When and how to exercise with “cancer” pain
Of the thousands of cancer survivors Dr. Kathryn Schmitz talks to, low- grade pain and fatigue are the most common barriers to their exercising.
“But these are actually reasons to do it; physical activity usually lessens pain, makes you stronger, and at least gives you more control. It’s also associated with better survival rates,” says Dr. Schmitz, the lead investigator in the PAL trials, showing exercise benefits cancer patients with lymphedema—people who’d heard, stay out of the gym and off the track.
But when do you need to back off? And when do you press on the accelerator?
Before answering that question let’s see how exercise can help with pain.
How exercise reduces pain from cancer treatments
The simple explanation: When a nerve is damaged by surgery, chemo or radiation, exercise retrains that nerve to do something else. It no longer pays attention to the pain.
The more scientific explanation: Exercise prompts a neuromuscular connection that resets how our nerves send signals. You are changing chemicals in the nerve and the way electrical signals are delivered between the brain and tissue.
When pain is a reason not to exercise
“You do need to rest at certain points. These times would be when pain is intolerable or you just can’t do it,” says Dr. Schmitz.
“If you’ve had surgery and have pain at the incision site, do not exercise. Wound healing takes energy and you need to rest to recover. When your surgeon says you can return to normal daily activities, you’re ready to go,” says Dr. Schmitz.
She also advises to stop if you have pain in the neck, back, abdomen or where the tumor was. And see a doctor. But take a breath and know these pains often are not “c.” Commonly, drugs and surgery are the culprits.
Should I exercise with pain from radiation?
There are two types of pain from radiation: a burning sensation and nerve pain.
With a burn, avoid swimming because chlorinated water aggravates the problem.
With nerve pain (neuropathy from damaged nerves and tissue) it’s fine to exercise. In fact, this is when you should push.
Neuropathy can start during treatment, or anytime thereafter. It may fade, or may not.
“Know that radiation continues to change tissue for the rest of your life, but also know this does not mean you can’t exercise ever again; it’s something you should actually be doing,” says Dr. Schmitz.
What about exercise when you’re dragging from chemo?
Be aware of the cyclicity of your ability to exercise during cancer treatment, and do what you can when you can.
“You may not have pain per say, but just feel too punk; you are under the weather. Get through your punk days; put your sneakers on. Data shows you will feel better if the pain is low grade and not getting worse.
“Start where you are; use what you have; do what you can. Even if it’s a few laps around the dining room table,” says Dr. Schmitz.
This goes for pain from other cancer drugs, like aromatase inhibitors (which lower estrogen).
How much do I exercise?
Be a scientist with yourself. Start low, progress low, let your symptoms be your guide. Dr. Schmitz recommends walking on a treadmill for five minutes, using light weights, doing a few exercises.
“See what happens over 24 hours. If you’re not feeling worse, keep going, and next time do a little more,” she says.
Pain from lymphedema
You may know this pain if you’ve had lymph nodes removed. It’s typically in the shoulder, arm, hand and or torso following node removal for breast cancer. It’s in the lower abdomen for colon cancer, gynecological cancers and bladder cancer.
“If you have a change of sensation, but not necessarily pain, where nodes were removed, don’t exercise that part of your body. And see your doctor if it persists,” says Dr. Schmitz.
She gives the same advice if your skin gets warm and you develop a bright red rash. In this case, get seen immediately because it could be a serious infection. But you can relax in this scenario too; this infection can be eradicated.
How do you know if pain is caused or worsened by exercise?
If you have pain before you work out that’s not getting better, but you can withstand it, you should be fine. Keep going.
“If you feel okay before or during exercise, but have mild to moderate pain afterward, that’s peaking, which is okay because you worked the muscles. You are potentially making them stronger,” says Dr. Schmitz.
“If you still have pain once you’re hitting the gym or track regularly that starts during exercise and continues, you’ve gone too far. Back off.”
Can exercise help with pain from the cancer itself?
With cancer pain, especially with metastatic disease, it’s hard to say exactly how much exercise is safe. And we don’t know if exercise helps with that pain.
“I would love if people would blog and tell their stories, so we can learn more,” says Dr. Schmitz. She does advise to stay active as you can, based on pain level.
You will gain control
“I had a woman in my studies who was an equestrian. She was totally in love with her horses. They were taken away because she was told not to exercise with low grade discomfort and lymphedema,” says Dr. Schwartz. “In this trial, little by little she could do more, and got back on her horse.
“I advise all cancer patients and survivors, do what you can. Start low and press on the accelerator very gradually. But do press on it.”
Four exercise types for cancer patients and survivors
Free fitness programs for cancer survivors
Finding a certified exercise instructor
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