When Gina Rugel was nearing the end of a recent two-day bicycle trip covering a distance of approximately 170 miles, she began to lose control of her emotions.
“I started to think back,” said Rugel, 52, a Doylestown resident who was diagnosed with breast cancer in January 2012. “I’d completed my radiation treatments almost exactly one year earlier. Before that, I’d been through chemo. Anyway, I found myself thinking about where I was physically last year compared to the way I was feeling at that point. I consider myself a mentally strong person, and I maintained a positive outlook throughout the entire ordeal,” she continued. “But as I was finishing up the bike ride, it sort of crystallized the transformation I’d made, and, well, it was a pretty emotional moment.”
Rugel has been an athlete since childhood. She’s a former gymnast who taught aerobics, kept physically fit and joined a recreational bicycle team along with husband, Rob, a number of years ago. She didn’t need to be persuaded to exercise during her recovery from cancer.
Valerie Wakefield, however, did.
When Wakefield, a 63-year-old Mount Airy resident, learned she had breast cancer in January 2013, her weight hovered around 250 pounds. Ironically, she was diagnosed barely a month after enrolling in a weight-loss program. “I was not somebody who exercised,” she admitted, “but after my surgery — I’d opted for a total mastectomy — I was told by my doctor that if I was able to lose weight, hormonal treatments wouldn’t be necessary. My decision was to use exercise as an alternative to hormonal therapy.”
She became a regular at the Einstein Healthcare Network’s Survivors in Pink exercise program for cancer survivors, went for frequent walks and, for good measure, improved her diet. Her weight is down to 200, and falling. “I’m so thankful for the way things have worked out,” Wakefield said. “I’ve been given an opportunity to improve my health, and exercise has proven to be an elixir for me. My entire lifestyle has changed.”
Less than a decade ago, it wasn’t unusual for medical professionals to instruct cancer patients to rest and reduce their physical activity as much as possible. While doctors agree that any movement increasing discomfort or causing such symptoms as shortness of breath or highly accelerated heart rate should be avoided, research has indicated that exercise is not only safe for cancer patients but also can improve a patient’s ability to function.
“Now that the realization that exercise is beneficial is evident to those of us in the medical field, the push is on, so to speak,” said Dr. Steven Levin, chief of Abington Memorial Hospital’s Rehabilitation Medicine Division. “The common assumption is that cancer patients might be resistant to an exercise program, considering the effects of the illness as well as the treatments. On the contrary, patients often welcome the idea of exercise as long as they feel it can help the quality of their lives.”
According to Dr. Daniel Monti, director of Thomas Jefferson University Hospital’s Myrna Brind Center of Integrative Medicine, the optimum time for a cancer patient to begin exercising is at the conclusion of acute medical treatment for the disease.
“During chemotherapy or radiation, there is nothing wrong with encouraging a patient to have as high an activity level as is tolerable, but exercise programs generally work best once treatment is completed,” he explained.
Dr. Mark Morganstin, a specialist in hematology and oncology at the Einstein Healthcare Network, noted that an exercise program needs to be tailored to each patient, taking numerous factors into consideration. He pointed out that someone with lung cancer is going to have a much different program than someone with breast cancer or colon cancer. Abington’s Levin added that a patient who hasn’t exercised in the past would likely be referred to a physical therapist, while a fitness enthusiast might be given a specific set of exercises that can be performed in a gym.
However, the doctors agreed that even the most physically fit patients must start slowly and be monitored carefully as they recover from cancer. Just ask Jeff Shernoff, 56, a Philadelphia native who relocated to Boynton Beach, Fla., in 2010. The previous year, Shernoff was diagnosed with prostate cancer, which was removed through robotic surgery. “When I was first up and around after the surgery, I remember having a conversation with my doctor,” said Shernoff, a multisport participant throughout his life. “He told me not to lift anything heavier than a pen.”
Medical professionals generally recommend that recovering cancer patients exercise between three and five hours per week. Patients often are encouraged by the wide range of exercise options available to them. “Exercise is considered to be an activity above your normal daily function,” said Miriam Rohr, a physical therapist associated with MossRehab since 1990. “A lot of people enjoy walking, but if you’re not someone who likes to walk, there’s biking, yoga, dance, swimming or golf, to name just a few possibilities. Then, there are activities not generally associated with exercise, such as mowing the lawn or gardening. The important thing is getting into a good, healthy routine of activity.”
Among the American Cancer Society’s suggestions are washing and waxing the car, walking the dog, using stairs instead of elevators and even scrubbing the bathroom. “Someone once asked me if I consider walking around the mall to be exercise,” Einstein’s Morganstin said. “I responded that I consider it to be better than sitting around in the house.”
“The bottom line is, cancer patients are likely to benefit from some type of exercise,” Jefferson’s Monti said. “Studies show that the immune system functions more efficiently, inflammation in the body is lowered, and the patient is energized. As a result, his or her mood and outlook are improved.”
Furthermore, health care professionals relate, muscles keep from wasting due to inactivity; blood flow, especially to the legs, is improved, which lowers the risk of blood clots; dependence on others is reduced; instances of nausea are lessened; balance is improved; and the ability to maintain social contacts rises. Jackie Castaldi of Audubon, N.J., was diagnosed with breast cancer late in 2008, leading to a bilateral mastectomy and four rounds of chemotherapy. Afterward, due largely to the side effects of her medications, her weight ballooned from 100 pounds to above 150. “I’m not a person who exercised, but my oncologist believed very strongly that exercise was something I needed to do,” Castaldi, 48, said. “I didn’t feel good, and I certainly didn’t feel like exercising, but I started with gentle weight training and light stretching, then added a little bit of cardio, and I gradually continued to progress.
“The weight started coming off, and I began to understand that the exercise was enabling me to attain a sense of normalcy at a faster pace. My oncologist told me I’d see a huge improvement.
“And I did.”
Matt Schuman is an area writer. This article originally appeared in the special section, "Fighting Cancer."