- Researchers in the Netherlands conducted a 5-year study on cancer patients receiving chemotherapy to assess whether the timing of an exercise program makes a difference in cardiorespiratory health.
- The researchers placed the participants in one of two groups: patients who exercised during their chemotherapy program and patients who exercised after their chemotherapy treatment program was over.
- The researchers observed that patients may see an improvement in cardiorespiratory health more quickly if they begin exercising during treatment.
Chemotherapy is a standard cancer treatment, but it often comes with a lot of negative side effects. One issue chemotherapy causes is that it reduces peak oxygen uptake in patients.
With this in mind, researchers at various hospitals in the Netherlands worked together to try to pinpoint the impact exercising either before or after chemo treatments can have.
The latest study on the topic is published in JACC: CardioOncology.
Side effects of chemotherapy
Cancer affects millions of people. The American Cancer Society (ACS) estimated that doctors diagnosed around 1.9 million new cancer cases in 2021 and that nearly 610,000 people died from cancer.
There are a number of ways to treat cancer, such as extracting cancerous tumors through surgery or using radiation treatments. However, the cancer treatment depends on the form of cancer and how far it has progressed.
Doctors often treat patients with cancer with chemotherapy. According to the ACS, chemotherapy “is considered a systemic treatment because the drugs travel throughout the body and can kill cancer cells that have spread to parts of the body far away from the original tumor.”
Some types of chemotherapy drugs include alkylating agents, antimetabolites, plant alkaloids, and antitumor antibiotics.
Chemotherapy often causes side effects:
- fatigue
- nausea and vomiting
- hair loss
- mouth sores
- anemia
Additionally, chemotherapy can affect cardiorespiratory fitness.
Exercising during or after chemotherapy?
The research team’s goal was to determine the impact the timing of an exercise regimen can have on the cardiorespiratory fitness of participants undergoing chemotherapy.
Doctors gauge a person’s cardiorespiratory fitness on their peak oxygen uptake (VO2peak). According to the National Institutes for Health, VO2peak is “a measure that combines cardiovascular and skeletal muscle oxidative function.”
“In previous studies in which patients did not attend an exercise intervention during or after adjuvant treatment (chemotherapy, radiotherapy, or hormonal therapy), a decline of up to 25% in VO2peak was found compared with healthy, sedentary women,” write the authors. “VO2peak and physical activity levels are strongly associated with cardiovascular risk.”
The researchers studied a group of 266 people who had one of the following cancer types: breast, testicular, colon, or lymphoma.
The researchers randomly placed the participants in one of two groups. Group A consisted of people who started a 12-week supervised exercise program (36 sessions) during chemotherapy, followed by a further 36 sessions over 12 weeks of home-based exercise after chemotherapy. Group B consisted of people who began their 24-week exercise program after finishing chemotherapy.
During the supervised portion of the intervention, the participants rode a stationary bicycle for cardio exercise and lifted weights or used weight machines for muscle strengthening. The researchers assessed the participants’ VO2peak levels via bicycle ergometers.
After determining the participants’ baseline VO2peak levels, the researchers checked their levels at varying times depending on which program they were in. The researchers also checked in with the participants 1 year after finishing both their chemotherapy treatments and exercise programs.
Exercising during chemo provides a boost
Regardless of when the participants started their exercise programs, both groups were back to their baseline scores at their 1-year checkup.
However, the VO2peak levels of people who participated in the exercise program during their chemotherapy treatment period did not decline as much, and at 3 months following their treatment window, their levels had returned to normal. In comparison, the VO2peak levels in Group B declined for a longer period but also caught up after their 3 months of supervised exercise post-chemotherapy.
“These findings suggest that the most optimal timing of physical exercise is during chemotherapy,” says study author Dr. Annemiek M.E. Walenkamp. “However, initiating a physical exercise program after chemotherapy is a viable alternative when exercising during chemotherapy is not possible.
Dr. Walenkamp is an oncologist at the University Medical Center Groningen in the Netherlands.
“We hope our findings motivate healthcare providers to guide patients to engage in exercise interventions during anti-cancer treatment,” says Dr. Walenkamp.
Advice for exercise during cancer treatment
Dr. Rami Hashish, body performance and injury expert and founder of National Biomechanics Institute, spoke with Medical News Today about the study.
Dr. Hashish noted that the study provides “evidence that supervised aerobic and anaerobic exercise during chemotherapy can help prevent fatigue and limit losses in muscle strength and cardiorespiratory fitness, in turn resulting in a higher quality of life relative to not performing exercise.”
“The findings further suggest that all is not lost in individuals who cannot exercise during chemotherapy, as a supervised exercise program upon the completion of chemo will allow these patients to achieve similar levels of function within one year.”
— Dr. Rami Hashish
Dr. Hashish said that people undergoing chemotherapy treatments should talk with their doctors about what is best for them in terms of exercise but thought walking and riding on a stationary bike could be safe.
“I would caution against the intensity of exercise as opposed to avoiding a particular exercise, although the intensity will be dictated by one’s particular condition and should also be set by a supervising medical practitioner,” said Dr. Hashish.
Dr. Samantha Edwards, a physical therapy provider, also weighed in and said the study “demonstrates the immediate impact of exercise in the prevention of decline during chemotherapy.”
Dr. Edwards is the assistant manager for rehabilitative services at Atlantic Rehabilitation in Cedar Knolls, New Jersey. She oversees the Moving Beyond program, an exercise program for oncology patients post-treatment.
There are numerous benefits to exercising during chemotherapy treatments, which Dr. Edwards elaborated on for MNT.
“These can include improved fatigue, cardiovascular endurance, strength, and quality of life,” said Dr. Edwards. “Exercising can also help improve patients’ balance, which can be impacted during chemotherapy if the patient is struggling with peripheral neuropathy.”
“A balanced program that includes cardiovascular exercise in conjunction with a strengthening program that targets the body’s major muscle groups is preferred. The intensity of the exercise should always stay in the low to moderate range and should be dictated by the patient’s healthcare provider.”
— Dr. Samantha Edwards
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