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It wasn’t the heat of the night that woke Karen Curnow over the summer of 2021 and 2022, but the extreme pain in her legs, a side effect of the chemotherapy drugs she was taking to treat ovarian cancer.

She’d wake at 2am and, unable to lie in bed, she would pace her house in Victoria’s Macedon Ranges waiting for the sun to rise, so she could feed her horses. She would then take her 12-year-old chestnut quarter horse, George, who’d had his own health challenges, for a 30-minute stroll around the paddock to try to ease the pain.

Karen Curnow with her horse, George.Credit: Fi Mims

On these, the worst of nights, Curnow had tried using a combination of strong painkillers.

“Not even Endone, Nurofen and Panadol together made any dent,” says the 58-year-old. “The only thing that made any difference was walking.”

She let herself rest on the days the “chemo-fog” loomed large, but when she felt up to it – most days – she’d also take her dogs for a one or two-kilometre walk. Being outdoors, in fresh air, helped. It took her focus off her diagnosis and helped shift her mindset: “It kept me sane,” she says.

“Being physically fit gave me some strength and some semblance of control over what was happening. And it reassured me that my body was still working.”

It was also the doctor’s orders. When Curnow had asked her oncologist if there was one thing was she could do that could make a difference, she was told, physical activity.

Long-gone are the days when prolonged bed rest was prescribed for cancer, along with virtually every other acute or chronic ailment.

Though it’s true that we feel tired when we are unwell and good sleep can aid recovery, numerous studies have found that prolonged bed rest doesn’t improve anyone’s outcomes and, often, leads to worse outcomes.

So, what should we do? How much should we exercise when we’re sick? Does it make a difference if we have a cold compared with a chronic condition? And does exercise have different benefits when we’re unwell?

A new meta-analysis, published in The British Journal of Sports Medicine, found that people with cancer who exercised during their treatment (such as chemotherapy), were less likely to be admitted to hospital, and overall spent fewer days in hospital.

“If all the benefits of exercise were wrapped up into a pill, every doctor would be prescribing it,” said the lead researcher Dr David Mizrahi, from the University of Sydney’s Daffodil Centre.

Previous research has found that it is helpful for cancer patients to exercise most days regardless of type or stage of cancer, and even when undergoing difficult treatments. This study demonstrates that exercise also helps improve clinical outcomes. “It is helping to actually keep patients out of hospital during a challenging time when there are many medical unknowns,” Mizrahi says.

“Exercise is proving more than just an afterthought or supportive care for cancer patients, it is providing real clinical improvements.”

“If all the benefits of exercise were wrapped up into a pill, every doctor would be prescribing it.”

Professor Rob Newton, the deputy director of Edith Cowan Univeristy’s Exercise Medicine Research Institute, says the findings are “pretty much universal” to all chronic diseases.

“If a patient with any chronic disease remains sedentary, then the disease will only accelerate more quickly, they will experience worse signs and symptoms, and the side effects of any medical treatments will be worse.”

Still, the dosage and intensity will vary widely depending on the type of illness, the severity, and the side effects of their medical treatment.

“For example, a man with prostate cancer who is receiving testosterone suppression therapy and is suffering from treatment toxicities such as muscle and bone loss requires a resistance and impact exercise program to ameliorate the side effects,” Newton says.

Someone who is obese and diagnosed with type II diabetes, on the other hand, requires a combination of aerobic exercise and resistance training to prevent the loss of muscle mass as a side effect of dietary changes.

Mizrahi adds that patients undergoing stem cell transplants are often constricted to staying in hospital for weeks at a time, so bringing bikes and light equipment into the hospital rooms for low-intensity movement can help them.

Women who have had a mastectomy, which can limit the movement in their shoulders, can benefit from exercise programs targeting the upper body, while chemotherapy for colorectal cancer can cause nerve damage in the patient’s feet, so an exercise program may focus on improving their balance.

Just as the type of exercise and duration will vary for those who are sick, the benefits of exercise are different for people who are unwell compared to those who are healthy. This is because the exercise prescription is specific to the health issues that the patient is experiencing, like improving the cardiorespiratory function of someone with cardiovascular disease, for instance.

As for exercising when you have a cold, flu, coronavirus, hepatitis or some other short-term infectious disease, the infection must be managed first and rest remains important.

“Having said this, some amount of low-intensity exercise is still important to help them overcome the infection because exercise is crucial to facilitate the immune system,” Newton says.

Regardless it is a time the exercise guidelines go out the window.

“I often tell patients at the beginning to not worry about the guidelines for now. Our goal with this ‘new normal’ with this exercise is to try something small such as a five-minute walk or some body weight exercises, such as standing up from a chair five times,” Mizrahi says. “Each week patients will be able to build off that start.”

The key, adds Newton, is to tailor the exercise prescription to the individual. Given the potency of the intervention, Mizrahi says exercise should not be an afterthought in a patient’s treatment.

“We needed to do this analysis to advocate to our federal and state ministers to be funding this service more, so all patients going through treatment can receive tailored exercise programs to their individual needs, so they can cope with their treatment better.”

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