Program Design for the Treatment, Care and Prevention of Cancer
While a lot of articles on the #1 Killer: Cardiovascular Disease are written daily, less is prepared on the Exercise Prescription for Cancer. The 5 Broad Categories for the cause are: (1) Environment; (2) Heredity; (3) Oncogenes; (4) Hormones; (5) Impaired Immune System Function. There is growing opinion that to strengthen the Immune System to fight off Cancer and other chronic disorders, physical activity and lifestyle changes are essential.
Research has shown that exercise has both acute and chronic benefits to fighting cancer including improvements in the quality and quantity of Innate Immune System, Monocytes, Macrophages, Neutrophils, Natural Killer Cells, Acquired or Adoptive Immune System, and Cytotoxic T Lymphocytes.
The following Exercise Prescription is based on effecting the acute exercise response by getting your client to exercise daily or at the very least, 6 days/week.
- Maximal Cardiovascular (Medical Professionals Only) Test
- Submaximal Cardiovascular Test
- Muscle Strength and Endurance Test
- Flexibility Test
Contraindications to Exercise for Patients with Cancer
- Hemoglobin <10.0g •dl-1
- White Blood Cells <3,000/ml
- Neutrophil count <0.5 •109ml-1
- Platelet Count <50•109ml-1
- Fever >38°C (100.4°F)
- Unsteady gait (ataxia)
- Cachexia or loss of >35% of premorbid weight
- Limiting dyspnea with exertion
- Bone pain
- Severe nausea
- Extensive skeletal metastases
Summary of Exercise Prescription for Patients with Cancer
Training Method: Aerobic
Mode: Walking, stationary bike or other exercises that use large muscle groups
Intensity: 50% to 85% of heart rate reserve or oxygen uptake reserve, or RPE 11 to 14
Frequency: Three to five times per week
Duration: ≥150 minutes/week of moderate intensity or ≥ 75 minutes/week of vigorous intensity
Progression: 30 seconds to 2 minutes per day
Goals: Increase peak VO2, total work, endurance
Special considerations during active treatment: Intensity may need to be adjusted during treatment to <50% HRR or RPE 9 to 11. If needed, divide exercise into two or three sessions per day and begin at 5 to 10 minutes.
Training Method: Resistance
Mode: Free Weights, Machines, Resistance Bands
Intensity: 50% to 70% of 1RM for lifts involving the lower body 40% to 70% of 1RM for lifts involving the upper body
Frequency: Two or three times per week
Duration: One set of 8 to 12 reps
Progression: Gradual increase in resistance (1.1-2.3 kg) following two consecutive symptom-free sessions
Goals: Increase muscle strength and endurance
Special considerations during active treatment: Patients with metastatic bone disease should avoid excessive weight-bearing exercises and seek medical approval due to increased fracture risk.
Training Method: Flexibility
Mode: Stretching, Yoga
Intensity: Stretch maximally but avoid pain, especially in joints
Frequency: Before and after exercise
Duration: 15 to 30 seconds per stretch. Repeat one to three times for a total of 60 seconds per stretch.
Progression: As tolerated
Goals: Increase flexibility and range of motion
Special considerations during active treatment: Following approval from surgeon, special attention should be given to shoulder mobility stretches in breast cancer survivors.
Carefully evaluate how the patient feels particularly in regard to their cancer therapy and motivation to exercise. Keep careful watch for sudden loss of exercise tolerance, increased shortness of breath with or without exertion, an increase in depression as manifested by difficulty in falling asleep or sleeping through the night, loss of interest in social contacts and/or sudden changes in nutritional status or loss of appetite. You will also need to be aware that the degenerative effect of cancer can result in other disorders, i.e.: Cardiovascular Disease, Osteoporosis, etc., that can also affect the patient’s ability to exercise and exercise tolerance.
Exercise is the best medicine for the treatment care and prevention of cancer and all chronic disorders, but you must find the correct dose. Your goal should be to reach a level of moderate intensity. Low intensity activity may not provide the dose that the patient needs to provide the many improvements to the immune system and other physiological systems of the Body.
High intensity exercise can be exhausting and that may temporarily depress the immune system and other physiological system of the body. Your Aerobic and Strength Training Exercise Modes (Types) should be at Moderate Intensity, or an RPE of 11 to 14 on the 20 RPE Scale.
The very deconditioned patient will benefit from “Interrupted” exercise sessions. Instead of continuous exercise sessions, the patient exercises for a few minutes and then reduces or stops exercise activities for a period of time that will vary until the patient feels comfortable resuming exercise. Tailor the exercise session to the needs of the patient. You should always be supportive, not pushy and not demanding.
One successful technique is the “50-Rule” Ask the patient how far they think they can walk before becoming trained, and then have them walk 50% of that distance/time.
Cancer Related Fatigue (CRF) is the most common side effect of cancer. It is defined as sustained physical, emotional, or cognitive exhaustion experienced during and after adjuvant cancer treatments that is not proportional to recent activities and interferes with usual functioning. Because CRF is debilitating, it is associated with reduced compliance to treatments, particularly exercise treatments.
Causes of CRF may include emotional distress, sleep disturbance, anemia, nutrition, comorbidities and a decrease in physical activity. Lack of physical activity results in depression of the endocrine system, which results in loss of production of anabolic hormones with an increase in stress hormones and catabolic hormones. Lack of physical activity, results in a decrease in energy from lack of ATP Production. The body cannot produce energy without physical activity. In simplest terms: “what you don’t USE… You LOSE!”
Therefore, it is critical that the clients’ exercise Prescriptions be executed by IFPA Certified Medical Fitness Specialist (MFS) who understand the impact our exercise prescriptions have on ALL the physiological systems of the body, not simply the CV and Skeletal-Muscular Systems that is the focus of a Personal Trainer, as well as drug and other contraindications.
Frequency: 3-5 times/week; Preferably: Every day and when necessary, shorter periods: 3-5 times/day
Intensity: RPE 11 to 14/on the RPE 20 Scale
Time: Progress to 150mins/week or more of moderate intense exercise (RPE: 11 to 14)
Type: Walk, Recumbent Bike, Swim, Water Aerobics, Bike, etc.
Strength (Resistance) Training:
Frequency: 2-6 Times/Week, Increased Frequency provides important ACUTE Exercise Effects.
Intensity: Initially: Light-Moderate: 8-15 Reps: Not to Failure
Time: Initially: One set of each exercise
Type: Initially: Machines or Assisted Exercise: One Exercise/Body Part. Pick exercises appropriate for your patient’s level of conditioning/CRF.
Muscle/Group-Exercise: Low Condition-to-High Conditioned Client
1) Quadriceps: Chair Squat- Leg Extension- Squat
2) Hamstrings: Leg Curl
3) Chest: Chest Press- Push-Up- Start with kneeling Push-ups and increase difficulty with safe conditioning
4) Back: Lat Pull Down
5) Shoulders: Side Lateral Raise- Overhead Press
6) Biceps: Biceps Curls
7) Triceps: Triceps Extension
8) Calf: Heel Raise
9) Abdominals: Crunch
10) Forearms: Wrist Curls
Start with the above program 2-3 days/week. The program can progress to 4-6 days/week with appropriate body part splits, i.e.: 4 days on 1 day off:
Day 1: Chest and Back
Day 2: Legs
Day 3: Arms ad Shoulders
Day 4: Cardio
Day 5: Light or light Cardio and Flexibility
Or 6 days/week:
M, W, F: Upper Body
Tu, Th, Sat: Lower Body
Note: the purpose of increased Frequency is simply to increases the many benefits of acute exercise.
Frequency: Everyday and can be performed 2-3 times/day
Intensity: Very LOW! Stretch to the point of “Tight” never to the point of pain! Defined as 30% of ROM.
Time: Stretch for 30 secs, feel the muscle elongate to a slightly longer stretch move to a slightly deeper stretch (Tight! NEVER PAIN) and hold for an additional 30 secs.
Type: Static Stretches (Always following a proper CV Warm-Up) or PNF when an IFPA Flexibility TRAINING SPECIALIST IS AVAILABLE
Exercises: Use the exercise appropriate to your patient’s condition in the IFPA Personal Trainer Textbook.
Note: Motivation, Encouragement, Understanding and your ability to communicate the necessity for exercise are the keys to success!
It is highly recommended that you increase your scope of practice by increasing your knowledge, skills, and abilities on how to safety and effectively conduct exercise management for people with all chronic disease, disabilities, and dysfunctions. All of these chronic disorders are covered thoroughly in the IFPA Medical Fitness Specialist Certification course. Whether your goal is to help your fellow man or increase your revenue and profitability, the Medical Fitness Specialist gives you an opportunity to grow your business rapidly by addressing the 92% of our population that needs your help the most. Personal Trainers target the 8% that have no medical restrictions to exercise. The Medical Fitness Specialist targets the 92% that need exercise for the treatment, care, and prevention of all chronic disorders. This represents a huge market for you period.
Good luck in Progressing your Personal Training Career
Dr. Jim Bell
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