Kathy D. Miller, MD; Jennifer A. Ligibel, MD


December 23, 2013

In This Article

Exercise: How Much and What Type?

Dr. Miller: Let's talk about the exercise dose, because it is important to get it right to get the benefits for the patients, but we also need to give patients more of a concrete goal and guidance. How much is enough? Is there a threshold that we should try to get our patients to reach?

Dr. Ligibel: There is no completely clear answer to that, but several guidelines have been developed for exercise in cancer survivors. The American Cancer Society, for many years, has put together guidelines for physical activity and nutrition for cancer prevention.[2] Last year, for the first time, they felt that there was enough evidence to specifically talk about exercise in cancer survivors. The American College of Sports Medicine[3] has also looked at exercise for cancer survivors, and they both endorsed the physical activity guidelines for the general US population, although most people don't know what those are.

Dr. Miller: Most of our patients and maybe most of our readers don't meet them.

Dr. Ligibel: Right. The recommendations are generally for about 150 minutes weekly of aerobic exercise, which is moderate-pace walking, bicycling, or anything that gets your heart rate up, as well as 2-3 strength training sessions. That is a newer requirement, but many studies show that strength training is important for maintaining lean muscle and bone mass, so strength training has been added to the recommendations for the general population and has been endorsed in cancer survivors as well. In this study particularly, there was a mixture of both aerobic exercise and strength training.

It means that we can't tell if one type of exercise vs another is more important for the alleviation of joint pain, but it goes along with the general recommendations for cancer survivors. Nothing extreme was done; we weren't helping people prepare to run marathons or anything like that. It was general walking for cardiovascular exercise and strength training, using the large muscles of the lower body and some upper-body strength training. Katie Schmitz, an exercise physiologist at the University of Pennsylvania, has done a lot of groundbreaking research in exercise and lymphedema and was a collaborator on this study, to make sure that the strength training program that involved the upper body fit the criteria that she has established as being safe: very slow, progressive increases in strength training. You don't want to tell someone to lift 100 pounds the first time they go to the gym. You want to make sure that they build those muscles gradually so that it doesn’t put women at risk for lymphedema.


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