Hormone Therapy

In 1996, the first Surgeon General's report on physical activity and health was published, including the currently accepted public health recommendations for physical activity for general health, 20 minutes of moderate intensity activity - such as brisk walking - on most days of the week. This recommendation has been adopted by the American Cancer Society and is included in the current recommendations from the American Cancer Society in preventing cancer. Exercise has many proven health benefits for both preventing disease and promoting health and well being. There is substantial evidence that suggests that increasing physical activity, including structured exercise programs, is associated with lower rates of certain cancers. In particular, there is evidence that high levels of physical activity can work to prevent colon cancer. Cancers of the breast, prostate, lung, and uterus have also been linked to exercise-related prevention. In a large scale study of 17, 148 Harvard alumni, men who burned as few as 500 calories a week in exercise - the equivalent of an hour's worth of brisk walking or less than ten minutes of waking a day - had death rates 15-20 percent lower than men who were almost completely sedentary. Men who burned 2,000 calories a week (about four hours of brisk walking per week) had about 35 percent lower cancer mortality. The researchers concluded that the more exercise you get, the lower your risk of premature death from cancer or heart disease. The Harvard study also found that the risk of colon cancer, the second leading cause of cancer-related death in the U.S., was dramatically reduced by exercise. Prostate cancer is the most common cancer affecting men today. In the Harvard study, alumni who expended greater than 4,000 calories per week (equivalent to about eight hours of brisk walking) were at a reduced risk of developing prostate cancer compared to their inactive counterparts. For women, a history of moderate, recreational exercise is associated with reduced risk of breast, uterine, cervical, and ovarian cancers, although not all studies have shown this effect. Findings from a 1993 study suggest that women engaged in moderate to high levels of physical activity may have a reduced risk of endometrial cancer. Currently, scientists are studying the biological impact that exercise has on the risk of cancer.

Some of the methods that are being studied include:

• Maintenance of a healthy body weight and overall amounts of body fat.
• Maintenance of low levels of fat in and around the abdomen.
• Maintenance of the biological system that regulates blood sugar levels.
• Control of some tumor growth factors.
• Suppression of 'prostaglandins' (hormone-like substances that are released in greater quantities by tumor cells).
• Improved immune function, including increased levels of Natural Killer cells.
• Reduced symptoms of mild to moderate anxiety and depression (which may improve immune function and overall physiologic functioning).
• Increased levels of free radical scavengers to assist the body in preventing DNA damage

It is not clear exactly how high amounts of physical activity work to prevent cancer. We know that exercise can help prevent obesity, which is related to some types of cancers. It can also change the body's hormone levels, which might also have a favorable effect. Exercise, by speeding up metabolism, is generally believed to speed up the passage of ingested foods through the colon - thus reducing the amount of time the colon mucosal lining is in contact with possible carcinogens. Additionally, those who engage in a high level of physical activity are much less likely to smoke cigarettes, the single largest contributor to cancer.

Benefits of exercise during treatment

Starting or maintaining an exercise program after cancer diagnosis results in patients who are stronger both mentally and physically, concludes a statistical analysis of 24 studies. Kerry Courneya of the University of Alberta, Canada led the research, which is published in the Annals of Behavioral Medicine. Courneya says "Cancer diagnosis and its' treatments are often associated with negative side effects that diminish the quality of life. Overall, studies have consistently demonstrated that physical exercise following cancer diagnosis has a positive effect on the quality of life." The various studies mention increased stamina, increased functional capacity, strength, self-esteem, improved treatment tolerance, and satisfaction with life, and decreased pain. Psychological changes, including a decrease in total mood disturbances, decrease in depression, and fewer problems sleeping were noted between the exercise and non-exercise groups. It has also been noted that increased physical activity has been associated with less fatigue during and after chemotherapy and radiation. The specific exercise "dose" (frequency, intensity, and duration of sessions) needed to improve physical and psychological functioning in cancer patients probably differs according to specific treatment, cancer type, and individual response to treatment. Some forms of cancer treatment, particularly those that are used to treat childhood cancers, have been found to have long-term negative effects on the heart and lungs. This makes it even more important to exercise regularly, but it may important to do so under medical supervision. Fatigue is the number one side effect of cancer treatment affecting 76% of patients undergoing treatment. Cancer fatigue is not like everyday fatigue that one experiences due to lack of sleep, stress, overextending oneself etc.... This type of fatigue is not usually relieved by rest and can have a negative effect on one's quality of life. There are many things that may lead to fatigue, but one thing is certain; exercise reduces fatigue. Research has demonstrated that beginning or maintaining an exercise program during cancer treatment can have a positive effect on combating fatigue.

Benefits of exercise during recovery from surgery

After cancer surgery exercise plays an invaluable role in helping one return to the strength and fitness level that was maintained prior to surgery. In many cases, due to lack of physical activity prior to surgery, patients are able to reach new heights in strength, flexibility, and cardiovascular conditioning. There are certain postural implications that often arise after mastectomy and lymph node dissection that are often compounded by reconstruction and radiation. After years of working with cancer survivors, we declare with certainty, that most of these issues can be dramatically improved upon if not entirely corrected, through the proper combination of stretching and strengthening. Anytime there is an amputation, it will ultimately result in some type of muscle imbalance. These issues will not correct themselves. Unfortunately, even patients who undergo physical therapy are released long before they are fully recovered, leaving the patient to go it alone in determining how to resume normal activities. In addition, when patients receive radiation to a particular area, there is bound to be some tightness, perhaps even scar tissue, where they received treatment. This can cause tightening in that area, and depending on where it is, can also contribute to many postural deviations. These postural imbalances are notable in most people due to everyday circumstances i.e.; working at a computer all day, holding a phone between your ear and your shoulder, sitting at a desk all day, holding a baby on one hip etc... Not only are they compounded by the surgery and radiation, but they can create a chain reaction, leading to neck, back, hip, knee, and even ankle pain. A thorough postural assessment can determine what areas need to be stretched to relieve tightness and spasm and which need to be strengthened to create a counter balance. Let's not forget about the many benefits of cardiovascular conditioning. Many of you may still be suffering from fatigue long after your treatment has ended. Cardiovascular training, biking, walking, running, etc., will produce endorphins that will give them much needed energy. Unfortunately chemotherapy and radiation can have a detrimental effect on the heart and lungs. The good news is that both can be strengthened through a regular cardiovascular exercise program. Swimming can provide an excellent source of relief for tight muscles without putting excessive strain on them. The buoyancy of the water allows for a wonderful workout that allows you to focus on range of motion for your arms and shoulders. This is highly recommended for breast cancer patients, particularly those who have undergone an axillary node dissection. Swimming should not be limited only to breast cancer patients, however, for it has benefits for everyone. Those clients suffering from arthritis will want to make sure the water is at least eighty-four degrees

Strength Training

Strength training is a very important component of an exercise program, however, without a proper assessment, it can create more problems than it can prevent. Proper attention must be paid to not only your goals, but your bodies' needs. This can be accomplished by conducting a postural evaluation to look for muscle imbalances that may lead to degeneration of the joints over time. It is critical to determine which muscles are shortened, or overly tight, so that proper attention can be paid to stretching those muscles first. This will help you to regain normal range of motion and functioning. If you begin strength training before addressing the muscular imbalance, it can lead to a greater imbalance and degeneration. Done properly however, strength training can lead to an increase in lean muscle mass which will not only give a desirable physical appearance, it can help to prevent obesity and osteoporosis. Obesity is the fastest growing health problem in the United States. Obesity is not only associated with other diseases, it has a huge emotional impact as well. There is distinct connection between obesity and Type II diabetes. This is of particular concern when dealing with cancer patients. Following chemotherapy and certain hormonal therapies, many cancer patients find themselves gaining weight. Many were over their ideal weight to begin with are now struggling with a serious weight problem in addition to their cancer diagnosis. Obesity is not only connected to Type II diabetes, it is also thought to be associated with certain types of cancer, yet another compelling reason to start exercising, eating right, and losing weight.

For those of you who have undergone a lymph node dissection, or radiation to the lymph nodes and vessels, you are now at risk for lymphedema. Lymphedema is the swelling of an area do to damage to, radiation, or removal of lymph nodes and vessels. It is usually a permanent and irreversible condition that is both painful and disfiguring. Having an excess amount of body fat can actually increase your risk for lymphedema because the fatty tissue retains fluid. Both men and women who are undergoing hormonal therapy are at risk for osteoporosis. This risk is magnified if you have also undergone chemotherapy. In addition to osteoporosis, men may also experience a loss in lean muscle tissue over time. The good news is that strength training can help to reduce body fat by increasing lean muscle mass, increase bone density and prevent osteoporosis, and prevent and/or manage Type II diabetes.

In summary, the benefits of strength training:
• Increase lean muscle mass; better physical appearance, higher metabolism, less body fat
• Reduces the risk of Type II diabetes and lymphedema by reducing the amount of body fat
• Reduces the risk of osteoporosis by increasing bone mass

Aerobic (cardiorespiratory) training

Aerobic training is exercise that places a stress on the cardiorespiratory system. Any form of activity can be used; walking, biking, basketball, strength training, etc. All forms of exercise must utilize the cardiorespiratory system to either sustain and recuperate from the activity. Many people who have undergone chemotherapy and radiation may have damage and scarring of the heart and/or lungs. Aerobic exercise can help to strengthen the heart and lungs, minimizing the amount of damage they will sustain. As with strength training, aerobic exercise helps one to maintain their ideal body weight thereby reducing the risk for diabetes, future cancers associated with obesity, heart disease, high blood pressure, high cholesterol, and lymphedema. It is critical to perform a warm-up to prepare the body for physical activity. There are two types of warm-ups; general and specific. A general warm-up consists of movements that are not specific to the activity to be performed. A specific warm-up more closely imitates movements form the actual activity. NASM suggests that the cardiorespiratory portion of a warm-up should be five to ten minutes long at a low-to-moderate intensity. On a scale of 1-10, 1 being bed rest and 10 being all out exertion, aim for a five! If you don't have an exercise machine, climb stairs, march in place, walk around the block, shoot some hoops, etc. If you would like to continue to do your aerobic exercise beyond five to ten minutes, go ahead and increase the intensity. Try pushing yourself to a 6 OR 7 on that scale of 1-10. Remember that this is general advice. If you have a heart condition, high blood pressure, have had a stroke, or any other special consideration, please consult your doctor for specific recommendations. Additionally, if you have had lymph nodes removed or had radiation to lymph nodes or lymphatic vessels, you must not allow yourself to overheat. Overheating will increase your circulation and can lead to the onset of lymphedema. If you already have lymphedema, the same rule applies because it can worsen your condition. If you have not been exercising regularly, begin with 10-20 minutes of aerobic activity three times a week. Gradually increase the time (duration) and number of workouts (frequency) to meet your goals.
Once you have completed your warm-up, it will be time to stretch. Specific stretches will be outlined for each type of cancer and particular surgeries.

In summary, the benefits of aerobic training:

• Increase lean muscle mass; better physical appearance, higher metabolism, less body fat
• Reduces the risk of Type II diabetes and lymphedema by reducing the amount of body fat
• Reduce the risk of heart disease, high blood pressure, and high cholesterol

Flexibility Training

Flexibility is overlooked by most of us. Lack of flexibility may lead to long-term joint degeneration, overuse injuries, and muscle imbalances. By definition, flexibility is the extensibility (ability to lengthen) of all soft tissues that allow a joint to move within it's full range of motion. Your muscular, skeletal, and nervous system make up your kinetic chain. Your kinetic chain must be aligned properly to prevent patterns of joint dysfunction. When things are not properly aligned, it is known as postural distortion. Postural distortion leads to decreased neuromuscular efficiency and tissue overload. In laymans' terms, injury! Your primary goal needs to be to maintain homeostasis of your kinetic chain. Imagine a chain link fence. Your dog skurries his way underneath the fence for years. You think nothing of it. Gradually the fence becomes distorted; some of the links are squashed together, the metal is buckling, there is a big gap in the bottom, it's structural integrity is weakened. Now imagine the same thing happening to your spine. It may not be noticeable now, but over the course of time it, too, will deteriorate and weaken. Muscle imbalances may be caused by cause a variety of external and internal influences; poor posture, emotional stress, repetitive movements (tennis, golf, bowling, etc.), cumulative trauma, poor training technique and form, lack of core (abdominals and low back) strength, and lack of neuromuscular control. Following surgery and radiation, there is usually a foreseeable amount of scar tissue and, in some cases, adhesions that can bind the joint and inhibit movement. This would fall under the trauma category. Under each type of cancer and their respective surgeries, I will address particular postural and kinetic chain concerns and how to correct them. If these issues are not corrected, you will find yourself stuck in a cumulative injury cycle. When there is a dysfunction in the connective tissues of the kinetic chain, the body views it as an injury. As a result, the body will initiate the repair process.

Remember that although beneficial in many ways, strength training creates trauma to the tissue which will then lead to inflammation. The bodies' protective mechanism will increase muscle tension and cause a muscle spasm. As a result of the spasm, adhesions (knots) begin to form in the soft tissue. The adhesions make the normally elastic soft tissue unable to stretch. The end result is muscle imbalance and altered joint motion. If this is not corrected, the adhesions can begin to form permanent structural changes in the soft tissue.

In summary, benefits of flexibility training:

• Increase range of motion in joint movements
• Injury prevention
• May help to prevent arthritis and other degenerative joint disorders
• Eliminates neck, shoulder, back, hip, knee, ankle, and other associated pains

Functional Fitness Training

Functional fitness is the ability to perform one's activities of daily living free of pain and with a relative degree of ease. Most of us take this one for granted, at least until it's gone! Every day we awake from bed, use the bathroom, take a shower (wash your hair and body), brush your teeth, blow dry your hair, put on your underwear, put on your clothes, put on and tie your shoes, etc. Did it ever occur to you that if you had an injury, or a muscle imbalance, it could become relatively impossible to perform one of these otherwise mundane tasks? Well, it's true! In a perfect world we would sit up straight in our chairs, walk with our shoulders back, not carry a heavy briefcase or bag on one shoulder, bend our knees when we bend to pick something up, and so on and so on. Unfortunately, because we live in a less-than-perfect world, most of us have not practiced these methods of self preservation and are now experiencing the aftermath of our poor decisions; pain. You may have been suffering with chronic neck and back pain for years, or you may be new to this game and just beginning to get aches and pains. In either case, flexibility training is the answer for you. Believe it or not, most of these nagging aches and pains are reversible with proper corrective training. Corrective training is a balance of strength training and flexibility training that is customized to meet your particular needs. Following your personal assessment, you will be able to identify the areas that need stretching as well as those that need strengthening. There are several different types of stretching; self-myofacial release, static stretching, and dynamic stretches. Each of these methods is described below.

Self-myofacial release: Using a foam roller, you apply gentle pressure to an adhesion or "knot" for 20-30 seconds. The force that is applied stimulates a relaxation response. This technique is recommended prior to static stretching, as well as during the cool down.

Static stretching: This is the most popular form of stretching. In this method, you passively take a muscle to the point of tension and hold it there for 15-30 seconds. This will stimulate a relaxation response. This method should be used following self-myofacial release and as part of a cool down.

Dynamic stretching: Dynamic stretching uses the force produced by a muscle, along with the body's momentum, to take a joint to the full available range of motion. Rather than hold a stretch for 15-30 seconds, one can perform a set of ten repetitions of dynamic stretches. This is a more advanced method of stretching that can also be used as a warm-up prior to activity. It is recommended that you have good levels of flexibility, core stability, and balance capabilities prior to engaging in a dynamic stretching program