The medical literature has documented causal relationships between the benefits of exercise in cancer prevention and treatment and quality of life issues. Although specific dosages for exercise programs have yet to be established, some guidelines based on research in nonclinical populations offer clues. For example, detrimental effects on the immune systems in athletes suggest that cancer patients would benefit from exercise at moderate levels rather than intense.
For nonclinical populations, the National Institute of Health (NIH) recommends a program of moderate exercise that includes activities such as walking, climbing stairs, gardening and playing with children. These activities should be performed six to seven days a week and can occur in three ten-minute sessions. The same moderate prescription is recommended for cancer patients.
The American College of Sports Medicine (ACSM) recommends that patients with cancer and other chronic illness undergo treatment exercise programs that help them maintain cardiovascular endurance, muscular strength and level of functioning. Scientific research shows that walking or bicycling thirty to forty-five minutes per session, three to five days a week produces the following benefits: decreased nausea, decreased fatigue, increased physical endurance and increased quality of life. The benefits are believed to come from effects on hormone levels, belly fat and intestinal function. The hormone effects produced by exercise are believed to positively impact mood as well.
Both aerobic and resistive exercises improve muscle strength and the functioning of the cardiovascular system (heart and lung circulation). Aerobic exercise has the added benefit of increasing the red blood cell count, positively affecting the fatigue suffered by patients undergoing cancer treatment. The main goals of an exercise program while a patient is undergoing cancer therapy are to minimize the loss of muscle tone and flexibility and maintain overall body condition. The better condition your body is in, the better you will tolerate the side effects of chemotherapy, radiation and other invasive treatments. It will also be easier to do the required activities of daily living (ADLs).
Begin each exercise session with a warm-up. Warm-ups start you moving slowly and gradually increase the blood flow to the muscles to prepare them for further work. Begin with checking your resting heart rate. If your rate is above 100 beats per minute, do not exercise before checking with your doctor. The warm-up should be sustained for two to three minutes and should elevate the heart rate ten to twenty beats above resting. This should correspond with an RPE score of eight to nine (see chart below). Try the following movements for your warm-up:
- Shoulder shrugs
- Alternate shoulder rolls
- Wrist rolls
- Alternate opening and closing of the hands
- Arm lifts to the side, front and back
- Elbow bends or bicep curls
- Alternate arm lifts to ceiling
- Double arm reaches to ceiling followed by pull downs
- Toe taps
- Heel touches
- Small knee lifts
- Stepping from side to side
Borg Rating of Perceived Exertion (RPE)
One method of determining the intensity physical activity is by applying the Borg Rating of Perceived Exertion. Perceived exertion is how hard you feel your body is working. It is based on the physical sensations a person experiences during physical activity, including increased heart rate, increased respiration, increased sweating, and muscle fatigue. Although the RPE is a subjective measure, a person's exertion rating may provide a fairly good estimate of the actual heart rate during physical activity.
Practitioners generally agree that perceived exertion ratings between twelve to fourteen on the Borg Scale suggests that physical activity is being performed at a moderate level of intensity. During activity, use the Borg Scale to assign numbers to how you feel (see instructions below). Monitoring how hard your body is working can help you adjust the intensity of the activity by speeding up or slowing down your movements.
Pay attention to the cues your body gives you, including your breathing rate, how fast your heart is beating, and the fatigue in your working muscles. Take all cues into consideration and assign a number as to how hard the work feels. For example, a six is how you might feel sitting comfortably in a chair and resting. Above eighteen would be working so hard physically that you couldn't continue for more than several seconds.
Borg Rating of Perceived Exertion (RPE) Table
| RPE = 6 | Very, very light | | RPE = 8 | Very light | | RPE = 11 | Light | | RPE = 13 | Somewhat hard | | RPE = 15 | Hard | | RPE = 17-18 | Very hard |
Follow the warm-up with three to five minutes of stretching, then begin your aerobic exercise of choice. The duration and intensity of the conditioning portion of the exercise session is based upon your functional status as a patient.
Karnofsky Performance Scale
The Karnofsky Performance scale is used to determine a patient’s level of exercise.
| 100% | No evidence of disease that interferes with your functioning |
| 90% | Normal activity with minor signs of disease |
| 80% | Normal activity with effort, signs of disease |
| 70% | Cannot do normal activity, but cares for self |
| 60% | Requires occasional assistance |
| 50% | Requires considerable assistance and frequent medical care |
| 40% | Disabled, requires special care |
| 30% | Severely disabled; hospitalization may be indicated |
| 20% | Very sick; hospitalization necessary for supportive treatment |
| 10% | Moribund |
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Editor’s Note: This article has been adapted for GilbertGuide.com by Harvey Gilbert, MD, with permission from Cancer Supportive Care. The authors are Kathleen Dzubur, MS; Francine Manuel, RPT; Gary Abrams, MD; Lee Erman, NCTMB and Ernest H. Rosenbaum, MD.