Written by Gurleen Bhogal
Reducing cancer symptoms is an important aspect involved in improving the quality of life for cancer patients, in which there is a growing concern on mitigating cancer-related fatigue. Physical activity has been an area of focus when it comes to improving the quality of life in general, thus this mechanism can provide benefits to patients undergoing rigorous cancer treatments and the associated side-effects. Clinical trials have presented numerous outcomes of using physical activity interventions in cancer patients, in which many see positive results. On the other hand, there are concerns regarding the feasibility of being physically active for ill individuals, as well as the adverse effects that may occur as a result of already tired patients being physically active. Nevertheless, physical activity interventions should be manipulated according to an individual’s personal needs and desires, in order to establish an appropriate balance, while relieving cancer-related fatigue. Measuring fatigue remains a challenging aspect to work with when determining the efficacy of physical activity as a feasible strategy.
The drive in our society to continue fighting cancer is an ongoing phenomenon. Although the world of technology continues to meet the anti-cancer world through the discovery of innovative ways to prevent the development of cancer, the unfortunate reality is that, for most individuals, eliminating cancer is just not an option. Just two years ago, terminal cancer, the form of cancer which cannot be completely cured and eliminated throughout the duration of one’s life, was the second leading cause of death globally.1
Quality of Life Vs. Quantity of Life?
Improving quality of life has become a popular way of dealing with the implications of cancer. Although contrasting quality of life and longevity of life is a controversial topic, there is a focus on how individuals can maintain a high-quality life as opposed to solely prolonging the duration of time one lives for. Studies have shown that, in many cases of advanced cancer, patients tend to prioritize quality of life over the longevity of life.2 Life with cancer can be impacted by factors including treatment methods, side-effects of treatment, and the condition itself. One of the most prevalent symptoms of experiencing cancer, along with its treatments, such as chemotherapy, is cancer-related fatigue (CRF). As one of the most distressing side effects of cancer, CRF has been known to disrupt many, if not all, aspects of quality of life by interfering with daily functioning.3 A keen focus has been placed on physical movement of the body to provide relief in CRF.
There are multiple factors to consider when investigating the effects of physical activity on reducing CRF for cancer patients. The stage of cancer, treatment plans, and the patient’s history of physical activity prior to diagnosis play a role in determining the efficacy of implementing active movement to mitigate CRF. Physical activity can have a positive influence on reducing fatigue for many cancer patients, thus greatly improving quality of life.
On the surface of it, it may seem as if doing physical activity just tires out the body even more, both physically and mentally. In a study done on women diagnosed with breast cancer who participated in aerobic and resistance training, some participants showed nausea and headaches from undergoing physical training.4 However, it is important to contrast the short-term and long-term effects of physical activity. While being physically active may present short-term negative effects, it has been shown that persistent activity induces interventions that reduce fatigue by decreasing the activity of NF-κB, a primary regulator of inflammation that can induce fatigue from cancer treatments.3
Further, the extent to which one should be physically active to see sustainable and positive results is dependent on factors like the stage of cancer and the individual’s history of physical activity. Thus, physical activity regimens should be tailored to each patient’s needs. The ways in which one engages in physical activity and how long they are active for should vary between individuals. In one study, simple home-based walking programs focused on aerobic exercise, in which participants are active for 10-45 minutes per day, 4-6 days a week, have been shown to provide significant relief for CRF in chemotherapy and radiation therapy patients when compared to non-exercising controls.5 Another study showed that increasingly intense intervals of walking, specifically 7 days a week for a total of 33 minutes, led to fewer signs of CRF for patients undergoing hospitalization.5
Exploring Various Types of Training
While the duration of physical activity by cancer patients is important in relieving CRF, it is significant to consider the types of physical activity patients should be undergoing. The two main aspects of physical movement that have been emphasized for cancer patients are aerobic and resistance training. These types of training have been shown to provide relief in multiple key dimensions of healthcare involved with cancer, such as the intensity or tolerance of treatment plans.5 Aerobic training involves prolonged periods of muscle group utilization, such as walking, as described in the study mentioned above. This training has been associated with relieving sleep disruption, depression and anxiety, which in turn can improve CRF.6 Resistance training uses muscle contractions, often in the form of weight against the body. While this form of exercise focuses on enhancing muscle strength, it can simultaneously improve CRF. One study that combined aerobic and resistance training programs revealed their influence on a cancer patient’s tolerance to receiving extensive doses of treatment, without any explicit negative impact on fatigue.5 Participants in usual cancer care with no exercise received a treatment dose intensity of 84%; with a mix of aerobic and resistance training, the relative dose intensity increased to 89%.5 This was a promising result, since being able to receive a higher dose of treatment indicates a positive effect on body strength. By experiencing an enhancement in their treatment plan, further improvement can be seen in their condition and quality of life.
How is Fatigue Measured?
One of the factors that makes it challenging to determine the efficacy of physical activity in relieving CRF is the inability to accurately measure fatigue. Due to its subjective nature, it is hard to quantify the level of fatigue. One of the limitations in the studies discussed is how fatigue is measured, in which solely the perception of fatigue is taken into account by an external party.7 These perceptions may not accurately reflect the effects of physical activity on CRF. However, multidimensional measures of fatigue with psychometric properties, like the Cancer Fatigue Scale, could strengthen the findings of studies that explore levels of CRF.8
Eliminating side-effects of cancer, including CRF, is often glossed over in science or healthcare especially when compared to eliminating cancer itself. The desire to establish a physical activity regimen to mitigate fatigue varies greatly between cancer patients and depends on personal interests. Nevertheless, physical wellbeing, with an emphasis of improving quality of life, is an important aspect to consider. With growing concerns of quality of life, the investigation of convenient treatment plans like physical activity can be a revolutionary shift in healthcare for patients affected by dominant health issues, especially cancer.
1. World Health Organization. Cancer [Internet]. 2018 Sept 12. Available from: https://www.who.int/news-room/fact-sheets/detail/cancer#:~:text=Cancer%20is%20the% 20second%20leading,%2D%20and%20middle%2Dincome%20countries [cited 2020 Dec 20]
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7. Bersevick AM, Cleeland CS, Manning DC, O’Mara AM, Reeve BB, Scott JA et al. ASPCRO Recommendations for the Assessment of Fatigue as an Outcome in Clinical Trials. JPSM. 2010;39(6):1086-1099. Available from doi: 10.1016/j.jpainsymman.2010.02.006.
8. Jacobsen PB. Assessment of Fatigue in Cancer Patients. JNCI Monographs. 2004;2004(32):93-97. Available from doi:10.1093/jncimonographs/lgh010 9. Tello M. Exercise as part of cancer treatment [Internet]. Harvard Health Publishing. 2018 June 13. Available from: https://www.health.harvard.edu/blog/exercise-as-part-of-cancer-treatment-201806131403 5
10. Lowe SS, Tan M, Faily J, Watanabe SM, Coreya KS. Physical activity in advanced cancer patients: a systematic review protocol. BMC Systematic Reviews. 2016;5(43). Available from doi: /10.1186/s13643-016-0220-x