Regaining Your Balance After Cancer

Dale Ischia, CSEP, Accredited Exercise Physiologist, specializes in exercise rehabilitation for cancer survivors at InspireHealth. InspireHealth is a nonprofit integrative cancer care organization helping Canadians since 1997; it’s partially funded by the BC Ministry of Health. 

Good balance, whether you’re standing still, walking your dog, or climbing a mountain, depends upon having a stong, flexible, and agile body. However, when you’re dealing with cancer and treatment, your balance can be negatively affected in a number of ways. The good news is that exercise can counteract these negative effects and greatly improve your ability to balance.

First, it is important to understand balance.

We achieve physical balance by receiving and interpreting input from a number of body systems. Visually, we receive input from our eyes about where we’re located compared to our surroundings, which is our spatial orientation. We also receive spatial orientation feedback from our inner ears: the vestibular system. Our inner ear consists of two tiny canals of fluid. When we move, the fluid moves. The information about how the fluid is moving is sent directly to the part of our brain that controls eye movements and postural muscles that keep us stable.

Proprioception is the other mechanism contributing to our balance. Proprioception is the internal feedback we get from our own skin, muscles, and joints about where they are relative to one another and how much effort the muscles are exerting. This is feedback from our somatosensory system. Our nerves and brain receive, process, and deliver messages to keep our body in a constant state of perfect balance.

Cancer and its treatment can impede balance in a number of ways. Cancer can directly affect nerves by compression from a tumour or by direct infiltration. Some medications used to treat cancer can directly damage nerves or cause shortness of breath and dizziness that can negatively affect balance.

Peripheral neuropathy

Some chemotherapy drugs can cause damage to the nerves in the hands and feet. This damage can result in numbness, pain, tingling, and muscle weakness. This reduction in sensation impairs the feedback we receive from our hands and feet, directly impairing proprioception.

Peripheral neuropathy also reduces how well we react to feedback. For example, if we’re out walking, we may not feel a tree root or a chestnut on the pavement and can roll our ankle before we have time to respond. If you experience peripheral neuropathy, it may be necessary to avoid high impact activities such as running and jumping which could result in injuries.

General deconditioning

General deconditioning, just as it sounds, refers to the body becoming unfit which occurs due to a lack of physical activity and exercise. Being unfit may involve one or more symptoms:

• muscle atrophy
• reduced cardiovascular capacity
• reduced strength
• reduced endurance
• reduced flexibility and agility, and/or
• worsening body composition (more fat, less muscle)

Cancer causes general deconditioning in a number of ways: through the illness itself, making us too unwell to be active; the treatment toxicities; and being too fatigued after treatment to be physically active.

Fatigue and “chemo-brain”

Our brain is responsible for processing proprioceptive feedback and sending out messages to correct our body when we’re off balance. Chemo-brain is a phenomenon of cognitive impairment caused by chemotherapy treatment affecting memory, attention, and coordination. This reduction in attention and coordination has a negative effect on balance. Combine this with the sluggish reactions that come with fatigue and you may find yourself bumping into walls or tripping over the living room rug.

Joint and muscular pain

Joint and muscular pain can be another cancer treatment side effect. Pain inhibits muscular contractions, thus reducing our ability to regain balance once we’re off balance.

Bone issues

Unfortunately, some cancer treatments, such as hormone therapies, cause bone loss. Combine this lower bone density with a reduced ability to balance and you have a high risk of fracturing a bone.

Bony metastases are also a site of increased fracture risk. Thus, if you have bone tumours, it is essential you have the ability to maintain good balance.

Loss of confidence

Being nervous about losing your balance and having a fear of falling can increase your actual incidence of falling.

The good news

This may sound all doom and gloom, but we can do something about it. Exercise has been proven to reverse the deconditioning process by increasing strength, muscle size, flexibility and agility, and reducing chemotherapy-related fatigue. Exercise can relieve joint and muscle pain and slow bone loss. Balance exercises can improve our overall balance.

Assessing balance

It is important to have fitness and functional assessments by a trained exercise physiologist or kinesiologist. Two good balance tests you might encounter are the “Stork Stand test” and the “Timed up and go.” If your balance is found to be deficient, further tests might be done and the therapist may prescribe appropriate exercise for you.

Managing balance deficiencies

Ensuring that we have good balance means less falls, improved quality of life, and less chance of a bone fracture.

Treatment of balance disorders in cancer patients should include medical assessment. If the balance deficiency is caused by swelling in the ear or vertigo, there may be medications that can help. Or if it is medications causing the balance disturbance, doctors can help. Vision and hearing tests will address any concerns from the vestibular and visual systems.

Balance can be improved through exercise. An assessment of your balance will dictate the most beneficial exercises for you. Often an improvement in balance is achieved, even in people with lower limb peripheral neuropathy, through increasing hip and core stability and reactions.  If you require significant balance retraining, a specific rehabilitation program will be prescribed. Balance exercises can incorporate the use of the fit ball, Bosu, Dura Disc, foam pad, single leg standing, and heel raises. You can also learn how to catch yourself if you start to fall.

Simply improving your confidence can improve balance. Nordic walking poles provide great physical and psychological support while at the same time incorporating upper body exercise into your walking.

Exercise classes that you may find useful for improving balance include tai chi, yoga, Pilates, dance, and specific balance classes. A balance component is an essential part of any cancer recovery exercise class.