Ambulatory older adult cancer survivors have unique concerns that must be considered and addressed when developing a restorative exercise program. Foremost, one needs to assess current co-morbidities that may impact physical activity. Other key factors include the type of cancer, stage of disease, type of treatment(s), and side effects a survivor may be coping with. Side effects may be acute, long-term, or late effects of treatment.
Acute Side Effects
During treatment, patients are often immune compromised and experience problems with nausea, vomiting, fatigue, peripheral neuropathy, hair loss, pain, anxiety, depression, and changes in self-esteem and body image. All these acute effects negatively impact quality of life.
Long-term effects of cancer treatment are side effects that begin during treatment, and linger after treatment ends. Some examples include:
- Peripheral neuropathy
- Pre-mature menopause
- Changes in body composition
These effects often necessitate adapting exercises to the survivor’s ability to minimize risk for injury or lymphedema flare and still give the survivor optimal benefits from exercise. For example, lymphedema does not preclude exercise, but precautions must be observed. Exercise is actually recommended to reduce the risk of lymphedema and flares.
Late effects of cancer treatment develop years after treatment. Osteoporosis and cardiovascular disease are two common examples of late effects.
Many of the chemotherapy and hormonal therapies used to cure or control cancers cause bone wasting that leads to osteopenia and osteoporosis.
Cancer survivors are 70% more likely to develop a cardiovascular disease than someone without cancer. The most common conditions are atherosclerosis, hypertension, thrombus, arrhythmia, heart valve degeneration, and heart failure. Radiation poses the greatest risk for cardiac problems but many chemotherapy agents confer risk (e.g. doxorubicin, epirubicin, and trastuzumab). And, just as in cardiovascular disease in people without cancer, exercise is beneficial.
Exercise Programs for Cancer Survivors
The cancer restorative program should be customized for each patient. At each stage of treatment and recovery, the patient will respond to restorative exercise differently.
- When a survivor begins chemotherapy, they learn to manage and cope with side effects of treatment.
- After treatment ends, survivors cope with the lingering effects of treatment and learn to adapt to their ever-changing body. They become focused on how to feel better and get stronger.
- Long-term survivors may be coping with cardiac and respiratory limitations that require special restorative exercise to help them regain their fullest/maximal functional ability.
The sooner a survivor begins exercise after diagnosis the greater the benefit: improved tolerance for treatment, and emotional and physical benefits.1,2 Survivors who exercise during treatment maintain and often improve their muscle strength and functional ability. Their quality of life improves and they regain the ability to pursue meaningful activity.
- Schwartz, A.L., Thompson, J.T., Masood, N. (2002). Interferon Induced fatigue In Melanoma: A pilot study of exercise and methylphenidate. Oncology Nursing Forum 29,7 web feature.
- Schmitz, K.H., Courneya, K.S., Matthews, C, Demark-Wahnefried, W., Galvão, D.A.Pinto, B.M., Irwin, M.L., Wolin, K.Y., Segal, R.J., Lucia, A., Schneider, C.M., von Gruenigen, V.E., Schwartz, A.L. (2010). American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc. Jul;42(7):1409-26.