Exercise is an important part of post-cancer care

Image result for nhs humourAustralia is one of the countries with better cancer care than UK.  Their recently issued guidelines recommend exercise as part of cancer treatment, for ALL cancer patients.

Their Dr. Prue Cormie says “If we could turn the benefits of exercise into a pill it would be demanded by patients, prescribed by every cancer specialist and subsidised by government. It would be seen as a major breakthrough in cancer treatment.”

This is echoed in the UK, but here it’s one of those things everyone agrees on, but does nothing about.

The Clinical Oncology Society of Australia (COSA) is very clear about its recommendations:

  • Exercise should be embedded as part of standard practice in cancer care and viewed as an adjunct therapy that helps counteract the adverse effects of cancer and its treatment.
  • All members of the multi-disciplinary cancer team should promote physical activity and help their patients adhere to exercise guidelines.
  • Best practice cancer care should include referral to an accredited exercise physiologist and/or physical therapist with experience in cancer care.

NHS paying lip service to this, but …..

Recent cut-backs have sneaked in which ‘they’ hope we won’t notice, such as

  1. Physios giving you an exercise ‘to get on with’, whilst they go elsewhere to supervise another patient.  They should stay to supervise you and ensure you are aligning your body correctly.
  2. Previously, when referred for a course of treatment, you were entitled to six exercise or hydrotherapy sessions.  At the JR in Oxford last week I was offered THREE sessions only, “because we are cutting down”.  Thanks a bunch.
  3. The top Level 7/8 Physios aren’t being replaced;  we now find ourselves looked after by newly-qualified physios, at a lower level, and without the expertise to deal with complex cases.

What evidence can we quote when asking for more/better care?

You could start with the powerful evidence that has come from Australia via the Chair of the COSA Exercise Cancer guidelines committee, Dr. Prue Cormie

Look up https://aftercancers.com/exercise-is-very-good-for-us/

for more

‘naughty’ tip: EVERY time you see a Consultant, ask if they recommend exercise.  As many survivors end up with one or all conditions, such as osteoporosis, lymphoedema, fatigue, weight gain, neuropathy etc.,  all of which benefit from exercise, get your consultants to ALWAYS include a request for you to be given physio  in their notes they send to your GP.

Then ask the GP to refer you for physio.  That way I managed to get far more sessions than the pathetic limit of six on the NHS!

So what other evidence is there?

On the research supporting the bold guidelines, Dr. Cormie states: “the level of evidence is really indisputable and withholding exercise from patients is probably harmful.”

There are hundreds of studies showing real, tangible benefits of exercise for patients with a variety of different cancers and at different stages.  Exercise specifically as an additional therapy for patients undergoing cancer treatment has been well-studied and associated with many benefits. In one analysis of 61 clinical trials of women with all stages of breast cancer, those who underwent an exercise program during treatment had significantly improved quality of life, fitness, energy, and strength, as well as significantly less anxiety, depression, and lower body mass index and waist circumference compared with the regular care groups. In another major analysis of 28 trials involving over 1,000 participants with advanced cancers (including leukemia, lymphoma, multiple myeloma, lung, breast, GI, and prostate), an exercise program during treatment was associated with significantly improved physical function, energy levels, weight/BMI, psychosocial function, sleep quality, and overall quality of life.

Many cancer patients also have diabetes, weight gain, etc. and with all of these there is ample evidence to show benefits.

COSA’s advice 

COSA advises that people with cancer should:

Avoid inactivity and be as physically active as they are able, with the goal of:

  • at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic exercise (e.g. walking, jogging, cycling, swimming) each week; and
  • two to three resistance exercise (e.g., lifting weights) sessions each week involving moderate- to vigorous-intensity exercises targeting the major muscle groups.

Their care team should:

  • tailor exercise recommendations to the individual’s abilities, anticipated disease trajectory, and health status
  • consult with accredited exercise physiologists and physical therapists as the most appropriate health professionals to prescribe and deliver exercise programs to people with cancer
  • promote these recommendations throughout treatment;

Include exercise as part of cancer treatment

Not only do COSA recommend exercise, BUT clinical trials and research has proven it helps keep down blood sugars (many cancer patients also have diabetes); it helps control fatigue, it’s proven to help with weight loss, in Italy I was told that if I didn’t undertake an exercise programme for osteoporosis I would be taken off a drug, and there are on-going trials re benefits of hydrotherapy on lymphoedema.

Nurse practitioner and cancer survivor Eileen Wyner, is four years in remission from lymphoma, “I was in very good physical shape when I got sick, but I got weak fast. I would walk the hospital hallways with my IV pole when I could, because I knew from being a healthcare provider how important it was to stay as active as I could. But I did not do anything for my arms at all.”

What about you?

Being treated for cancer, taking on exercise can sound overwhelming, but it’s important to remember to tailor the activity plan to yourself. Wyner suggests a little stretching and strengthening class during chemo infusions. “We were there all the time anyways, why not do something formal right then and there? It could be something basic and easy, modified for where the patients are at. It could really help people.”

Another tip: Hdrotherapy. Some areas have excellent facilities, but the NHS seems to hide them,  Initialy you receive six session, then can usually  self-refer for further sessions at a cost of £5 – £20 per session.  I was having this weekly in London;  when I moved to Oxfordshire and had to wait six months, I was horrified at how my health deteriorated.

And another tip! If you have private insurance, many companies have changed their policies and now encourage members to have physiotherapy as they acknowledge its massive benefits.  Check your policy to see if you are eligible.

Age UK are rolling out excellent exercise classes in local village halls, clinics, etc. all over UK.  These usually cost around £4 per session.  Go on their website and you may be surprised how many classes there are local to you. https://www.ageuk.org.uk/search/?q=exercise+classes#

As COSA says, the idea is for patients to do whatever they can manage, as they will reap the benefits, from conditioning to emotional well-being to relapse prevention.

And many survivors will confirm it helps stabilise you body to lose/gain weight.  It’s a win win situation whatever we do!

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