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Marathon Run under Chemotherapy: Is It Possible?

The medical history of the 39-year-old woman included a weight loss of 5 kg, night sweats, and a decreasing general health over a 4-month period. Extirpating a newly appeared left cervical lymph node, the diagnosis of nodular sclerosing Hodgkins’s lymphoma was confirmed in June 2008. After completing the staging, computed tomography (CT) scans demonstrated unilateral cervical lymph nodes and a mediastinal bulky disease of 7 cm, corresponding to 1/3 the thorax diameter; a biopsy of the bone marrow discovered no infiltration. Even though the patient suffered from stage IIb disease, inclusion into the German Hodgkin’s disease study group HD14 protocol had to be denied due to personal and family-related reasons. Therefore, the patient was planned to be treated with the current gold standard regimen, 4 cycles of ABVD followed by IF-RT [1]. As the patient had lost a family member due to cancer a few months ago and she was facing divorce and unemployment, depression was noticed as a concomitant finding and treated with 20 mg paroxetin daily. The chemotherapy treatment started in July 2008 and the patient’s blood count presented no pathological results: Hemoglobin concentration (13.8 g/dl), erythrocytes (4.81/nl), and thrombocytes (239/nl) were normal; leukocytes (11.54/nl) were slightly elevated, but C-reactive protein (CRP) levels were normal (2 mg/l). Electrocardiogram (ECG) and echocardiogram did not show any pathologic results. At the beginning of the 2nd cycle in August 2008, the patient asked for supporting activities because she was not able to bear staying at home all the time during the treatment. Physical activity was therefore recommended as an effective supportive care in this case. The patient underwent a sports medicine screening and performance testing with stress ECG, treadmill test (modified Bruce protocol) including spiroergometric assessment with lactate threshold. We measured a moderate to good VO2 peak of 39 ml × kg × min in comparison to other Hodgkin’s lymphoma patients matching stadium IIb [12]. The estimated VO2 max walking in the Bruce protocol was also matching at 38.88 ml × kg × min [13]. The anaerobic threshold level was determined at a blood lactate level of 3.7 mmol/l at a pulse of 126 beats/min (bpm), and the maximum pulse rate was 168 bpm. On the basis of this assessment, the patient received individualized exercise routines containing an extensive aerobic training in between