Physical Activity After Cancer

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Physical Activity After Cancer

• Scott J. Capozza, MS, PT
• CT Challenge Survivorship Clinic
• Yale New Haven Hospital

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Life after cancer is all about living

• Lance Armstrong
• 7 time Tour de France Champion
• And
• 12 year cancer
• survivor

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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?

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Why exercise after Ive 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
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Why exercise after Ive 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
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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
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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
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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 gt90 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?

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Getting Started

• Get medical clearance from your oncologist
• Type of activities you like
• Frequency
• Accessibility
• Setting realistic goals

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The journey of 1,000 miles begins with a single
step
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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

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Good for the Heart

• Exercising at 60-70 of your maximum heart rate
  (maxHR) is considered aerobic and enough to
  cause positive changes in ones 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

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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

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Some ideas

• Walking/Running
• Cycling (indoors or outdoors)
• Cross country skiing/snowshoeing
• Swimming
• Aerobics class
• Yoga/Pilates
• Good for overall flexibility and stability

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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

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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

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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
• Dont get caught up in day-to-day fluctuations
  its the long range, big picture that youre
  focused on!

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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)

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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

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Exercises to promote lymph drainage

• Diaphragmatic breathing
• Pelvic tilts
• Partial sit-ups with breathing
• Neck movements
• Yes/No
• Side to side
• Rotations

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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)

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Exercises to promote lymph drainage (continued)

• Elbow isometrics
• Flexion and extension
• Pronation and supination

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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

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Staying healthyfor the long haul!
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Questions??
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