Surviving a cancer diagnosis and treatment regimen is no small achievement, and when I recall the limited options available to my dad in the late ’70s and my mom in the early aughts, it’s clear that medical science has come a long way in treating the many varieties of this harrowing disease.
Surviving is one thing, though; thriving is quite another.
By some estimates, as many as 75 percent of cancer patients face cognitive impairment during treatment. And fatigue, anxiety, and insomnia may persist long after the cancer has been successfully eradicated. It’s a reality that has inspired a good deal of research in recent years.
Among the more surprising insights these ongoing investigations have unveiled is a gradual realization that exercise may be one of the more effective tools a cancer survivor may wield to rebuild and sustain a robust quality of life. And, yes, that may even include yoga.
A 2022 review of 52 studies, for instance, found that “[e]xercise during cancer treatment led to improvements in cardiorespiratory fitness, strength, fatigue, and other patient-reported outcomes.” More recently, Karen Mustian, PhD, MPH, and her colleagues at the University of Rochester Medical Center released a trio of reports building on earlier research while revealing the salutary results of more-specific exercise approaches.
In March, Mustian’s team published a study suggesting that an exercise regimen focused on aerobic walking and resistance training may reduce the effects of what’s known as “chemo brain” — a condition featuring cognitive impairment (CRCI) and mental fatigue that is a common malady among patients undergoing chemotherapy.
The phase-3 clinical trial involved 700 cancer patients from 20 U.S. clinics who were randomly assigned to one of two groups: one receiving standard chemotherapy without an exercise component and the other undergoing chemo while participating in a six-week exercise program. Both groups recorded their daily steps and physical activity during the study period.
Participants reported average daily step counts of 4,000 to 4,500 prior to their cancer treatment, and researchers found that most of those enrolled in the exercise program were able to maintain that level of activity throughout the six-week trial. Those receiving standard care, on the other hand, reported a 53 percent reduction in daily steps.
Researchers also measured participants’ cognitive function and mental fatigue after the six-week trial while comparing pre- and posttrial serum levels of cytokines, an inflammation marker. The results, Mustian writes in JNCCN — Journal of the National Comprehensive Cancer Network, suggest a strong correlation between physical activity and cognitive health among cancer patients.
“[T]hese findings,” she notes, “suggest that individualized exercise prescriptions for walking and resistance band exercises at the beginning of chemotherapy may help patients avoid significant reductions in their walking to levels that are associated with higher all-cause mortality, while also improving CRCI and mental fatigue.”
Not all the exercisers experienced the same benefits from the workouts, Mustian says. Those receiving chemotherapy every two weeks were more likely to remain active than patients on a three- or four-week schedule. This could be due to the higher chemo doses used for less-frequent treatment cycles, resulting in stronger side effects — and more fatigue.
“Once a person starts lowering their activity levels, it is more difficult to get back to their baseline activity or maintain it,” she explains. “It may be possible that patients receiving chemotherapy on the three- or four-week cycles were experiencing more toxicity and more side effects.”
In a study published in April in the journal Cancer, Mustian’s team looked more closely at how a specifically anti-inflammatory approach — exercise and ibuprofen — might reduce chemo-induced cognitive impairment among a group of 86 cancer patients. During the six-week study, one group of patients followed a moderate exercise regimen and took a twice-daily low-dose ibuprofen, another exercised and took a placebo, a third took ibuprofen only, and a fourth used only a placebo.
Researchers found the two combos that included exercise produced more cognitive improvement than the placebo- and ibuprofen-only groups, but they noted that exercise alone may do the trick. “We are encouraged by the findings of this trial that suggest possible benefits of both interventions for some cognitive domains,” says lead study author Michelle Janelsins, PhD, MPH. “Clearly, we saw a more pronounced effect with exercise, which is notable considering the multiple health benefits of exercise for cancer survivors.”
And just last week, Mustian’s crew released the results of research showing the benefits of a yoga-specific regimen for cancer patients. The paper, presented at the annual gathering of the American Society of Clinical Oncology, found that three weekly sessions of gentle yoga over a four-week period significantly improved mood, anxiety, and fatigue among 410 cancer survivors.
These were not regular yogis, Mustian points out, so the gentle hatha and restorative yoga sessions offered an accessible approach to the mindfulness and breathing she believes is essential to posttreatment healing. “Just doing downward dog without the breathing and mindfulness is simply calisthenics,” she says. “It’s the synergy of the mind-body movement that brings positive effects.”
Mustian, who has been exploring exercise and integrative oncology for more than 20 years, says clinicians shouldn’t hesitate to recommend gentle yoga to their cancer patients. “This is not going away,” she argues. “It’s only going to become a more important part of how we treat cancer all along the continuum.”
I can’t quite picture Mom or Dad navigating a yoga mat — or even following a prescribed exercise regimen — during their cancer treatments. The chemo doses back then were brutal, and I suspect they much preferred rest over resistance training. It’s an obstacle patients face even today, when treatment strategies are more nuanced.
As Karen Basen-Engquist, PhD, MPH, director of MD Anderson’s Center for Energy Balance in Cancer Prevention and Survivorship, put it in a recent interview, “Your natural inclination when you’re feeling like that is not to say, ‘Hey, let’s go out and take a walk.”
So, it’s best to ramp up your physical activity gradually. “It’s OK to start with light activity and build up to short bouts of moderate aerobic activity,” she advises. “You can add in resistance exercise as you get more comfortable with your aerobic exercise routine, or some people find starting with resistance exercise is easier for them.”
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