Cancer Related Fatigue: Are You Pushing Yourself Too Hard?
Sometimes it’s really hard to find the balance.
On the one hand you’re fighting through all of the physical and emotional struggles that come with a cancer diagnosis AND the treatment.
On the other hand you have your Oncologist, cancer websites you’ve been reading through, research articles (that you’re trying to read through) and people like me (!!!) telling you that if you exercise you’ll feel better and it will help with cancer fatigue.
How can you possibly balance all the s*!#*/<! (stuff) that’s going on by having a lovely stroll in the morning that’s supposed to clear your head, give you energy, and help you combat feeling tired all the time from cancer?
So, you decide to give it a whirl – exercise that is – even though you think it might just break you. How can all these experts be wrong??? So you start out on a walk and as you start to move you begin to wonder – how long should I walk? What if I don’t go far enough to make a difference? Or worse, what if I go too far and end up in bed for a week?
These are important questions and it’s this fear of the unknown that’s one of the top reasons patients and survivors don’t put on their sneakers. So I am here to give you a hand – and a handout – to help with these questions and take away some of that fear with moving.
I must say though – before we get going – there are reasons to have a Pre-Exercise Assessment before you start any exercise program after cancer diagnosis. If you’re starting this on your own it’s important to know if there are any neurological issues.
Chemotherapy can cause neuroendocrine toxicity which affects motor function. This can make you unstable and therefore unsafe for some forms of exercise, particularly unsupported exercise. Make sure you’re aware of your neurological stability so you stay safe.
One of the first things I teach my patients is how to rate their exertion. It can be a little difficult at first but it’s important to know how hard you’re working. And it becomes easier – I promise.
There’s a scale therapists use with their patients so we know how they’re feeling. Yes, we look at heart rate and blood pressure and biomechanics… but these things don’t give us a sense of how our patients FEEL.
When patients tell you they’re working at a 3 this week but 4 weeks ago the same workout was a 7, that’s really useful information.
So you’re going to learn how to use the same scale. It’s called the Borg CR-10 Scale – we’ll just call it the Borg Scale. This scale has been researched extensively and shows that the numbers on the scale correlate well with how the body responds to exercise*. This scale also has a colour code and some patients find this easier to use.
Green is the zone you want to be in and red is the zone that represents ‘danger’ (exercising at too high a level).
Now if you’re new to exercise, you HAVE TO start out at the low end of the scale. This is also where you should start AND stay if you’re exercising during treatment and have not regularly exercised in the past. As you exercise, use the scale to rate your exertion level.
Here’s an example…
You start off walking and after the first 30 seconds or so you rate your exertion at a 1 which corresponds to “little or no effort” on the Borg Scale.
After a minute or two you find that you’re at a 3 which is “moderate”. This is where you should stay when you’re first starting out with exercise. This is the Green Zone. As you continue your walk and you find that your rating is creeping into the red zone – 5 or higher – you need to look for ways to lower that number.
I’ve outlined these Exercise Modifiers in the WELLFIT Exertion Cheat Sheet – Just click the button below. What you’ll find is that with regular exercise you’re time in the Green Zone will increase and you will need less Exercise Modifiers to stay in the safe zone.
And this scale doesn’t have to be just for walking, swimming, or when at the gym. This can be while grocery shopping, vacuuming, or any activity that can get your heart rate up and requires exertion.
So take a look at this week’s WELLFIT Exertion Cheat Sheet. I’ve included a color outline of the Borg Scale that you need to use as well as instructions on how to use the scale. I’ve also included a list of Exercise Modifiers – ways to decrease your intensity as you exercise – so you can stay safe and keep exercising.
Grab Your Free Cancer Related Fatigue Checklist
*ACSM Guidelines for Exercise Testing and Prescription provides an outline of what exercise variables correlate to perceived exertion ratings from the Borg Scale.
Dr. Carole Schneider et al. Exercise and Cancer Recovery, Human Kinetics Inc.