Southwest Florida's Health and Wellness Magazine Health and Wellness Articles
By Colin E. Champ, MD, CSCS – Radiation Oncologist
There are many benefits to adding exercise to cancer treatment, particularly with muscle resistance training activities that increase muscle cell size, bone mineral density (bone strength), muscle strength, functional mobility for daily living activities, and body composition. Strength training that puts sufficient stress on the musculoskeletal system to improve the structural integrity of bones and muscles, stimulates metabolism and the immune system, increases the body’s ability to heal, and minimizes the risk of injury is the goal of an exercise program for everyone, but perhaps more so for individuals treated for cancer. Exercise and strength training should be recognized for those who want to add years to their life or improve the quality of the years they have left.
The current medical research suggests that applying the above exercise principles, practiced in a safe environment under expert observation, may offer cancer patients an effective means of improving overall health and cancer-specific outcomes. Resistance exercise training for the cancer patient improves the mind and the heart in literal and figurative ways. Read on to see the connection.
Sarcopenia is the loss of muscle tissue, a process that increases with aging. Cancer patients often experience sarcopenia, as well as the loss of strength, energy, and mobility when undergoing treatments. Those changes are visible to the patient and the caretaker. However, what can’t be seen is that the heart muscles are also weakened. The cardiac muscle must stay healthy to pump blood thru the body. Therefore, keeping our body moving and strong, even during illness. Significantly increases our number of days and our quality of life.
Obesity, strength, and functional mobility loss are significant challenges to the cancer patient both during and after cancer treatment. Sarcopenia (the loss of muscle tissue) and obesity are associated with an increased risk of heart disease in cancer survivors. With loss of physical fitness, frailty, and decreased bone health accompanying many cancer treatment strategies, cancer patients are at higher risk for falls, fractures, hospitalizations, and death.
Cancer patients experience high rates of orthopedic issues like pain, nerve damage, limited mobility, frailty, musculoskeletal problems like sarcopenia (decreased muscle mass and strength), and decreased bone mineral density (BMD). These issues are also related to survival outcomes, with the principal underlying factor of a lack of muscle mass strongly associated with poorer outcomes after cancer treatment.
Despite multiple studies demonstrating improved quality of life, physical function, and overall positive outcomes, exercise regimens and resistance training are still not routine in cancer treatment. To date, exercise oncology efforts have predominantly focused on aerobic and lower-intensity resistance training. While specific protocols aimed at improving strength and preserving muscle mass have been established in the literature, the majority of medical professionals are hesitant to apply contemporary resistance training and performance principles that would typically be utilized in individuals without cancer, partially due to fear of exacerbating conditions like lymphedema (swelling of the soft tissue and hardening of the skin) and physical exhaustion.
As a result of cautiousness and the need to establish safety and validity, these strength training regimens have generally focused on seatedmachine-based lifts that isolate muscles often in seated positions, as opposed to compound body movements and free weight exercises to improve strength, mobility, function, and hypertrophy. As exercise prescriptions become more advanced and relevant to cancer patients, newer regimens should mirror exercise principles used in noncancer populations while accounting for each individual’s health and the specific limitations of their diagnosis and treatment. The treatment of early-
stage breast and prostate cancer, for instance, may leave individuals without deficits and at an exercise capacity similar to that of the general population.
Muscle mass loss of up to 50% with atrophy of type II muscle fibers and a decrease in the overall number of muscle fibers is common during aging. This correlates with losses in strength and mobility and a higher risk of falls. Muscle loss and sarcopenia appear to be higher among cancer patients than in the general population, and skeletal muscle depletion independently predicts unfavorable clinical outcomes across various cancer histologies. Greater muscle mass is more important than body mass index (BMI) as a marker of mortality. Adequate muscle mass provides multiple benefits, including enhanced strength and physical function, reduced risk of falls and fractures, and enhanced metabolic function and insulin sensitivity.
Exercise is the most direct method to increase physical functioning and performance, specifically through exercise routines that utilize and improve muscular fitness and fundamental movement patterns (push, pull, hinge, squat, and core activation). Specificity of workouts is vital, as regimens should be aimed at targeting and improving task-specific activities, focusing on exercises that precisely imitate and improve typical movement patterns. Many fractures occur due to loss of strength and balance issues. Optimal functional movement ability improves balance, proprioception, gait, and dynamic agility and is directly associated with a lower risk of injury, particularly among those who are elderly. Compound and functional movements with opposing resistance are performed to improve and optimize particular movements or activities, specifically those of activities of daily living (ADLs), which can help prevent falls and injury. Compound exercises employing functional movements rely on coordination, balance, and extensive muscular activation to offset shear stresses during joint movement.
In summary, there are many benefits of exercise in the cancer treatment and survivorship setting. Optimal implementation of resistance therapy should target hypertrophy, bone mineral density, strength, functional mobility, and body composition, which are best achieved through a series of individualized, high-intensity, compound movements that mirror functional mobility patterns, routinely performed over sessions limited to 60 minutes. Adequate stress on the musculoskeletal system is necessary to promote compensatory cellular mechanisms that improve the structural integrity of bones and muscles, stimulate metabolism and the immune system, optimize functional performance, and minimize mechanical injury risk. The current evidence suggests that applying the above exercise principles, practiced in a safe environment under expert observation, may offer cancer patients an effective means of improving both the quality and quantity of life.
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Dr. Colin Champ, MD, CSCS
Dr. Colin Champ, MD, CSCS, is a radiation oncologist with board certifications in radiation oncology and integrative and holistic medicine. Dr. Champ is a certified strength and conditioning specialist, and his research interests include the prevention and treatment of cancer with lifestyle modification, including exercise and dietary modification.