Most people have some knowledge of the blood circulating system in the body and how it works. Blood is pumped away from the heart, through the arteries, arterioles, and capillaries, and returns to the heart through the venules and the veins. However, there is another “vascular system” in the body that most people do not know about. It is called the lymphatic system.
The lymphatic system is a network of fluid carrying vessels, much like the cardiovascular system, whose vessels are structured much like veins. However, the lymphatic vessels are not filled with blood. As blood circulates through the body some of its fluid content (about 10% of the total blood volume per one complete circuit through the body), containing cell waste and proteins, leaks out of the blood vessels and infiltrates the body tissues. Left unchecked, this phenomenon would ultimately cause a build up of fluid and waste products in the body, resulting in toxicity, swelling and weight gain from the increased body water content. The job of the lymphatic system is to pick up the fluid lost from the blood and return it to the heart, thus preventing build up of toxic substances and excess fluid in the body. Once the fluid enters the lymphatic vessels, through one way valves, it is called lymphatic fluid or just lymph. The ultimate example of what can happen in response to a deficit in lymphatic function is demonstrated by the disease called elephantiasis. In this disease, the lymphatic vessels become blocked, the flow of lymph fluid is impaired, fluid and toxic waste builds up in the body tissues, and swelling ensues until the point of damage to or the death of the affected tissue.
A unique characteristic of the lymphatic system is that there is no pump, like the heart, associated with its vascular network. There is no active, continuous, mechanism in the body which puts pressure on the fluid in the lymphatic vessels in order to drive it back toward the heart. There are however other types of methods that the body uses to push the lymph in the direction of the heart and thus put it back into the blood circulatory system. One method that the body uses involves respiration, breathing. When an individual inhales, the thoracic cavity expands and a negative pressure is developed within the cavity. This negative pressure essentially sucks the lymphatic fluid toward the thoracic cavity and thus toward the heart. The faster and deeper one breathes the larger the negative pressure generated in the thorax and the faster the lymph fluid flows back toward the heart. A second method that the body uses to get lymph fluid back to the heart is called the muscular pump. When skeletal muscles contract they squeeze the lymphatic vessels present within themselves, and in other parts of the body, and ultimately propel the lymph fluid back toward the heart. The flow of lymph fluid is one-way only, from the peripheral tissues toward the heart, because the lymphatic vessels have one-way valves in them which prevent backflow, away from the heart, once the lymph fluid has moved forward. So, with every deep breadth and every contraction of the skeletal muscles of the body, lymph fluid is propelled toward the heart.
Here is where exercise comes into the scheme. Exercise causes increases in the rate and depth of breathing, and it causes the skeletal muscles to contract heavily. Both of these functions then cause the lymph fluid to move toward the heart. When the lymph fluid is continually being pumped back into the blood, the blood volume then is constantly being replenished and the cellular waste products in the lymph fluid can enter the blood and be removed by the kidneys and liver. This then alters the compartmentalization of the fluid in the body. The blood volume remains within normal limits, while the fluid and cell waste which might have accumulated in your body tissues through lack of exercise, is decreased. This causes a natural decrease in body weight through decreasing body water content and a natural detoxification of your body by getting waste products out of the body tissues and into the blood where they can ultimately be removed by the kidney and liver.

The Human Body in Health and Illness
Second Edition
Herlithy, Maebius
Saunders
11830 Westline Industrial Drive
Saint Louis, Missouri 63146

An associate of mine recently asked me if there was a beneficial effect of exercise on cancer patients. I immediately did a Google search (search words: effect of exercise on cancer patients) on this topic and came up with some interesting information. One article that I found was a review of a number of other previous publications, about the effects of exercise on cancer. I have summarized this article below.

Journal of Clinical Oncology: Volume 23, Number 16, June 2005

The authors of the above manuscript have compiled the results of the effects of a variety of exercise modalities on individuals with cancer, or those being treated for cancer, or those after being treated for cancer.
The types of exercises employed in the reviewed studies included: walking, cycling, swimming, resistance exercises, aerobic exercises or a combination of these exercises; all performed at intensities which induced the patients to work at between 50% and 90% of their estimated maximal heart rate.
The frequency of the exercises performed ranged from: a low level, two times a week, up to a high level of two times daily, with long-term durations ranging from 2 weeks up to 1 year. In some studies, the exercising group was compared with a group that received some form of training of a lesser intensity, frequency, and/or duration, or to a group that did not receive any exercise at all.
A diverse set of outcomes were subsequently measured in the exercising patients and included: subjective, self-reported, function and symptoms evaluations, psychological well-being evaluations, overall health-related quality of life evaluations, and; objective outcomes, such as measurement of physiologic and performance functions.
The types of cancers that were present in the exercising group included: breast, stomach, head, neck, colon, ovarian, brain and lung cancer, and non-Hodgkins lymphoma.
The objective physical functions that were changed in a positive way in the exercising group included: increased aerobic capacity, increased muscle strength, longer walking distance, better range of motion/body flexibility.
body weight, body mass index, total body water content, fat free body mass, general body composition, increased total energy expenditure, bone mineral density, creatinine excretion rate, decreased neutropenia, increased hemoglobin content, more natural killer cell activity, decreased fasting glucose levels, decreased insulin resistance and increased IGF2 and IGFBP-1 levels were also changed for the better.
Subjectively rated, self-reported out-comes, included: symptomatic relief from nausea, fatigue, difficulty sleeping, pain and diarrhea.
Psychological related well-being outcomes included: better mood status, increased fighting spirit, less depression, less anxiety, more happiness, increased levels of self esteem and a generally increased quality of life.

The authors concluded that: “The general pattern of results indicates that exercise can be effective in reducing symptoms and improving the physical and psychosocial functioning of patients with cancer.”

Dr. J
Dr. J’s Personal Training
Newtown Square Shopping Center
Newtown Square, PA 19073

For those of you who want to research this topic further, listed below are the original publications referenced by the above article.

1. Lindley C, Vasa S, Sawyer W, et al: Quality of life and preferences for treatment following systemic adjuvant therapy for early-stage breast cancer. J Clin Oncol 16:1380-1387, 1998
2. Meuser T, Pietruck C, Radbruch L, et al: Symptoms during cancer pain treatment following WHO-guidelines: A longitudinal follow-up study of symptom prevalence, severity and etiology. Pain 93:247-257, 2001
3. Hanson-Frost M, Suman V, Rummans T, et al: Physical, psychological and social well-being of women with breast cancer: The influence of disease phase. Psychooncology 9:221-231, 2000
4. Schwartz A: Daily fatigue patterns and effect of exercise in women with breast cancer:
Cancer Pract 8:16-24, 2000
5. Schwartz A: Fatigue mediates the effects of exercise on quality of life. Qual Life Res
8:529-538, 1999
6. Schwartz A, Mori M, Gao R, et al: Exercise reduces daily fatigue in women with breast cancer receiving chemotherapy. Med Sci Sports
Exerc 33:718-723, 2001
7. Courneya K, Keats M, Turner A: Physical exercise and quality of life in cancer patients following high dose chemotherapy and autologous bone marrow transplantation. Psychooncology 9:127-136, 2000
8. Dimeo F, Rumberger B, Keul J: Aerobic exercise as therapy for cancer fatigue. Med Sci Sports Exerc 30:475-478, 1998
9. Courneya K, Friedenreich C: Physical exercise and quality of life following cancer diagnosis: A literature review. Ann Behav Med 21:171-179,
1999
10. Courneya K: Exercise interventions during cancer treatment: Biopsychosocial outcomes. Exerc Sports Sci Rev 29:60-64, 2001
11. Friedenreich C, Courneya K: Exercise as rehabilitation for cancer patients. Clin J Sport Med 6:237-244, 1996
12. Pinto B: Exercise in the rehabilitation of breast cancer survivors. Psychooncology 8:191-206, 1999
13. Courneya K: Exercise in cancer survivors: An overview of research. Med Sci Sports Exerc 35:1846-1852, 2003
14. Dimeo F: Effects of exercise on cancer related fatigue. Cancer 15:1689-1693, 2001
(suppl 6)
15. Fairey A, Courneya K, Field CJ, et al: Physical exercise and immune system function in cancer survivors: A comprehensive review and future directions. Cancer 94:539-551, 2002
16. Oldervoll L, Kaasa S, Hjermstad M, et al: Physical exercise results in the improved subjective well-being of a few or is effective rehabilitation for all cancer patients? Eur J Cancer 40:951-962,
2004
17. Irwin M, Ainsworth B: Physical activity interventions following cancer diagnosis: Methodologic challenges to delivery and assessment.
Cancer Invest 22:30-50, 2004
18. Bentzen S: Towards evidence based radiation oncology: Improving the design, analysis, and reporting of clinical outcome studies in radiotherapy. Radiother Oncol 46:5-18, 1998
19. Moher D, Schulz K, Altman D: The CONSORT statement: Revised recommendations for improving the quality of reports of parallel-group randomized trials. Lancet 357:1191-1194, 2001
20. Schulz K, Chalmers I, Hayes R, et al: Empirical evidence of bias: Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 273: 408-412, 1995
21. Moher D, Cook D, Eastwood S, et al: Improving the quality of reports of meta-analyses of randomised controlled trials: The QUOROM statement ”Quality of reporting of metaanalyses. Lancet 354:1896-1900, 1999
22. Dickersin K, Scherer R, Lefebvre C: Identifying relevant studies for systematic reviews. BMJ 309:1286-1291, 1994
23. Van Tulder M, Assendelft W, Koes B, et al: Method guidelines for systematic reviews in the Cochrane Collaboration Back Review Group for Spinal Disorders. Spine 22:2323-2330, 1997
24. Verhagen A, de Vet H, de Bie R, et al: The Delphi list: A criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. J Clin Epidemiol 51:1235-1241, 1998
25. van Tulder M, Malmivaara A, Esmail R, et al: Exercise therapy for low back pain: A systematic review within the framework of the Cochrane collaboration back review group. Spine 25:2784-2796, 2000
26. Colle F, Rannou F, Revel M, et al: Impact of quality scales on levels of evidence inferred from a systematic review of exercise therapy and low back pain. Arch Phys Med Rehabil 83:1745-1752, 2002
27. Cunningham B, Morris G, Cheney C, et al: Effects of resistive exercise on skeletal muscle in marrow transplant recipients receiving total parenteral nutrition. JPEN J Parenter Enteral Nutr 10:558-563, 1986
28. Winningham M, MacVicar M: The effect of aerobic exercise on patient reports of nausea. Oncol Nurs Forum 15:447-450, 1988
29. Winningham M, MacVicar M, Bondoc M, et al: Effect of aerobic exercise on body weight and composition in patients with breast cancer on adjuvant chemotherapy. Oncol Nurs Forum 16:683-689, 1989
30. MacVicar M, Winningham M, Nickel J: Effects of aerobic interval training on cancer patients functional capacity. Nurs Res 38:348-351, 1989
31. Mock V, Burke M, Sheehan P, et al: A nursing rehabilitation program for women with breast cancer receiving adjuvant chemotherapy. Oncol Nurs Forum 21:899-908, 1994
32. Dimeo F, Fetscher S, Lange W, et al: Effects of aerobic exercise on the physical performance and incidence of treatment-related complications after high-dose chemotherapy. Blood 90:3390-3394, 1997
33. Young-Moo N, Min-Young K, Young-Kyumn K, et al: Exercise therapy effect on natural killer cell cytotoxic activity in stomach cancer patients after curative surgery. Arch Phys Med Rehabil 81:777-779, 2000
34. Segal R, Evans W, Johnson D, et al: Structured exercise improves physical functioning in women with stages I and II breast cancer: Results of a randomized controlled trial. J Clin Oncol 19:657-665, 2001
35. Mock V, Pickett M, Ropka M, et al: Fatigue and quality of life outcomes of exercise during cancer treatment. Cancer Pract 9:119-127, 2001
36. Segal R, Reid R, Courneya K, et al: Resistance exercise in men receiving androgen deprivation therapy for prostate cancer. J Clin Oncol 21: 1653-1659, 2003
37. Mello M, Tanaka C, Dulley F: Effects of an exercise program on muscle performance in patients undergoing allogeneic bone marrow transplantation. Bone Marrow Transplant 32: 723-728, 2003
38. Coleman E, Coon S, Hall-Barrow J, et al: Feasibility of exercise during treatment for multiple myeloma. Cancer Nurs 26:410-419, 2003
39. Mcneely M, Parliament M, Courneya K, et al: A pilot study of a randomized trial to evaluate the effects of progressive resistance exercise training on shoulder dysfunction caused by spinal accessory neurapraxia/neurectomy in head and neck cancer survivors. Head Neck 26:518-530, 2004
40. Dimeo F, Tilmann M, Bertz H, et al: Aerobic exercise in the rehabilitation of cancer patients after high dose chemotherapy and autologous peripheral stem cell transplantation. Cancer 79:1717-1722, 1997
41. Mock V, Dow K, Meares C, et al: Effects of exercise on fatigue, physical functioning, and emotional distress during radiation therapy for breast cancer. Oncol Nurs Forum 24:991-1000, 1997
42. Dimeo F, Stieglitz R, Novelli-Fischer U, et al: Effects of physical activity on the fatigue and psychologic status of cancer patients during chemotherapy. Cancer 85:2273-2277, 1999
43. Hayes S, Davies PS, Parker T, et al: Total energy expenditure and body composition
changes following peripheral blood stem cell transplantation and participation in an exercise programme. Bone Marrow Transplant 31:331-338, 2003
44. Hayes SC, Rowbottom D, Davies PS: Immunological changes after cancer treatment and participation in an exercise program. Med Sci Sports Exerc 35:2-9, 2003
45. Pickett M, Mock V, Ropka M, et al: Adherence to moderate-intensity exercise during breast cancer therapy. Cancer Pract 10:284-292, 2002
46. Nieman D, Cook V, Henson D, et al: Moderate exercise training and natural killer cell cytotoxic activity in breast cancer patients. Int J Sports Med 16:334-337, 1995
47. Berglund G, Bolund C, Gustafsson UL, et al: One-year follow-up of the Starting Again group rehabilitation programme for cancer patients. Eur J Cancer 30A:1744-1751, 1994
48. Berglund G, Bolund C, Gustafsson UL, et al: A randomized study of a rehabilitation program for cancer patients: The starting again group. Psychooncology 3:109-120, 1994
49. Burnham T, Wilcox A: Effects of exercise on physiological and psychological variables in cancer survivors. Med Sci Sports Exerc 34:1863-1867, 2002
50. Mckenzie D, Kalda A: Effect of upper extremity exercise on secondary lymphedema in breast cancer patients: A pilot study. J Clin Oncol 21:463-466, 2003
51. Pinto B, Clark M, Maruyama N, et al: Psychological and fitness changes associated with exercise participation among women with breast cancer. Psychooncology 12:118-126, 2003
52. Courneya K, Mackey J, Bell G, et al: Randomized controlled trial of exercise training in postmenopausal breast cancer survivors: Cardiopulmonary and quality of life outcomes. J Clin Oncol 21:1660-1668, 2003
53. Fairey A, Courneya K, Field C, et al: Effects of exercise training on fasting insulin, insulin resistance, insulin-like growth factors, and insulin-like growth factor binding proteins in postmenopausal breast cancer survivors: A randomized controlled
trial. Cancer Epidemiol Biomarkers Prev 12:721-727, 2003
54. Courneya K, Friedenreich C, Sela R, et al: The group psychotherapy and home-based physical exercise (group-hope) trial in cancer survivors: Physical fitness and quality of life outcomes. Psychooncology 12:357-374, 2003
55. Courneya K, Friedenreich CM, Quinney HA, et al: A randomized trial of exercise and
quality of life in colorectal cancer survivors. Eur J Cancer Care (Engl) 12:347-357, 2003
56. Segar M, Katch V, Roth R, et al: The effect of aerobic exercise on self-esteem and depressive and anxiety symptoms among breast cancer survivors. Oncol Nurs Forum 25:107-113, 1998
57. Berglund G, Bolund C, Gustavsson U, et al: Starting again: A comparison study of a group rehabilitation program for cancer patients. Acta Oncol 32:15-21, 1993
58. Landis J, Koch G: The measurement of observer agreement for categorical data. Bio-
metrics 33:159-174, 1977
59. Wu A, Pike M, Stram D: Meta-analysis: Dietary fat intake, serum estrogen levels, and
the risk of breast cancer. J Natl Cancer Inst 91:529-534, 1999
60. Yu H, Berkel H: Insulin-like growth factors and cancer. J La State Med Soc 151:218-223, 1999
61. Vadgama J, Wu Y, Datta G, et al: Plasma insulin-like growth factor-I and serum IGF binding protein 3 can be associated with the progression of breast cancer, and predict the risk of recurrence and the probability of survival in African-American and Hispanic women. Oncology 57:330-340, 1999
62. Chlebowski R, Aiello E, Mctiernan A: Weight loss in breast cancer patient manage-
ment. J Clin Oncol 20:1128-1143, 2002
63. Davidow A, Neugut A, Jacobson J, et al: Recurrent adenomatous polyps and body mass index. Cancer Epidemiol Biomarkers Prev 5:313-315, 1996
64. Amling C, Riffenburgh R, Sun L, et al: Pathologic variables and recurrence rates as related to obesity and race in men with prostate cancer undergoing radical prostatectomy. J Clin Oncol 22:439-445, 2004
65. Brown J, Byers T, Doyle C, et al: Nutrition and physical activity during and after cancer treatment: An American Cancer Society guide for informed choices American Cancer Society. CA Cancer J Clin 53:268-291, 2003
66. Fearon K, Luff R: The nutritional management of surgical patients: Enhanced recovery after surgery. Proc Nutr Soc 62:807-811, 2003
67. Evans W: Effects of exercise on senescent muscle. Clin Orthop Relat Res Oct: S211-S220, 2002 (suppl 403)
68. Courneya K, Friedenreich C, Sela R, et al: Correlates of adherence and contamination in a randomized controlled trial of exercise in cancer survivors: An application of the theory of planned behavior and the five factor model of personality. Ann Behav Med 24:257-268, 2002
69. Samarel N, Fawcett J, Krippendorf K, et al: Women perceptions of group support and adaptation to breast cancer. J Adv Nurs 28:1259-1268, 1998