You may experience fatigue as a symptom of your CLL16. Exercise can help reduce the symptoms of fatigue in people who have or have had cancer17.
Exercise may also make you feel better physically and emotionally, and help you cope better too21, 24, 25. Due to the increased risk of catching infections, you should avoid situations where you might catch infections such as participating in activities where there are large groups of people23. There are many ways to become active and it is never too late to start or take up activities25. You could try:
- Joining a walking group
- Cycling, dancing or gardening
- Playing a sport such as badminton, table tennis or lawn bowls
- Walking to see friends or to work
- Try stretching exercises, such as yoga, Tai Chi or Pilates
You should discuss your exercise plan(s) with your health care team prior to commencing any activities.
Ensure you warm up before exercise, stretch out after exercise and wear appropriate clothing, footwear and sunscreen for outdoor activities. If you experience any of the following sudden symptoms during exercise, you should stop temporarily and seek guidance from your health care team26:
- Feeling dizzy
- Chest pain
- A racing heart
- Breathing problems
- Feeling sick
- Unusual back or bone pain
- Muscle weakness
- A persistent headache
Set realistic goals, undertake suitable levels of exercise and most importantly do activities you enjoy!
Cancer diseases are accompanied by numerous fears and questions. Many people encounter the challenge of a cancerous disease during a very active period of their life. Patients suffering from hematologic cancers are among them, also. Consequently, there are more than few of those who are concerned and wonder whether they can still run, ski or cycle. They particularly want to know whether their physical activity might harm them during the treatment of malignant disease.
But many people who were never physically active may also fall ill with cancer. Surely, these people will ask different questions. And as everyone would to do almost "everything" to get better, many people ask themselves whether there is anything to gain by starting to be physically active during the treatment of cancer. And also, is this even necessary? Let's try to give an answer to both of them; to those who find it difficult to live without doing sports, and those who need special incentives to engage in sports.
What can we learn from Science?
Even without resorting to hard-core science, we already know that exercise is beneficial in terms of health. But what to do when we fall ill? This is actually the time – although many people may feel that the time of being ill is the time to rest – when physical activity becomes almost crucial, which is true for a number of health conditions. With physical exercise, patients hold back the loss of muscle and functional body weight, thus contributing to the optimal treatment of cancer. This is particularly important during the use of anti-cancer medicines, in which muscle damage is particularly pronounced as a side effect. These medicines are also commonly used in hematologic cancer.
Scientific findings speak strongly for physical activity, as well. Due to the nearly strikingly positive effects of exercise as a supportive therapy in the treatment of cancerous diseases, and as a powerful tool in preventing the development of cachexia, the number of studies on relations between physical exercise and cancer has increased significantly. Numerous studies have shown the beneficial effects of physical exercise on well-being, but there is also solid scientific evidence that physical activity supports the survival of cancer patients. Moreover, physical activity also proved to be an important therapeutic tool in patients with advanced forms of cancer. It could even be argued that physical activity, of course in conjunction with proper nutrition, is a certain kind of parallel therapeutic pathway during all stages of cancer treatment. In cancer survivors, an active lifestyle contributes to the rehabilitation and helps reduce the likelihood of recurrence.
Positive effects of physical exercise
Beneficial effects of physical exercise are numerous, ranging from psychological to physical influences. For a beneficial effect of physical activity to become evident, it is not necessary for a cancer patient to run a marathon or climb the highest mountain. A moderate degree of physical activity is enough to ensure that cancerous illness and also the oncology treatment will be less stressful and worrisome. In patients who are physically active, fewer depressive disorders can be found; they are less tired and even their perception of pain scales down. Physical activity moreover positively impacts the patient's appetite. Desire for food is extremely important for patients undergoing anticancer therapy as it alleviates eating problems that often accompany the treatment of cancerous diseases. Food intake is of key importance in gaining the positive effects of physical exercise: do not let the patient exercise on an empty stomach as we all know the saying "an empty sack cannot stand upright". With improved appetite and a lower dose of pain relief medicines, digestion becomes better and patients experience less constipation difficulties.
Physical exercise in cancer patients also affects sleep in a good way. Patients who are regularly physically active sleep better and experience less insomnia.
Nevertheless, positive effects of physical exercise may rapidly turn into negative impacts and further accelerate degradation processes in the body should the patient exaggerate the exercise. During the time of illness and its treatment, it would be misplaced to pursue personal records or sports achievements which might even be attributed a touch of heroism. To enjoy positive effects, physical exercise should be moderate, and when it is fun at the same time, its psychological effect will be even better. A cancer patient needs to know that "more" is not "better" and that the body also needs time to recover after physical exercise. This is why it is best to postpone any great sports ventures to the time after the treatment will be completed.
Is there a time physical activity is inappropriate?
Please be careful with physical exercise or avoid it altogether when encountering severe consequences of the treatment, such as high fever, severe nausea and vomiting, or unmanageable pain. When experiencing such conditions and other health problems that endanger vital bodily functions, symptomatic therapy is needed first and foremost. Once the symptoms are overcome, start exercising gradually and cautiously.
Physical activity works against cachexia in patients with hematologic cancer
In cancer patients, chronic inflammatory condition develops due to cancerous disease or its treatment, resulting in degradation metabolic changes. The first to fall victim are protein body structures that slowly degrade. This may first be perceived on large muscle groups, on legs and arms. The most apparent casualty are muscles that make up the largest part of the functional body mass. In patients with hematologic cancers, it is the treatment with aggressive medicines which exacerbates the degradation processes to a very large extent or even more than the disease itself.
As the patient loses muscle strength and body weight, functional weakening and poor quality of life follows. Such degradation metabolic changes cannot be completely prevented, but we can effectively hold them back with proper nutrition and regular physical activity. On the other end of the spectrum, physical inactivity and excessive rest promote metabolic changes, also called cachectic metabolism changes. As of today, we do not yet know precisely whether the main cause of the loss of protein structures lies in increased degradation, or primarily in the decline of protein formation in the body. There are probably several mechanisms involved; and some of them can very successfully be influenced by physical exercise. We also know that physical inactivity or excessive rest contribute to the decrease of protein structure formation, thus directly promoting the decay of the body.
These scientific findings, therefore, offer convincing reasons why physical exercise is actually a necessity for patients suffering from cancer.
What kind of physical exercise to choose?
Knowledge of the metabolic changes in cachexia is, in addition to the well-known favourable effects of physical exercise, the basic starting point in forming advice on exercise for patients with cancer. As the most effective countermeasure against muscle degradation is "muscle building" training, this is actually the first type of activity recommended to patients; it is also called strength training or resistance training. Endurance training furthermore increases the effectiveness of strength training.
To summarize, you should take good care of your muscles, in the first place. Basic strength training exercise will be enough, such as weight lifting and squats, and also push-ups, if you can do them, or other similar exercises that you might remember from your primary school. Do strength training for 20 minutes, 2–3 times per week. At the same time, do not forget the exercises to strengthen your core, such as crunches.
Physical exercise therefore offers good support to patients and helps to overcome the difficulties of cancerous disease treatment. If you perform the activities moderately, there will be no adverse effects.
16. American Cancer Society. Leukemia - chronic lymphocytic. April 2016. http://www.cancer.org/acs/groups/cid/documents/webcontent/003111-pdf.pdf. Accessed April 2017.
17. Macmillan Cancer Support. Managing symptoms of fatigue. July 2013. Available at: http://www.macmillan.org.uk/information-and-support/coping/side-effects-and-symptoms/tiredness/tips-manage-symptoms-fatigue.html. Accessed April 2017.
21. Macmillan Cancer Support. If you have diarrhoea. September 2014. Available at: http://www.macmillan.org.uk/information-and-support/coping/side-effects-and-symptoms/eatingproblems/diarrhoea.html. Accessed April 2017.
24. NHS. 10 stress busters. January 2016. Available at: http://www.nhs.uk/Conditions/stressanxiety-depression/Pages/reduce-stress.aspx. Accessed April 2017.
25. NHS. The importance of exercise as you get older. July 2015. Available at: http://www.nhs.uk/Livewell/fitness/Pages/activities-for-the-elderly.aspx. Accessed April 2017.
26. Macmillan Cancer Support. Making sure you're safe when you're active. March 2014. Available at: http://www.macmillan.org.uk/information-and-support/coping/maintaining-ahealthy-lifestyle/keeping-active/making-sure-safe-when-active.html#tcm:9-8441. Accessed April 2017.