EXERCISE & CANCER

Moreover, patients with neurological com- plications affecting coordination or bal- ance (ie.ataxia) will require stable exercis- es (eg.cycle ergometer) rather than less stable exercises (eg.treadmills or step tests). Finally, some cancer patients will experience severe sickness and fatigue at certain times during chemotherapy and/or radiation therapy and will not tolerate maximal testing or vigorous exercise. Consequently, submaximal tests and mod- erate intensity exercises are advised with lower initial power outputs and smaller incremental increases.

Exercise prescription guide- lines after cancer diagnosis Presently there is no evidence that one type of aerobic exercise is superior to another for the general rehabilitation of cancer patients and survivors. As with all older, chronic disease populations, safety must be the primary issue (8,9). Swimming should be avoided by those patients with nephrostomy tubes, non- indwelling central venous access catheters, and urinary bladder catheters. Swimming is not contraindicated for patients with continent urinary diver- sions, uterostomies or colostomies, but patients should wait eight weeks post- surgery and avoid open-ended pouch appliances. High impact exercises or con- tact sports should be avoided in cancer

Parameter Mode

Guideline/comment

Most exercises involving large muscle groups are appropriate but walking and cycling are especially recommend- ed. The key is to modify exercise mode based on acute/chronic treatment effects from surgery, chemotherapy, and/or radiation therapy

Frequency Intensity

At least 3 to 5 times per week but daily exercise may be optimal for deconditioned cancer patients performing lighter intensity or shorter duration exercises

Moderate intensity depending on current fitness level and severity of side effects. Guidelines include 50-75% VO2max or HRreserve, 60-80% HRmax, or 11-14 RPE. HRreserve* is the best guideline if HRmax is estimated rather than measured

Duration

At least 20-30 continuous minutes but this goal may have to be achieved through multiple intermittent shorter bouts (eg. 5-10 minutes) with rest intervals for deconditioned patients or those experiencing severe side effects of treatment

Progression

Initial progression should be in frequency and duration - only when these goals are met should intensity be increased. Progression should be slower and more gradual for deconditioned patients or those experiencing severe side effects

* HRreserve = maximal heart rate (HRmax) minus standing resting heart rate (HRrest). Multiply HRreserve by .60 and .80. Add each of these values to HRrest to obtain the target heart rate range. HRmax can be estimated as 220 - age (years).

Table 3: General aerobic exercise recommendations for otherwise healthy cancer survivors and early stage cancer patients. Reprinted with permission from: “Courneya KS, Mackey JR, & 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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patients with primary or metastatic bone cancer. From a clinical perspec- tive, it is probably safest to prescribe walking or cycle ergometry for most cancer patients. Although evidence for the efficacy of weight training is only beginning to emerge, the optimal rehabilitation programme for older persons with chronic diseases, includ- ing cancer, will be likely to combine aerobic and weight training (9).

The volume of exercise (ie. frequency, intensity, and duration) prescribed for cancer patients has closely followed the American College of Sport Medicine’s guidelines (10). Most stud- ies have prescribed moderate intensity exercise performed three to five days per week for 20-30 minutes per ses- sion. This prescription generally appears appropriate for cancer patients (4-7) but may need to be modified based on current medical treatments, co-morbid conditions, and fitness level.

Many cancer patients will not feel like exercising at certain times during their chemotherapy cycles. These so-called ‘down days’ are different for each patient and may even vary from cycle to cycle. The key point is to build flex- ibility into the exercise prescription so