The exercise prescription will provide a person with cancer with guidelines for safe and effective levels of aerobic exercise training. The intensity level for aerobic training will be based on the individual's exercise test, their present physical status, and the individual's current phase of treatment or recovery. The following chart describes the three intensities of training for the individual with cancer and the subsequent discussion will describe guidelines for determining the appropriate training intensity.

(Adapted from ACSM's Guide to Exercise Testing and Prescription, 6th Ed., 2000.)

Not all people with cancer will be able to participate in moderate-intensity aerobic exercise training. People who are confined to bed or who fatigue with mild exertion may not be candidates for moderate-intensity aerobic exercise training but may benefit from low levels of physical activity (Winningham, 1991). These people may require supervision in the early stages of their recovery by a health care professional. These severely compromised individuals may benefit from range of motion exercises and gentle resistive work within their tolerance levels in the early stages of rehabilitation. This low-level physical activity will allow them to gradually build up their tolerance for activity. These people in the early stages of recovery may later progress to short (3- to 5-minute) bouts of walking or bed bicycling several times per day in order to gradually build their endurance and allow them to advance to moderate-intensity levels of aerobic exercise training.

A study by Dimeo and colleagues (1998) demonstrated this concept. In this study, five people with profound weakness following treatment for a variety of cancers began aerobic exercise programs that consisted of treadmill walking. The beginning exercise sessions for these people lasted for only 3 minutes but were performed five times per day. Following six weeks of training, all of the people in this study were able to increase their exercise session durations from 5 minutes to 30 to 35 minutes of uninterrupted walking. Subjects anecdotally reported returning to regular activities such as re-enrolling in school, returning to work, or taking up jogging. Not all individuals with cancer can begin moderate levels of aerobic exercise training, but with proper instruction, and gradual applications of low levels of training, they may progress to higher levels of training and function.

For persons undergoing chemotherapy or radiation treatments, moderate-intensity aerobic exercise training should be performed to maintain endurance, strength, and function. The goal of exercise at this time is to maintain function and prevent the loss of endurance and strength. Cancer treatments exhaust physical and emotional reserves, so the goal of moderate-intensity aerobic exercise training is to maintain these resources. Persons undergoing intensive chemotherapy or radiation may benefit from routine physical therapy, occupational therapy, and ambulation, as well as strength and flexibility exercises. These people are easily fatigued but appear to benefit from moderate-intensity aerobic activities. Moderate-intensity aerobic exercise during this time improves strength and endurance and assists in countering signs and symptoms associated with the cancer and its treatments, such as fatigue and nausea. Moderate-intensity aerobic exercise training may also offer profound psychological benefits for persons in cancer therapy, particularly with regard to depression. It is not known, however, at this time, whether moderate-intensity aerobic exercise training helps individuals withstand the rigors of treatment. Additionally, special modifications in the type of exercise performed may be required if orthopedic limitations, such as range of motion deficits, occur as a result of cancer surgery or cancer treatments.

Persons with generalized weakness and musculoskeletal atrophy should, whenever possible, include strength and cardiovascular training in their rehabilitation programs. Generalized weakness associated with cancer treatments can be more debilitating than the disease itself. Strength training appears to maintain lean body mass that prevents weakness, while aerobic training has been shown to improve endurance, promote physical function, and diminish fatigue (Pfalzer, 1988). People with generalized weakness and musculoskeletal atrophy typically benefit a great deal from exercise training. These subjects typically begin with low-intensity aerobic exercise and then progress to the moderate level within approximately six weeks (Dimeo, et al. 1998).

People recovering from cancer treatments or in remission from cancer have the most to gain from rehabilitation and exercise training. For cancer survivors, the objective of exercise training is to return them to their former level of physical and psychological function. Following appropriate medical screening and exercise evaluation, people in this group can participate in aerobic exercise training not merely to maintain function, but to improve fitness, physical work capacity, and cardiovascular responses to exercise. People in the recovery or remission phase typically begin in the moderate-intensity level of exercise training, but can progress to high levels of training. THINK LANCE ARMSTRONG!

Following the exercise session, it is important to allow 5 to 10 minutes for the body to "cool down." The cool-down period allows the heart rate and blood pressure to return to resting levels in a gradual and safe manner. It is important to monitor vital signs during this post-exercise period. People with cancer should be taught to monitor their heart rate, blood pressure, and heart rhythm following exercise. A general guideline is that the cool-down phase has successfully ended when an individual's heart rate returns to 100 beats per minute or less, heart rate and rhythm are regular, and blood pressure response is normal. Hot showers or heavy meals should also be avoided for several hours following a bout of aerobic exercise.