and diarrhea.79-94
These benefits can be gained through participation in moderate physical activity on most, if not all days of the week.
Moderate activities are activities that make a person breathe as hard as they would during a brisk walk. Activities such as walking, biking, and swimming are considered of moderate intensity, as well as activities such as yard work and brisk house cleaning. Ideally, at least 30 minutes of activity should be accumulated each day.
Cancer survivors can find many ways to incorporate physical activity into their daily lives. Parking further away from a destination and using stairs instead of elevators are easy ways to be more active throughout the day. A little bit of physical movement is far better than none.
Additional benefits can be gained through progressively greater amounts of physical activity. In choosing a level of activity, it is important to take into consideration the cancer survivorsí physical functioning and previous levels of activity.
If the disease and/or treatment results in confinement to bed rest, physical therapy in bed should be initiated to maintain strength and range of motion of joints. Prolonged bed rest can result in reduced fitness, reduced endurance, and decreased muscle strength, all of which can increase the effort required for performing daily activities. Physical activity for cancer survivors who are confined to bed, even those with advanced cancer, can help counteract the fatigue spiral and feelings of low energy that some experience under those circumstances. Even modest levels of physical activity can help maintain mobility, relieve muscle tension, and provide a mental and emotional boost.
Physical activity during cancer recovery should be individualized, initiated slowly, and progress gradually. Individuals with disabilities are encouraged to seek out specialists (e.g., physiatrists and physical therapists) to assist in developing an individualized program of physical activity.
Some situations or conditions may limit the ability of cancer survivors to be active. For instance, some cancers can cause electrolyte imbalances and deplete the body of fluids. In these situations, it is especially important to ensure that adequate hydration and electrolyte balance are maintained during exercise.
Survivors with metastasis to the bone, or with bone loss due to therapy, should be careful to prevent bone fractures by avoiding activities that involve jumping or twisting the hips. Survivors with chemotherapy-induced neuropathy that affects their balance should be careful to exercise in ways that avoid the risk of falls.
Many community programs provide physical activity programs for people with special needs. Programs that are designed for individuals beginning or resuming physical activity should be recommended as a starting point. As the level of physical activity improves, more challenging programs can be tolerated. Survivors who wish to participate in more intense or vigorous programs, or in high level sports, should be evaluated on an individual basis by an exercise specialist and health care provider.
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