Exercise and Chemo Brain with Breast Cancer Treatment

A recent study found that regular exercise before, during, and after breast cancer treatment can help minimize the cognitive difficulties known as chemo brain. Many, if not most, people going through cancer treatment experience some blunting of their usual mental sharpness,  and difficulty with concentration, focus, and word-finding. Most of us compensate fairly easily and return to our normal level of mental focus within a few months. Unfortunately, there are people who have a harder time.

This particular study involved more than 500 women who had been treated for breast cancer. A national prospective study, it evaluated women pre-treatment, immediately after the conclusion of chemotherapy, and six months later. The overall finding was that those who were the most active were the least likely to experience memory issues and foggy thinking. The researchers were unable to confirm how exercise may protect our brains during chemotherapy, but they did find that even small amounts make a difference. It is so reassuring to read that a half-hour walk can be protective and helpful; we don’t have to spend hours at the gym or run miles to take the best possible care of ourselves and our health.

The study included women with Stage I-IIIC breast cancer and asked them to complete questionnaires and tests three times. Questions were asked about how much physical activity they had, including routine activities like gardening and vacuuming. They were also asked how they felt during and after the exercise.

Of note, most women were relatively inactive before the cancer diagnosis. Only one third reported meeting the standard recommendations of moderate exercise (150 minutes per week). By the end of chemotherapy, that number had dropped to 21%, but increased to 37% six months later. A positive comment was that more women were physically active after cancer than they had been prior to the diagnosis. I interpret that fact to suggest that many of us are aware of the research suggesting that regular mild to moderate exercise may reduce the risk of recurrence.

No one really knows what causes chemo brain. Of note, there have been studies that found similar patterns of cognitive issues among women with breast cancer who did not receive chemo but were treated only with anti-estrogen therapies. The best guess is that there is a complicated mixture of physical and psychological stressors that add up to the syndrome. Certainly, women going through breast cancer treatment are taking many drugs, and there may be some brain cell reactions to some of them.

Everyone going through any kind of cancer is stressed, exhausted, and distracted. I hesitate to include depression in that sentence because many people go through cancer without developing a clinical depression or the need for meds. I do suspect that no one, or hardly anyone, goes through cancer treatment with being a small “d” depressed, meaning feeling some degree of sadness and isolation from the world.

Nothing in this study is intended to pressure women to do more. Virtually everyone going through cancer treatment, especially if it includes weeks or months of chemotherapy, is already pushing herself close to the limits of possibility. No one gets gold stars in heaven from daily exercise time. We do, perhaps, clear the fuzziness in our heads and help ourselves live as long and as healthily as possible. Start small and appreciate the time spent. If you dislike a particular kind of exercise, you are never going to stick to it. Whether you enjoy pickle ball, walks in the woods, or jumping jacks in your living room, just do it.

Reference:

Witlox, L., Schagen, S. B., de Ruiter, M. B., Geerlings, M. I., Peeters, P., Koevoets, E. W., van der Wall, E., Stuiver, M., Sonke, G., Velthuis, M. J., Palen, J., Jobsen, J. J., May, A. M., & Monninkhof, E. M. (2019). Effect of physical exercise on cognitive function and brain measures after chemotherapy in patients with breast cancer (PAM study): protocol of a randomised controlled trial. BMJ open, 9(6), e028117. https://doi.org/10.1136/bmjopen-2018-028117