Welcomed Workout

CURESpring 2010
Volume 9
Issue 1

Finding an exercise routine you enjoy makes sticking to it easier.

Beau Stubblefield-Tave took up walking two years ago to lose weight and manage symptoms of his diabetes. He didn’t know at the time he would be diagnosed with prostate cancer months later, at age 51. His treatment called for prostate removal—yet he was not going to let something like cancer keep him in bed.

“I was walking the halls of the hospital literally the day I had the surgery,” he says. And so he has walked ever since. With his sweats and sneakers, and occasionally the family’s yellow lab, Stubblefield-Tave walks through his Newton, Massachusetts, neighborhood for two to three miles, as many days as his schedule allows. “If I go from five days a week to two or three days, I feel the difference,” he says. “I don’t have as much energy. I’m not as relaxed.”

Despite the known benefits of physical activity, too few cancer survivors actually stick with an exercise routine—only about 16 to 20 percent, according to the best estimates. Getting enough exercise isn’t just an issue for people who have cancer—after all, only about half of all American adults engage in the recommended amount of physical activity. The American Cancer Society recommends a minimum of 30 minutes a day, at least five days a week. But if you’ve had cancer, the need may be particularly profound, given research suggesting that physical activity can increase energy, ease the side effects of treatment, and perhaps reduce the risk of recurrence.

“If there’s any group of people who really should be active, it’s cancer survivors,” says Colleen Doyle, RD, director of nutrition and physical activity for the ACS. But even knowing they ought to be active, patients often feel a kind of mental paralysis from not knowing what to do, when to begin, or how often to do it.

Some types of exercise, such as walking, running, or swimming, target the cardiovascular system. Other types, such as weight lifting, focus on building strength, while activities like yoga and tai chi can increase flexibility and balance. But the most important consideration may not be what you do, but how you feel about doing it. “You need to find something you’re going to do that won’t be a chore,” Doyle says. Otherwise, it becomes too easy to quit, especially if exercise is a new routine.

‘‘Walking is something I can do by myself any time. There’s no cost to it. I don’t need to find a class. I find it’s like a form of meditation.’’

Because treatment can often weaken muscles and bones, cancer survivors can also benefit from strength training, despite previous advice that people with cancer should avoid weight lifting for fears it would exacerbate conditions such as lymphedema. However, research published last August in The New England Journal of Medicine confirmed the opposite is true: breast cancer survivors who lifted weights twice a week—starting slowly and working up—had less arm and hand swelling, and other symptoms (see “Pumping Iron” at www.cure?today.com/pump?ing_iron).

You don’t have to be Mr. Olympia. Even lifting a 2-pound dumbbell while watching the evening news will build muscle, so long as you lift the weight with the proper range of motion. Doyle advises resistance training that works all your major muscle groups, at least twice a week. There’s no set amount of curls and lifts, she says, but work toward a goal of eight to 12 repetitions on your upper body, and 15 to 20 on your lower body. No matter how many lifts you do, she says, “your last one should be tough. You shouldn’t be able to do another one. And if that’s only three, it’s OK.”

Other types of exercise, such as yoga, can also help flexibility and balance. Studies among breast cancer patients have found that yoga can improve quality of life and symptom management.

View Chart: Going Through The Motions

Most guidance about exercise comes from research studies of breast cancer survivors, says Melinda Irwin, PhD, of Yale School of Public Health. But there’s no reason to think that physical activity can’t benefit everyone who has, or once had cancer. The best place to start is with something that moderately increases your heart rate, she says. “For any cancer, I would recommend an aerobic exercise program of moderate intensity,” she says. It doesn’t matter whether it’s walking, jogging, water aerobics, or riding a bike. It does matter whether you like doing it.

For Stubblefield-Tave, the choice was easy. “Walking is something I can do by myself any time,” he says. “There’s no cost to it. I don’t need to find a class. I find it’s like a form of meditation.” It’s something he knows he can do easily and consistently.

The simplicity of walking—the fact that it’s just between you and a pair of shoes—is what makes it probably the natural choice for most cancer survivors, Irwin says. “All of my studies have been with walking,” she says. For example, in 2008, she and her colleagues reported in the Journal of Clinical Oncology that breast cancer survivors who walked about two to three hours per week before their diagnosis experienced better prognosis two years later. And inactive women who increased their physical activity after diagnosis also had better odds of survival two years later.

We’re talking about brisk walking, however, not a window-shopping stroll. While the intensity is defined by each person’s age and physical condition, a general rule of thumb is that while exercising, you should be sweating and breathing heavier than normal, but not breathing so heavily you can’t carry on a conversation. If you can say the Pledge of Allegiance, stopping to catch your breath a few times, you’re probably at the right pace. However, if you can sing “America the Beautiful,” speed up. How long? About 50 minutes if you can, Irwin says. Try to do it soon after you get out of bed. “If you add in a walking program in the morning, you’ll have energy for the rest of the day,” she says.

But experts caution that you should talk with your doctor before embarking on any exercise routine to make sure that you don’t have special considerations, such as a bone or muscle injury, or other limitations to aerobic or weight training exercises.

If you need more information, check with your local cancer center or gym to see if it offers exercise guidance specific for cancer survivors. For example, YMCA has teamed with the Lance Armstrong Foundation to provide programs in many cities (www.livestrong.org/ymca; 866-673-7205).

“I’m not sure there’s one type of exercise to pick,” says Jeffrey Meyerhardt, MD, of Dana-Farber Cancer Institute in Boston. Last December, he reported in the Archives of Internal Medicine that colon cancer survivors who exercised more than 27 METs per week lowered their risk of dying from cancer by about 50 percent. A MET, or metabolic equivalent task, is a measure of your body’s energy use. One MET is the energy used while sitting quietly. The people in the study who exercised the most used about 49 METs per week, which is equivalent to about 12 hours of brisk walking. More vigorous activity, like running or biking, would use the same METs in less time.

“The most important thing,” Meyerhardt says, “is that it’s something that increases your heart rate, and something you like to do.”