So if exercise helps with overcoming cance what exercise exactly should you try ?

My previous blog pointed at piles of research showing that exercise helps both while receiving cancer treatments like surgery, chemo and/or radiation, and after cancer treatment, so what exactly should one try or not try ?

The previous post referenced Anna Schwartz's book Cancer Fitness. It so happens that she also wrote the cancer chapter in one of my favorite text books: ACSM's Exercise Management for Persons with Chronic Diseases and Disabilities. The whole story in the title.

It is possible to get too addicted to exercise! As Anna points out, if one has uncontrolled vomiting or diarrhea then postpone exercise. I'd agree with that.

This afternoon my wife, a breast cancer survivor, and I did our aerobic workouts on treadmills next to each other. She did interval training with the upper limit on heart rate set to 133 beats per minute and the lower limit set to 115 beats per minute. These clever treadmills allow you to set exactly how hard you want your heart to work and then when you get up that upper limit the treadmill automatically slows down so that you heart rate can come down to the lower limit - in my wife's case this afternoon - 115. When you get back to this lower limit the treadmill immediately speeds up and inclines up to take the heart rate back up.

The basic exercise plan, which needs to be varied for each person and varied by day depending upon how you are feeling, includes:

• aerobic exercise (which helps heart and lungs plus helps keep down weight gain)
• strength training to hold onto as much muscle as possible
• stretching and flexibility to try and deal with reduced range of motion in some joints which can be very uncomfortable
• Balance to keep you away from falling and hurting yourself.

Aerobic exercise such as walking, water aerobics, cycling (probably best on a stationery cycle) or rowing (again probably best on land rather than actually on the water) 3 days a week (alternate days makes sense). 10 minutes is good as a start and building upon by adding maybe 2 minutes to the length each week up to around 30 to 40 minutes. It does not all need to be in one go on aerobic exercise day. In fact there is a lot in favor of splitting the exercise up into 2 or 3 chunks.

Strength exercise on 2 or 3 days a week. This could be just using your own body weight with, for instance, push ups against a wall or with elastic bands or with weights or if you go to a gym, with gym machines. You can do really excellent strength training at home.


Stretching to try to get rid of stiffness and to improve the range of motion around tight joints is a most days of the week activity.

Then there is balance. Balance exercises are important. It's amazing just how fast balance improves with regular practice but a lot of care is needed that you try balance exercises where it's safe, you can grab hold and the floor is soft and definitely no sharp edges close by.

Watch this short video of my wife balancing or, if you want to smile, look at me trying to balance.

When should you not exercise? OK, so we are past vomiting and diarrhea, what else to be careful about ? Blood counts give a lot of exercise related information.

• If hemoglobin level is less than 8.0 g/dl-1 then avoid high intensity exercises because your body's oxygen transport capability is going to be way down.
• Neutrophil count (absolute) is less than 0.5 x 10 to the 9/l then avoid activities that might increase the risk of bacterial infection e.g. swimming.
• Blood Platelet count less than 50 x 10 to the 9 /l then avoid activities which increase the risk of bleeding. This would include high impact activities like plyometrics, sprinting and football.
• Bone pain indicates that you should avoid activities which might cause fracture at the place of bone pain. For instance, bone pain in the wrist might indicate avoiding push ups.
• Severe lymphedema then avoid upper body exercises with the affected arm.

The early research on cancer and exercise all had the objective of "do no harm" and you can't argue with that. Thus far more than 40 controlled clinical trials have been performed looking at exercise in both cancer patients and cancer survivors. In general exercise helps but common sense is essential as is shown in this controlled study of physical activity in cancer survivors.

Look at this recommendation from the ACSM entitled "Physical Activity and Public Health in Older Adults: Recommendation from the American College of Sports Medicine and the American Heart Association."

Then there is the question of improving one's fitness prior to surgery. Read this!

If there is one last thing to say, it's that even a little exercise will make you feel better about yourself. Dorelle Laffal, diagnosed with breast cancer at 37, shows that a little exercise can take you a very long way.