Exercise and cancer

Exercise is important for everyone’s overall health and wellbeing, but it has a range of general benefits for people with cancer. It may:

• improve how you respond to treatment (for some cancers)
• reduce the risk and severity of side effects of cancer treatments
• reduce complications from surgery and time spent in hospital
• help with recovery from treatment by increasing energy levels, reducing treatment-related  muscle loss, strengthening bones, and improving mobility and balance
• improve sleep and fatigue, and relieve stress, anxiety and depression
• help maintain a healthy weight
• reduce the risk of developing or improve health issues, such as high blood pressure, heart disease, stroke, osteoporosis and type 2 diabetes
• reduce the risk of some cancers coming back, including breast, prostate, bowel and  endometrial (uterine) cancers
• boost mood and self-esteem
• offer new ways to meet people and socialise.

The Clinical Oncology Society of Australia (COSA) recommends that exercise should be prescribed to all cancer patients as a standard part of their cancer care to help manage the effects of cancer and its treatment. Exercise & Sports Science Australia (ESSA) also encourages people with cancer to exercise.

Aim to be as physically active as your abilities allow. Exercise for people living with cancer  should be tailored to the type and stage of cancer and any side effects. Talk to an exercise professional (an accredited exercise physiologist or physiotherapist) or a clinical nurse consultant about how much and what type of exercise is best for you. COSA recommends that people with cancer who are relatively healthy and have been assessed as low risk, aim for and maintain per week:

• at least 2½ hours of moderate intensity aerobic or cardio exercise or 1¼ hours of vigorous aerobic or cardio exercise
• 2–3 strength or resistance sessions to build muscle strength.

It can take time to build up to this level of exercise. After treatment, aim to gradually increase exercise to ‘Australia’s Physical Activity and Sedentary Behaviour Guidelines for Adults’, which recommend you:

• move more and sit less
• aim to be active on most, preferably all, days of the week
• get a total of 2½ to 5 hours of moderate intensity or 1¼ to 2½ hours of vigorous intensity physical activity (or an equivalent combination of both moderate and vigorous activities) throughout a week
• do 2–3 strength or resistance training sessions a week, involving large muscle groups
• break up long periods of sitting as often as you can.

Cancer treatment causes various physical effects that are different for different people. Exercise has been shown to help ease some of these.

Side effect – fatigue
Why exercise can help – Losing fitness can make fatigue worse, but low intensity exercise can help you stay fit (unless you have severe anaemia). Try to keep active and build your muscles and adjust how hard and often you exercise. Some people find that short, frequent aerobic and cardio sessions are easier; others prefer strength and resistance training, where you can take a rest between sets.

Download our fact sheet ‘Understanding Fatigue and Cancer’

Side effect – anaemia
Why exercise can help – Low red blood cell and/or haemoglobin count is a common side effect of cancer treatment. Symptoms include unexplained tiredness and fatigue. Combined with good nutrition, exercise has been shown to improve anaemia. For mild or moderate anaemia, try low intensity exercise, with a gradual increase in intensity and/or duration. If anaemia is severe, ask an exercise professional about what exercise to avoid until it improves.

Side effect – loss of muscle strength/muscle tightness
Why exercise can help – If muscles aren’t being used, they can get smaller and weaker. Lost muscle strength is a side effect of some hormone therapy and steroid treatment. Some treatments also leave muscles tight. Strength and resistance training improves muscle condition.

Side effect – lymphoedema
Why exercise can help – Starting exercise early in treatment may reduce the risk of  lymphoedema (swelling in a part of the body). A lymphoedema practitioner or exercise professional can develop a tailored exercise plan. After lymph node surgery, follow post-operative instructions for exercise and gradually return to activity.

Download our fact sheet ‘Understanding Lymphoedema’

Side effect – mood changes
Why exercise can help – Feeling anxious or depressed during and after treatment is common. Exercise helps the brain to produce chemicals (e.g. endorphins, endocannabinoids) that  improve your mood.

Side effect – heart problems
Why exercise can help – Radiation therapy to the chest and some types of chemotherapy and targeted therapy drugs may damage the heart muscle, making it less effective at pumping  your blood. Some hormone therapy drugs, low physical activity and poor nutrition may also increase the risk of heart problems. Aerobic and cardio exercise can help reduce the risk of long-term heart problems.

Side effect – loss of bone strength
Why exercise can help – Cancer and its treatment, particularly hormone and radiation therapy, can have long-term effects on bone strength. Early menopause and reduced levels of physical activity may also cause bones to weaken and break more easily (osteoporosis). Resistance training and exercises where you support your own body weight can help keep your bones strong.

Side effect – joint pain
Why exercise can help – Some hormone therapy and cancer treatments can cause joint pain. Exercise can improve muscle size and strength, flexibility and range of motion, and increase your ability to move, which can help protect your joints and reduce pain.

Side effect – weight gain
Why exercise can help – Weight gain is a common side effect of many treatments, including some types of hormone therapy, and steroids given to manage the side effects of  chemotherapy or immunotherapy. People with cancer may also gain weight due to inactivity. Exercise can help you manage weight gain and assist in weight loss, when necessary.

Side effect – quality of life
Why exercise can help – Studies show that physical activity can help improve wellbeing,  sexuality, brain fog, sleep issues, anxiety, fatigue, pain and how you feel about yourself in general.

Some side effects of cancer or treatment need extra care, which means you may have to adjust how hard and long you exercise. Speak to your doctor, physiotherapist or exercise physiologist before you exercise. Check with your health professional first, but most people are able to exercise with a port or PICC line, a chemotherapy pump or a stoma. Ask a nurse, exercise physiologist or physiotherapist to show you how to avoid bumping or disrupting it when moving.

Weak bones – If you have cancer in the bones (bone metastases or bone mets) or myeloma, you may be at risk of a break or fracture. Radiation therapy and hormone therapy may leave bones more fragile. Choose gentle activity such as walking and swimming, and avoid contact sports, running or jumping. Resistance exercise may help by strengthening the muscles around the bones. If you have osteoporosis, consult your doctor and ask for advice from a physiotherapist or accredited exercise physiologist.

Low white cell count (neutropenia) – Some cancers and treatments can weaken your immune system and cause your white blood cell count to drop. This can increase your risk of developing an infection. When your immune system is not working well (called being  immunocompromised), it is important to clean any shared exercise equipment before use and avoid public spaces such as gyms, swimming pools and training venues until your white blood cell count returns to a safe level.

Low platelet count (thrombocytopenia) – Platelets stop bleeding in the body by forming clots. When the platelet count drops, you are at increased risk of bruising or bleeding. It is best to avoid contact sports, cycling and high-impact activities (such as jumping or boxing), as these could cause bruising or bleeding if you get knocked or fall over.

Skin irritation – Areas of skin affected by radiation therapy can be extremely sensitive and often uncomfortable. Choose activities and clothing to minimise fabric rubbing on affected areas. Chlorine can irritate the skin, so avoid the pool if you have a rash or your skin is red.

Surgical wound – You will need to wait for the wound to heal before starting any exercise, so follow your surgeon’s or doctor’s advice about when it is safe to begin. If you have post-surgery stiffness and pain, you may need an assessment from an oncology physiotherapist or other exercise professional. They can suggest specific exercises to reduce stiffness and pain in the affected area. Pain, weakness, stiffness and reduced movement are common after surgery, but they usually improve with time.

Poor balance and coordination – Surgery or cancer treatment may affect balance and  coordination. This can make you unsteady and lead to a fall. Choose exercises to improve balance and muscle strength, or exercise sitting down. If your balance or coordination has been affected, avoid exercise such as riding a bike outside or using a treadmill, and avoid lifting free weights without a training partner.

Peripheral neuropathy – Some chemotherapy drugs damage nerves, causing pins and needles and numbness in the hands and feet (peripheral neuropathy). This means you could injure yourself without noticing. If you can’t feel your feet, you’re more likely to lose balance or fall, so walk on even surfaces. Ask an exercise professional how to lift weights safely. Some people may find exercise machines safer to use than free weights.

Heart damage – Some chemotherapy drugs and other treatments can cause damage to the heart (cardiotoxicity). In this case you will need specialised exercise advice before taking on exercise.

Personal trainers, fitness instructors and exercise scientists aren’t trained to work with people affected by cancer. The appropriate allied health professionals to design an exercise program for people with cancer are:

Exercise physiologists – Also called accredited exercise physiologists (AEPs), these allied health professionals have completed at least a 4-year university degree. They use exercise as medicine to help with chronic disease management and overall wellbeing.

Physiotherapists – These allied health professionals have completed at least a 4-year university degree. They focus on physical rehabilitation, and prevention and treatment of injuries using a variety of techniques, including exercise, massage and joint manipulation.

How to find an exercise professional

There may be an exercise physiologist or a physiotherapist at your cancer treatment centre  who you can see. If not, your general practitioner (GP) can refer you to an exercise physiologist or a physiotherapist as part of a chronic disease management plan (which means you may be eligible for a Medicare rebate for up to 5 visits per calendar year).

In most cases, you will still have to pay to see an exercise professional. Check with your health insurer if they cover seeing an exercise physiologist or a physiotherapist. The Department of Veterans’ Affairs may also be able to financially assist some people.

When you look for an exercise professional, ask to see someone with experience working with people who have cancer.

Search for an accredited exercise physiologist (AEP) by name, location or specialty (i.e. cancer) at Exercise & Sports Science Australia’s website. Search for a physiotherapist on the Australian Physiotherapy Association’s website.

To find a group exercise program, ask at your cancer centre, ask your GP for a referral or call
Cancer Council 13 11 20.

An exercise professional can help develop a program based on what you can do, and any health issues, physical problems, disease impacts or treatment side effects related to the type and stage of cancer you have. You may go to one-on-one or group sessions, or your exercise professional may develop a program for you to follow at home. They will show you how to exercise safely and monitor the intensity of your exercise (e.g. by measuring your heart rate or how difficult it feels to do). If you can’t see an exercise professional, guides and information on these pages may help.

Find an exercise program that you enjoy, and that matches your current fitness level. Ask your health professional what activity is best for you and your ability.

Begin at home – Home-based exercise can be the easiest to start with. You can try some strength or resistance training exercises at home.

Try outdoor activities – Being active outdoors is a good way to add physical activity and exercise into your daily routine. You could try walking, riding a bike or swimming.

Join a group exercise program – Many gyms and fitness centres run group exercise programs. When joining, let your gym know that you have or are recovering from cancer, and ask if they have someone who can check whether the exercise program is right for you. Ideally, an exercise physiologist or physiotherapist will assess your health and fitness and tailor a program to
your needs. Your cancer centre may offer classes designed for people with cancer.

Do incidental activity – Move more throughout the day. You could walk or ride to the shop or hospital, or take the stairs. The important thing is to try and be active most days of the week.

Choose what to wear – You don’t need to buy expensive equipment or special clothing to do exercise, but the correct shoes are needed for walking or jogging. Visit a reputable shoe shop for suggestions to suit you and your health concerns. You may like loose, comfortable clothes, such as shorts and a T-shirt, when exercising. Or you may find close-fitting or supportive tights and a top are best for some exercise.

Find equipment – Activity monitors, hand weights, heart rate monitors and home-gym systems can be useful but aren’t necessary. You can add exercise equipment into your program at little to no expense. For example, a step is a great aerobic and resistance training device. A  backpack filled with a bag of sand makes for a good piece of resistance training equipment.

Mix things up – Try to include aerobic and cardio exercises as well as strength and resistance training in your weekly exercise program. Doing a combination of different types of exercise helps to improve more areas of your health and fitness.

There are 3 general parts to an exercise session.

1. Warm-up

The aim of a warm-up is to increase blood flow to warm your muscles or gradually raise your heart and breathing rates. This prepares your body for further activity without a sudden elevation. A warm-up can include 5–10 minutes of low intensity aerobic and cardio exercise and light stretching. Walking or stepping up and down on a stair are good warm-ups. If approved by your doctor or exercise professional, you can use light weights to warm up before strength training.

2. Training

This is the part of an exercise session when the work is done. It could include activities from one or more types of exercises:

• aerobic and cardio exercises
• strength and resistance training
• flexibility exercises
• balance exercises. People with weakened bones or peripheral neuropathy can improve stability with balance exercises
• pelvic floor exercises. Some people may need to exercise their pelvic floor muscles – especially if they have leaking or incontinence issues.

3. Cool-down

The cool-down allows your heart rate and blood pressure to gently return to normal. It also helps your body and muscles recover and reduces soreness after exercise. After aerobic or cardio exercise, cool down with 5–10 minutes of relaxed, low intensity activity such as slow walking or cycling. After strength or resistance training, you can cool down with light stretching.

Start an exercise diary – Record each day’s physical activity and exercise in a paper or digital diary or calendar. List the type of activity, and how long and hard you exercised.

Go online – Use free websites such as MyFitnessPal to record your exercise sessions. You can also use this website to record how much you’re eating and exercising.

Use fitness apps – Free smartphone apps such as Runkeeper, MyFitnessPal or STRAVA track your movement while you are exercising if you wear a smartwatch or keep your smartphone on you, or you can record your activity later. You can download them from the App Store (Apple) or Google Play (Android).

Wear a gadget – Also called wearables, devices such as those from Fitbit and Garmin are worn like a watch. They can track your steps or minutes of activity and transfer the data to your smartphone or computer. Some also monitor your heart rate and take electrocardiogram (ECG) measures.

Have options for bad weather – A combination of indoor and outdoor exercise options will mean you can keep exercising even if the weather changes or if it’s after dark.

Buddy up with someone – Exercise with family and friends to keep each other motivated. You can even share an online class together.

These diagrams show the major muscle groups of the human body. Aerobic and cardio exercise focuses on improving your heart and lung fitness, but it also works many of your body’s muscles. Strength and resistance training, and flexibility exercise both focus on the muscles, with individual exercises usually targeting specific muscle groups. The exercises on these pages cover a range of muscle groups. An exercise professional can help you plan a weekly program that covers all the muscle groups and focuses on any areas that may need particular care or attention.

Muscle group: Chest and shoulders

1. Stand with your feet shoulder width apart. Lean slightly against the wall with your arms outstretched at shoulder height and your hands on the wall. Do not lock your elbows or knees.
2. Slowly move your body towards the wall, by bending your arms at the elbow. Keep your feet where they are.
3. Once your nose is close to the wall, breathe out as you slowly push away, against your body weight, and return to the starting position. Repeat.

If this is too easy, move your feet back a bit or try a modified knee push-up.

Muscle groups: Chest, shoulders and arms

1. Start with your knees and hands on the floor and your arms extended. Keep your back and bottom as straight as possible, and keep your head in line with your spine.
2. Lower your torso slowly, by bending your arms at the elbow. Aim to keep your chest moving straight towards the floor (not forwards or backwards). Only go as far down as you feel you can.
3. Breathe out as you push back up to the starting position, and try not to fully straighten your arms and lock your elbows at the top. Repeat.

If you feel any pain in your back doing this exercise, bring your hands closer to your body. If this still feels hard, do the wall push-up until you build more strength.

Muscle group: Calves
Equipment: Wall, step, hand weights (optional)

1. Stand upright, with your hand resting against a wall or on a stable chair as a support (if necessary).
2. Breathe out as you lift your heels off the ground, keeping your knees and body straight.
3. Hold the position for a moment. Return to the starting position. Repeat.

Don’t try this exercise if you have balance issues or tend to feel dizzy or light-headed.

As you improve, increase the difficulty by standing with the balls of your feet on a step (so that your heels hang over the edge), holding a hand rail. You can also try the exercise as pictured holding hand weights, or doing one leg at a time.

Muscle groups: Shoulders, back, and back of upper arms
Equipment: Elastic resistance band

1. Attach the resistance band to a fixed point such as a railing, pole or a closed door handle, ensuring it’s well secured. Stand with your feet shoulder width apart and your arms outstretched at waist height.
2. Breathe out as you pull the resistance band towards you, keeping your elbows and hands at waist height. Make sure your back doesn’t move, and look straight ahead. Keep neck and shoulders relaxed to avoid your shoulders lifting up.
3. Slowly and with control return to the starting position. Repeat.

Muscle groups: Front of thighs and buttocks
Equipment: Chair

1. Sit towards the middle or slightly to the front of a chair with your hands on your knees.
2. Breathe out as you stand up, using your hands on your knees for assistance if you need to. Keep your back tall and straight as you stand up. Keep your head up and look straight ahead. Try to stand up in one movement, without rocking forward and back to help you.
3. Slowly sit back down. Repeat.

Increase the difficulty by crossing your arms over your chest, or holding hand weights. Or try not sitting down, but just touching the seat lightly before  standing up again.

If you are doing this exercise for the first time and feel off balance, please do this with an exercise professional, carer or friend.

Muscle groups: Front of thighs and buttocks

1. Stand about 30 cm in front of a wall with your feet shoulder width apart. Slightly bend your  knees and lean back onto the wall, putting your arms and palms against it. Tilt your pelvis so your back is flat against the wall and tuck your chin in a little.
2. Keeping your body against the wall, slowly slide down (as if you’re going to sit) until you can feel your legs working – this may not be very far. Hold for 10–30 seconds if you can.
3. Slowly slide back up the wall again until you are back to the starting position. Repeat.

Increase the difficulty by sliding further down, but stop before your knees go over your toes (there should be no more than a 90-degree angle between hip and knee).

Muscle group: Shoulders
Equipment: Gym stick, barbell, pole, broomstick, tin cans or hand weights

1. Stand with your feet shoulder width apart. Hold the bar at chest height with your elbows  almost completely bent (so they are almost touching your sides).
2. Breathe out as you push the bar up until it is above and slightly in front of your head. Keep your back and neck straight and don’t lift your shoulders.
3. Pause, then lower the bar back to the starting position. Repeat.

Muscle groups: Shoulders and upper back
Equipment: Hand weights, tin cans

1. Stand with your arms by your side and your feet shoulder width apart. Hold the hand weights with your palms facing backwards. Tighten the tummy muscles (abdominals).
2. Breathe out as you bend your arms and raise the hand weights slowly up to shoulder height.  Avoid jerking the weights when lifting them up. Keep your head and neck aligned, and look straight ahead. Avoid lifting your shoulders to your ears. You should feel the muscles in your shoulders work, not the ones in your neck.
3. Pause, then lower the hand weights back to the starting position. Repeat.

Muscle group: Front of upper arms
Equipment: Hand weights, gym stick, barbell or tin cans

1. Stand with your arms by your side and feet hip width apart. Hold the hand weights with your palms pointing away from you.
2. Breathe out as you bend your elbows to lift the weights to shoulder height. Keep your elbows tucked in at the sides. Try not to move your shoulders and make sure your body does not sway.
3. Slowly return the hand weights almost to the starting position without fully straightening your elbows – keep them slightly bent. Repeat.

Muscle groups: Stomach and side (core)

1. Lie on your back with your knees bent and your feet flat on the floor about hip width apart.  Place your hands on your lower tummy (abdomen) and lift your pelvic floor muscles. Keep breathing normally.
2. Slowly lower one knee a little bit out to the side, without moving the hips. If your hips tilt to one side, you have lowered your knee too far. Hold for 15–30 seconds.
3. Slowly return to the starting position. Repeat with the other knee.

Muscle groups: Stomach and side (core)

1. Lie on your back with your knees bent and feet flat on the floor about hip width apart.
2. Flatten your back by tightening the muscles in your abdomen and buttocks. This will tilt your pelvis up slightly. Hold for several seconds.
3. Fully relax the muscles and rest for a few seconds. Repeat.

Muscle groups: Stomach and side (core)

1. Start on all fours, with legs hip width apart, knees directly under hips, hands directly under shoulders, and back and head in a straight line. Keep the elbows slightly bent. Gently lift your pelvic floor and lower abdomen to support your lower back.
2. Keeping your back straight and steady, extend one leg while supporting the torso with both hands on the floor. Once balanced, slowly extend the opposite arm. Hold for 5–10 seconds.
3. Keep breathing normally. Slowly return to all fours. Repeat on the other side.

If you find it hard to keep your balance, leave both hands on the floor and just extend one leg at a time. You can also do the bird-dog lying over a fitball, which can be a good alternative for people with bad knees who find it difficult to kneel.

Increase the duration of each hold by a few seconds each week. To make it more challenging, try holding a light hand weight with your outstretched arm.

Muscle group: Shoulders

1. Stand with your feet about hip width apart and arms relaxed by your sides.
2. Raise one arm to shoulder height and slowly and gently pull it across your chest and wrap your other arm underneath to support it. Do not stretch more than feels comfortable. Keep the elbow of your straight arm just below shoulder level.
3. Hold for 15–30 seconds, before returning to the starting position. Switch arms and repeat.

Muscle group: Back of arms

1. Stand with your feet about hip width apart and arms relaxed by your sides.
2. Lift one arm to shoulder height and bend your elbow with your forearm down your back.
3. Using the elbow as a lever, use your other arm to gently push the arm down your back. Hold for 15–30 seconds.
4. Return to the starting position. Switch arms and repeat.

Muscle groups: Chest, forearm and upper arms

1. Stand near a wall. Raise one arm out to the side so it is parallel to the floor, and put your hand against the wall with your fingers pointing away from you.
2. Partially turn your body away from the wall and arm that is against the wall. Hold the stretch for 15–30 seconds.
3. Return to the starting position. Switch arms and repeat.

Muscle group: Front of thighs

1. Stand near a wall to use as a support.
2. Lift your foot behind you and hold in front of the ankle. Gently pull the leg towards your  buttocks. Make sure you keep your torso straight. Hold for 15–30 seconds.
3. Return to the starting position. Switch legs and repeat.

Muscle group: Calves

1. Stand facing a wall with your arms straight and hands flat against the wall. Step one of your feet straight back, placing the heel flat on the floor.
2. Lean forward against the wall and partially bend your front leg. Keep your back leg (stretching leg) completely extended and your foot flat on the floor – move the foot backwards until you feel the stretch. Hold for 15–30 seconds.
3. Switch legs and repeat.

Muscle group: Back of thighs
Equipment: Chair

1. Sit on a chair with one leg bent at the knee and the other leg straight, toes pointing upwards.
2. Lean forward from the hips, pushing your chest forward towards your knee. Keep your back straight. Hold for 15–30 seconds.
3. Switch legs and repeat.

For more of a stretch, stand and put one foot on a step (about 30 cm high), toes pointing up. You may want to do this near a wall in case you need to steady yourself.

One-leg lift

• Stand with feet hip distance apart.
• Lift your arms to shoulder height and extend them out to the sides.
• Lift your left foot off the floor and bend your knee to bring your heel towards your bottom.
• Hold for up to 30 seconds. Repeat on the opposite side.
• Do each side 3 times.

Tightrope walk

• Use a line in floorboards or tiles, a line of tape or any straight line.
• Like walking a tightrope, extend your arms out to the sides and walk slowly, being careful to keep your feet on the line at all times.
• Walk from heel to toe, counting at least 5 seconds before each step, until you reach the end.

Muscle groups: Legs, stomach, side and back
Equipment: Chair (optional)

1. Stand on a soft but firm surface, such as an exercise mat or carpet.
2. Slowly bend one knee to lift the foot off the ground so that you are balancing on the other leg. Keep your eyes on a fixed point in front of you and breathe slowly and deeply. Hold the pose for several seconds if you can.
3. Lower your leg and put your foot back on the ground. Switch to the other leg and repeat.

You may want to start near a chair or wall so you can steady yourself.

For a challenge, put your hands on your head as you balance and/or close your eyes. Aim to increase the duration by a few seconds each week.

Pelvic floor exercises should be done several times a day. You can be standing, sitting or lying  down. You can even do them while watching TV or waiting at traffic lights.

Finding your pelvic floor muscles

When you try to stop your urine stream for a couple of seconds while you are peeing, you use your pelvic floor muscles. Another way is to feel the muscles you use when you imagine stopping the flow of urine and holding in wind.

How to exercise your pelvic floor muscles

1. Start by relaxing all of your pelvic floor (including the muscles around the bottom) and your tummy (abdominal) muscles.
2. Gently lift your pelvic floor muscles up and hold while you continue breathing normally. Keep your upper abdominal muscles relaxed. Try to hold the contraction for up to 10 seconds (while breathing). Then relax your muscles slowly.
3. Repeat the exercise up to 10 times. Rest and completely relax your pelvic floor muscles for 10–20 seconds between each set.

Safety tips

• Do not hold your breath.
• Do not tighten your tummy above the belly button. Focus on pulling up and holding on to urine and wind.
• Do not try too hard. You may end up contracting other nearby muscles. Try changing positions  if you can’t feel the pelvic floor muscles lifting and squeezing.

Pelvic floor exercises should be done several times a day. You can be standing, sitting or lying  down. You can even do them while watching TV or waiting at traffic lights.

Finding your pelvic floor muscles

Imagine resting your scrotum on a plate, then contract the muscles that lift your scrotum off the plate. Some cues to help turn on the pelvic floor muscles include trying to lift the scrotum up towards the tummy, trying to bring the base of the penis in towards the lower tummy and trying to stop as you’re doing a pee.

How to exercise your pelvic floor muscles

1. Start by relaxing all of your pelvic floor (including muscles around the bottom) and your tummy (abdominal) muscles.
2. Gently lift your pelvic floor muscles up and hold while you continue breathing normally. Keep your upper abdominal muscles relaxed. Try to hold the contraction for up to 10 seconds (while breathing). Then relax your muscles slowly.
3. Repeat the exercise up to 10 times. Rest and completely relax your pelvic floor muscles for 10–20 seconds between each set.

Safety tips

• Do not hold your breath.
• Do not tighten your tummy above the belly button. Focus on pulling up and holding on to urine and wind.
• Do not try too hard. You may end up contracting other nearby muscles. Try changing positions if you can’t feel the pelvic floor muscles lifting and squeezing.