为癌症治疗做准备的健身锻炼

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Fitness Training in Preparation for Cancer TreatmentKristan Marques and Roni Jamnik, York University
Originally published in the CSEP member newsletter, Communiqué, September 2007.
Introduction ≤
Exercise has a rehabilitative role in various diseases including coronary artery disease, hypertension, stroke, obesity, non-insulin dependent diabetes, and musculoskeletal disorders. The role of exercise in Cancer treatment has yet to be fully examined. However, there is a strong belief that improving one´s fitness level prior to the onset of Cancer treatment will improve the healing process and help maintain quality of life.
Cancer is a disease that affects people on different levels and in different ways depending on the location of the tumor and whether the tumor is localized or metastasized. There are generalized symptoms based on the location of the tumor that must be considered when prescribing an exercise program, specifically; pain, shortness of breath, neural deficiencies and seizures, easy fatigability and anemia. These symptoms plus any other that the patient experiences must be considered when prescribing an exercise program, as the inability to tolerate exercise is common. As well, the goals of the exercise program will vary depending on the stage of the cancer.
Combating the Side-effects of Cancer Treatments
Many Cancer treatments have problematic side-effects. Therefore, it is best to physically prepare the body for the stress that lies ahead. Glucocorticoids are immunosuppressant drugs commonly used in Cancer treatment that have negative side effects including bone remodeling, muscle wasting and weakness. Aerobic and resistance training have been proven to combat these detrimental side-effects. Further, patients who have been prescribed a rest-only regimen during Cancer treatment typically show a 25 % decrease in functional capacity over an 8 week treatment program.
This decrease would bring a patient closer to the threshold of 14ml O2/Kg or 4 METS - the minimum physical capacity required to complete the Activities of Daily Living (ADL) - a threshold that determines whether a person can live independently. During a rest-only Cancer treatment regimen, the patient´s reserve capacity, which is the difference between the demands of an activity and the person´s maximum physical capacity, would decrease progressively so that ADLs become increasingly more taxing on the body. Through a pre-treatment fitness training program, a Cancer patient could increase his/her functional capacity and consequently maintain a greater reserve capacity throughout treatment, thereby remaining above the ADL threshold. Maintaining the patient´s ability to live independently is a primary goal of a pre-treatment exercise program for Cancer patients.
Fatigue can be detrimental to a patient´s daily life in other ways, negatively influencing mood, sense of well-being, personal relationships and, very importantly, compliance to treatment. By providing Cancer patients with a higher functional capacity, a pre-treatment exercise program would allay the effects of fatigue and thereby lead to an improved mood, quality of life and treatment compliance.
Applying What Has Been Learned from Cardiac Disease
Although studies specifically examining the effect of pre-treatment exercise programs on cancer patients are sparse, knowledge gained from other areas of research provide hope to this growing area. For example, in cardiac disease, the importance of pre-intervention fitness training has been well documented and can be extrapolated to apply to other disease conditions. As with Cancer treatment, in particular surgical intervention and chemotherapy, cardiac surgery presents a major stress to the body; physical, metabolic and psychological. A recent study by Hadj et al. (2007) examined the benefits of a holistic pre-surgery program for cardiac patients including physical, metabolic, and psychological interventions. Significant improvements in all three of the above were achieved during the pre-surgery training period. Further, the benefits of the holistic program were sustained one month post surgery. The researchers proposed that the ability of exercise to modulate hormone levels, prevent obesity, enhance immune functioning and reduce oxidative stress are possible mechanisms by which exercise is beneficial. In Cancer patients, the hormonal balance, immune function and the body´s ability to combat oxidative stress is compromised. Average improvements of 20% in functional capacity were recorded in the cardiac patients, which would nearly negate the 25% loss in functional ability typically seen in Cancer patients post-surgery. It is important to note however, that the long term effects of a pre-treatment exercise program on survival and quality of life are yet to be researched.
Additional Benefits of Pre-Treatment Fitness Training
The benefits of pre-treatment fitness training extend beyond the maintenance of physical capacity; they also provide assurance that a pre-conditioned patient will be able to engage in physical activity both during and post treatment. The benefits of exercise during and post Cancer treatment have been more widely studied and a number of advantages have been reported. Among these benefits are the preservation of cardiopulmonary function, mobility, muscle and bone strength, and a potential improvement in psychological wellbeing, all of which are adversely affected by Cancer therapy. The effect of exercise during Cancer treatment on fatigue varies among patients, some experience an exacerbation while others experience an improvement. Some patients experience a relief of nausea from exercise both during treatment and during recovery after treatment.
Role of the Fitness Professional
The role of the fitness professional is to provide an exercise program that maintains or improves the Cancer patient´s muscular strength and aerobic endurance at a pace that is not over exhausting and in a manner that does not exacerbate their current symptoms. Keeping in mind that a Cancer diagnosis does not affect the physiological ability to improve fitness, have the patient engage in an aerobic activity that he/she enjoys, three to five times per week, at a mild to moderate intensity. The patient should also engage in a resistance training program designed to incorporate all the major muscle groups three days a week along with daily stretching exercises. For the best guidance, Cancer patients should work with a CSEP Certified Exercise Physiologist™.
References:

• Durstine, L.J., Moore, G.E. (2003) ACSM´s Exercise Management for Person´s with Chronic Disease and Disabilities Second Edition. Windsor, ON: Human Kinetics.
• Flood, C., Fleisher, L.A. (2007) Preparation of the Cardiac Patient for Noncardiac Surgery. American Family Physician 75: 656-665.
• Hadj, A., Esmore, D., Rowland, M., Pepe, S., Schneider, L., Lewin, J., Rosenfeldt, F. (2006) Pre-operative Preparation for Cardiac Surgery Utilising a Combination of Metabolic, Physical and Mental Therapy. Heart Lung and Circulation 15: 172-181.
• Kim, H.S., Park, D.H., Kim, J.W., Jee, M.G., Baik, S.K., Kwon, S.O., Lee, D.K. (2005) Effectiveness of Walking Exercise as a Bowel Preparation for Colonoscopy: A Randomized Controlled Trial. American Journal of Gastroenterology 100: 1964-1969.
• Stevinson, C., Lawlor, D.A., Fox, K.R. (2004) Exercise intervention for cancer patients: systematic review of controlled trials. Cancer Causes and Control 15: 1035-1056.
• Torti, D.C., Matheson, G.O. (2004) Exercise and Prostate Cancer. Sports Medicine 34: 363-369.
  

The Active Living Coalition for Older Adults (ALCOA) has devoted their September 2007 Research Update to "Physical Activity and Cancer: From Prevention to Recovery". You may download the PDF file here: http://www.alcoa.ca/research_u_docs/2007_09sep_en_update.pdf
The CSEP Knowledge Translation Committee supports the translation of research-based knowledge for the practical application of improving the heath of Canadians through the publication of this article.


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