Cancer and your balance

Good balance, whether you are standing still, walking your dog or climbing a mountain, depends upon having a strong, flexible, and agile body. However, when you are 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.

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

Proprioception is the other mechanism contributing to your balance. Proprioception is the internal feedback you get from your 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 your somatosensory system. Your nerves and brain receive, process and deliver messages to keep your 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 your hands and feet. This damage can result in numbness, pain, tingling and muscle weakness. This reduction in sensation impairs the feedback you receive from your hands and feet directly impairing proprioception. Peripheral neuropathy also reduces how well you can react to feedback. For example, if you are out walking you may not feel a tree root or a chestnut on the pavement and can roll your ankle before you 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 you too unwell to be active; the treatment toxicities; and being too fatigued after treatment to be physically active.

Fatigue and chemo-brain
Your brain is responsible for processing proprioceptive feedback and sending out messages to correct our body when we are off balance. “Chemo-brain” is a phenomenon of cognitive impairment caused by chemotherapy treatment affecting memory, attention and co-ordination. This reduction in attention and co-ordination 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 your ability to regain balance once you are 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 you can do something about it. Exercise has been proven to reverse the deconditioning process by increasing strength, muscles size, flexibility and agility, and reducing chemotherapy related fatigue. Exercise can relieve joint and muscle pain and slow bone loss. Balance exercises can improve your overall balance.

Assessing balance
It is important to have fitness and functional assessments by an accredited Exercise Physiologist. 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 you 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 your 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 re-training, 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 in improving balance include Tai Chi, yoga, pilates, dance, Nordic walking, and specific balance classes. A balance component is an essential part of any cancer recovery exercise class.

About the Author
Dale Ischia, ESSA, Accredited Exercise Physiologist specialising in exercise rehabilitation for cancer survivors.