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A comeback: India’s Yuvraj Singh, a cancer survivor, displayed his prowess on the cricket field. Photo: Laurence Griffiths/Getty Images.
A comeback: India’s Yuvraj Singh, a cancer survivor, displayed his prowess on the cricket field. Photo: Laurence Griffiths/Getty Images.

Bounce back from cancer

Physical exercise can help cancer patients and survivors but few doctors suggest it

Lance Armstrong is being crucified as a cheat for having doped in Le Tour de France contests. I don’t know if he did and I don’t care. What I do know is that he and the organization that he started, Livestrong, have helped spread awareness of what cancer is all about and what survivors are capable of achieving. Our own Yuvraj Singh just proved that too by standing out as the best Indian player during the recent 2012 ICC World Twenty20 in Sri Lanka.

Both Armstrong and Singh went against conventional medical advice and courted sporting success post cancer treatment. They showed us the difference between “living" and “existing".

Today, we all know someone—a friend or a family member—who has been affected by this deadly disease. A study published in The Lancet, medical journal (Global Burden of Cancer in 2008) suggested that in 2008 alone, Indians lost 18.7 million years of productive healthy life to cancer. On the one hand, India’s young workforce is supposed to take on the world; on the other, 70% of all cancer deaths in India are happening in the 30-69 age group, when people are productive.

The adverse effects of cancer and its treatment are enormous—increased fatigue, depression, anxiety, cardiovascular disease, cardio-toxicity, weight loss and bone loss (osteoporosis)—all of which lead to a poor quality of life. The one thing that is common across all of these is that physical activity drops to almost nothing for people with cancer as well as those who survive it.

Cancer develops in a complex interaction between genetics, environment and lifestyle—lifestyle is the only factor that is really in our control. Studies have shown that sedentary lifestyles, smoking/tobacco products and obesity alone account for a quarter of all new cancer cases in the world. It’s very important to understand that health is not a destination but a dynamic state we are all striving for.

A recent review shows that increased physical activity and regular exercise may have beneficial effects on the health-related quality of life as they reduce the side effects of the disease and treatment, helping patients or survivors combat them. The Cochrane Collaboration (a non-profit dedicated to healthcare research) systemic review by S.I. Mishra, of the University of New Mexico, Albuquerque, US, titled Exercise Interventions on Health-related Quality of Life for Cancer Survivors, included 40 trials with 3,694 participants randomized to an exercise or comparison group. It shows that too much rest, something that may be advised to cancer survivors, can lead to a decrease in aerobic fitness, strength and mobility, and unwanted weight gain.

So, can cancer survivors reclaim their lives and fitness? Does the job of the super-specialized doctors who get them back from the jaws of death stop when the patients are cancer-free?

Given what such studies show, you would imagine doctors would be prescribing increased physical activity and exercise to all cancer survivors. Surprisingly, that’s not the case. A study conducted in the UK and published in the British Journal of Sports Medicine (BJSM) showed that even though 84% of cancer survivors wanted to receive information on physical activity, only 28% of oncologists initiated the dialogue and only 14% referred them to specialists (Physical Activity Interventions for Cancer Survivors, 2009).

In a 2011 study, an audit of physiotherapy provision among breast-cancer survivors after completion of treatment at the Western General Hospital, Edinburgh, UK, Anika Preet Kaur, a sports and rehabilitation physiotherapist, found that only 27% of cancer survivors were asked to undergo physiotherapy to address the side effects of cancer treatment. This was her dissertation for the MSc programme at Edinburgh.

Why are oncologists reluctant? Lack of clinical trial data is one prime reason why “physical activity and exercise" are not part of the cancer treatment plan, and it’s not a priority in the healthcare setting. This also means there is no insurance coverage for physical activity counselling.

But while patients work at rehabilitation after cancer treatment, they should begin with physical activities that involve large muscle groups, like walking, cycling and swimming. Start with a minimum of 15 minutes, very gradually building up to an hour. The simple rule is to gradually build up the intensity and not do too much right away. Once you’ve got used to being more physically active, you can increase the intensity, introducing strength-training into the schedule two-three times a week.

There can, however, be no one-size-fits-all scenario. It has to be customized differently for each person. This does throw up another barrier, since there aren’t many therapists trained to cater to the exercise needs of cancer survivors.

While treatment is still on, the oncologist in charge should be kept in the loop on increasing physical activity, more so if you are taking special medication or have some form of heart or lung disease. For these diseases make it that much more difficult.

In an ideal situation, a rehabilitation specialist and an oncologist would discuss your case and come up with a plan together.

Rajat Chauhan is an ultra marathon runner and a doctor specializing in sports and exercise medicine and musculoskeletal medicine, and founder of Back 2 Fitness.

Write to Rajat at treadmill@livemint.com

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