Cancer-Related Fatigue

Cancer-related fatigue is the most common and distressing side effect experienced by cancer survivors. The severity and length of the fatigue depends on the type of cancer, treatments, and overall the health of the patient. Cancer-related fatigue differs significantly from fatigue that is not associated with cancer. It can also last for years after treatment is finished. There are things personal trainers can look for and suggest to their clients undergoing cancer treatment and experiencing fatigue, including exercise; exercise can improve cancer-related fatigue, mobility, strength, stamina, and overall quality of life. 

Resting or a good night’s sleep usually does not relieve cancer-related fatigue.  Some words used to describe this fatigue include: tired, exhausted, washed-out, wiped out, weak, and no energy. Fatigue may make it difficult to participate in the activities that one enjoys and in performing basic home tasks.  

This article discusses the possible causes of cancer-related fatigue and the methods that have proven to be successful in fighting fatigue. 

 Causes of Cancer-Related Fatigue

• Chemotherapy — Physical fatigue may be worse after a session of chemotherapy. There may be a pattern of fatigue.   
• Radiation — Like chemo, radiation treatments can create a pattern of fatigue.
• Chemo brain or brain fog — Chemotherapy, radiation, and hormonal therapy can cause changes in a cancer survivor’s mental function.  It can be extremely frustrating. The mental energy needed to do simple tasks can be exhausting.
• Inflammation — Cancer treatments are intense and can be aggressive, causing systemic inflammation which can trigger fatigue.
• Surgery — Surgeries take a toll on the body and require a recovery period for tissue to heal.
• Pain — Can increase fatigue and pain meds cause fatigue.

In addition to the above most common triggers of fatigue, the following conditions can also play a role:

• Hormone imbalance
• Medication
• Low thyroid levels
• Low blood pressure
• Anemia
• Electrolyte imbalance
• Malnutrition or poor nutrition
• Dehydration
• Lack of sleep
• Emotional and mental health issues, i.e., Depression, anxiety, and stress. 

Management of Fatigue

If you have a client undergoing cancer treatment, implementing some of the following lifestyle changes can help mitigate and/or manage cancer-related fatigue:

• Cooking: Learn how to save energy–sit while cooking! If possible, get a meal-delivery service during treatment weeks or when fatigue is worse. Ask friends to set up a meal-train. 
• Childcare: Get help with little ones! Putting too much pressure on oneself while undergoing cancer treatment can lead to more emotional fatigue and feelings of inadequacy.
• Work: Try to work from home, ask for help from colleagues, take breaks, and avoid rush hour.
• Journal/Track: Track fatigue to determine patterns by using an app or written log.
• Schedule Smart: Schedule your day and needs according to your energy pattern.
• Capitolize: Be active during the time of day when you feel most energetic.
• Exercise: When performed at the appropriate times and intensity, movement can help improve fatigue (see below)
• Pace yourself: A slow to moderate pace uses less energy than hurrying.
• Plan time to rest: You need it!
• Delegate: Get help with household duties and responsibilities
• Do things that you enjoy: Just do a bit less.
• Emotional Health: Stress and anxiety can be decreased by acupuncture, massage, yoga, qui gong, reiki, and relaxation techniques
• Nutrition: Cancer treatments can decrease appetite and fatigue may decrease appetite leaving your client tired and weak. Chemotherapy and immunotherapy make things taste differently and upset the stomach so they should try smaller more frequent meals and make sure to drink. Radiation can upset the stomach and inflame the intestinal tract and part of the intestinal track may be removed for some cancers.

Exercise and Fatigue

Inactivity and the cancer treatments cause muscles to atrophy and the body to function less efficiently, leading to inactivity which result in even more fatigue. The good news is fatigue can often be ameliorated by a good exercise program. It can help to reduce fatigue, pain, increase endurance, and the ability to tolerate cancer treatments.

But when some people hear the word exercise, they might immediately think about a difficult gym class or boot camp. Exercise is probably the last thing on the mind of a cancer survivor after a cancer diagnosis. Cancer-related fatigue is the type of fatigue that continues to be felt even after resting and may deter a cancer survivor from embarking on an exercise program.

They might know that they should exercise but do not know what to do. You can help, encourage, and motivate your client to engage in physical activity. The NFPT Cancer Recovery course will give you the information needed to work safely with your client. An exercise specialist can help design a properly tailored program.  

Recent studies have indicated that even during chemotherapy, exercise may increase fitness and energy levels, improve mood, and help patients tolerate cancer treatments. Exercise during treatments can increase strength and aerobic capacity, improve joint flexibility, elevate mood, and assist with the resumption of regular activities. A good fitness program will help your client to improve mood and promote recovery. 

Your client may feel lethargic at times during chemotherapy and/or radiation cycles. If a patient feels lethargic then decrease the intensity of the exercise. Allowing the body time to heal or to rest is important. It is best to be conservative when determining the time, type, and intensity of any exercise activity. The cancer patient should listen carefully to their body when engaging in physical activity and act accordingly and a physician should be consulted before starting an exercise program.

Tips for Personal Trainers

The following are some tips we use in our Cancer Recovery Fitness program to help our clients overcome and exercise safely when they are not working with a trainer, even when they are fatigued:

• Walking, even if it is limited to around the house.
• Perform breathing, stretching, and balance exercises on the high fatigue days.
• Exercise with a friend.
• Listening to music.
• Break up an exercise session into smaller sessions.
• Be physically active at the times when they have the most energy.
• Changing exercise routines will minimize boredom.
• Keeping a journal.
• Understanding their limitations by listening to their body.
• Using common sense. Knowing when to rest.
• Exercise to tolerance.
• Stay hydrated. Drink before, during, and after exercise

We also recommend that a cancer patient have both short-term and long-term exercise goals. Select an activity and set an achievable goal. Goals should be able to be adapted to changes in work, health, and family situations. A cancer survivor should slowly add exercise to their daily activities and find something that works with their lifestyle.

Goals should be specific and realistic. Goals could include, for example, weight-loss and increased muscle mass. If flexibility is an issue, the goal may be to improve the range of motion. Other goals might be to become stronger, have a good quality of life, better mood, or to decrease the chance of recurrence.

Cancer survivors should follow a systematic and progressive plan. Exercise starts with a warm-up and ends with a cool down. Begin with deep breathing. Stretch daily using relaxation breathing. We add strength training to a program after a client has achieved an acceptable range of motion, optimal posture, and obtained medical clearance. 

Make it a point to communicate with your client’s healthcare team.  This way you can fully understand the health issues of the client as it relates to exercises and gives you the ability to relay movement concerns that you have discovered. 

A personal trainer should be ready to modify cancer exercise routines when their clients are fatigued. If complicated exercises are introduced, it may cause the client to drop out and increase their stress levels. Each cancer survivor has unique health issues and the fitness professional must make sure that they progress gradually.

It is important for a cancer survivor to adhere to a routine and not give up on the days they are not feeling their best. Always tell them to listen to their body and to understand the difference between some muscle fatigue and a health concern. Tell your client how proud you are that they are being physically active and always create a warm encouraging environment.