Nearly 100% of cancer patients report fatigue as a major symptom of their illness.
Traditionally, doctors urged their cancer patients to rest, believing that the disease and its various forms of therapy robbed individuals of energy; most experts thought that including exercise in the treatment regimen would only add undue stress and create unrealistic expectations for people who were already overburdened.
Fatigue and Physical Performance: A Vicious Cycle for the Cancer Victim
Even when cancer is not an issue, fatigue is a relatively common complaint for patients seeking medical care. 20% of family medicine patients present to their physicians with fatigue, and one third of teenagers complain of fatigue at least four days per week. (Viner R, Christie D. Fatigue and somatic symptoms. BMJ 2005;330[7498]:1012-15)
For the cancer patient, fatigue is compounded by several factors: One of the symptoms of cancer – whether due to accompanying metabolic dysfunction or to “paraneoplastic” syndromes – is pervasive fatigue; chemotherapy and radiation treatments further drain the energies of patients.
Fatigue results in impaired physical performance, which in turn leads to psychological stress or outright depression. Psychological dysfunction then worsens fatigue, and cancer patients soon find themselves in a downward spiral.
Recent Review Reveals the Benefits of Exercise for Cancer Patients
A 2008 Cochrane review of 28 studies showed that aerobic and resistance exercise (e.g., weight training) reduces fatigue and leads to an improved quality of life for cancer patients, whether they are currently in treatment or have already undergone therapy. (Cramp F, Daniel J. Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev 2008;[2]:CD006145)
The type, intensity, and frequency of exercise varied widely in the studies included in the review: Walking, weight training, stationary bicycling, flexibility training, yoga, and seated exercise were all evaluated; frequency varied from two to seven days weekly, and exercise duration ranged from ten to 75 minutes per session.
Although most of the studies lasted 12 weeks, their durations ranged from three to 32 weeks; there was a nearly equal distribution of trials that evaluated patients either during cancer treatment or after treatment had been concluded.
Several studies included supervised, institution-based exercise programs, but many were home-based, as well. Some trials evaluated the effects of exercise in both types of exercise settings.
Since methodologies varied from study to study, the authors of the Cochrane review used a statistical method (standard mean difference) to quantify the studies’ results in a meaningful fashion.
Even though the magnitude of the effect due to exercise varied widely, nearly every study in the review documented a reduction in fatigue among the cancer patients who exercised when compared to patients who did not.
Exercise Recommendations for Cancer Patients
Whenever possible, the management strategy for cancer patients should include exercise. Obviously, the program must be tailored to an individual’s needs and should include the following considerations:
- Age
- Gender
- Cancer type
- Stage of therapy (and potential side effects of treatment)
- Residual disabilities (e.g., amputations, peripheral edema, etc.)
- Degree of physical fitness prior to diagnosis
Research suggests that cancer patients who participate in three to five hours of moderate-intensity exercise each week will experience fewer adverse effects (including fatigue) from their disease and its treatment, and the National Comprehensive Cancer Network recommends exercise for dealing with cancer-related fatigue both during and after treatment. (National Comprehensive Cancer Network. Clinical practice guidelines in oncology. Cancer-related fatigue. V.1.2009)
Cancer patients who include exercise in their treatment programs will experience less fatigue, improved physical performance, and a better quality of life.
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