Walking Helps Fight Cancer Treatment Fatigue By Judith Sherman-Wolin, ACSM-certified health/fitness instructor "My doctor suggests I do aerobic exercise. She says it will help me feel better during my chemotherapy treatment," Phyllis tells me. "Does she mean I should take an aerobics class? That might be too difficult to manage. Is there some other form of aerobic exercise I can do? What type? How often do I need to do it?" Health benefits of aerobic exercise Under the best of circumstances introducing an exercise program into your life can be difficult. It becomes even more daunting when suggested as therapy to help you manage your cancer treatment side effects. Although there are not enough data yet to prescribe a standardized program appropriate for everyone, some studies have shown that aerobic exercise offers substantial benefits to help combat fatigue associated with radiation and chemotherapy treatment. Joyce O'Shaughnessy, M.D., a medical oncologist at the University of Texas Medical School, Dallas, says, "Aerobic exercise, even [simple activities] like just walking, makes a difference during chemotherapy." There is also some evidence that exercise improves immune function. Benjamin Bonavida, Ph.D., professor of microbiology and immunology in the UCLA School of Medicine, says, "There have been several studies that demonstrate exercise impacts the immune system in a positive way. Neurohormones are regulated by the nervous system, which is impacted by physical exercise." One such study, conducted at the University of Copenhagen in Denmark, concludes, "In essence, the immune system is enhanced during moderate and severe exercise." Additionally, exercise helps reduce stress. Researchers conducting a study in 1998 at the University of Wollongong in Australia proposed that stress and depression can foster tumor progression by inhibiting certain immune-regulating hormones. More studies need to be conducted, but exercise does positively impact depression. In its position statement on depression, the National Institute of Mental Health states, "Exercise is related to fewer depressive symptoms in observational studies and appears to be as efficacious as psychotherapy in patients with mild depression." What is aerobic exercise? By definition, it is any physical activity that requires oxygen in order for cells to generate the chemical energy necessary for prolonged body movement. Brisk activity promotes circulation of oxygen-rich blood through the heart and lungs and improves heart rate. Some examples, in addition to walking, are jogging, swimming and biking. Why walking is a good choice The form of aerobic exercise I recommend most frequently is walking. It is simple and has many advantages. It is: * High adherence/low tech * Convenient * Inexpensive * Accessible * Enjoyable High adherence/low tech. Walking requires very little athleticism and equipment. All you need is a good pair of walking shoes and a safe surface to walk on. You can dress it up by adding pedometers, heart rate monitors or metabolic calculators, but all you need is time and the desire to get moving. The prevailing myth is that exercise must be complicated, difficult and painful to be effective. This is untrue and unfair. Exercise positively impacts both mind and body with even the simplest of movements: one foot in front of the other. Convenient. In order for you to be able to adhere to any exercise program, it must be convenient. If it requires rearranging your life, is too time-consuming or requires equipment you're uncomfortable using, you probably won't do it. To obtain maximum benefits, exercise must fit into your life in a manageable way. Inexpensive. Expensive fitness programs can be a deterrent for some people. Gym memberships and home exercise equipment, such as treadmills or stationary bikes, can be costly. The best time to invest in home equipment is after about six months of training when you feel comfortable and committed to a specific program and are fairly certain you like it enough to stick with it. I can't tell you how many treadmills and stationary bikes I have seen morph into ad hoc clothes hangers and storage units. Accessible. Walking can be done whenever the mood strikes. If you can't walk in the morning, you can walk in the afternoon or after dinner. If you live in an extreme climate, you can walk in a shopping mall. If you live in a hot climate, you can walk in the early morning or evening when the air is cooler. Enjoyable. The best advice I can give is to select an exercise you enjoy. If you dislike the activity, you will have a hard time sticking with it. During cancer treatment it is especially important to conserve and parcel out your energy. Your exercise program should be pleasurable, stress-reducing and life-enhancing. Make arrangements to walk with a friend or with your dog. Walking away fatigue Nietzsche said of walking, "Only those thoughts that come by walking have any value." Walking does offer the added benefit of contemplation and mood improvement. The mood improvement may come from the release of hormones called endorphins into your blood from the pituitary gland located in the brain. There is some evidence that blood concentrations of endorphins increase in direct response to exercise-in fact, they can be five times as high as levels at rest. The exact mechanism is unclear, but endorphins may play a role in modulating mood, stress, pain tolerance and appetite. These chemicals are also thought to reduce anxiety, tension, anger and confusion. Lessening the intensity of these energy drains may lessen fatigue. Good shoes go a long way The most important piece of equipment any exerciser can own is a good pair of walking or running shoes. This advice applies to both marathon runners and people starting a simple walking program. The foot is actually a complex network of bones, muscles and ligaments, and all of these structures should sit comfortably in your shoe. Well-fitted walking shoes provide ankle and foot stabilization, which can help with poor foot mechanics, such as over-pronating, in which most of your weight is placed on the inside of the foot. Generally, running shoes offer more support than walking shoes. So even if you only plan to walk, it might be worth it to invest in a good pair of running shoes. Be aware that a high price tag doesn't guarantee quality. Some sporting goods stores have a specialist in fitting athletic shoes to assure a proper fit. Tips on fit There should be a finger's width between your longest toe and the front of your shoe. The lacebox sides should be parallel to each other. Avoid any shoes that place pressure on the toes. Heel slippage should be minimal. Test out shoes by walking around the store or outside. Don't rush. Get a good feel for comfort, balance, sole flexibility. Try on a variety of brands to compare fit and comfort. Try shoes on wearing the thickness of socks you will usually be exercising in. Each time you buy new shoes, even if you're going to buy the same style, try them on again. There could be subtle changes in your feet. Also, manufacturers do alter design, which could affect fit. Body weight, biomechanics, running surface and weather will all affect how long your shoes last. The walking exercise prescription The amount of energy you have to expend during exercise depends on the cancer treatment you are receiving and your overall psychological and physical condition. Exercise prescriptions are based on four components: type, frequency, duration and intensity. The following is a generalized exercise prescription: Type: Aerobic Frequency: 3-6 days Duration: 10-45 minutes Intensity: Light to moderate Specific exercise recommendations can be customized to your needs. Before beginning any exercise program, even something as seemingly uncomplicated as walking, speak with your physician. If you had been exercising before your cancer treatment, you may have to start at a lower level until you regain your previous strength and endurance. If you have been mostly a couch potato, begin and progress slowly-say, a 10- to 15-minute walk to start. If you are in poor physical condition, a five-minute gentle walk and some easy, seated stretching is enough to begin. Walking wisdom Never push yourself beyond your comfort zone. If you are feel pain or discomfort, stop exercising. Walk outside only in moderate temperatures, either in the morning or late afternoon, never in the high heat of the day. Protect your skin with sunblock, hats, light comfortable protective clothing and sunglasses. Drink plenty of fluids: 6 to 8 ounces before and after your walk Savor the experience. Because of exercise's physical and mental benefits, you should try to do some form of physical activity most days of the week. This is the general recommendation of both the Centers for Disease Control and Prevention and the American College of Sports Medicine. However, while you're undergoing treatment for cancer, the best exercise prescription is one that you can do comfortably and on a regular basis. Exercise is a valuable resource. Rely on it to help you regain strength, increase your ability to manage the treatment-induced fatigue and enhance your emotional well-being. Judith Sherman-Wolin is a health-fitness journalist, practitioner and lecturer. Thanks to HealthScout.com Remember we are NOT Doctors and have NO medical training. 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