A Common Patient Question: How Can Chemotherapy Adverse Effects Be Reduced?

For people with cancer, a leading item on the list of “questions for the doctor” is “what they can do to reduce treatment adverse effects”. Patients often ask about vitamins, antioxidants, foods or herbal products as supplements to reduce adverse effects. These often have more potential to harm than to help. A frequently overlooked approach may be the best way to ease adverse effects: exercise!

Exercise During Chemotherapy

A new study of 266 patients receiving chemotherapy for colon, breast or testicular cancer or non-Hodgkin lymphoma found that exercise during chemotherapy helps patients overcome treatment’s debilitating effects and return to normal life sooner.

Study Design

All participants undertook a 6-month exercise programme. Half began during chemotherapy (3 months before it ended), while the other half began afterwards. Earlier research had shown benefits of exercise for people with cancer, but this was the first study examining how exercise timing might affect the impact of treatment.

Peak Exercise Capacity

Peak exercise capacity is defined as “ the maximum ability of the cardiovascular system to deliver oxygen to exercising skeletal muscle, and of exercising muscle to extract oxygen from the blood”.

Peak VO2 is an indicator of overall fitness. Those exercising during chemotherapy had a smaller decline in peak VO2 when chemotherapy ended. At that point, their peak VO2 had fallen by about half as much as the other group’s (–2.8 mL/kg/min versus –5.8 mL/kg/min).

The exercise group reported less loss of strength, quality of life and physical functioning, and experienced less fatigue than those not exercising.  

Dr Annemiek Walenkamp, an oncologist at University Medical Center Groningen in the Netherlands, says: “Even when patients are tired from treatment, exercise can change muscle strength and improve physical condition.”

Exercise for Fitness After Cancer Treatment Too

Walenkamp explains that exercise causes cellular changes and stimulates mitochondrial production in muscle cells. “More mitochondria increase the amount of energy your body has. Exercise also improves oxygen circulation, helping you use energy more efficiently.” she adds.

If exercising safely during chemotherapy is not possible, a programme started afterwards can still help. All study participants regained their baseline fitness 1 year after completing the exercise programme, regardless of when they began.

Maintaining lung and heart fitness matters for people with cancer because it can improve survival. Another study found that every 1 MET (metabolic equivalent: the energy expended while sitting still) gained during an exercise test reduced the risk of cancer death by 25%.

What Types of Exercise Should People with Cancer Do?

In the Dutch study, participants did 30 minutes of cardio exercise (stationary cycling or a treadmill) 3 days a week, 20 to 30 minutes of weight training twice a week, and a recreational sport such as floor hockey, football or badminton once a week. They worked with a physiotherapist for the first 3 months and were asked to continue the routine independently for the last 3 months.

Walenkamp says more research is needed to identify the safest training for different cancers. People with lung or bone cancer, for example, need extra care and should work with a physiotherapist specialising in helping people with cancer.

In conclusion, with safety precautions, all patients with cancer can benefit from an exercise programme.