Starting Exercise During Chemotherapy Helps Reduce Severity of Side Effects
People who started an exercise program while receiving chemotherapy had less severe side effects and got back to regular physical functioning faster than people who started exercising after completing chemotherapy, according to a Dutch study.
Still, one year after completing the exercise program, both groups had regained the same level of function they had before starting chemotherapy.
The research was published online on Oct. 18, 2022, by the journal JACC: CardioOncology. Read “Optimal Timing of a Physical Exercise Intervention to Improve Cardiorespiratory Fitness: During or After Chemotherapy.”
Chemotherapy side effects
Breast cancer cells grow and divide faster than healthy, normal cells. Chemotherapy affects rapidly dividing cells, such as cancer cells, more than it affects healthy cells. Still, chemotherapy medicines are powerful and can damage healthy cells, especially cells that grow and divide quickly, such as cells inside your mouth and intestines and cells that make your hair grow.
The side effects you have depend on the chemotherapy regimen you're on, the number of cycles you’re receiving, and your general health. Some of the most common chemotherapy side effects are:
fatigue
diarrhea
muscle loss
nausea
memory loss, or chemo brain
Exercise and breast cancer treatment
In May 2022, the American Society of Clinical Oncology (ASCO) released guidelines on exercise, diet, and weight management during breast cancer treatment — effectively making exercise a part of breast cancer care.
A study of more than 1,500 U.S. cancer survivors also showed how important it is to exercise after you complete breast cancer treatment. Survivors who didn’t exercise and sat most of the day were more likely to die from cancer or other causes than people who sat less and were more active, the study found.
About the study
In this study, the researchers wanted to see if having people start an exercise program during chemotherapy helped them maintain or improve cardiorespiratory fitness better than if they started an exercise program after completing chemotherapy.
The study included 266 people diagnosed with four different kinds of cancer:
139 people were diagnosed with breast cancer
95 people were diagnosed with testicular cancer
30 people were diagnosed with colon cancer
two people were diagnosed with lymphoma (cancer of the lymphatic system)
All the people lived in the Netherlands and joined the study between February 2013 and November 2018.
The researchers randomly assigned the people to an exercise program that started either:
during chemotherapy
about three weeks after they completed chemotherapy
The exercise program had people do 12 weeks of supervised exercise followed by 12 weeks of unsupervised exercise at home. Exercises included:
30 minutes of aerobic exercise three times a week on a stationary bicycle or treadmill
20 to 30 minutes of resistance training two times a week using free weights, such as barbells
one session a week of a sport, such as badminton, indoor hockey, or soccer
Because they had different chemotherapy regimens, people who started the exercise program during chemotherapy began exercising 12 weeks before finishing chemotherapy and exercising for 12 weeks at home after finishing chemotherapy.
The researchers assessed the people four times during the study:
before starting chemotherapy
after completing chemotherapy
after completing the exercise program
one year after completing the exercise program
During each assessment, the researchers measured the people’s:
peak oxygen uptake (VO2 peak), measured while they were riding a stationary bicycle; VO2 peak is an indicator of overall fitness
muscle strength
The people also filled out questionnaires so the researchers could assess:
health-related quality of life
fatigue
side effects
physical function
Overall, 75% of the people in the group that started exercising during chemotherapy and about 83% of the people in the group that started exercising after chemotherapy stuck with the exercise program.
There were no differences in VO2 peak between the two exercise groups right after the exercise program or one year after the exercise program.
Still, people who exercised during chemotherapy had less of a decline than people who started exercising after completing chemotherapy. This difference in VO2 peak decline was statistically significant, which means that it was likely because of the difference in when the exercise started rather than due to chance.
There were no differences in muscle strength between the two groups right after the exercise program or one year after the exercise program. In fact, a year after the exercise program ended, the people in both groups regained the muscle strength they had before starting chemotherapy.
Still, people who started exercising during chemotherapy lost less muscle strength right after completing chemotherapy than people who started exercising after completing chemotherapy.
One year after the exercise program ended, the people in both groups reported better health-related quality of life than they did before starting chemotherapy; there were no differences between the two groups.
Still, right after chemotherapy, health-related quality of life and physical function declined less in people who started exercising during chemotherapy than for people who started exercising after completing chemotherapy.
One year after the exercise program ended, there were no differences in general fatigue or physical fatigue between the two groups.
But right after chemotherapy, the people who started exercising during chemotherapy had less general fatigue and physical fatigue than people who started exercising after completing chemotherapy. People who started exercising during chemotherapy also didn’t have to reduce their level of physical activity as much as the people who started exercising after completing chemotherapy.
The rate of side effects was about the same in both groups:
People who started exercising during chemotherapy reported 27 side effects.
People who started exercising after completing chemotherapy reported 26 side effects.
The researchers said that one side effect in each group was likely related to the exercise program.
“Exercise can be performed during chemotherapy, prevents fatigue and decreases in VO2 peak, muscle strength, and [health-related quality of life], and hastens the return of function after chemotherapy,” the researchers concluded. “Also, if exercise cannot be performed during chemotherapy, a program afterward can allow patients to regain the same level of function, measured one year after completion of the intervention.”
What this means for you
The results of this study show that exercising during chemotherapy can lessen fatigue and help you lose less fitness and muscle mass than if you start exercising after completing chemotherapy.
But if you can’t safely exercise during chemotherapy because of side effects, this study also shows that starting to exercise after you finish chemotherapy helps restore your fitness and physical function.
The bottom line is that exercise can help you recover from chemotherapy, no matter when you do it. Essentially, exercise is part of your breast cancer treatment plan.
Finding the time to exercise almost every day can be challenging, especially if you’re recovering from breast cancer, are currently receiving treatment, or are busy with everyday life activities.
Starting slowly, especially if you’ve never exercised before, may help you stick with a routine in the longer term. Some people start walking for 15 to 20 minutes a day and work up from there after a few weeks. You may also want to consider slow bike riding or gentle stretching.
Some people prefer walking with a friend. It’s easier for some people to stick with a routine when they can exercise with someone.
It’s never too late to get moving, regardless of how old you are. And once you start, keep at it!
Learn more about exercise.
— Last updated on January 25, 2023 at 6:12 PM