Fatigue is one of the most common side-effects of cancer and leukemia chemotherapy treatments. A consequence of this side-effect is lower levels of daily physical activity among cancer patients undergoing chemotherapy. Furthermore, fatigue side-effects of chemo often persist for several weeks. Hence, cancer patients who used to be physically active can find themselves out of shape by the time the side-effects of chemo wear off. For that reason, maintaining a sufficient level of physical activity during cancer treatment is of the utmost importance.
Walking and counting steps is known to be beneficial to the long-term survival of vulnerable but otherwise healthy populations (such as the elderly). Hence, a common recommendation to cancer patients is simply to walk more. However, walking is considered a “non-exercise” physical activity for healthy folks. By contrast, walking the lobby of a cancer ward with an IV drip under chemotherapy-induced fatigue definitely feels like exercise.
This is especially true for leukemia patients (like myself) whose chemotherapy treatments lower the red blood cells count. Their cardiovascular system then becomes much less effective at sending oxygen to the muscles. Under these conditions, walking not only feels like exercise, but like hard exercise.
And yet, even under those conditions, walking should still be thought of and presented as “non-exercise” to cancer and leukemia patients. The argument requires a bit of a build-up so I’ll develop over in series of posts rather than in a single one.
In this first post, I’ll consider a possible counter-argument, namely that walking is, after all, an Olympic sport (and a hard sport at that) and thus that walking-as-exercise makes a lot of sense after all. Unfortunately, walking-as-a-sport does not support the notion of walking-as-exercise. Let us see why.
The sports of walking
Race walking has been an Olympic sport since the 1904 Olympics. It may not as popular or spectacular as other Olympic sports, but walking is one of the most challenging of Olympic endurance sports. It is also one of the most extensively researched, as the rules of race walking make it fascinating from a biomechanical standpoint. If you are curious, you can watch the short (5’30”) introduction to the sport and its science embedded below.
Due to the rules of the sport, race walking is very unlike ‘ordinary’ walking. In particular, the rules state that a race walker must extend their knee before contact with the ground and must always have one foot in contact with the ground. Failure to comply with either rule is ground (pun intended) for disqualification. As a consequence, race walkers have developed a special type of gait relying on hip action that is not at all seen in ‘ordinary’ walking.
From a biomechanical standpoint, race walking has more in common with strong(wo)man competition events than with ‘ordinary’ walking. The details of this parallel exceed the scope of this post, but if you have watched the video above and compare it with the Instagram video embedded below, you’ll have a sense of the similarity (look for the side-to-side hip action when I face off and walk away from the camera).
Stong(wo)man carries have their own fascinating biomechanics but it has not been as extensively studied as race walking (you can read more about it here). Just as race walking, loaded carries in strong(wo)man competitions rely on muscles that are not used in ordinary gait to generate motion but only to stabilize the trunk (namely, the quadratus lumborum). Using those muscles in ordinary walking would actually be pathological and would call for re-patterning and rehabilitation.
Summing up the above, the existence of “sports of walking” cannot be a reason to recommend walking as exercise if only because the walking action in these sports is not the ‘ordinary’ walking action that is recommended to cancer patients. That being established, there is another reason to be cautious with the recommendation to walk for exercise purposes.
Training vs. Exercising
Training for a competitive sport is not typically referred to as “exercising”. To give but one reason (and unless we are talking about “competitive exercising” like CrossFit Games or National Pro Grid League) “exercising” does not come with the same kind of performance goals as training for a competitive sport. Of course, doing 100 push-ups is a ‘performance’ goal, as would be running a given distance under a given time even without any thought of competing in running. And so, there is a continuum between exercising and training rather than a sharp divide.
A more important difference is that, unlike recreational exercisers, competitive athletes cannot ‘skip’ training without serious consequences. Their training is
is constrained by a rigid competition calendar, and subsequently planned weeks and often times months ahead. Missing a training session or two is often enough to disrupt the plan and compromise the performance goals for the day of a competition. By contrast, a physically active person can miss one or two exercise sessions during the week and either make up for the missed activity during the week-end or delay the completion of their goals (if they have any). For these above reasons, “training” and “exercising” are not synonymous.
The connotations associated with “exercising” may even cause the recommendation to “walk for exercise” to collapse entirely. “Exercising” is typically understood as something that we should do if we can, but that we can skip if we lack the time and/or energy to do it. Subsequently, telling someone that walking is their exercise might be taken to imply that they could ‘skip’ walking if they lack the time and/or energy for it, and make up for the lack of activity when their energy level come back to normal.
Now, let me clear up a possible misunderstanding. There is no denying that cancer and leukemia chemotherapy affect one’s energy level to the point of making walking an effort. For patients undergoing these treatment, or any type of treatment for any type of conditions with similar side effects, maintaining the habit of walking is a necessity. And thus I’m not saying that people should not be encouraged to walk more.
What I am saying is that, because of the connotations associated with the word “exercise” and to the verb “exercising” in everyday contexts, recommending walking as a form of exercise may even be counterproductive when addressing people whose conditions and treatments make walking an effort.
Wrapping up: if not walking, what else?
Because of the connotations associated with the word “exercise” and the verb “exercising”, recommending walking as exercise is tantamount imply that one might ‘skip’ walking if they lack the time or energy for it and make up for the lack of exercise later. Someone suffering from a condition which by itself or by a side-effect of its treatment makes walking an effort can easily perceive themselves as lacking the energy for it, and thus justified in skipping it. For that reason alone, such a person should never be encouraged to think that walking is “exercising”.
Granted, a condition that makes walking an effort (be it by itself or by a side-effect of its treatment) does not seem to leave much choice for physical activity. After all, if walking is an effort, “exercising” is a harder effort requiring even more energy. And so, something that one could ‘skip’ when lacking the energy for it. And so, it may seem that I have painted myself into a corner, and that recommending walking is, in fact, the only option left when walking itself is an effort.
But just because some exercise options would require more energy than walking does not imply that they are off the table. Of course, exercising during chemotherapy causes more fatigue, and may cause someone to walk less. And yet, some exercise options can more than make up for the lack of walking, and even improve one’s condition to the point that walking becomes less of an effort. I’ll consider those options in a follow-up post.