Training After Chemotherapy

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I am about to begin a six month course of chemo. I am bound and determined to continue full steam ahead with training for next year's roster of events. Can I train under these conditions?

Member Question

I am about to begin a six month course of chemo. I am bound and determined to continue full steam ahead with training for next year's roster of events (2 half marathons, 2 marathons, 1 HIM, IMWI and my first Olympic with two of my daughters for fun). Ambitious under any circumstance but not sure how this will work with chemo.  Fortunately the course of treatment will be over the winter months. The drugs I will be given are targeted monoclonal antibodies and not the kind that kills every fast growing cell causing considerable suffering to the recipient. Hopefully it won't be terrible.

Can I train under these conditions? How do I maintain strength? Any tips to offer a newbie? Should I get a port or go the vein route? Thoughts on either in terms of training?

Answer from Dr Michael Jonesco, DO
Member AMSSM

Dear Ambitious IronPerson,

Great question(s).  In fact, it is so great, that we have very little (if any) scientific data to support or refute recommending this level of exercise while undergoing treatment.  You are a case study in the making! 

I suppose I should start with a disclaimer.  It is hard to assess your ability to do the above without knowing your experience/training level and more importantly, your specific treatment and diagnosis.   Monoclonal antibodies range from relatively benign side effects to severe heart failure.  I would need to know your exact diagnosis and treatment plan to give the right advice. However, I thought some of the following points would be helpful.

There are dozens of "monoclonal anti-bodies" used to treat a range of ailments from autoimmune disease, inflammatory bowel disease, and, yes, cancers.  Monoclonal antibodies in cancer treatment bind to specific molecules to inhibit growth of and destroy cancer cells.  As I mentioned, the mechanisms and side effects can all be very different, but in general they act similarly and thus share common side effects.  Side effects may range from mild nausea and vomiting, to fatigue, and can even increase your risk for heart failure and severe infections.  In my experience with exercise and chemotherapy, fatigue will be most likely to limit your training.

Judging by your ambitious goals, I can assume you are at near peak percentile of experience and conditioning.  While there have not been any specific studies with Ironman training during cancer treatment, there have been various studies examining the effects of exercise in cancer patients leading up to and during treatment.   Many of them are limited by small patient sizes, variability in cancer and chemotherapy regimens, and involved less demanding levels of exercise than what you seek.  However, they do suggest that exercise can help you both physically and psychologically in enduring cancer treatment.  

Two of the larger studies highlighted these benefits.  One study in 2007 studied 242 breast cancer patients undergoing chemotherapy who concurrently performed aerobic training or resistance training.  The patients enrolled in the aerobic and resistance training showed higher levels in self esteem, body composition, and even completion rates of chemotherapy.   Another study published in 2009 of other cancer patients showed that higher intensity exercise training (aerobic and resistance training) in patients actively receiving chemtherapy could be pursued safely.  Patients were closely monitored and allowed to exercise as long as their blood pressure and heart rate were not extremely high or low, were without infection or low blood counts, and none of them had cancer involvement of brain or bone. The patients who completed the higher intensity exercise regimen reported less fatigue and higher physical functioning and vitality. 

If you plan on your ambitious schedule, I would offer the following recommendations:

1.  Communicate.  It is VERY important that your team of physicians is aware of these goals.  Your events can cause aches, pains, shortness of breath and fatigue, but so can your treatment!  If these symptoms occur they should be reported so your doctor can order any further work-up if needed.  If you are lucky enough to have a proactive sports medicine physician and hematologist (or oncologist), ask if they are willing to sit down with you to ensure how training can be safe and successful.  Your team of physicians can discuss the details of your training, from your intensity to your access (port vs intravenous). 

2.  Have a plan.  Several changes to your body will occur over the next year.  Depending on your treatment you may develop blood abnormalities, including anemia which could hinder your energy level and performance.  Many treatments cause profound nausea or vomiting, complicating hydration balance.  Furthermore, following vigorous prolonged endurance trials the immune system and can actually shut down and make the body more susceptible to infection.  This risk is certainly magnified with chemotherapy and it is vital to plan events and treatment accordingly. 

3.  Prepare for acceptance.  Understand exercise is important for your body, but so is the treatment you are receiving.  While certainly a diagnosis of cancer is scary, we hope your treatment will be successful.  Realizing your treatment can put an immense stress upon your body is important in understanding if you are limited in your success.  It is understandable if fatigue or motivation wavers.  Focus on successful treatment and there will be many other races and opportunities for personal bests and to enjoy the sport with your daughters!

I respect your dedication and commitment.  I am in awe of your spirit to let nothing slow you down.   Good luck from your newest fan(s)!

Dr Michael Jonesco, DO
The Ohio State University
Internal Medicine and Sports Medicine Physician

Dr Jonathan Huang
Internal Medicine Resident

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Small study with Patients with platelets < 20k and without spontaneously bleeding or infection were able to cycle under controlled settings.  Transfused at

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date: August 29, 2014

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The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

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The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

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