Patients with esophageal cancer should maintain an active and effective level of exercise after surgery, and the exact intensity and duration of exercise should be determined by the current treatment and physical condition.
Postoperative breathing exercises first
Radical esophageal cancer surgery often destroys the integrity of the patient’s thorax, leading to postoperative complications such as decreased lung function, lung infection, and pneumothorax, which affects lung expansion and is detrimental to the patient’s postoperative recovery. Respiratory training can reduce postoperative complications and mortality of esophageal cancer patients, and moderate activities and respiratory function exercise can promote the recovery of digestive system. Adherence to long-term respiratory training therapy can improve respiratory function and enhance exercise endurance and survival quality, providing a better physical foundation for improving patient prognosis.
Common respiratory exercises include abdominal breathing, lip reduction breathing, and respiratory gymnastics training.
Abdominal breathing
Patients can sit, lie or stand in a natural relaxed position, slowly inhale deeply through the nose to maximum lung capacity and then hold the breath for 2 to 5 seconds, gradually increasing to 8 to 10 seconds, with the abdomen rumbling at the end of the deep inhalation, and then slowly exhale through the mouth. This training is repeated for 15 to 20 minutes each time, several times a day.
Lip-reduction breathing
The patient chooses a natural and relaxed posture, inhales as hard as possible through the nose, exhales slowly through the mouth, exhales with the lips contracted like a whistle, while contracting the abdomen, inhales deeply and exhales slowly, the time ratio between inhalation and exhalation is 1:2 or 1:3, 7 to 8 breaths per minute, and so on for 15 to 20 minutes each time, several times a day. During the training of lip reduction breathing and abdominal breathing, the thorax and shoulders are kept at the minimum amplitude of activity as much as possible, and if necessary, appropriate pressure is given at the end of exhalation with both hands on top of the abdomen to assist in emptying the residual air volume.
Breathing gymnastics
Limb exercises based on abdominal breathing and lip reduction breathing. In the early postoperative period (before removal of the chest drain, or when activity is restricted for other reasons), the lower extremities can be trained in sitting or lying, with flexion and extension of the legs, 10 times/group, 3 groups per day; the upper extremities can be trained with supination, forward extension, abduction and expansion of the arms during inspiration, and natural dropping of the arms during exhalation, 15-20 minutes each time, 3 times per day; after extubation, along with the above respiratory gymnastics training, appropriate indoor and After extubation, at the same time of the above respiratory gymnastics training, appropriate indoor, corridor walking training, eating alone and toilet training can be arranged, and the training plan is gradual and according to the ability.
Post-discharge, rehabilitation: comprehensive exercise is carried out gradually
During the active treatment period and within 3 months after the end of treatment (recovery period), if patients with esophageal cancer recover well, they can gradually increase the amount of exercise and develop a personalized aerobic exercise program based on their individual physical ability and exercise habits. Aerobic exercise is mainly of low to medium intensity, including walking, hand washing, stair climbing, bicycling and other forms of home exercise that are closely related to daily life. The exercise can be performed at 9:00-10:00 and 16:00-17:00 or 2 hours after eating; the duration of exercise is 20-30 minutes/time, 3-5 times/week, and the interval between two aerobic exercises is less than 2 days. For patients with esophageal cancer, exercise should be tolerated, gradual and measured, and the best state is to keep exertion but not fatigue.
There is a difference in exercise intensity, so figure out the definition before exercising
The intensity of aerobic exercise can be controlled by monitoring the heart rate. A heart rate of 40% to 60% of the maximum heart rate during exercise is considered low-intensity exercise, and a heart rate of 60% to 70% of the maximum heart rate is considered moderate-intensity exercise, where the maximum heart rate is (220 – actual age) beats per minute. In a 60-year-old patient with esophageal cancer, for example, the maximum heart rate was 160 beats/min, and the heart rate reached 64-96 beats/min during exercise as low-intensity exercise, and the heart rate reached 96-112 beats/min as moderate-intensity exercise.
Judging exercise intensity by self-perception
If it is not convenient to judge exercise intensity by heart rate, you can also use subjective sensory methods to describe exercise intensity. Medium intensity is to feel “a little panting, but still able to talk”. If you don’t get out of breath at all, the intensity is too low for you; if you get so out of breath that you can’t talk, the intensity is too high.
What to do during exercise
Because patients with esophageal cancer are prone to anemia and malnutrition, attention should be paid to assessing blood indicators before exercise. Patients with moderate or higher anemia (hemoglobin <80 g/L) should delay exercise and correct the anemia before exercising, but they can perform normal daily life. For patients who are severely fatigued due to anemia and malnutrition, they can perform 10 minutes of light exercise every day (e.g., wiping tables and sweeping the floor).
Some patients have indwelling catheters during chemotherapy, and these patients should reduce or avoid factors that may cause infection, such as public pools, and especially patients with leukopenia due to chemotherapy should hold off on swimming.
In addition, these patients with severe pain, peripheral neuropathy due to chemotherapy (often manifested as numbness or tingling in the hands and feet, decreased balance, etc.), and bone metastases need to consult with their physicians before exercising.