Exercise Recommended for Cancer Patients

New Guidelines Call for Physical Activity Before, During, and After Treatment

By Charlene Laino
WebMD Health News

Reviewed by Laura J. Martin, MD

June 9, 2010 (Chicago) -- Though cancer patients have long been told to take it easy, they can -- and should -- be as physically active as possible before and during treatment, according to new guidelines from the American College of Sports Medicine (ACSM).

"We have to get past the idea that exercise is harmful for cancer patients," says Kathryn Schmitz, PhD, MPH, lead author of the guidelines and associate professor of epidemiology and biostatistics at Abramson Cancer Center of the University of Pennsylvania School of Medicine.

Physical activity brings many benefits, including improved aerobic fitness and strength, decreased fatigue, better quality of life, and improved body image, Schmitz tells WebMD.

No one is saying you should go out and run a marathon during chemotherapy. "You know your own body, do what's comfortable," she says.

Many cancer patients who stop being physically active during treatment and early recovery never start up again, says Jennifer Ligibel, MD, of Dana-Farber Cancer Institute in Boston.

"If we can prevent cancer patients from decreasing physical activity in the first place, we can stop them from going down that slippery slope," she tells WebMD.

Ligibel led a discussion on the guidelines here at the annual meeting of the American Society of Clinical Oncology.

Moderate Activity Is Recommended

The 13-person ACSM panel came up with the exercise recommendations after reviewing published studies looking at the safety and effectiveness of physical activity during and after cancer therapy. The panel focused on breast, prostate, hematologic, colon, and gynecologic cancers.

In general, the same 30 minutes a day, five days a week, of moderate-paced activity such as walking recommended for the general population is beneficial for cancer patients, even during treatment, according to the guidelines.

But it's not a one-size-fits-all prescription, and regimens should be tailored to individuals, taking into account their overall fitness, diagnoses, and other factors that could affect safety, the panel recommends.

For example, people with stomach or other gastrointestinal cancer as well those whose cancers have to spread to the bone may be advised to avoid heavy weight training.

People with compromised immune systems may want to avoid exercising in public gyms.

If you have loss of sensation, or feelings of pins and needles, in your hands and feet -- a condition called peripheral neuropathy that's a common side effect of many cancer treatments -- a stationary bike may be preferable to weight-bearing exercise, the panel says.

Yoga generally appears safe, Schmitz says. As for Pilates, there was no published evidence for the panel to review, so a recommendation could not be made.

Women with breast cancer can do upper body training, "but it should be done very slowly, which is not how many people approach it," Ligibel says.

In general, cancer patients do not need any formal testing, such as stress testing, prior to starting a moderate-intensity exercise program, she says. But patients should check with their doctors.

People with heart conditions, whether related to their cancer or not, as well as those who are morbidly obese, may require additional supervision and exercise modifications, the guidelines state.

"The important thing," Schmitz says, "is to avoid inactivity."


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American College of Sports Medicine's 57th Annual Meeting, Baltimore, June 1-5, 2010.
American Society of Clinical Oncology Annual Meeting 2010, Chicago, June 4-8, 2010.
Schmitz, K. Medicine & Science in Sports & Exercise, July 2010.
Kathryn Schmitz, PhD, MPH, associate professor of epidemiology and biostatistics, Abramson Cancer Center, University of Pennsylvania School of Medicine.
Jennifer A. Ligibel, MD, Dana-Farber Cancer Institute, Boston.
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