Cancer related fatigue is one of the most stressful sequelae of cancer treatment. According to the Journal of Physical Therapy, fatigue affects 70% - 100% of individuals receiving radiation, chemotherapy and bone marrow transplantation.  In the recent past, rest was a prescribed treatment for cancer related fatigue, but this philosophy is quickly changing.  It is now, that cancer patients are being encouraged to be more physically active.  Moderate exercise may actually help to break the fatigue cycle.

There have been studies that have documented the benefits of exercise that include decreased nausea, decreased fatigue, and increased physical tolerance and increase quality of life.  Exercise has demonstrated an improvement in both physical and psychological aspects of the patient with cancer.  Physical improvements include: increase red blood cell production, improved functioning of the heart and circulatory system.  Psychological benefits include: improved memory, less depression, better mood and stronger sense of personal control. 

The physiological and cytotoxic effects of chemotherapy can be damaging to normal tissue and bodily functions.  Some chemotherapy regimens do not distinguish between healthy cells and cancer cells.  Often both types of cells are destroyed by cancer treatments. 

Some of the physiological benefits of exercise may include but are not limited to:

• Prevention of muscle wasting caused by inactivity
• Enhanced restfulness and better sleep patterns
• Reduced risk of heart disease
• Detoxification through sweat and better circulation
• Addressing muscular imbalances resulting from cancer treatment
• Better supply of oxygen to brain and tissues
• Improved flexibility and strength

Some of the psychological benefits may include enhancing the quality of life such as:

• Improved self-esteem
• Enhanced feelings of self confidence and independence
• Mood elevation due to increased endorphins
• Stress reduction
• Relaxation
• Decreased fatigue

As with any exercise program, the goals should meet the individual’s needs as well as be safe and effective.  Before beginning any exercise program, it is suggested that you consult your oncologist first.  An exercise program should be of light to moderate intensity

Precautions:  not inclusive

• Do not exercise if blood counts are low which may increase the risk of infection or anemia.
• If there is much vomiting and diarrhea, potassium and sodium levels may be depleted, so consult your oncologist and get enough adequate fluids.
• Avoid falls by not exercising on uneven surfaces.
• Some chemotherapeutic agents affect the heart and lungs, monitor for swollen ankles, hands and shortness of breath, consult oncologist first.
• Watch for bleeding if you are taking blood thinners and exercise extreme caution in preventing falls.
• Do not exercise if you have unrelieved pain that causes you concern.
• Do not use heavy weights if there is any limitation in your activity like bone disease, poor balance or excessive weakness.

According to the American Cancer Society and after speaking with your oncologist, one should begin an exercise program slowly and routinely. It is important to listen to the signs your body may be sending and monitor for any changes in pain, shortness of breath, clamminess, or headache.  These may be warning signs that you have overextended yourself, especially if you don’t have a history of exercising.  Keeping hydrated is imperative to maintain homeostasis within your body.

One should begin with a warm-up that includes shoulder shrugs, shoulder circles, toe-tapping, overhead shoulder lifts, marching, knee lifts. To begin, one can start with 5 minutes of exercise three times per day, until you are able to exercise for 10 minutes without rest.  The goals would be to build up to 20-30 minutes three to five times per week.  This activity does not have to be in the form of a “formalized exercise program”.  It can simply include some normal activities of daily living.

Activities of Daily Living:

• Use stairs rather than elevator
• Go dancing
• Do outdoor lawn care
• Ride a bike
• Walk around the neighborhood
• Do exercises while watching television
• Prepare dinner
• Light house-keeping
• Go for walk at lunch

Types of exercise programs:  (not inclusive)

• Yoga
• Pilates
• Water aerobics
• Walking
• Running
• Physioballs
• Low-Impact aerobics
• Stepping Classes

Sources: 
Journal of Physical Therapy August 2004
American Cancer Society Website
Sportsmedicine.about.com Website
Cancer Supportive Care Website