I’m Too Tired to Exercise: Cancer, Exercise, and Sleep

Thanks to foundational research, we know that cancer diagnosis and treatment present sleep challenges. We know that disturbed sleep joins hands with other symptoms such as pain, fatigue and emotional distress to result in decreased quality of life. We survivors also know physical activity is good for us. The CHOICE Study’s Principal Investigator (PI) Jun Mao, MD, MSCE, is also the PI in a newly published study, authored along with postdoctoral fellow, Sally Romero, PhD, MPH. This Memorial Sloan Kettering Cancer Center (MSKCC) trial shows 75% of us have decreased levels of physical activity a year out from diagnosis.(1) Why is this so?

As Dr. Romero explains, “Currently there are 15.5 million Americans alive with cancer diagnosis. Many will experience a variety of symptoms, such as pain, fatigue and other symptoms that can affect and impact their ability to maintain physical activity levels”. Participants in this study were at least a year out from cancer diagnosis, and reported fatigue, pain, lack of motivation and lack of self-discipline as barriers to engaging in physical activity.

As a cancer survivor who has lived with cancer fatigue, pain and insomnia, I am familiar with these obstacles. In my experience, underneath “lack of motivation” or “lack of self-discipline” are real physical and emotional symptoms that relegate exercise to a low spot on our to-do lists.

One possible solution, the study suggests, is for cancer care teams to provide patients with integrative therapies to help manage symptoms so patients can maintain or increase their level of physical activity. Oncologists may soon ask us questions like, “What is keeping you from exercising?”, and, “How can we help you overcome these barriers?”.  Integrative therapies such as the ones the CHOICE Study is examining (acupuncture and cognitive behavioral therapy for insomnia) can improve sleep and overall quality of life. This can decrease the severity of underlying symptoms, and may enable more cancer patients to feel well enough to begin walking again or to try a tai chi class.

The MSKCC study also recommends providers refer patients to support groups and exercise classes for cancer patients and survivors. A study done in the UK advocates combining these two into one intervention: a program for physical activity in cancer patients which considers the hurdles of fatigue and incorporates social support.(2) This makes sense - adding social support to cancer exercise programs intentionally can maximize benefits of both. This may  help cancer survivors feel more in control of their lives.

In another forward-thinking study, Dr. Jennifer Ligebel, director of Leonard P. Zakim for Integrative Therapies at the Dana Farber Cancer Institute, examined a “pre-habilitation” exercise intervention in the weeks before breast cancer surgery.(3) The study found a “supervised preoperative aerobic and strength-training exercise program led to changes in genes expressed by tumor cells, showing for the first time that exercise could have a direct effect on breast cancer in patients”. Although the size of the tumors did not change, the study opens promising new avenues of exploring how exercise affects cancer.

In my own experience, I was in good physical condition when I was diagnosed with cancer due to martial arts training. The night after my cancer surgery, the hospital nurse noted that I turned over easily in the bed, and that my previous exercise would ease my recovery. However, after months of chemotherapy and radiation, I found myself back to square one, exhausted and swollen from weight gain. Perhaps pre-habilitation programs may head off some of these post-treatment issues for future cancer patients, eliminating some of the roadblocks to maintaining physical activity levels. Yoga was what gave me a starting point, and from there, I gradually worked in more movement over the months following treatment.

There are a few tips all cancer care programs agree on: First, consult with your doctor before you begin any exercise or program. Secondly, eat well to help achieve your goals. I would add the advice of beginning slowly. Try befriending your post-cancer body and gently explore what activities may help. Ask your doctor about integrative therapies which can address symptoms like insomnia and pain. In the future, results from research like the CHOICE Study may illuminate further how cancer survivors think about sleep and fatigue, enhancing ways to be more active after diagnosis.

1.Healio.com. Jan. 24, 2017. Available from URL: http://www.healio.com/hematology-oncology/practice-management/news/online/%7Bb11772b6-449a-4d6d-bc23-9b1727525b32%7D/most-patients-report-decreased-physical-activity-1-year-after-cancer-diagnosis
2.Smith, et al. “Cancer survivors’ attitudes towards and knowledge of physical activity, sources of information, and barriers and facilitators of engagement: A qualitative study. Eur J Cancer. 2017 Jan 30. Available from URL: https://www.ncbi.nlm.nih.gov/m/pubmed/28135016/
3.Dana Farber Cancer Institute blog. Can prehabilitation benefit cancer patients?. Jan. 24, 2017. Available from URL: http://blog.dana-farber.org/insight/2017/01/can-prehabilitation-benefit-cancer-patients/