EXERCISE & CANCER

26 (85%) reported statistically significant results despite the small sample sizes. The physical and functional benefits that have been demonstrated include improvements in functional capacity, muscular strength, flexibility, body composition, haemato- logical indices, natural killer cell activity, nausea, fatigue, pain, and diarrhoea.

The psychological and emotional benefits that have been demonstrated include pos- itive changes in personality functioning, mood states including anxiety and depres- sion, perceived physical competence, self- esteem, general QOL, and satisfaction with life.

Although these studies are not without limitations (2), and many important ques- tions remain to be answered (2), it seems clear that exercise is a safe, feasible, and beneficial QOL intervention for most can- cer patients and survivors.

Complication Haemoglobin level <8.0 g/dl

Absolute neutrophil count ≤ 0.5 x 10 * 9/l

Considerations for exercise testing and prescription Cancer and its treatments may affect all aspects of physical functioning in cancer patients including cardiorespiratory endurance, muscular strength and endurance, flexibility, anthropometry and body composition, and gait and balance. Consequently, a comprehensive fitness test and exercise programme is warranted. Not surprisingly, exercise testing and pre- scription for cancer patients and survivors requires special precautions and consider- ations in addition to those recommended for healthy, asymptomatic middle-aged and older adults (Table 2).

These precautions arise from the signifi- cant morbidity experienced by cancer patients during and following individual or combined modality therapies. These precautions are not meant to imply that cancer patients with such conditions

Precaution Avoid exercises that require significant oxygen transport (ie. high intensity)

Avoid exercises that may increase risk of bacterial infection (eg. swimming). Ensure proper sterilization of testing equipment and avoid maximal tests

Platelet count < 50 x 10 * 9/l Avoid exercises that increase risk of bleeding (eg. contact sports or high impact exercises) Fever > 38 C

May indicate systemic infection and should be investigated. Avoid exercise altogether

Ataxia/dizziness/peripheral sensory neuropathy

Avoid exercises that require significant balance and coordination (eg. treadmill)

Severe cachexia (loss of >35% Loss of muscle mass usually limits exercise to mild intensity depending on degree of cachexia. of premorbid weight)

Avoid exercise testing altogether Dyspnoea (breathlessness) Bone pain Severe nausea Extreme fatigue/weakness Dehydration Surgical wound/tenderness Poor functional status Investigate aetiology. Exercise to tolerance. Avoid maximal tests Avoid exercises that increase risk of fracture (eg. contact sports, high impact exercises, 1 RM) Investigate aetiology. Exercise to tolerance. Avoid maximal tests

Exercise to tolerance. Begin tests at lower power output, use smaller incremental increases, and avoid maximal tests

Ensure adequate hydration. Avoid exercise altogether Select an exercise that avoids pressure/trauma to the surgical site Avoid exercise testing altogether if Karnofsky Performance Status (KPS) score ≤ 60%

Table 2: Special precautions for exercise testing and prescription in cancer patients and survivors. Adapted from: Courneya K, Mackey JR, and Jones LW. Coping with cancer: Can exercise help? The Physician and Sportsmedicine. 2000;28 (5),49-51, 55-56, 66-68, 71-73

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could not benefit from an appropriately designed and supervised exercise pro- gramme, but only that the risk/benefit ratio may be higher and close medical supervision may be required.

With regard to selecting an activity mode, it is important to take into account any acute or chronic physical impairments that may have resulted from surgery or adjuvant therapy (3). For example, cancer patients that have recently undergone rectal or prostate surgery may prefer a treadmill test and walking programme as opposed to a cycle ergometer test and cycling programme. Similarly, cancer patients presenting with specific limita- tions in range of movement in the upper extremities following surgery or radiation therapy (eg. breast, head and neck) will be unlikely to be able to perform exercis- es involving upper body movements (eg.arm ergometer tests, bench press).