Cancer and Fatigue: The Vicious Cycle

Kate Williams Cancer and Fatigue, Side Effects

It is probably the most common issue we hear when people first come into the MAC clinic: “I’m so tired all the time”. Cancer related fatigue is a debilitating and distressing issue that tends not to discriminate, more often than not affecting a sufferer regardless of type of malignancy or treatment undertaken. While there are many proposed biological mechanisms responsible for inducing cancer-related fatigue, it is also well understood that a loss of physical fitness can further deteriorate energy levels.

Physical inactivity is a common problem for many cancer patients, often due to lack of motivation or perception that this will result in an exacerbation in fatigue and other symptoms. However the lack of movement itself causes many unwanted side effects, including decreased cardiorespiratory fitness and muscle wastage, making everyday activities seem much harder than before. It is in fact this resultant deconditioning which contributes to cancer-related lethargy. This lack of energy in turn leads to a drop in motivation and negative thoughts such as “I’ll do it next week” or “it will make me worse” start to appear. This of course tends to mean a reduced amount of activity – from typical daily chores through to planned exercise regimes – which further facilitates muscle weakness, and so on and on the ‘vicious cycle’ goes.

Rather than envisioning fatigue as a factor that stops you from being active, you should aim to turn the tables on fatigue by counteracting it with exercise. Exercise has been shown help improve the energy levels of people with cancer, provided it is adjusted to the individual and carefully monitored. Key factors such as the frequency, intensity, volume and type of activity are important in ensuring that fatigue is managed. While these may vary between two people, they may also vary for YOU on given days or weeks.   Where periods of worse fatigue are experienced, lower intensity activities such as stretching, yoga and tai chi may be better options.

Here are some other tips you may find useful in dealing with fatigue during and after treatment:

  • Plan the time of your activity. Most of us have an optimal time of day at which we feel most energetic. While it may not always be possible to fit activity in here, try as best possible to plan your exercise around this time. At the least avoid that time at the other under of the spectrum – when you feel most run down. Many of my patients report feeling more energetic in the morning, and needing to take a nap in the afternoon. Often simply prioritizing exercise in the morning, before the slump hits, has made a big difference in consistently achieving their daily walk or weights session.
  • Break it up. While we advocate ideally aiming to achieve 30 minutes of exercise each day, did you know this is actually a ‘total’ we should aim for, rather than 1 constant block? Dividing your aerobic exercise routine into two or three blocks over the course of the day (for example, taking a 15 minute walk in the afternoon, and another in the evening) will yield the same results as one half hour one.
  • Keep a diary. Not just of your exercise, but also all of your daily activities which require an amount of physical exertion and the fatigue you experience (at MAC we use a simple 1-10 scale to rate fatigue). This will not only help you to better plan your overall exercise schedule and ensure you are ‘pacing’ yourself correctly (see below), but will serve as a valuable tool to help you identify any ‘triggers’ for more severe or unusual fatigue.
  • Pace yourself. Achieving a balance over the course of your week is important in conserving your energy levels. This means taking into account not just your exercise time, but also other daily activities which may involve some exertion. If you are planning a shopping trip, to get the house work done or some gardening time, it may be wise to take these days as rest days from exercise, or adjust your exercise plan accordingly. Also be sure to break up these activities, taking regular rest breaks rather than ‘pushing through’ hours at a time – even if it feels ok at the time, doing this will often trigger a fatigue ‘relapse’ the following day.
  • Talk to your practitioner. As best we try to manage these things, there can be aspects overlooked or valuable advice professionals can pass on to assist you. Your exercise physiologist, oncologist or general practitioner are good places to start.

What we absolutely DO NOT recommend is doing nothing. This will restart the ‘cycle’ and eventually result in a loss of fitness and strength, in turn making the fatigue worse. Even light exercise (such as those options recommended above) is better than nothing.

Remember: “Some exercise is better than no exercise, and more is generally better than less.”

Break the cycle!

McMillan, EM & Newhouse, IJ 2011, ‘Exercise is an Effective Treatment Modality for Reducing Cancer-Related Fatigue and Improving Physical Capacity in Cancer Patients and Survivors: A Meta-Analysis’, Appl. Physiol. Nutr. Metab., vol. 36, pp. 892-903.

Cancer Council Victoria 2013, Exercise for People Living with Cancer: A Guide for People With Cancer, Their Families and Friends.

Exercise is Medicine Australia 2014, Cancer and Exercise.

Hayes, SC, Spence, RR, Galvao, DA & Newton, RU, ‘Australian Association for Exercise and Sport Science Position Stand: Optimising Cancer Outcomes Through Exercise’, Journal of Science and Medicine in Sport, vol. 12, pp. 428-434.