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Medical Forum / Diseases and Disorders / Breast Cancer / June 2005Exercise reduces fatigue after breast cancer
Merritt McKinney, "Exercise reduces fatigue after breast cancer", Reuters, June 14, 2005, Link: http://www.reuters.com/newsArticle.jhtml?type=healthNews&storyID=8787653 After being treated for breast cancer, women who engage in moderate exercise have more energy and feel better about their bodies than less active women, a study shows. Women treated for breast cancer often experience fatigue that can be long-lasting, study author Dr. Bernardine M. Pinto told Reuters Health. "Physical activity can help manage this problem," according to Pinto, who is at Brown Medical School and Miriam Hospital in Providence, Rhode Island. Her team's findings demonstrate "that increased physical activity is feasible, it can improve their fitness, reduce fatigue and improve vigor" for women who have been treated for breast cancer, Pinto said. The study included 86 women who had undergone treatment for early-stage breast cancer. At the start of the study, none of the women exercised regularly. Half of the women were randomly assigned to participate in a home-based exercise program. Each week for 12 weeks, a researcher called these women to monitor their physical activity. The eventual goal was 30 minutes of moderate physical activity --walking, biking, swimming or home exercise equipment -- at least five days per week. The other half of the women also received weekly phone calls for 12 weeks, but they were not encouraged to increase their physical activity. Women in the home-exercise program reported higher levels of physical activity than the other women, the researchers report in the Journal of Clinical Oncology. What's more, women in the exercise group seemed to be more physically fit at the end of the study. On average, they walked a mile in much less time than the other women. Women who exercised regularly also reported feeling more vigor and less fatigue than women who remained sedentary. There were signs that exercise had psychological benefits as well. Women in the exercise program were somewhat more likely to have a healthy body image. However, the difference in body image was not statistically significant, which means it could have been the result of chance. Commenting on the findings, Pinto noted that much attention has been placed on the benefits of exercise for preventing chronic disease. "This study showed evidence of potential benefits of physical activity for fitness and psychological health after disease diagnosis," she noted. One of the exciting aspects of the exercise program is that women were able to exercise at home, according to Pinto. "They didnt have to show up for exercise classes," she said. Women do not have to be natural athletes to benefit. In fact, the volunteers were "quite sedentary" at the start of the study, according to Pinto. The Rhode Island researcher is hopeful that the benefits of this program will not be limited to people who have been treated for breast cancer. "Stay tuned," Pinto said. "We have a similar study that we plan to offer to patients with colorectal cancer." The researchers also have plans for a study that would incorporate the home-based exercise program into routine post-treatment cancer care. SOURCE: Journal of Clinical Oncology, May 20, 2005. > Merritt McKinney, "Exercise reduces fatigue after breast cancer", > Reuters, June 14, 2005, [quoted text clipped - 4 lines] > exercise have more energy and feel better about their bodies than less > active women, a study shows. Does this belong in the category of research into the blindingly obvious? Surely this can be said about the population in general, not just women and not just cancer patients, so would be surprising if it did not extend to that group. Tim Jackson > > Merritt McKinney, "Exercise reduces fatigue after breast cancer", > > Reuters, June 14, 2005, [quoted text clipped - 6 lines] > > > Does this belong in the category of research into the blindingly obvious? ----------- Thank you! Those who feel *well enough* to engage in moderate exercise are obviously going to be the ones who feel better in the first place. It's circular reasoning. Eva >> Merritt McKinney, "Exercise reduces fatigue after breast cancer", >> Reuters, June 14, 2005, [quoted text clipped - 6 lines] >> > Does this belong in the category of research into the blindingly obvious? Yes. > Surely this can be said about the population in general, not just women > and not just cancer patients, so would be surprising if it did not extend > to that group. Yes. It beggars belief that such a thing can be researched and reported! Mary > Tim Jackson >>>Merritt McKinney, "Exercise reduces fatigue after breast cancer", >>>Reuters, June 14, 2005, [quoted text clipped - 16 lines] > > It beggars belief that such a thing can be researched and reported! A couple of points, just to be tiresome & pedantic (and, as usual, contrary). 1. IMO, part of the nature of "science" is that the blindingly obvious needs to be tested/proven in a disciplined way. Sometimes the blinding obvious is plain false. (The sun doesn't set. The earth rotates. <g> But the principle applies even in small ways. Doctors considered it blindingly obvious that we should restrict the weight born by our axillary-dissection side arms, it seems?) 2. There is potentially a difference in exercise effects between cancer patients and others, I would think. If blood counts are depressed by chemo, ought one to conserve energy, or expend it? Looks like when you expend it, you're really investing it, just like relatively-more-well people. While that's certainly what I'd hope for and expect, it seems conceivable that the result could've been different among those whose physiology was being stressed by other factors (chemo, radiation, surgery). Ann T. Remove 'dontsendspam' from address to reply by email >>>>Merritt McKinney, "Exercise reduces fatigue after breast cancer", >>>>Reuters, June 14, 2005, [quoted text clipped - 22 lines] > 1. IMO, part of the nature of "science" is that the blindingly obvious > needs to be tested/proven in a disciplined way. Of course it does. But do you consider that a sample of 86 people - all bc people - is sufficient to prove something 'in a disciplined way'? And half of those were the control group! Now, to prove that it's particularly beneficial to bc people means that you should have 86 NON bc people as a larger control group. I bet if that were done in exactly the same way (half being encouraged to exercise and half not) the results would be the same in the non bc group as in the bc group. And I'm not a betting man :-) > Sometimes the blinding obvious is plain false. (The sun doesn't set. > The earth rotates. <g> But the principle applies even in small ways. > Doctors considered it blindingly obvious that we should restrict the > weight born by our axillary-dissection side arms, it seems?) I'm not sure what you mean by that. I've never heard of any general restriction of weight borne by axillary dissection side arms, only dependent weight bearing ... and even then, I can't see why it's blindingly obvious that it should be restricted. I was surprised to be told that (and fail most of the time to follow the advice<G>) > 2. There is potentially a difference in exercise effects between cancer > patients and others, I would think. If blood counts are depressed by > chemo, ought one to conserve energy, or expend it? Ah well, I looked again at the post, I can't see anything about chemo ... > Looks like when you expend it, you're really investing it, just like > relatively-more-well people. While that's certainly what I'd hope for > and expect, it seems conceivable that the result could've been different > among those whose physiology was being stressed by other factors (chemo, > radiation, surgery). In UK, as far as I can see, post operative patients of all kinds are encouraged to exercise moderately. Abdominal surgery patients seem to be given advice about certain activities and there ARE some blindingly obvious facts - such as a patient with both legs amputations not being allowed to touch his toes (I made that up!) I'm still with Tim on this one. Sorry, Ann, I hate disagreeing with you. Well, that's not 100% true either, you're a great sparring partner :-) Mary Note newsgroups trimmed (just realized how broadly this was cross-posted!) >>1. IMO, part of the nature of "science" is that the blindingly obvious >>needs to be tested/proven in a disciplined way. > > Of course it does. But do you consider that a sample of 86 people - all bc > people - is sufficient to prove something 'in a disciplined way'? And half > of those were the control group! \\ No, but it's a start. > Now, to prove that it's particularly beneficial to bc people means that you > should have 86 NON bc people as a larger control group. Yup, and a few thousand more of each to make it statistically persuasive. >> Sometimes the blinding obvious is plain false. (The sun doesn't set. >>The earth rotates. <g> But the principle applies even in small ways. [quoted text clipped - 6 lines] > that it should be restricted. I was surprised to be told that (and fail most > of the time to follow the advice<G>) I've seen multiple lymphedema-avoidance guides that said "don't lift more than 10 (or 5 or 15) pounds with the affected arm". And *I* don't consider it blindingly obvious that lifting heavy stuff would be a problem. I'm thinking of my surgeon's comment about where these precautionary lists came from: Lymphedema specialists saw women who had lymphedema, and tried to explain to their own satisfaction what caused it. From that perspective, it apparently seemed blindingly obvious (to those doctors) that carrying heavy stuff could cause lymphedema. >>2. There is potentially a difference in exercise effects between cancer >>patients and others, I would think. If blood counts are depressed by >>chemo, ought one to conserve energy, or expend it? > > Ah well, I looked again at the post, I can't see anything about chemo ... Assumption on my part that for a substantial fraction of the study group, "treatment" would include chemo. > In UK, as far as I can see, post operative patients of all kinds are > encouraged to exercise moderately. Abdominal surgery patients seem to be > given advice about certain activities and there ARE some blindingly obvious > facts - such as a patient with both legs amputations not being allowed to > touch his toes (I made that up!) In my personal experience, I was not *dis*couraged from exercising. But I sure as heck didn't feel like exercising (even beyond my natural laziness that applied pre-treatment). I "knew" that exercise was good for me in general. Now there's more research evidence (even of a preliminary/small-scale nature) that's coming out to document that there are no contraindications to exercise, that it *does* combat the fatigue, that it minimizes bone/muscle depletion during chemo, and that it improves survival/recurrence outcomes. And experience (my own & meeting/learning about others) is suggesting that the extent of movement restrictions or aches & pains post-treatment is more than I knew going in. So, I guess I wish there were more active emphasis on prescribing/dictating/exhorting breast cancer patients to get exercise, physical therapy, etc., as part of an overall treatment plan. Ann T. Remove 'dontsendspam' from address to reply by eamil > Note newsgroups trimmed (just realized how broadly this was cross-posted!) > [quoted text clipped - 11 lines] > > Yup, and a few thousand more of each to make it statistically persuasive. Indeed, that's my point. >>> Sometimes the blinding obvious is plain false. (The sun doesn't set. >>> The earth rotates. <g> But the principle applies even in small ways. [quoted text clipped - 11 lines] > consider it blindingly obvious that lifting heavy stuff would be a > problem. No. And in my life, not lifting things which weighed more than those suggested would mean that I'd do hardly anything, my life would virtually end :-( > I'm thinking of my surgeon's comment about where these precautionary lists > came from: Lymphedema specialists saw women who had lymphedema, and tried > to explain to their own satisfaction what caused it. From that > perspective, it apparently seemed blindingly obvious (to those doctors) > that carrying heavy stuff could cause lymphedema. Have you any idea why? Was it perhaps handed down from previous generations of doctor/tutors? Or wasthere statistical evidence? I suppose that it might affect some people some of the time. >>>2. There is potentially a difference in exercise effects between cancer >>>patients and others, I would think. If blood counts are depressed by [quoted text clipped - 5 lines] > Assumption on my part that for a substantial fraction of the study group, > "treatment" would include chemo. Oh, I didn't think of that, I didn't think it :-) >> In UK, as far as I can see, post operative patients of all kinds are >> encouraged to exercise moderately. Abdominal surgery patients seem to be [quoted text clipped - 6 lines] > that applied pre-treatment). I "knew" that exercise was good for me in > general. But weren't you given specific exercises to do? We had sessions in hospital, the whole ward (except those who were recovering from anaesthesia) were allowed no excuse :-) It WAS awful at first but those of us who persisted certainly benefited and have maintained full arm movement. Those who lapsed when they got home are sorry now and can't be persuaded that they could begin again. > Now there's more research evidence (even of a preliminary/small-scale > nature) that's coming out to document that there are no contraindications > to exercise, that it *does* combat the fatigue, that it minimizes > bone/muscle depletion during chemo, and that it improves > survival/recurrence outcomes. That's been the message in UK for years, but for the whole population. About twenty years ago over sixties were encouraged to exercise to improve their health and wellbeing. Now children are being encouraged (largely to combat obesitywhich brings its own health problems). > And experience (my own & meeting/learning about others) is suggesting that > the extent of movement restrictions or aches & pains post-treatment is > more than I knew going in. Oh ... > So, I guess I wish there were more active emphasis on > prescribing/dictating/exhorting breast cancer patients to get exercise, > physical therapy, etc., as part of an overall treatment plan. I assumed that, if anything, you'd be far ahead of us in that as in most other things. There's so much to learn - so little time to learn it in :-) Mary > Ann T. > Remove 'dontsendspam' from address to reply by eamil Hi All Been watching this discussion for days regarding arm lymphedema, breast cancer and exercise. I must say that I totally agree with those who have been saying exercise is a good thing and vital to your overall health and recovery from cancer. The concept behind the suggestion that you not "over-exert" an at risk arm or one that already has lymphedema is based on the body's inflammatory response to overly strenous exercise. The typical response is edema, thus if the arm already has lymphedema adding inflammatory edema on top of that would overwhelm the lymphatics even more. However, having said that I always urge just good basic common sense. I personally feel your body will let you know when you get to the point ox over exertion. I have lymphedema and am also a cancer survivor of two lymphomas. It drives me nutso when people suggest that with lymphedema you should do nothing but sit and let life go by. Here's a page with a bunch of info that might be helpful on arm lymphedema http://www.lymphedemapeople.com/thesite/arm_lymphedema.htm Pat Lymphedema People http://www.lymphedemapeople.com > Hi All > [quoted text clipped - 14 lines] > I personally feel your body will let you know when you get to the point > ox over exertion. Hurrah! > I have lymphedema and am also a cancer survivor of two lymphomas. It > drives me nutso when people suggest that with lymphedema you should do > nothing but sit and let life go by. With your arm resting at not higher than shoulder level ... :-) > Here's a page with a bunch of info that might be helpful on arm > lymphedema [quoted text clipped - 4 lines] > Lymphedema People > http://www.lymphedemapeople.com Thanks, Pat. Sound information is always good. Mary >>I've seen multiple lymphedema-avoidance guides that said "don't lift more >>than 10 (or 5 or 15) pounds with the affected arm". And *I* don't [quoted text clipped - 4 lines] > suggested would mean that I'd do hardly anything, my life would virtually > end :-( Yes! >>I'm thinking of my surgeon's comment about where these precautionary lists >>came from: Lymphedema specialists saw women who had lymphedema, and tried [quoted text clipped - 5 lines] > of doctor/tutors? Or wasthere statistical evidence? I suppose that it might > affect some people some of the time. AFAIK, it's simply experiential/subjective, based on looking for causes among those who got lymphedema, as my surgeon suggested. After all, that's about all doctors have to go on, in the absence of (or before) any research. I haven't found any research supporting the weight restriction (not that I'm a doctor -or- a research expert). I have the feeling the "old school" conservative trend was to minimize exertion/exercise in a lot of kinds of cases - post-surgical (for a variety of surgeries), post-heart-attack, etc. Nowadays, more and more, they're deciding it's better for us to be up & moving around (maybe even vigorously) as rapidly as possible. >>>In UK, as far as I can see, post operative patients of all kinds are >>>encouraged to exercise moderately. Abdominal surgery patients seem to be [quoted text clipped - 13 lines] > when they got home are sorry now and can't be persuaded that they could > begin again. Sure, I was given specific exercises to do multiple times/day. Basically stretchy, range-of-motion kinds of things. *Not* weight training, not aerobic exercise (which latter is what a lot of the more recent reseach seems to be looking at). The prescribed exercises were important, necessary, and helpful . . . but kind of wuss-y stuff on the grand scale of real exercise, if you know what I mean. Even simple yoga looked pretty intensive by comparison <grin>. I've now heard (on an exercise DVD for BC survivors that I just saw within the last few months) that bone loss and muscle wasting frequently/cusomarily happen during chemo (DVD said essentially that it's equivalent to up to 10 years of aging!) and that weight training during chemo can counteract that. Though it seems self-evident when you say it, I was never told that, and never thought of it myself (other things on my mind during treatment, I guess <grin>). I was also not particularly encouraged/exhorted to continue or ramp up aerobic exercise during treatment. There was a lot more of "rest when you're fatigued" than "exercise when you're fatigued", though I can't say anyone ever really said "don't exercise". (Although my chemo nurse was quite shocked/cross with me when she learned I'd shoveled my driveway before coming to chemo. For context, this was a big driveway -- couple hours work -- and something around a foot of wet snow, so constited fairly serious weight-bearing -and- aerobic exercise.) The recent research suggesting that aerobic exercise counters chemo-induced fatigue, -and- reduces or delays recurrence, suggests to me that there's a basis for trying to give BC survivors in treatment a whole different set of messages than the ones that got through to me. >>Now there's more research evidence (even of a preliminary/small-scale >>nature) that's coming out to document that there are no contraindications [quoted text clipped - 6 lines] > health and wellbeing. Now children are being encouraged (largely to combat > obesitywhich brings its own health problems). Yeah, the same is true here. My point is more that there are additional reasons to encourage it in the BC population, beyond the normal ones that apply to the population at large. That is, to make it in effect part of the treatment. > There's so much to learn - so little time to learn it in :-) You ain't just whistlin' "Dixie", lady! By the way, just for the record: I am no longer disagreeing with you & Tim on this thread. If you both disagree with me (on earlier points), then I'm 100% certainly surely definitely unquestionably WRONG. <g> Lovely chattin'! Ann T. Remove 'dontsendspam' to reply by email >>>> Merritt McKinney, "Exercise reduces fatigue after breast cancer", >>>> Reuters, June 14, 2005, [quoted text clipped - 9 lines] >> >> Yes. > A couple of points, just to be tiresome & pedantic (and, as usual, > contrary). [quoted text clipped - 5 lines] > blindingly obvious that we should restrict the weight born by our > axillary-dissection side arms, it seems?) True, I've nothing against conducting the experiment, or publishing the results somewhere deep in the pages of a learned journal, but a small trial which shows that what most people would expect to happen, happens, is hardly news. Or even a PhD thesis. > 2. There is potentially a difference in exercise effects between cancer > patients and others, I would think. If blood counts are depressed by [quoted text clipped - 3 lines] > conceivable that the result could've been different among those whose > physiology was being stressed by other factors (chemo, radiation, surgery). I don't think there is such a "blindingly obvious" outcome if it were being done actually during chemotherapy, but I'd still expect that mild exercise would boost your metabolism and increase your recovery rate. (And if that were the object of the study, then it is a lousy report not to mention it, and one would also want to look at the impact on nausea etc.) It seems to take fairly extreme exercise to sap other body systems of energy. I never heard of any level of exercise compromising the immune system, so I don't really see why it should be different under chemo. Tim |
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