Taking on blood cancer - actively

Being diagnosed with a blood cancer can leave people feeling overwhelmed and both mentally and physically exhausted. Unsurprisingly, the idea of exercising while enduring blood cancer and the often-invasive treatments may be the last thing you’d feel like doing.

However, our research team is demonstrating that exercise is exactly what you should be doing to support your physical and mental recovery during and after blood cancer.

As one of the participants in our published studies said:

“I just felt so fatigued I thought there’s no way I’ll be able to do any of this, but I then realised that actually doing the exercise was the thing that was going to get me over the fatigue”.

Exercising when you’re not well, however, requires guidance and support from professionals to help you navigate your symptoms and judge how hard to push yourself.

Every day in Australia, 50 people are diagnosed with a blood cancers like leukaemia, lymphoma or myeloma. While medical treatments have improved drastically over the past 30 years, they can be traumatic and have the potential to cause serious side effects.

Our research team has focused on people with blood cancer who undergo a bone marrow transplant (also known as a stem cell transplant). This is an intensive treatment which often requires a prolonged recovery period in hospital – it temporarily weakens the immune system, leaving patients at high risk of side effects like infection and organ malfunction.

Many of our research participants describe symptoms including debilitating fatigue, pain and weakness. As one of them told us:

I get really so fatigued that all I want to do is sleep, and my bones hurt so bad that I can’t even exercise. And it’s extremely frustrating.

Previous research has shown that some of the symptoms and side effects associated with blood cancers can be improved through physical exercise. However, it is difficult to know how and when to start exercise.

To better understand when it is safe to exercise and what types of support people may require, we carried out two patient studies. We hypothesised that a group-based approach to exercise during treatment for blood cancers may help to improve motivation and participation.

In the first study, we introduced a group-based exercise program – supervised by a physiotherapist and nurse specialist – at a Melbourne hospital’s outpatient physiotherapy gym. There were 43 participants, each starting the program two-months after their bone marrow transplant.

The eight-week program proved to be safe and feasible and we saw signs of recovery in physical and mental wellbeing among the participants.

However, the overwhelming feedback was that participants had already lost a lot of their fitness and strength by the time they started and wanted to start the structured exercise program sooner.

In the second study of 42 participants, we started a group-based exercise program as soon as participants were admitted to hospital for their transplant and for the duration of their admission, which varied from two to 10 weeks.

Despite people feeling at their worst during their inpatient hospital admission, this program had excellent uptake and demonstrated improvement in psychological wellbeing, which we suspect was due to the peer-support provided by the group-based approach.

Participants in our programs overwhelmingly reported enjoying exercising in a group-based setting.

Receiving treatment for a blood cancer can be isolating and mentally exhausting – and so exercise was a way of bringing back some semblance of control or normality.

“I think [the exercise program] provides such a good opportunity…to meet people and talk to people and see where everyone else is at and see that you actually are still a person…It takes it away from the medical stuff and you just get to be you and exercise…that’s really important mentally and physically.” – study participant.

Participants appreciated the importance of the support they received from a physiotherapist to help keep them accountable and monitor their symptoms when they are feeling unwell.

Given that each person is different and will respond to treatment differently, an individualised approach to supervised exercise is paramount.

“...when I was on the ward…feeling terrible, you know that [physiotherapy staff] were there to get you out of bed and to your session, and that just helps you maintain that momentum...” – study participant

“…as long as it’s tailored to the person [and] their limitations, because there’s all sorts of ages and health concerns and whatever, that’s the main thing…” – study participant

Our research establishes that physiotherapy-guided exercise is safe at all time points of the treatment journey for blood cancers.

There are also various physical and psychological benefits associated with physiotherapy-guided exercise, and we now have increased knowledge to develop and implement structured exercise programs into routine clinical care in Australia.

Complementing our work, behavioural psychologist Dr Camille Short and Professor in Physiotherapy Linda Denehy are developing models for delivering exercise supervision, diet and behaviour change support to bone marrow transplant patients at home, before and after treatment.

By developing high-quality, home-based programs they hope to expand access to include patients in regional and rural areas.

However, currently these programs aren’t funded at most hospitals and only occur as a result of research. We need support from policymakers and funders to embed evidence-based programs offering professionally-guided exercise support as part of routine care for blood cancers.

Not only can this improve patient quality of life, it could also reduce hospital costs.

International evidence has demonstrated that supervised exercise can reduce the length of a hospital stay which can potentially reduce the long-term burden and cost on the healthcare system.

So, if you, or someone you know, is going through treatment for blood cancer – regardless of where you are in your treatment journey – here are just some general tips to get you started:

• Reduce the amount of time you are spending sedentary or sitting – stand up every one to two hours to walk around the house or do some simple arm and leg movements for two to five minutes.
  
• Start off slow and build gradually.
  
• Listen to your body; when you are fatigued, short gentle bursts of physical activity can help.
  

• Keeping physically active does not have to be boring, consider the activities you enjoy.
  
• Enlist an exercise buddy and share your desire to exercise with others to keep you accountable.
  
• Seek support from an exercise professional if you are unsure where to start or how to progress. A physiotherapist or Exercise Physiologist with oncology expertise would be ideal.
  

As one of one participant told us:

“...it’s not like we’re doing heavy intense like gym sessions, but just moving your body makes a difference...”.

May 28 is World Blood Cancer Day.

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