Regular
exercise may help lessen “chemo brain” among women being
treated for breast cancer, according to a large-scale new study of the
associations between physical activity, chemotherapy and cognition. The study,
which involved more than 500 women with breast cancer, found that those who
were the most active before, during or after their treatment were the least
likely to develop the memory decline and foggy thinking that characterize chemo
brain.
اضافة اعلان
The study does not pinpoint precisely how exercise may protect
the brain during chemotherapy, but it does suggest even small amounts of
activity, such as a half-hour walk when possible, could make a difference in
cancer patients’ ability to think and remember as they move toward recovery.
Cognitive problems are nearly universal among women undergoing
chemotherapy for breast cancer. “Most patients will experience some degree of
cognitive decline” during or after their treatment, said Elizabeth A. Salerno,
an assistant professor of surgery and public health at Washington University
School of Medicine in St. Louis, who led the new study. In an earlier study
written by many of her collaborators, researchers found that women’s ability to
concentrate and remember worsened significantly after they began chemotherapy,
and the falloff lingered or even accelerated during the six months after their
treatment ended.
The causes of this so-called chemo brain remain somewhat
mysterious, Salerno said, but probably involve a complex interplay between
physical and psychological side effects from the disease and treatment.
Chemotherapy drugs may directly undermine the operations of certain brain
cells, for instance, or cause inflammation throughout the brain. Women with
breast cancer also often struggle with fatigue, depression or anxiety during
their treatment, which likewise can influence the ability to think and
remember.
Meanwhile, experts increasingly recommend exercise for people
with cancer of almost any type, including breast cancer, since it typically
combats certain of the more debilitating side effects of treatment, such as
fatigue and muscle loss. Perhaps even more important, in high-risk breast
cancer patients, exercise is linked to longer life spans and significantly
lower risks of recurrence.
But little has been known about whether being active might also
alter the severity of chemo brain. Past research into moving and thinking
during breast cancer treatment has been mostly small in scale or centered on
physical activity during chemotherapy, when few women, understandably, manage
to get much exercise.
So, for the new study, which was published in August in the
Journal of Clinical Oncology, Salerno and her colleagues decided to reanalyze
the data from the earlier study of cognitive decline in women undergoing
chemotherapy. This time, they focused on how much the women moved before and
after, as well as during, their chemo, and the relationship between being
active and their ability to think clearly. (The original research was designed
and led by Michelle C. Janelsins, an associate professor of surgery at the
University of Rochester Medical Center in Rochester, New York, who also was an
author of the new study.)
In the original study, 580 women with a diagnosis of Stage I to
Stage IIIC breast cancer, meaning malignancies that were contained in or near
the breast, completed questionnaires and tests about a week before starting
chemotherapy. One form asked them to recall how much time they spent recently
in any physical activity, whether vacuuming, gardening, walking or more-rigorous
sports like jogging. Separate questionnaires asked how they felt, right at that
moment, about their ability to think and remember. Finally, several computer
tests measured their visual memory, which is the vital ability to remember what
something looks like, as well as their attention.
The women repeated these forms and tests during the final week
of their chemotherapy and again six months later. Separately, 363 women without
breast cancer completed the same forms and tests on about the same schedule, to
serve as a control.
Then the researchers compared activity levels and cognition.
Overall, the women with breast cancer were relatively inactive before starting
chemotherapy. Only a third of them met standard exercise guidelines, which call
for at least 150 minutes a week of moderate exercise, such as a brisk,
half-hour walk most days. The percentage of patients meeting these guidelines
dropped to 21 percent near the end of chemotherapy, but rebounded to 37 percent
six months later. For the control group, it hovered around 40 percent
throughout the experiment.
Women’s symptoms of chemo brain generally paralleled their
activity levels. Those few patients who met the guidelines before and
throughout their treatment showed little cognitive decline at all. Their
results on the computer tests before, during and after their chemotherapy were
comparable to those for the control group (although some of the patients
reported feeling less sharp). Perhaps most compelling, if women with cancer
started out active, meeting the exercise guidelines before chemo, they tended
to score higher on the cognitive tests six months later than women who had been
inactive from the start, even if they stopped moving much during treatment.
For any woman who has been diagnosed with breast cancer and
wonders how to start or maintain regular exercise, Salerno has several
suggestions.
— First, talk with your physician to discuss which exercise
routine would be safest and most feasible for you in your current health and
situation.
— Look up cancer survivorship groups in your area. They
sometimes offer group walking or other exercise programs. Some gyms, YMCAs or
hospitals also provide exercise classes geared to cancer patients.
— Remember, small steps are still steps. If you cannot manage a
brisk 30-minute walk, “making it to the mailbox and back is something,” Salerno
said. “Any movement,” no matter how brief or gentle, “is likely to have
benefits.”
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