The Importance of Exercise for Cancer Patients: What You Need to Know

The Importance of Exercise for Cancer Patients: What You Need to Know

The term “cancer survivor” refers to anyone who has been diagnosed with cancer, no matter where they may be in their journey. With earlier detection and improvements in screening and treatment, cancer survivors are living longer. ACSM recommends for patients to aim for 150 minutes per week of moderate aerobic exercise with an additional two to three sessions of strength training (such as weight lifting) unless contraindicated. A 2017 systematic review suggests that there is sufficient research to support the promotion of exercise for adults with cancer, and some to support the promotion of exercise in group or supervised settings and for a long period of time to improve quality of life and muscular and aerobic fitness (1). Exercising at moderate intensities can be sustainable for longer periods of time and could encourage the formation of an exercise habit. It is important that an assessment be conducted to evaluate the effects of disease, treatments, and comorbidities and that a survivor receives clearance from their oncologist (1).

How cancer patients should approach exercise?

A patient’s approach to exercise should be rehabilitative and should consider their fitness level prior to diagnosis and treatment. The survivor will need to consider the recency of surgery, chemotherapy, radiation, hormonal therapy, and any side effects that may have occurred with each. The patient’s oncologist/physical therapist/trainer can be helpful in identifying side effects that could influence one’s performance and help them determine what modality of exercise could be the most appropriate to prevent injury. These health/fitness professionals should also work with the patient to come up with realistic activity goals. Having goals will increase motivation and facilitate a lasting behavior change!

Some of the best exercise for cancer patients – does this vary between those who are currently undergoing cancer treatment versus those in remission?

The best exercise is the one that fits the individual. Again, it’s important to consider any treatment-related side effects that may be present. This can serve as a foundation for tailoring the patient’s regimen. Common treatment-induced side effects that could have implications on exercise include neuropathy, lymphedema, and cardiotoxicity.

If the survivor is experiencing neuropathy (often referred to as chemotherapy-induced peripheral neuropathy (CIPN)), it would be best to steer away from high-impact free weights and aerobic exercises that require a lot of balance. Safer modalities would be low-impact exercises such as swimming and biking. For lower extremity neuropathy, patients should try to incorporate calf stretches, ankle circles, walking, leg lifts, and balancing exercises (2).

While most common in breast cancer survivors, lymphedema can be present in any part of the body that has been subject to surgery or radiation. It is essential to seek out care from a lymphedema specialist and resolve the issue. Contrary to popular belief, once the lymphedema is under control, it is safe to exercise at a slow and progressive rate (3). The survivor will need to pay close attention to any changes in the affected area. This can include swelling of part or all of your arm or leg including fingers or toes, a feeling of heaviness or tightness, restricted range of motion, aching or discomfort, recurring infections, or hardening and thickening of the skin (4).

For those experiencing cardiotoxicity after chemotherapy (in particular, anthracycline-based treatment) or radiation to the chest area, it will be important to get physician clearance before engaging in exercise. However, engaging in a low-to-moderate intensity exercise regime prior to or during treatments could potentially mitigate the severity of treatment-induced cardiotoxicity (5).


Why exercise is so important for cancer patients.

The benefits from exercise for this population are extensive. Cancer survivors are almost three times more likely to report fair or poor health after treatment and twice as likely to have psychosocial disabilities and physical and functional limitations as persons without cancer (6). In addition to the possibility of neuropathy, lymphedema, and cardiotoxicity as mentioned above, some other lingering effects of treatment include but are not limited to cancer-related fatigue, weight gain, weight loss, depression, anxiety, insomnia, altered body composition, and changes in bone mineral density. Of these, strong evidence suggests that exercise can directly improve fatigue, weight changes, depression, anxiety, and bone health (7).

  • Fatigue: Fatigue occurs in approximately 50-90% of patients undergoing treatment. While it may seem contradictory, exercise happens to be the number one non-pharmaceutical approach to combatting cancer-related fatigue. It can be hard to get started, but great benefits will be reaped if one can get going…even if it’s something as small as walking around the block for 10 minutes or doing house cleaning. A meta-analysis of 70 studies reported that exercise reduces fatigue by 32% during treatment and by 38% after cancer treatment [8]. Resistance, aerobic, flexibility and mixed training programs have all demonstrated improvements in fatigue levels.
  • Weight loss/weight gain: There are many mechanisms that can cause a patient to lose weight. One is associated with the side effects of chemotherapy such as nausea, vomiting, diarrhea, and anorexia. Another mechanism is the presence of an altered metabolism and increased inflammatory cytokines that speed up muscle degradation and can lead to a more serious condition called cancer cachexia (7). On the other hand, weight gain and/or increased fat-to-lean mass ratio can be caused by certain cancer therapies, especially hormonal therapies (7). Exercise can mediate inflammation and help maintain lean mass to help keep weight in check.
  • Depression/Anxiety/Insomnia: Some of us are familiar with the endorphins and serotonin increase that exercise brings on, but exercise is also associated with increased levels of endocannabinoids which have an anti-anxiety effect and promote a sense of well-being [9]. Physical activity also helps patients develop an increased sense of control in his/her own life. Exercise also reduces many negative emotions such as anger, contempt, disgust, guilt, fear and nervousness. The anti-anxiety and antidepressant effects of exercise has been demonstrated in patients undergoing treatment [10, 11] as well as cancer survivors [12]. Insomnia is often induced by increased depression and anxiety, so by treating the root of the problem (depression and anxiety), insomnia can be reduced.
  • Bone health: Bone density can be by hormonal therapies or by metastases to the bone. In those without mets, impact and weight exercise training are preferred to maximize bone health (7). Impact exercises include activities such as running and jumping. Weight and resistance training refer to activities that require the shortening (contraction) and elongation of muscles. By loading the bones through impact and weight bearing activity, you help to prevent further bone loss. If mets are present in the bones, you will want to be extra careful when choosing appropriate activities. As with other exercises, if a patient is experiencing bone metastases or a loss of bone mineral density, it will be essential to seek out advice from an experienced fitness professional.

How family and friends can help show their support (fitness and nutrition wise).

Encouragement! Exercise can be daunting for some. It is important to recognize the benefits of exercise and help your loved one find a good regimen that fits their needs. You may also consider exercising with them. That way you hold each other accountable and both get the amazing benefits of exercise.

Where our readers can go for more information.

Look for an ACSM Cancer Exercise Trainer in your area.

ACSM.org, WCRF/AICR


References:

  1. Segal, R., Zwaal, C., Green, E., Tomasone, J. R., Loblaw, A., Petrella, T., & Exercise for People with Cancer Guideline Development Group (2017). Exercise for people with cancer: a systematic review. Current oncology (Toronto, Ont.)24(4), e290–e315. doi:10.3747/co.24.3619
  2. Tips for Managing Neuropathy. (n.d.). Retrieved from https://www.dana-farber.org/health-library/articles/tips-for-managing-neuropathy/
  3. Lymphedema (PDQ): Health professional version. National Cancer Institute. https://www.cancer.gov/about-cancer/treatment/side-effects/lymphedema/lymphedema-hp-pdq#section/all. Accessed Sept. 24, 2017.
  4. Lymphedema. (2017, December 21). Retrieved from https://www.mayoclinic.org/diseases-conditions/lymphedema/symptoms-causes/syc-20374682
  5. Chen, J. J., Wu, P., Middlekauff, H. R., & Nguyen, K. (2017). Aerobic exercise in anthracycline-induced cardiotoxicity: A systematic review of current evidence and future directions. American Journal of Physiology-Heart and Circulatory Physiology, 312(2). doi:10.1152/ajpheart.00646.2016
  6. Hewitt Maria, Rowland Julia H, Yancik Rosemary. Cancer survivors in the United States: age, health, and disability. The journals of gerontology. Series A, Biological sciences and medical sciences. 2003;58:82–91.
  7. Ferioli, M., Zauli, G., Martelli, A. M., Vitale, M., McCubrey, J. A., Ultimo, S., … Neri, L. M. (2018). Impact of physical exercise in cancer survivors during and after antineoplastic treatments. Oncotarget9(17), 14005–14034. doi:10.18632/oncotarget.24456
  8. Puetz TW, Herring MP. Differential effects of exercise on cancer-related fatigue during and following treatment: a meta-analysis. Am J Prev Med. 2012;43:e1–24. https://doi.org/10.1016/j.amepre.2012.04.027.
  9. De Moor MH, Beem AL, Stubbe JH, Boomsma DI, De Geus EJ. Regular exercise, anxiety, depression and personality: a population-based study. Prev Med. 2006;42:273–9.
  10. Mehnert A, Veers S, Howaldt D, Braumann KM, Koch U, Schulz KH. Effects of a physical exercise rehabilitation group program on anxiety, depression, body image, and health-related quality of life among breast cancer patients. Onkologie. 2011;34:248–53. https://doi.org/10.1159/000327813. [PubMed] [Google Scholar]
  11. Quist M, Adamsen L, Rorth M, Laursen JH, Christensen KB, Langer SW. The impact of a multidimensional exercise intervention on physical and functional capacity, anxiety, and depression in patients with advanced-stage lung cancer undergoing chemotherapy. Integr Cancer Ther. 2015;14:341–9. https://doi.org/10.1177/1534735415572887. [PubMed] [Google Scholar]
  12. Courneya KS, Friedenreich CM, Quinney HA, Fields AL, Jones LW, Fairey AS. A randomized trial of exercise and quality of life in colorectal cancer survivors. Eur J Cancer Care (Engl) 2003;12:347–57. [PubMed] [Google Scholar]
  13. Rizzo A. (2016). The Role of Exercise and Rehabilitation in the Cancer Care Plan. Journal of the advanced practitioner in oncology, 7(3), 339–342.

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Metabolism Advice for Those Over 50+

Metabolism Advice for Those Over 50+

Question:

I am a member at LA Fitness in San Antonio Texas, just signed up! Ever since I turned 50 I have been gaining weight with the same diet. I don’t drink sodas and I eat at home most of the time; lean poultry, tilapia, quinoa and sometimes rice. I try not to add too much salt to food. I have a busy life and I don’t have time to cook complicated meals or eat 8 times a day. Even though I hardly eat bread, I do like corn tortillas. Obviously, my metabolism has slowed down. 

– Rosa T.

Answer:

Sounds like the “same diet” you’ve followed isn’t working for you now. From what you describe, the lean protein and plain grains are okay if the volume is appropriate. Check your portions as you should target 3-4 oz. poultry/fish and ½-1 C quinoa/rice (or 2-3 corn tortillas) per meal. Look at all the other foods that make up your diet and compare to recommended serving sizes.

Consider filling up on fruits and vegetables which provide bulk with fewer calories. Great that you avoid soda, but make sure other beverages aren’t loaded with sugar either – particularly coffee drinks or juices/smoothies. Regarding your metabolism, remember that reductions in activity and lean body mass are usually to blame. Use your new membership by getting in both calorie-burning aerobic exercise and muscle-retaining strength workouts.

– Debbie J., MS, RD

This article should not replace any exercise program or restrictions, any dietary supplements or restrictions, or any other medical recommendations from your primary care physician. Before starting any exercise program or diet, make sure it is approved by your doctor.

Some questions have been edited for length and/or clarity.

Ask our Dietitian

Have a nutrition question? Our registered dietitian is ready to help!

Email nutrition@lafitness.com or submit your question below and it may be featured in an upcoming article!

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Member Spotlight | Let’s HIIT It! Part 2

Member Spotlight | Let’s HIIT It! Part 2

“Challenge yourself, anything’s possible.”

Ed B.

HIIT by LAF® Member

I want to share my experience with my fitness journey at LAF to hopefully motivate and inspire all those who may be struggling to meet their fitness goals. I also want to show that anything is possible if you put your mind to it!

My story is divided into two parts. The 1st part (read here) focused on my fitness training and the second part is focusing on my experience with the HIIT by LAF® program.

I’m 67 years old. I’ve had a history of knee issues and a partial knee replacement on my right knee.

When I decided to resurrect my fitness journey at LA Fitness, my main goal was to get my legs/knees back in shape. So, I decided to get a personal trainer to assist me to achieve that goal. That is when I met Lauren H. (HIIT by LAF® trainer).

It has been 15 months since I started training. I couldn’t get off the floor without some assistance or go up and down stairs very easily. It took about 9 months to get my legs/knees back in shape. Now I’m pain-free. I don’t have to get injections in my knees or take any medications.

My success comes from Lauren’s leadership and months of hard work on my behalf. My flexibility, strength, mobility, and stamina have improved dramatically. I no longer need assistance getting up off the floor and I can go up and down stairs without any problems. As I continue to get stronger, Lauren brings on new challenges.

Lauren has taught me the following:

  1. Challenge yourself.
  2. Never give up.
  3. Nothing is impossible.
  4. Work hard.
  5. Practice the power of positivity. (Still working on this!)
  6. Set a few short- and long-term goals, then crush them.
  7. Believe in yourself.
  8. Nutrition and caloric intake (still working on this too!) This continues to be a hard one for me! I need to find an easy way to prepare nutritious food without the fuss.
My Journey with HIIT by LAF®

Last October I had the opportunity to take a free HIIT by LAF® class. I was amazed at how I was able to get through it. So, I decided to join. It’s been 6 months since my HIIT journey began and I just moved up to my third HIIT level which is silver. The other amazing thing is that I continue to always finish with the most MEP’s (My Effort Points) and the most calories burned at the end of each HIIT Class. HIIT continues to be a great way to relieve stress for me as well!

In the floor portion of HIIT, if I have difficulty with an exercise there’s always an alternative exercise available. In the cardio portion, I switch off between bike and rower since I can’t have high-impact on my knees.

I recently signed up to participate in a 90-minute HIIT challenge. On the day of the challenge, I was nervous and asked myself why I did this because I am usually gassed after a 50-minute HIIT class. After numerous texts back and forth with my personal trainer Lauren, who is always focusing on the positives, I settled down. Then it was HIIT time.

Once the HIIT challenge began, the only thing that I was focused on was HIIT. I not only successfully finished the 90-minute challenge, but I won it. It would have been a huge accomplishment for me to just finish the 90-minute marathon, but winning the challenge meant anything is possible. It was like winning an Olympic Gold medal.

Special Acknowledgements

A special thank you to Michaelangelo for generating lots of energy to get all of us to finish strong. Michaelangelo, you kicked all our booties as well! You’re awesome! From not being able to get off the floor to finishing/winning the 90-minute HIIT challenge and always finishing on top of the pack after each HIIT class. Wow! This continues to be surreal to me!

I’m being told that my success in HIIT is also motivating and inspiring other HIIT members. I’m really honored to have such an Impact!

My next HIIT challenge will be to “HIIT” the gold level in 6 months. Beyond that, platinum, which will take 1 year. My ultimate goal is to be the first 70-year-old to make it to the HIIT Hall of Fame (HOF) level by 2021.

I’m blessed to have Lauren H. as my personal trainer. I couldn’t have done it without her expertise. Lauren is truly the master of her craft. Lauren motivates, inspires, and brings out the best in her clients. Lauren may be small in stature but can kick your booty! I forgot to mention that Lauren is the “Master of Pain” as well!  I continue to work with Lauren to keep my legs/knees strong and work on getting the rest of my body in shape.

Ed’s Advice for Others Out There

Finally, find out what works best for you! Challenge yourself and work hard and never give up – You can reach your fitness goals too! I’m proof of that! I’m on the wildest fitness journey of my life! The combination of a personal trainer and HIIT has worked miracles for me. I look at this as an investment in my health. HIIT wouldn’t have been possible without Lauren’s expertise and my dedication to work hard.

From the start of my journey, Lauren already knew what end results were possible. I was the skeptical one!

Thank you, Lauren! Thanks to all the personal training and HIIT coaches at the LA Fitness Tinley Park location! I’m also friends with a few of them. I also made friends with many of the HIIT members too!

I wish you all the best on achieving whatever goals you set!

Remember, you’re never too old to “HIIT” it!


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Advice from an RDN on How to Gain Healthy Weight

Advice from an RDN on How to Gain Healthy Weight

Question:

My name is Patrick. I am a new member to the gym since in January. Since joining, I go 4 times a week (Monday – Thursday) and want to optimize my results. I work out for about an hour and fifteen minutes each time, mostly focusing on the upper body and abdomen. I drink a protein shake every day and try to also eat an avocado. I have trouble it seems gaining weight even though I’m consuming 2,500+ calories a day usually. I also drink a Gatorade every time I go to the gym and try to eat a lot of nuts with my turkey at every meal. I don’t have a lot of time to prep food so like buying pre-packaged cold turkey. I can eat straight out of the package or pre-packed snack mixes of dried fruit and nuts. I have gained about 10 pounds in the last 5 months, but results are slow to come. I do the same workout every time hitting nearly every muscle group in my body sometime during my workout. What are the best workouts/machines to use for upper bodybuilding and what should I be eating?

– Patrick

Answer:

Ten pounds gained is a testament to your efforts thus far! Based on the loose description of your intake it sounds like you’re getting dense foods like nuts, dried fruit, and avocado in. You say you drink 500 calories worth and I’ll assume that is from the two beverages you’ve mentioned – a protein shake and Gatorade. Not bad. Hopefully, you are drinking other fluids! Make sure they also have calories like milk (alternatives) and juice.

For solid foods – even quick/packaged items – maximize every bite by making sure it’s topped, soaked or loaded with condiments. For instance, make instant oatmeal with milk instead of water and use extra mayo packets on a turkey sandwich or wrap. High-calorie ready to eat food includes cheese cubes, full-fat sweetened yogurt, potato salad, bars suitable for hiking, and shelf-stable meal pouches (though they may taste better heated).

Not fixing your own food is a disadvantage to healthier eating, as most other energy-rich items are loaded with sugar, salt and fat or contain few fruits and vegetables: canned chili, fried chips, fruit strips/leather, jerky, burritos, egg rolls, etc. Try to take time the night before to pack a small cooler of a few healthier staples. For example, hard-cooked eggs or a single-serve peanut butter tub with a bagel, raw apples or celery sticks as snacks.

– Debbie J., MS, RD

This article should not replace any exercise program or restrictions, any dietary supplements or restrictions, or any other medical recommendations from your primary care physician. Before starting any exercise program or diet, make sure it is approved by your doctor.

Some questions have been edited for length and/or clarity.

Ask our Dietitian

Have a nutrition question? Our registered dietitian is ready to help!

Email nutrition@lafitness.com or submit your question below and it may be featured in an upcoming article!

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LAF Group Leagues is What Your Life Has Been Missing

LAF Group Leagues is What Your Life Has Been Missing

They say there’s nothing wrong with a little healthy competition, and we couldn’t agree more! Whether you have a competitive spirit or you’re looking to meet some new people, LA Fitness Group Leagues is for you!

It doesn’t matter whether you’re a beginner or a more advanced athlete, we have a division that will fit you. From basketball to racquetball and volleyball, our gleaming courts beckon you to bring your A-game.

How to Join

The easiest way to sign up for a Group League is at the front desk of your local club. You can also sign up for a league online by clicking here!

Leagues Offered

Cost to Play

Basketball: 8-10-week league – $89 per member

Racquetball: 12-week league – $40 per member

Volleyball: 8-10-week league – $30 per member


 

Testimonials

“I have been playing in LA Fitness Group Leagues since moving to California in 2008.  From that time, I’ve had the privilege of participating in basketball, volleyball, and even a racquetball league. I have always found LA Fitness Group Leagues to be a great place to compete and socialize with like-minded people. To this day, some of my best friends were met through the leagues at LA Fitness. If you’re on the fence, talk about it with one of the knowledgeable Sports Directors who can get you plugged in. It will add so much to your daily life.”

Lane C.

Basketball, Volleyball, and Racquetball, LAF Group Leagues

“I have been playing for LA Fitness Leagues since I moved to California over seven years ago – mostly basketball, but volleyball as well. I first joined at the urging of my wife, since we moved to a new state where I knew no one, and it turned out to be a great idea as many of the friends I still have today were made through those leagues. I also found it a great way to motivate myself to get to the gym since I have a team relying on me.” 

Jason R.

Basketball and Volleyball, LAF Group Leagues

“Ever since I joined the basketball league at LA Fitness, I have looked forward to Tuesday nights when our league is in season. I really enjoy the strong competition and healthy camaraderie among all the players. I’ve been playing for 4 years now and have no plans on stopping anytime soon.”

Keith G.

Basketball , LAF Group Leagues

For more information please visit https://www.lafitness.com/Pages/Leagues.aspx or reach out to your local LA Fitness front desk staff.

*While the opinions herein are Lane C., Jason R., and Keith G.’s own, Lane C., Jason R., and Keith G. are employees of LA Fitness and receive complimentary memberships in connection with their employment.


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