Give Yourself the Gift of Movement

Should I Exercise With Lung Cancer?

Elaine K. Howley

THE VERDICT IS IN: Exercise is good for us. Physical activity has been shown to offer a range of benefits, from improved longevity and increased strength and endurance to reduced risk of many chronic illnesses, including obesity, depression, diabetes, cardiovascular disease and cancer.

Despite the growing body of evidence that exercising regularly promotes good health, particularly in the fight against cancer, many people often assume that if you have lung cancer, exercise is out of the question. But this is a misconception that lies in a fundamental misunderstanding of all that can qualify as exercise, says Carol Michaels, founder of Recovery Fitness and creator of the Cancer Recovery Fitness program. “I think people didn’t really think about exercises for lung cancer because people think of exercise as always being very intense.”

But exercise doesn’t always have to mean working up a big sweat and being breathless. Gentle movement like simply walking can offer big benefits to lung cancer patients. “You can modify exercise, and strength training can be very gentle,” Michaels says, noting that lifting light weights slowly and engaging in slow breathing exercises all qualify as exercise and can pay big dividends for lung cancer patients.

Exercise during active treatment for lung cancer and long after should be a piece of your treatment puzzle. The American Lung Association reports that “moderate exercise during lung cancer treatment can improve fatigue, anxiety, stress, depression, self-esteem, cardiovascular fitness, muscle strength, gastrointestinal side effects and breathing.” It can also help you build up your endurance, making you more resilient to the rigors of treatment, Michaels says.

“Sometimes we’ll set people up with pulmonary rehabilitation if the doctor wants to increase their fitness prior to surgery,” says Scott Marlow, a respiratory therapist at the Cleveland Clinic. Pulmonary rehab includes breathing, stretching and relaxation exercises and is more commonly used for patients with COPD. But it can have some applications for lung cancer patients who need to boost lung capacity. Rehabbing before surgery may speed recovery after surgery and reduce the length of time you’ll be in the hospital.

Exercising at all stages of your cancer journey is so important, in fact, that about 10 years ago, the American College of Sports Medicine and the American Cancer Society teamed up to create a specialized certification program, the ACSM/ACS Certified Cancer Exercise Trainer certification for fitness professionals who want to work with cancer patients and survivors. The number of trainers who have completed the certification is still small; Francis Neric, national director of certification for the ACSM, says that since the program was rolled out in 2009, the number of trainers who have completed certification has “fluctuated between 65 to 100 certifications per year,” in part because the qualifying criteria to enroll are stringent and cater to trainers who have a lot of experience and a passion for working with the cancer population.

Nevertheless, as the number of cancer patients in the United States continues to grow alongside our understanding of how exercise should be part of the treatment, Neric says the program is expected to expand. “There’s a lot of evidence that shows that stretching, aerobic exercise and breathing can increase quality of life for cancer patients, reduce symptoms from some of the treatments and decrease the length of time you’re in the hospital.

How to Start

Before you begin exercising, speak with your doctor about any specific limitations you may have and what’s recommended for your particular situation. There’s lots of variation in types and stages of lung cancer and its treatment, with various side effects that could impact what you’re able to do.

Once you’re cleared for exercise, the key to getting started, especially if you weren’t physically active prior to your diagnosis, is “start small, make a little goal and slowly build that up,” Marlow says. “One of the things we have to be careful of is for someone to not all of the sudden throw themselves into something too quickly and wear themselves down by overdoing it. We want to make sure they’re eating healthy, and we don’t like to change too much all at once,” he says.

To make sure she’s starting her clients off in the right way, Michaels says she typically conducts a one-on-one fitness assessment “to see where they’re at and to see if they have preexisting conditions” that might restrict which exercises are good options. For example, “someone who has arthritis and has had a hip replacement may need different exercise from someone who doesn’t have any preexisting conditions. So, I like to do a full assessment on the person with lung cancer.” Marlow adds that if you have heart disease as well, that can also alter what kinds of exercise would be best and how much you should be doing.

In addition, “everyone heals differently,” so your program should be scalable for your needs, Michaels says. “Sometimes people have a partial lobe removed and they actually have reasonable endurance whereas someone else could have the same surgery and just be very deconditioned. Each person with lung cancer really needs, to some extent, an individualized program.”

That said, Michaels says she also likes to “create small exercise groups because this way it becomes like a support group.” She creates these groups around the specific type of cancer, so a few lung cancer patients meet regularly to exercise together. “This way, everyone learns from each other and they’re working with someone who has similar situations and goals.”

But there’s more to these groups than just exercise. “They can be very good for emotional health. The small groups have been really uplifting for people,” she says. “A lot of them never exercised before and a lot of them didn’t even like the concept of exercise, but they come sometimes just for the friendships they’ve formed in the group. I think that’s a really important component in terms of feeling better for emotional health and it’s all about quality of life.” By keeping the groups small, she says she can accommodate the range of fitness levels and capacity and make appropriate modifications based on individual needs.

What to Do

The biggest issue for most people going through treatment for lung cancer is fatigue and a lack of endurance, Michaels says. Particularly if you’ve had a substantial portion of a lung removed, that can impede your ability to breathe freely, so starting small and progressing in the duration and intensity of exercise is the best way to ensure you don’t hurt yourself.

You should also consider what you like to do for exercise. “Any type of exercise” is better than none, Michaels says, but as you get stronger, you’ll have more options. Think about what you’d find fun, as you’re more likely to stick with something you enjoy doing over the long-term. “The best exercise to do is the one that you like to do.”

A good lung cancer exercise program typically includes a combination of four major areas of exercise:

  • Stretching. “In order to help the lung cancer survivor take nice full deep breaths, we spend a lot of time doing a lot of rehabilitative stretching,” Michaels says. “That’s really where we get a lot of improvements in terms of fatigue levels because we try to move the arms and shoulders in a way that break up adhesions [bands of scar tissue in the lungs and chest that fuse tissues that shouldn’t be connected] and scar tissue,” improving range of motion and ability to take deeper breaths.
  • Breathing exercises. Similarly, gentle yogic breathing and other simple breathing exercises such as completely filling and emptying your lungs can help improve air flow and help break up scar tissue. This can all help you breathe more freely.
  • Strength training. Lifting light weights can help you build strength and endurance throughout your entire body and may help you reduce the chances of developing osteoporosis, Michaels says. “It’s bad enough to have lung cancer. No one needs that extra risk of osteoporosis.”
  • Aerobic exercise. Walking, swimming, water aerobics, cycling, dance, golf … the list of gentle aerobic exercises you can do is seemingly endless. Anything that elevates your heart rate will do and can pay big dividends for your overall health.

Especially if you’re new to exercise, working with a trainer, physical therapist or other exercise specialist is a great way to create a routine or plan that meets your specific needs. Neric recommends seeking out a trainer who has ACSM/ACS CET certification or is otherwise experienced in addressing the unique needs of cancer patients. Trainers with this added level of expertise “understand the lifestyle and the psychosocial well-being of the cancer patient,” and can help address some of those additional problems. “Particularly if there’s bouts of depression, of hopelessness,” trainers with experience in working with cancer patients and survivors may be better equipped to address these issues and adjust the exercise program to help you “along your journey and have that understanding where you’re coming from.”

Start Now, Here

The bottom line is start where you are, do what you can and progress slowly. “Walk,” Marlow says. “I think walking is probably one of the easiest and best things that you can do. And you can do it anywhere.” If you’re too debilitated or deconditioned to walk, ask your doctor or trainer for help in building up your strength and endurance. Marlow says that some patients need inspiratory muscle training – a series of controlled breathing exercises that strengthen the respiratory muscles and make it easier to breathe. And naturally, follow your doctor’s orders, take your medications as prescribed and if you’re still smoking, try to quit.

Just starting can be the toughest piece, but it’s a critical first step toward feeling better, Michaels says. “Just getting someone to start – they feel a little bit better mentally and physically,” almost immediately, she says.

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