Sport and exercise are essential for health. Even when dealing with cancer, movement Have a supportive effect: It strengthens physical performance and muscle strength, improves cognition and can also cause symptoms such as tumor-related fatigue, fears and depressions diminish. Sport and exercise are recommended even during treatment for many types of cancer. Since not every type of exercise is suitable for all types of cancer, it is advisable to discuss with the attending physician when which sport can be started.
If you experience dizziness, severe pain, nausea and infections, exercise should not be exercised or stopped immediately.

This article presents various types of exercise and highlights them with regard to cancer and common side effects.

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Endurance sport

Endurance sports include all physical activities that can be performed over a long period of time and aim to improve endurance and the cardiovascular system. Endurance sports are aerobic, i.e. they use oxygen to produce primary energy.
Jogging, walking, cycling and swimming are among the most popular endurance sports. Cross-country skiing, inline skating, rowing, or (mountain) hiking are also endurance sports.

Endurance exercise is generally associated with a number of health benefits. These include

• Improving cardiovascular health by strengthening the heart and improving blood flow
• Increasing endurance, which allows the body to remain active over a longer period of time without tiring
• Reduction of stress, as physical activity releases endorphins, which can increase well-being and reduce stress
• Improving overall wellbeing, mental health and mood, reducing anxiety
• Increasing general energy levels

These also apply to studies that have also shown that just two to three times 30 minutes of endurance exercise per week can reduce fatigue in cancer patients [1,2]. Endurance sports don't have to be extremely exhausting to have a positive effect. Even moderate-intensity training (around 65% of your maximum heart rate) is enough. Most people achieve this with just a quick walk, a round on a bike, or a few laps in the swimming pool.

However, it is important not to overwhelm yourself. It is generally recommended to start with light physical activities and slowly increase the intensity: walks in which you increase distance and walking speed over weeks and months, similar to other endurance sports. A training session should last 30-60 minutes, but intervals of at least 10 minutes are also okay. Easy activities are those where you can still have a good time. If it gets harder and you start snorting, activities are moderate training. But this is just a rule of thumb.

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Strength and resistance training

Weight training is a form of physical training that aims to strengthen and increase muscles through the use of resistance. In principle, this includes all exercises in which the muscles work against an opposite force, so that the muscles tense up more and work more physiologically than in exercises without resistance. This resistance can be generated by using weights, machines, elastic bands, or your own body weight.

The general benefits of strength and resistance training include

• Maintaining and/or building muscle mass through stimulation
• Improving strength, muscle endurance, and muscle function
• Improving posture and balance

Around 50% of cancer patients lose weight and muscle mass unintentionally during the illness. In a medical context, this is known as cachexia. According to studies, structured muscular training during chemotherapy or radiotherapy can positively influence cachexia [5]. Regardless of the entity, strength training is recommended for all tumour patients in the (early) rehabilitation phase.
It can also have a positive effect on mood and quality of life and reduce fatigue [2].

It is recommended that major muscle groups be moderately trained two to three times a week for 45 to 60 minutes. However, it is important to carry out a strength test with an expert (e.g. sports medicine specialist, physiotherapist, in a good gym) before the first training session in order to determine the maximum load and create a training program. Moderate strength and resistance training means that around 50-75% of muscle strength is used. Maximum strength training is not recommended during therapy. It is also recommended to discuss with the attending physician when training is possible.

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Gentle types of movement

Gentle forms of exercise are activities that are gentle on the body and often aim to promote flexibility, balance, relaxation and mindfulness. These activities are particularly suitable for people who want to exercise after an injury, during recovery, or when there are certain health restrictions. Gentle types of movement include

yoga
Yoga includes a variety of exercises, breathing techniques, and meditations that can improve flexibility, strengthen muscles, calm the mind, and reduce stress. There are various styles of yoga that focus differently on physical effort, stretching, and mediation.

Tai Chi
Tai chi is a Chinese martial art characterized by slow, flowing movements and deep breathing. Thai chi promotes balance, improves posture and can help reduce stress.

pilates
Pilates focuses on strengthening core muscles, improving flexibility, and promoting healthy posture. Through controlled movements and conscious breathing, Pilates can help improve body awareness and reduce stress.

Qigong
Qigong is a traditional Chinese practice that combines movement, breathing, and meditation to promote the flow of vital energy (Qi) in the body. It can help reduce stress, promote relaxation, and improve health.

water aerobics
Water aerobics or aqua fitness is carried out in water and offers a joint-friendly way to improve endurance, strength and flexibility. The water reduces pressure on the joints and enables gentle training. Water aerobics can also have a positive effect on stress levels and mood.

Meditative walks
A meditative walk involves walking slowly in nature. During meditative walks, particular attention is paid to sensory perception and breathing. They can help reduce stress and calm the mind.

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Gentle types of movement focus on perception of one's own body, targeted controlled movement, and breathing. You should also take body awareness into account. Healthy body awareness describes a coherent feeling that is in harmony with yourself. You accept yourself and how your body feels. Dramatic changes in life, such as a cancer diagnosis or surgery, which may involve external changes in the body, can change the perception of one's own body.

Gentle types of movement help to reduce stress through targeted and conscious movements and breathing. Clinical studies are increasingly showing that they can reduce fatigue and pain, counteract depression and anxiety disorders, and improve the quality of life. In addition, the repeated movement stimuli lead to improved physical flexibility, stability, and — depending on the method — strength. They can also alleviate stiffness. This can help you cope better with everyday life and prevent pain.
Studies show that yoga and Qigong can reduce fatigue in a comparable way or in some cases even better than strength and endurance training.

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[1] Brown, J.C., Huedo-Medina, T.B. et al.: Efficacy of Exercise Interventions in Modulating Cancer-Related Fatigue among Adult Cancer Survivors: A Meta-Analysis. 2011. Cancer Epidemiology, Biomarkers & Prevention, 20(1), 123-133

[2] Kessels, E.; Husson, O.; van der Feltz-Cornelis, CM: The effect of exercise on cancer-related fatigue in cancer survivors: a systematic review and meta-analysis. 2018. Neuropsychiatric Disease and Treatment, 14:, 479-494,

[3] Davies NJ, Batehup L, Thomas R. The role of diet and physical activity in breast, colorectal, and prostate cancer survivorship: a review of the literature. 2011. British Journal of Cancer 105, S52 — S73; doi:10.1038/bjc.2011.423

[4] German Cancer Society (ed.) Sport and cancer. Can you run away from cancer? FORUM, volume 26, issue 03.2011.

[5] Lemanne D, Cassileth B, Gubili J. The Role of Physical Activity in Cancer Prevention, Treatment, Recovery, and Survivorship. Oncology. 2013 Jun. 27 (6) :580-5.

[6] Strasser, B.; Steindorf, K. et al.: Impact of resistance training in cancer survivors: A Meta Analysis. Med Sci Sports Exerc 2013; 45:2080 — 2090.

[7] Bower JE, Woolery A, Sternlieb B, Garet D. Yoga for Cancer Patients and Survivors. Cancer Control. 2005; 12 (3) :165-171.

[8] Klein, P. J., Schneider, R. & Rhoads, C. J. Qigong in Cancer Care: a Systematic Review and Construct Analysis of Effective Qigong Therapy. Support Care Cancer24, 3209—3222 (2016)

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