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Cancer Related Fatigue and Exercise

By Michael P. Keenan

I have had the privilege to work with many clients who are cancer survivors. Each has a unique story, and is willing to serve others weathering this storm. This article is a testimony to those who refuse to quit!

Cancer Related Fatigue (CRF) is defined as a reduction in physical, psychological and social functioning and results in significant distress for clients and care givers. Clients report fatigue is a major obstacle to maintaining normal daily activities and quality of life. CRF can appear suddenly and is different from fatigue of everyday life.

Clients may use the following words when describing CRF:

Possible causes of CRF range from:

Seventy five percent of cancer patients surveyed consistently experienced fatigue during and after cancer related treatments. Sixty percent went on to say that fatigue affected their daily lives more than any other symptom. Fatigue was not only the most prevalent cancer side effect, but it also lasted the longest. So what can be done?

There are many therapies, such as pharmacology to increase white and red blood cells counts, humor therapy, cognitive therapy and physical therapy. The focus of this article will center on fitness therapy.

In order to stratify the potential client for fitness, we need to look at the following criteria. We begin with a comprehensive medical history, along with physicians recommendations. We review pharmacology and other treatments. We gather subjective information, such as goals and pain/fatigue. A full fitness assessment is preformed, and from this we design an exercise program to meet the client at their individual needs.

Depending on the individual, there may be restrictions to exercise. These should be reviewed with the client and their physician. These are:

Many times following chemotherapy, the clients white count is too low, and they are susceptible to illness. Strict contraindications for exercise are

Our Fitness Assessment is comprised of:

For the client who has experienced either surgery or radiation to the neck, upper extremities or torso, shoulder, elbow wrist and hand range of motion is evaluated as well.

When deciding on exercise prescription and program design, we first speak with the client’s physician to determine what their guidelines are. Secondly, we interview the client, to determine what subjective complaints they might have, and to ascertain what are their goals and expectation of entering our exercise program. In our one on one training environment, the program is individualized, and they are given instruction as to what should be done while they are away from our studio. It is important that reps, sets, resistance and rest periods are clearly spelled out. Generally, because we tend to stay in the 10 to 12 range with reps, our rest times are generally 30 to 40 seconds between sets. Longer rests are allowed, but keeping the client with 55% of their predicted maximum heart rate.

The components for exercise prescription are flexibility, strength training and aerobic conditioning. Flexibility helps improve joint function, relieves stiffness and pain that accompanies chemotherapy and radiation, and promotes physical and mental relaxation.

Strength training helps prevent muscle wasting, and aids with ability to perform normal activities of daily living. Program should include upper and lower extremity strengthening exercises, as well as trunk and abdominal exercise. When appropriate, performing multiple joint functional strengthening exercises is preferred. Modes of resistance vary, but could be dumbbells, cuff weights, rubber tubing or even body weight. When building your strength program, we try to indemnify a weight that can be lifted 10 to 15 repetitions, for 2 to 3 sets per body part. A full body workout is optimal, and should be performed 3 times per week. Again, watch for signs of severe fatigue or pain.

Cardiovascular exercise is the third component. By working the heart, patients can combat fatigue and increase their endurance. Cardio training helps to maintain your current level of function and prevent muscle wasting. Blood flow is increased to all the vital organs, especially the lungs, which aids in decreased risk of pneumonia. With most clients, heart rate is the indicator for level of exertion with cardio training. Target heart rate (THR) is defined as 55 to 70 % of your individual predicted maximum heart rate. Maximum heart is calculated as being 220- your age. Another method of gauging exertion is The Rate of Perceived Exertion Scale (RPE). For simplicity, we use a 0 to 10 scale, 0 is no effort, and 10 is an extreme effort. The reason for using this scale is that sometimes heart rate is not a true indicator of exertion. For example, Beta Blockers for hypertension and some chemotherapy drugs make using THR a poor indicator for exercise intensity. On average, chemotherapy clients should aim for a RPE of 5 to 6, with a maximum of 7.

Other positive effects of exercise for cancer clients are

Managing fatigue is important component as well. We encourage all of my clients to consider the following. Rest and sleep are important, but can be done is excess. The fatigue will not improve with excessive sleep and rest. Try to maintain as much normalcy in sleep patterns. Activity will help with avoiding excessive rest and boredom as well. Nutrition is very crucial to regaining energy. Focus on live foods, such as fruits, vegetables and grains. Meals should be well balanced, eating small portions every 3 to 4 hours. Set a goal to drink at least 1 gallon of water daily. Energy conservation allows you to prioritize your activities, and most importantly, do activities you enjoy. You this overview as a guide to overcoming your cancer related fatigue, and get back into life.

About the Author:

Michael Keenan is the owner/director of Fitness Together in Manasquan and Lake Como New Jersey. Michael is a Certified Fitness Therapist, and can be reached at www.ftmanasquan.com.

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