Skip To Navigation Skip to Content
Individuals & Caregivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregedivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregafgivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
 

NCHPAD - Building Healthy Inclusive Communities

Font Size:

Historical Perspective


The impetus for using aerobic exercise during treatment and recovery from cancer came from the exercise physiology literature on the hazards of immobility (Saltin, 1968). The decrements that result from bed rest and diminished physical activity include reductions in musculoskeletal performance, cardiovascular efficiency, pulmonary function, neuromuscular function, and psychological well-being.

Reductions in activity cause muscle atrophy, changes in muscle properties, and reductions in bone density. Muscle atrophy and reduced bone density lead to diminished musculoskeletal strength and performance, and contribute to an increased risk for bone fractures and musculoskeletal injuries (American College of Sports Medicine (ACSM), 1998). Musculoskeletal atrophy and changes in muscle properties contribute to declines in cardiovascular efficiency. Declines in cardiac efficiency are reflected in increases in heart rates and blood pressures at rest and with submaximal exercise. Reductions in cardiovascular efficiency combined with elevations in cholesterol levels and decreases in HDL levels from inactivity contribute to an increased cardiovascular risk profile (ACSM, 2000). Declines in pulmonary function that result from inactivity may include a blunting of the ventilatory response, diminished airflow and respiratory muscle function, and impairments in gas exchange from ventilation/perfusion mismatches, shunting, and declines in diffusion that predispose people to respiratory diseases such as pneumonia (ACSM, 1998).

Recent reviews of the literature support aerobic exercise training as positively influencing psychological well-being in both healthy subjects and people with cancer (Pinto & Maruyama, 1999; Petruzello & colleagues, 1991). Aerobic exercise training may influence psychological well-being through psychological and physiological factors. The psychological factors that result from aerobic exercise training and may positively influence psychological well-being include distraction from the stressful condition, enhanced self-esteem, improved self-efficacy from mastery of a task, improved physical independence, and the development of a social support group. The physiological factors that result from aerobic exercise training that may influence psychological well-being include reductions in heart rate and blood pressure in response to stress, increased opioid activity, reductions in stress hormones, such as catecholamines and corticosteroids, and alterations in brain monoamines related to depression and anxiety, such as serotonin (Petruzello, et al., 1991).

In addition to the above benefits attributed to aerobic exercise training, there is evidence in the literature that supports moderate-intensity aerobic exercise training as a means to improve immune function and decrease oxidative damage (Nieman & Pedersen, 1999; Powers, et al., 1999). Nieman and Pedersen (1999) reviewed the literature on exercise and immune function and concluded that people who performed moderate-intensity aerobic exercise most days of the week had markedly fewer sick days as compared to sedentary individuals. There is also evidence that people who participate regularly in moderate levels of aerobic exercise training develop enhancements in their anti-oxidant defense mechanisms that may lead to reductions in oxidative damage (Powers, et al., 1999). Since cancer and cancer treatments cause immunosuppression and oxidative damage, aerobic exercise may be investigated as a method to assist in managing these conditions.

A final important change occurred in the guidelines required to achieve health benefits from aerobic exercise training that has had a profound impact on exercise and rehabilitation protocols for people with cancer. Blair and colleagues (1996) and Paffenbarger and colleagues (1991) published studies that supported moderate-intensity levels of aerobic exercise, when performed most days of the week, as sufficient to achieve marked health benefits. The health benefits that could be achieved from regular participation in moderate-intensity aerobic exercise include the following (A Report of the Surgeon General, 1996):

  • Reductions in premature death
  • Reductions in premature death from heart disease
  • Reductions in the development of diabetes
  • Reductions in the development of high blood pressure
  • Reductions in the development of colon cancer
  • Reductions in depression and anxiety Improvements in weight control
  • Maintenance of bone, muscle, and joint health
  • Improved strength and fall prevention in older adults
  • Improved psychological well-being

The original guidelines for aerobic exercise training required people to exercise for 30 to 45 minutes at a high intensity (70% to 90% of their maximal heart rate) in order to achieve these health benefits. The new guidelines support moderate levels of exercise (50% to 70% of the individual's maximal heart rate), performed most days of the week, as sufficient to promote significant improvements in health. The new guidelines for aerobic exercise training are at a level that is realistic, safe, and achievable for people undergoing treatment for cancer or recovering from cancer. These revised guidelines led the Surgeon General of the United States to develop a new position paper on exercise for the American people (A Report of the Surgeon General, 1996). The recommendations for aerobic exercise training for fitness and for health are provided in the following table.


Physical Training for Fitness Physical Activity for Health
Definition
Ability to perform a sport or task10+ METS
Ability to perform daily activities Reduced Health Risk Factors8-10 METS
Exercise Type Moderate Intensity Training
Exercise Prescription 30 to 45 minutes -of continuous activity, 3 to 5 days per week Training Heart Rate: 70% to 90% of max HR (% Heart Rate Reserve: 60-85)Rate of Perceived Exertion: 14-16 Accumulate 30 minutes of activity most days of the week Training Heart Rate: 50% to 70% of max HR (% Heart Rate Reserve: 40-60) Rate of Perceived Exertion: 11-13

(American College of Sports Medicine, 2000)

Based on the benefits ascribed to apparently healthy subjects as a result of aerobic exercise training, several health care professionals began to examine the possibility that these benefits would aid in the management and rehabilitation of people with cancer.

More recently, the 2008 Physical Activity Guidelines for Americans provides science-based guidance to help individuals with disabilities aged 6 and older improve their health through appropriate physical activity.


blog comments powered by Disqus