Exercise Guidelines for Seniors & Cancer Patients: Part 2

Aerobic exercise is exercise that rhythmically uses the large muscles of the legs and arms to elevate the heart rate within a certain range. Some examples of aerobic activity include brisk walking, jogging, swimming, bicycling, gardening, dancing, playing actively with children, and sexual activity.

Recommendations for Aerobic Programs

If you have a Karnofsky score between 70–100%, you can begin with fifteen minutes of conditioning and increase the time of aerobic activity by one to two minutes each session, until you achieve a total of forty minutes per session. Try to exercise five days per week. The conditioning portion of the exercise session should be intense enough to elevate your heart rate between 60–80% of the maximal heart rate (MHR) as estimated by a treadmill test. If you have not had a treadmill test, you can predict your maximal heart rate by subtracting your age from 220. Begin your program working at the low end of your MHR—around 60%—and as you become more fit, increase the intensity of exercise until you are working at 80% of your MHR. You can do this simply by walking faster, gardening more vigorously or moving your arms more when you are active. The time it takes to become comfortable exercising for forty minutes at a higher heart rate will vary with each individual, but a reasonable goal is eight weeks.

If you have a Karnofsky score of 50–70%, you can begin with five minutes of exercise at 55% of your MHR three times per day, adding one minute to each interval each time until you achieve ten-minute intervals. Follow this program six to seven days per week. Then reduce the number of intervals to two per day, adding one minute each time until you achieve fifteen minutes. When you reach that point, exercise once a day, add on a minute each day and follow the program prescribed for those with a Karnofsky score of 70–100% (above). In addition to determining your exercise intensity by taking your heart rate, use the Borg Rating of Perceived Exertion (RPE) scale. Your RPE for the conditioning phase should be eleven to fourteen.

Note: People who take certain blood pressure medicines may not be able to elevate their heart rate and may have to use the RPE scale exclusively for determining appropriate exercise levels. Check with your physician to find out if your medications blunt your heart rate.

Dynamic Resistive & Isometric Exercises

Dynamic resistive exercise is performed with weights or resistive tubing. The joints are moved through excursion of the various range of motions. The force applied is sufficient to result in increased fiber thickness of the muscle belly. Isometric exercises are performed with the same types of resistance, but do not involve joint movement or can just consist of contraction (squeezing) of the muscles without any movement of the limb. Examples include holding in your stomach, tightening your buttocks and holding your leg straight. These squeezes are held for six seconds and released.

Most people are more motivated when they exercise in group settings such as in a class or with a professional, but if you prefer, there are many well balanced programs on tape or DVD that you can do at home, or you could also purchase exercise equipment for your home that would provide the necessary activity. If you go to a health club and work with a personal trainer, be sure to explain the specifics of your illness to the trainer before beginning your exercise program.

Three-Stage Cancer Exercise Program

Cancer Supportive Care recommends a three-stage program of progressive exercises that helps in maintaining physical function through all stages of cancer treatment. Following is a brief overview of the program.

Stage I: In Bed

During this initial stage when patients are too ill to get out of bed, they can start with range of motion activity for all four limbs. These exercises are very gently and do not have any resistance other than gravity.

Stage II: Bed/Chair with Resistance

The second stage of the exercise program is designed for patients who are out of bed part of the day and walking around home, and, in a limited capacity, into the community. It incorporates the use of weights and other resistive devices like surgical tubing.

Stage III: Up & Around

The final stage of the exercise program involves general fitness activities for patients who have recovered enough to go out into the community. The activities can be used to help the patient regain full prior function or simply as an introduction to a healthier way of life after recovery.

Precautions for Beginning Your Exercise Routine

Consider the following safety guidelines as you begin your exercise program. There are many factors, including side effects from medication, which will affect your ability to exercise.

• Do not exercise if blood counts show any of the following:
  A. Abnormal levels of sodium and potassium (electrolytes)
  B. Abnormal protein
• If you experience numbness in your legs or hands (which could be due to Oncvin, Velban, Vincristine, Vinblastine, Platinol, Taxol, Taxotere or Euflex):
  A. Alternately contract and relax limbs
  B. Avoid excessive weight-bearing activities and alternate walking with cycling, avoiding uneven surfaces
• If you have an infection, anemia, low blood pressure, bleeding (possibly due to abnormal blood count and plasma volume, and all chemo drugs):
  A. Identify nadir period (7–12 days post chemo) and avoid public swimming during this time
  B. Check lab values
  C. Drink lots of fluids
• If you have cardiac problems (possibly due to Doxorubicin, Cerubidine, Idamycin, Vovantron or Pharmarubicin):
  A. Monitor EKG and blood pressure
  B. Watch for swollen ankles, shortness of breath and consult your physician
• If you experience bone weakening (a sign of long-term Prednisone use)
  A. Strength train with resistive bands—no heavy weights!
  B. Be careful when walking
• If you have pulmonary tumors:
  A. Watch for shortness of breath
  B. Have neck/back pain evaluated for spinal cord compression or bowel obstruction

Yoga for Seniors & Cancer Patients

Yoga can help a person react to stressful situations by counteracting many of the body's natural responses to stress. Many yoga practices activate the parasympathetic nervous system, bringing relaxation and restoration to the body by stabilizing blood pressure, lowering heart rate and the body's demand for oxygen, slowing breath rate, increasing lung capacity, improving digestion, increasing feelings of calm and tranquility and bringing about measurable improvements in the immune system. In a yoga class designed especially for older adults or cancer patients, students are encouraged to gently extend their awareness of their physical, emotional, sensory and thinking levels. They practice a slow, deliberate yoga adapted to their own needs and physical limitations. Attention to breathing and a focused awareness of the movements and the stillness of each yoga pose characterize this particular style of yoga.

As the body gains flexibility and the breath deepens, the mind and emotions settle into greater ease and balance. In quiet times of deep relaxation and meditation, habituated patterns of thinking and behaving may become more obvious and lend themselves to change. Yoga practices include yogic postures and stretches, breathing practices, imagery, meditation and progressive relaxation. While each technique has its own specific purposes, all have the common aim of helping one develop a focused awareness of what is happening in the body and mind on an emotional, physical and spiritual level.

Read Exercise Guidelines for Seniors & Cancer Patients: Part 1.

Editor’s Note: This article has been adapted for GilbertGuide.com by Harvey Gilbert, MD, with permission from Cancer Supportive Care. The authors are Kathleen Dzubur, MS; Francine Manuel, RPT; Gary Abrams, MD; Lee Erman, NCTMB and Ernest H. Rosenbaum, MD.

Posted in Cancer Treatment, Recovering from Cancer, Senior Fitness, Senior Health, Tips for Healthy Living

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