The Canadian Cancer Society has identified April as cancer month, and the 27th of the month is dedicated to "daffodil day" where we are all to take a moment to reflect on the thousands of people who have been affected by cancer. An estimated 40% of women and 45% of men will be diagnosed with cancer in their lifetimes. The good news is that survival rates are climbing – and we should be doing everything we can to, at best, reduce the risk of diagnosis or, at least, reduce recurrence and death. Physical activity is one such strategy to help more people live longer, healthier lives post cancer.
Physical activity improves physical, emotional, and social well-being among individuals who have had a cancer diagnosis (see our summary of the benefits of physical activity in the American Journal of Lifestyle Medicine). Furthermore, physical activity has been found to be a significant factor protecting individuals from many types of cancer, such as breast, colorectal, and prostate, and from reducing risk of recurrence if cancer has been detected. In spite of these health-related benefits, few cancer patients and survivors are involved in regular physical activity.
The American College of Sports Medicine (ACSM) published the first physical activity guidelines for cancer survivors (who are defined in the report as any individual diagnosed with cancer). These guidelines suggest three main types of physical activity: (i) aerobic activity, (ii) musculoskeletal or strength training, and (iii) flexibility training. Aerobic activity (i.e., activity that uses large muscle groups, can be maintained continuously for a long period of time) is recommended at moderate intensity (i.e. heart rate and sweating increases; individuals can have a conversation) for a total of 150 minutes per week or strenuous intensity (i.e. fast and hard breathing, heart rate increases considerably, cannot maintain a lengthy conversation) for 75 minutes per week; or some combination of moderate and strenuous activities. Musculoskeletal or strength training (i.e., activities that use resistance (i.e., free weights, one's own body weight, bands) to increase one's ability to exert or resist force) is recommended two or three times a week, with exercises focused on the major muscle groups in the lower and upper body. Flexibility training (i.e., activities that lengthen muscles to increase range of motion around the joints) is recommended for all major muscle groups when aerobic and strength training activities are performed. Generally, these guidelines are similar to recommendations for all adults however it is important to highlight that following these physical activity guidelines is safe, feasible, and effective for cancer survivors. To read the ACSM guidelines on physical activity for cancer survivors, click here.
There are a few limitations associated with physical activity guidelines. First, the guidelines are directives set by others, meaning that the goal is not personal or individualized. Second, 150 minutes per week is difficult to achieve for people who have not been active in their lives, or who have just faced a traumatic event (e.g., cancer diagnosis) and related treatments that significantly ‘confuse' the usual or normal routine. The guidelines do recommend accumulating physical activity in small bouts of 10 minutes several times throughout the day, so this helps with the daunting task of reaching 30 minutes per day on most days of the week. However, on days when this amount of physical activity is (or seems) impossible, failing to reach the recommendation may foster feelings of personal failure, lack of self-confidence, and low perceptions of competence to be active in the future. A few days or weeks of these feelings and perceptions will undoubtedly foil attempts to be regularly physically active. Finally, the guidelines focus very little on lighter intensity activity that is likely to be more enjoyable and sustainable, is associated with mental health benefits (and probably physical health as well), helps to foster a sense of accomplishment, builds self-confidence, and supports long-lasting strategies of improved quality of life and well-being. Based on our studies and the accumulating evidence, it is clear that most cancer patients and survivors prefer lifestyle/light physical activity to more structured routines – walking is the most preferable and enjoyable activity reported. This is particularly true for women and middle to older aged adults who tend to dislike more strenuous exercise.
There are a couple of factors to keep in mind when thinking about physical activity either for yourself as a cancer survivor, or in helping to support a friend or family member. Physical activity plays a very different role for those individuals who have not been diagnosed with cancer (role of prevention), for those individuals going through the immediate diagnosis and treatment phases (role of maintaining functional health including but not limited to increasing energy, improving sleep, and coping with stress), for those finished the systemic treatments like chemotherapy and radiotherapy yet possibly on intermittent therapy (role of enhancing quality of life, including fostering growth, social support, and health benefits), for those individuals who have been cancer-free for five or more years (physical activity helps prevent secondary cancers and co-morbidities such as heart disease or osteoporosis), and for individuals at the end-of-life stage where palliation is a primary concern (physical activity may act as a coping strategy).
The barriers to physical activity may be very different for individuals at various points following a cancer diagnosis and as a result of the type of cancer(s). While most individuals (whether a cancer survivor or not) identify lack of time, motivation, and money as some critical (yet conquerable!) barriers, some of the additional barriers during active cancer treatment include but are not limited to fatigue, pain, nausea, dehydration, dry mouth, skin rashes, and hot flashes, along with body composition changes and body image concerns. Here are some strategies to help off-set these factors to help increase physical activity:
Timing: Believe it or not, physical activity actually helps ward off fatigue and provides energy and motivation. Most people feel the opposite is true (e.g., "I am too tired to exercise", or "I only have so much energy, I can't waste it on exercise"). The benefits of physical activity are only achieved through proper timing. It is important to engage in physical activity at times when fatigue, nausea, and pain levels are at their lowest. It is recommended that individuals try to exercise before their scheduled treatments; and to be aware that fatigue and nausea (and pain) are likely fluctuating elements of treatment – so alter exercise intensity and timing whereby more moderate or strenuous activity is done on ‘better' days and low-intensity is reserved for those ‘worse' days.
Planning: Dehydration, dry mouth, and hot flashes require careful planning. Be sure to drink lots of fluids (and to have extra with you at all times), and to exercise in a cool environment. If a wig or hat is worn during physical activity, be extra careful of over-heating and try to pick materials that breathe. Even dampen the hat or scarf with cold water before exercising.
Mindset: Set small goals, and modify these goals accordingly. Be ready to change the exercise type (e.g., swimming needs to be avoided if there is evidence of a skin rash, or immediately following surgery) or duration or intensity daily, and practice positive affirmations and self-talk to keep motivation up. Just remember any little bit of physical activity is important and beneficial.
With these ideas in mind, it is hopeful that more individuals going through and following treatment for cancer will engage in some physical activity. Experts do recommend any increase in physical activity is beneficial, and we suggest this increase in activity can be achieved with a range of activity choices from small, purposeful lifestyle changes to more structured exercise sessions (many of which we have covered on various segments of Lifetime).
