New Guidelines Stressing Need for Exercise by Cancer
Patients May Not Apply to Senior Citizens
Compelling body of evidence says exercise during and
after treatment is safe and beneficial for cancer patients, but effects
on senior citizens needs more study
June
1, 2010 – Most senior citizens know the drills – after a heart attack or
heart surgery you exercise, after cancer treatment you rest. Not
anymore, maybe. New national guidelines say cancer patients – even those
told to rest and avoid exercise – should find ways to be physically
active, both during and after the treatment. But, the researchers say,
the new guidelines may not apply to senior citizens.
Age, they say, is a critical element and more must
be learned about the effects of physical activity in cancer patients
over age 65, to develop interventions that may help these patients
continue to live and function independently.
Kathryn Schmitz, PhD, MPH, an associate professor of
Epidemiology and Biostatistics and a member of the
Abramson Cancer Center at the
University of Pennsylvania School of Medicine, will present these
guidelines at an educational session at the 2010 meeting of the American
Society of Clinical Oncology. The goal is to make cancer exercise
rehabilitation programs as common as those offered to people who have
had heart attacks or undergone cardiac surgery. (Exercise Testing and
Prescription for Cancer Survivors: Guidelines from the American College
of Sports Medicine)
Schmitz, whose
previous research reversed decades of cautionary exercise advice
given to breast cancer patients with the painful arm-swelling condition
lymphedema, led a 13-member American College of Sports Medicine expert
panel that developed the new recommendations after reviewing and
evaluating literature on the safety and efficacy of exercise training
during and after cancer therapy.
“We have to get doctors past the ideas that
exercise is harmful to their cancer patients. There is a still a
prevailing attitude out there that patients shouldn’t push themselves
during treatment, but our message – avoid inactivity – is essential,”
Schmitz says.
“We now have a compelling body of high quality
evidence that exercise during and after treatment is safe and beneficial
for these patients, even those undergoing complex procedures such as
stem cell transplants. If physicians want to avoid doing harm, they need
to incorporate these guidelines into their clinical practice in a
systematic way.”
Cancer patients and survivors should strive to
get the same 150 minutes per week of moderate-intensity aerobic exercise
that is recommended for the general public, the panel says.
Though the evidence indicates that most types of
physical activity – from swimming to yoga to strength training – are
beneficial for cancer patients, clinicians should tailor exercise
recommendations to individual patients, taking into account their
general fitness level, specific diagnosis and factors about their
disease that might influence exercise safety. Cancer patients with
weakened ability to fight infection, for instance, may be advised to
avoid exercise in public gyms.
One persistent area of concern for cancer patients
is change in body mass – both weight gain and weight loss tied to
disease symptoms and treatment side effects. Patients with hormone-based
tumors, breast and prostate cancers, tend to gain weight during
treatment and frequently have difficulty losing it.
Other patients, especially those with
gastrointestinal tumors, suffer from weight loss brought on by loss of
appetite and changes in their ability to swallow and properly digest
food. The new guidelines indicate that both groups can benefit from
exercise.
Studies show, for instance, that exercise for
weight control and reduction in body mass may actually reduce the risk
of recurrence for breast cancer patients, and ultimately decrease breast
cancer mortality. For patients suffering from cancer-related weight
loss, physical activity helps to maintain lean body mass, which can
contribute to increased strength and well being.
Schmitz and her colleagues analyzed published
studies related to five different adult cancer types (breast, during and
after treatment, prostate, hematologic – with and without stem cell
transplant – colon, and gynecologic), and reviewed the evidence for
multiple health outcomes.
The panel found that although there are specific
risks associated with cancer treatment that need to be considered when
patients exercise, there is consistent evidence that exercise training
can lead to improvements in aerobic fitness, muscular strength, quality
of life and fatigue in breast, prostate, and hematologic cancer patients
and survivors. They found the data for colon and gynecologic cancers
were too scant to draw firm conclusions, and identified several areas
requiring further study.
Age is critical variable
Age, for instance, is a critical variable, Schmitz
says, since more must be learned about the effects of physical activity
in cancer patients over age 65, to develop interventions that may help
these patients continue to live and function independently.
The panel urges fitness professionals to enhance
their capacity to serve the unique needs of cancer survivors. Schmitz
noted that a “groundswell” of training programs now assist physical
therapists and fitness trainers in deepening their knowledge of the
effects of cancer diagnosis and treatment and improve their skills in
this emerging area.
Schmitz also feels strongly that practicing
oncologists need to be informed about the new guidelines and their
importance, and says that patients can play a role in changing attitudes
and clinical practice. Her hope is that patients will read the
recommendations and discuss them with their doctors, creating the demand
for change that will drive more cancer centers and oncology practices to
create and offer cancer exercise rehabilitation services.
Schmitz will present the new guidelines at an
educational session on Sunday, June 6, from 4:45 to 6:00 p.m.
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June
1, 2010 – Most senior citizens know the drills – after a heart attack or
heart surgery you exercise, after cancer treatment you rest. Not
anymore, maybe. New national guidelines say cancer patients – even those
told to rest and avoid exercise – should find ways to be physically
active, both during and after the treatment. But, the researchers say,
the new guidelines may not apply to senior citizens.