Physical Activity After Cancer Scott J. Capozza, MS, PT CT Challenge Survivorship Clinic Yale New Haven Hospital
“Life after cancer is all about living” Lance Armstrong 7 time Tour de France Champion And 12 year cancer survivor
After finishing your cancer treatments, you may feel… • Tired • Sore or have post-surgical pain • Increased sensitivity to an area that received radiation therapy • Bloated from chemotherapy treatments • Depressed, confused, and/or angry • But do you feel like exercising?
Why exercise after I’ve already had cancer? • Physical activity decreases your risk of recurrence and increases survival. • Women who reported 4 hr/week of brisk walking had a 40% lower risk of recurrence and breast cancer death. Holmes JAMA 2005
Why exercise after I’ve already had cancer? • Women who are overweight at breast cancer diagnosis are at a 2-fold greater risk for recurrence and death compared with lighter women. • Women who gain weight (~5 lbs) are at 60% increased risk of death compared with women who do not gain weight. • Obesity and weight gain lead to an increased production of certain hormones and growth factors that increases cell proliferation. Goodwin JCO 2002
Research has shown that… • Exercising several times a week helps decrease body fat, and hormones associated with cancer prognosis. • By decreasing these factors, a woman post-breast cancer can decrease her risk of a recurrence by as much as 91%. Irwin JCO 2005
Research has shown that… • Cancer and its treatments often produce significant morbidities that undermine quality of life. • Exercise enhances quality of life both during and after cancer treatments. • Exercise decreases fatigue • Exercise decreases nausea • Exercise decreases depression and anxiety Courneya, ESSR, 2004
Physical Activity and other cancers • Prostate – decreases testosterone levels and insulin levels, but no definite proof yet • Endometrial – decreases estrogen and insulin levels • one study found women who exercise >90 min/day decreased their risk of endometrial cancer by 46% • Lung – increases ventilation, decreases amount of carcinogens in airways • Colon – decreases transit time (contact time between bowel wall and carcinogens), decreases body fat (area where carcinogens can be stored) • Other cancers?
Getting Started • **Get medical clearance from your oncologist** • Type of activities you like • Frequency • Accessibility • Setting realistic goals
Choosing the Right Physical Activity for You • Something you will enjoy • Something that will cause you to break a (mild) sweat • Something (ideally) you can do with another person • Something that will not injure you or exacerbate an old injury
Good for the Heart… • Exercising at 60-70% of your maximum heart rate (maxHR) is considered ‘aerobic’ and enough to cause positive changes in one’s cardiovascular system • Standard way to get maxHR is 220-your age • Can take your own pulse or use a heart rate monitor to gauge your intensity
Good For the Heart… • The Borg Scale: • Level 1: I'm watching TV and eating bon bons • Level 2: I'm comfortable and could maintain this pace all day long • Level 3: I'm still comfortable, but am breathing a bit harder • Level 4: I'm sweating a little, but feel good and can carry on a conversation effortlessly • Level 5: I'm just above comfortable, am sweating more and can still talk easily • Level 6: I can still talk, but am slightly breathless • Level 7: I can still talk, but I don't really want to. I'm sweating like a pig • Level 8: I can grunt in response to your questions and can only keep this pace for a short time period • Level 9: I am probably going to die • Level 10: I am dead
Some ideas… • Walking/Running • Cycling (indoors or outdoors) • Cross country skiing/snowshoeing • Swimming • Aerobics class • Yoga/Pilates • Good for overall flexibility and stability
How much, how often? • Beginning with what feels comfortable to you – especially if you have cancer-related fatigue • Ideally, begin with 20-30 minutes a session 3 times a week • Increase the number of sessions first, then increase length of each session, then intensity of each session • Long term goal (2-3 months down the road) of at least 30 minutes a session 5 times a week
Making it all fit • Finding a time that you can set aside for exercise • Morning vs. evening, when the kids are at school, etc. • Writing down your plan/goals and keeping it in view • Recording in a journal what you did, how long, and how you felt • Exercising at home or at a facility
“Be true to thyself…” • Set realistic goals • “I want to lose 10 pounds in 4 weeks” is NOT realistic or healthy • Setting physical activity goals such as “I want to be able to walk for an hour straight without stopping” benefits your whole body (mind included) and the other goals (such as weight loss) will take care of themselves • Break your goal into smaller goals and reward yourself when you achieve one • i.e., “I want to be able to walk 30 minutes without stopping by two weeks time, and 40 minutes in a month” • Don’t get caught up in day-to-day fluctuations – it’s the long range, big picture that you’re focused on!
Problem solving • Lymphedema in your legs • Try aquatic exercises/swimming • Lymphedema in your arms • Wear a compression garment and swing your arms when walking • Arthritis in your legs • Try indoor cycling or swimming • Scarring/tightness under your arm or along your chest wall • Wear loose fitting clothes made from Techwick or silk (but keep the compression stocking on your arm if you need it)
What about weight lifting? • Can be done once medically cleared • If lymph nodes were removed, should wear a compression sleeve just in case • Begin with LIGHT resistance (one pound, or 16 oz. can of soup) for 8-12 repetitions • Can perform 2-3 times a week in addition to cardiovascular/aerobic physical activity • “No Pain, No Gain” does NOT apply here! Work within your comfort level
Exercises to promote lymph drainage • Diaphragmatic breathing • Pelvic tilts • Partial sit-ups with breathing • Neck movements • Yes/No • Side to side • Rotations
Exercises to promote lymph drainage (continued) • Shoulder series • Shrugs, retraction, circles • Shoulder blade squeezes/external rotation in door wedge (“W”) • Shoulder rotation with outstretched arms • Pushing hands together (pectoral isometrics) • Shoulder blades/arms reaching out forward (bilateral boxing)
Exercises to promote lymph drainage (continued) • Elbow isometrics: • Flexion and extension • Pronation and supination
The Big Picture • Over 10 ½ million cancer survivors in the U.S. today (that includes all of us!) • Long term survival rates are about 65% over 5 years (but we CAN influence that with incorporating physical activity into our lives) • Physical activity is something YOU have control over, and can get you back on the road to recovery and keep you healthy