Resistance training as adjunct in
El entrenamiento de resistencia como ayuda en el tratamiento del cáncer: una breve reseña
*Faculdade de Medicina do ABC
**Universidade Federal Rural do Rio de Janeiro
Jemima Cristina Giandoso*
Nélia Reis da Costa*
Gilmar Campos Júnior*
Rodrigo Rodrigues da Conceição**
Cancer is an important public health problem in countries that are developed and in development so there are some therapeutic methods for treating this malignant neoplasias include surgical resection, radiotherapy, chemotherapy and hormone therapy. Therefore Different methods of exercise are used as adjuncts within Cancer treatment in patients submitted to chemotherapy and radiotherapy with the intention of improving body composition and functional capacity, besides increasing muscular strength levels. Goal of this review was to assess resistance training influence as adjunct in the Cancer treatment. The aim of this review was to assess resistance training influence as adjunct in the Cancer treatment.
Keywords: Resistance training. Exercises. Cancer. Chemotherapy. Radiotherapy.
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According to the World Health Organization (2002), Cancer is an important public health problem in countries that are developed and in development, accounting for more than six million deaths every year, which represents 12% of all death causes in the world. However, there is an estimation for 2020 of an annual number of new cases in the order of 15 million across the world, and 60% of these will occur in countries in development (INCA, 2007).
In line the National Cancer Institute (2003), the most frequent tumors in Brazil are: prostate, lung, stomach, colon and rectum and esophagus in the male population, and in women breast Cancer is predominant, followed by Cancers of the uterine cervix, colon and rectum, lung and stomach. Furthermore, the leading Cancer death causes in Brazil during 2001 were the breast of lung, prostate, stomach, esophagus, mouth and pharynx in men, and breast, lung, uterine cervix, cervical and stomach in women (Ministério da Saúde, 2004).
Current therapeutic methods for treating the malignant neoplasias include surgical resection, radiotherapy, chemotherapy and hormone therapy. While many of these treatments are effective in removing and/or attacking malignant cells, it is known that some of these interventions also affect healthy tissue cells and triggers a cascade of harmful effects that can lead to acute and chronic debilitation due to cytotoxicity. (Schneider, 2007).
According to Courneya (2003) combinations of these metabolic changes may be associated with psychological depression and a decrease of appetite, factors that cause patients to begin a vicious cycle of loss of muscle mass, decrease levels of physical activity resulting in a state generalized weakness. Corroborating with this statement the National Cancer Institute in the United States, reports that 72% to 95% of the patients receiving Cancer treatment show increased levels of fatigue, resulting in significant decrease in the functional capacity, as a consequence there is loss in their health and life quality. In addition the American College of Sports Medicine (ACSM, 2009) reports that physical activity and a balanced and healthy diet reduces from 30% to 40% the chances of Cancer development in individuals.
Therefore, the main goal of this review was to assess resistance training influence as adjunct in the Cancer treatment.
A quest of articles was conducted in PubMed, SciELO, and Google Scholar, using the following key words: "Cancer" "Quimiotherapy", "Radioterapy", "Cancer and Exercises", "Cancer and Resistance Trainning" longitudinal and transverse trials were selected. References found in the these article bibliographies, with the same methodology as specified above, were captured due to meeting the selection criteria for this study. Names of authors cited in researches were also used. Initially, all abstracts were evaluated independently by two reviewers. The articles approved by them were included in the study. Disapproved studies by one of the reviewers were subjected to a third reviewer.
Effects of resistance training in cancer’s patients
Fatigue related to Cancer can affect up to 70% of all patients undergoing chemotherapy or radiotherapy (Dimeo, 2001). At least 30% of Cancer survivors have been reporting fatigue, usually accompanied by lack of energy for many years after treatment (Dimeo et al, 1997). Causes of fatigue related to Cancer treatment are multifactorial and are associated with both poorer physical and emotional capacity which occur after Cancer diagnosis and its subsequent treatment (Mock et al, 2001).
Different methods of exercise are used as adjuncts within Cancer treatment in patients submitted to chemotherapy and radiotherapy with the intention of improving body composition and functional capacity, besides increasing muscular strength levels.
Although exercise in a general way provides benefits in Cancer patients subjected to radiation or chemotherapy treatments, resistance training seems the most effective for increasing lean body mass. Lonbro et al (2013) submitted patients, who were being treated with radiotherapy, to 12 weeks of resistance training and 12 weeks with a self-chosen activity. There were increases of 4.3% lean body mass and functional performance in the weeks that resistance training was performed.
Survivors of Breast Cancer with lymphedema may limit the movements of arms, providing a loss of functional capacity in the affected limb. Believing in the hypothesis that resistance training can improve life quality and functional capacity of women, Schmitz et al 2009 submitted patients to a progressive resistance training, verifying improvement in the affected arm, thus preventing routine injuries from this type of treatment. In addition menopausal women also survivors of breast Cancer, in the age group 40-60 years and with a post treatment 2-5 years, underwent cardio-respiratory resistance training and improvements in their life quality and overall physical fitness were verified. In another study, Kim et al 2010 divided patients with lymphedema in two groups: one only had decongestant therapy while the other group had physical therapy and was also subjected to resistance training; in the second group, patients had volume reduction in the arm proximal region. However, men with Prostate Cancer undergoing treatment with endrogenos deprivation therapy having eccentric resistance training seemed to have improved life quality beyond the strength and mobility in these patients (Hanser et al, 2009).
When comparing effects of different training methodology in relation to self-esteem in women undergoing chemotherapy for Breast Cancer, no difference between aerobic exercise and resistance training was observed, however differences were observed when the two methods were compared with women who did not perform exercises (Courneya et al, 2007). Performing a methodology of the concurrent training which included walking on a treadmill or ergometer cycle for a period from 06 to 12 minutes followed by whole body stretching exercises ranging from 05 to 10 minutes and finishing with resistance training that varied from 15 to 30 minutes (Battaglini et al, 2005), identified increased strength and reduced fatigue in patients with chemotherapy for Breast Cancer, corroborating with such findings (Courneya et al, 2007) also found improvements in life quality, physical fitness, increased lean body mass and self-esteem in patients with Breast Cancer undergoing aerobic and resistance training; on the other hand, patients with Breast Cancer which have not gone through chemo or radiation treatment, but undergo surgery and underwent aerobic, resistance, and flexibility training, did not increase their muscle strength; however, a reduction was observed in levels of fatigue (Battaglini et al, 2005). Pilates, which is a modality that mainly develops strength and flexibility, has shown to be beneficial to Breast Cancer patients, as shown by Eyigor et al (2010) in an evaluation of 40 patients aged between 18 and 75 years, patients practiced pilates with 3 weekly 1-hour sessions, for 8 weeks; positive benefits were verified in the physical function and also in their depression state.
In conclusion, all the investigations conducted to determine the influence of strength or resistance training associated with cardiopulmonary training or flexibility training, found increases in muscle performance, reduce fatigue, improve quality of life. Thus, the elaborations of resistance exercise sessions objectifying one assist in the treatment of Cancer is extremely important because it was shown that the improvement in functional capacity of these patients beyond the development of physical qualities mentioned above.
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