Exercise Following Hospitalization and/or Treatment

A common side effect of cancer treatment is cancer-related fatigue (CRF).  CRF has been known to affect over 70% of cancer patients who receive chemotherapy, radiation, or biotherapy.  CRF is a “persistent, subjective sense of tiredness related to cancer or cancer treatment that interferes with usual functioning.”  It is still not uncommon to hear healthcare providers advocating rest to deal with this kind of fatigue.  However unlike fatigue in the usual sense, CRF does not improve with more resting and rest can actually intensify CRF because of increasing cardiovascular and musculoskeletal deconditioning.  Several factors are proposed to contribute to CRF including but not limited to inactivity, prolonged bed rest, disruption of the normal sleep-wake cycle, stress of the diagnosis, and cancer treatment.  Exercise has been shown to be the most effective non-pharmacologic treatment for CRF.

A good exercise regimen includes the following components: cardiovascular, strengthening, flexibility, and balance exercises.  A physical therapist can help design a program for you based upon your unique needs.  How much should you exert yourself when exercising?  A good rule of thumb is to exercise moderately.  Light exercise is preferable to no exercise but is not as beneficial as moderate exercise.  Strenuous exercise should be avoided when first starting any exercise program and can be later permitted with your physician’s approval.  Also, look for a variety of exercises.  Doing the same list of exercises is boring and can to lead to burn-out.  Varying your exercises keeps it interesting and works your muscle groups differently so that your overall benefits are comprehensive.

• Cardiovascular
  A good goal is to work up to between 30-45 minutes of aerobic exercise most days of the week.  This can be done all at once or spread out throughout the day.  Breaking up your cardiovascular exercise throughout the day is especially helpful if your endurance is low.  This will gradually allow you to improve your stamina.  Common cardiovascular exercises which elevate your heart rate for a sustained period of time include walking, jogging, cycling, and swimming.  Be careful to make sure your cardiovascular activity does not inhibit you ability to gain or maintain a healthy weight.  Any exercise program should be designed to allow you to keep a healthy weight level. 
• Strengthening
  Strengthening exercises for the upper body and lower body are typically performed between 8 to 15 repetitions for each set.  The end of each set should feel very difficult to complete.  So if you can easily complete 15 repetitions, the exercise is too easy and the weight being lifted should be increased.  Conversely, if you can barely complete 8 repetitions, the exercise is too difficult and you should decrease the weight.  Each set is repeated 2 to 3 times with a period of rest between each.  Strengthening exercises are usually performed 3 to 4 times per week.  Pay attention to your form while exercising-this helps decrease your risk for injury and prevents compensatory actions from decreasing the effectiveness of the exercise.   Strengthening exercises to build up muscle bulk are particularly important for gastric cancer survivors and gastrectomy patients because the risk of anorexia is high due to nutritional challenges following surgery.
• Core strengthening exercises should not be over-looked because a strong core will improve the efficiency of your entire body.  Often, performing upper and/or lower body strengthening exercises in certain positions with attention to form and motion will strengthen your core.  Pilates is also an exciting way to strengthen the core musculature.  
• Flexibility
  Flexibility exercises are important to keep muscles, tendons, and connective tissue loose and in doing so decreases the strain on your joints.  When stretching to increase flexibility, the exercise should not be ballistic in nature where you see a lot of bouncing.  Instead, positions should be held for 30 to 45 seconds and repeated 2 to 4 times.  A stretch can be further enhanced by quieting your mind, shifting your attention to the muscle being worked on, feeling the stretch (which should feel light to moderate in intensity), and breathing deeply.  Stretches are most effective on muscles which are warmed up so these are best done following cardiovascular exercise.
• Balance
  Balance is often over-looked but is required to enhance performance and maintain safety in everyday life.  Balance exercises should feel challenging but not be impossible to do.  These exercises should be done in a safe environment where if balance is lost you can reach out for something to stabilize yourself.  Balance exercises can be done in isolation or can be combined with strengthening or flexibility exercises.  You can also incorporate them into your daily life.  For example, when waiting in line at the grocery store or brushing your teeth, try standing on one foot and see how long you can maintain your balance for.   

A commitment to an active lifestyle further reinforces the habit of exercise.  Choose to walk up and down stairs as opposed to taking the elevator or escalator.  This will not only strengthen your legs but also strengthen your heart.  Choose to leave the car at home when distances can be easily walked.  Limit naps to less than an hour at a time.  Practice good posture-this not only helps minimize and prevent muscle imbalances of tightness and weakness but also boosts your confidence and lifts your mood.