When you are getting chemotherapy, exercise may be the last thing on your mind. Now, new research suggests it should be the first.
Exercising during chemotherapy is safe, improves long-term cardiac and respiratory function and may help ease some of the ravages of treatment, Dutch researchers report. If you can't exercise during chemotherapy, then you should start after treatment to get your heart function back to normal, they added.
"These findings suggest that the most optimal timing of physical exercise is during chemotherapy," said senior study author Dr. Annemiek Walenkamp, a medical oncologist at the University Medical Center Groningen in the Netherlands.
"However, initiating an exercise program after chemotherapy is a viable alternative when exercising during chemotherapy is not possible," Walenkamp said. "We hope health care providers guide patients to engage in exercise interventions during anti-cancer treatment."
During chemotherapy, peak oxygen uptake, a predictor of heart health, typically declines by up to 25%, the researchers noted. Cancer treatment can also affect quality of life and cardiac and respiratory fitness. Not only that, it can trigger extreme fatigue and cardiovascular death, they added.
For the study, Walenkamp and her colleagues looked at the benefits of exercise among patients in a tailored exercise program. The patients suffered from breast cancer, colon cancer, testicular cancer or non-Hodgkin lymphoma. All were to undergo chemotherapy. The participants were randomly selected to take part in a 24-week exercise program either during or after treatment.
Exercise included a stationary bicycle, weight machines, free weight lifting and badminton.
In the end, the researchers found that those who exercised during chemotherapy felt less tired and exercised more. In addition, they also had better heart and breathing function and greater muscle strength.
Those who began exercising after three months of chemotherapy also showed some improvement. Both groups were back to their normal cardiorespiratory fitness one year after completing the exercise program, the researchers found.
The report was published Oct. 18 in the journal JACC: CardioOncology.
"This study is an important addition to the field of exercise oncology," said Dr. Eric Yang, director of UCLA's cardio-oncology program. He was not part of the study, but reviewed the findings.
"Exercise has yielded many benefits in our field of cardiology, and given the advances made in cancer treatments where more and more patients are living longer and surviving with their disease, it is important to evaluate strategies to optimize their heart health and quality of life," Yang said.
Although cancer treatments now have less toxic effects, treatment can still damage the heart, he explained.
"Because of many common side effects, such as fatigue, low blood cell counts, nausea and low energy, this directly and indirectly affects one's ability to normally exercise and maintain a daily routine, and thus affects cardiovascular reserve and health," Yang said.
Exercise is important to help counter the negative effects on the heart that cancer treatment can cause, he pointed out.
"It is important to not throw heart health to the wind, now that more and more evidence is emerging that these few years of treatment can put them at increased risk of cardiovascular events in the long term," Yang said.
Cancer treatment is changing, and patients are advised to be concerned with their overall health, not just their cancer, he said.
"The old era where it used to be where you were told to just focus on your cancer treatments, eat what you want, rest, is becoming outdated," Yang said. "This, amongst many other studies, has shown it is safe to exercise, with some caution towards high-intensity regimens."
He hopes patients will maintain as much of a healthy lifestyle as they can during chemotherapy.
"I encourage patients to maintain as much normalcy as possible and tolerated during their treatments," Yang said. "I understand that they cannot necessarily exercise to the same degree as they used to before their cancer treatments, but I emphasize to them and their families that exercise and healthy eating is paramount and will be a great investment to their quality of life in the long run. And, as this study demonstrates, if you can't exercise during your treatments, start after -- it's better late than never."
For more on cancer and exercise, see the American Cancer Society.
SOURCES: Annemiek M.E. Walenkamp, MD, PhD, medical oncologist, University Medical Center Groningen, the Netherlands; Eric Yang, MD, director, UCLA Cardio-Oncology Program; JACC: CardioOncology, Oct.18, 2022