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  • Exercise for people living with cancer

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    People with cancer should be as physically active as their abilities and condition allow.

    The current evidence suggests exercise is beneficial for most people during cancer treatment. It also shows there is little risk of harm if care is taken and professional exercise advice is followed closely.

    Exercise has been shown to help people cope with many of the side effects of cancer treatment including:

    • fatigue
    • feeling sick (nausea) and loss of appetite
    • anaemia (low red blood cell and/or haemoglobin count)
    • depression and anxiety
    • body weight and composition (muscle and fat) changes.

    Try to avoid being physically inactive. Some days will be harder than others but even a few minutes of light exercise is better than no exercise at all.

    Who should exercise?

    Most people being treated for cancer are able to participate in an exercise program. Some people may need a modified program and others may have to delay starting a program.

    Talk to your doctor before starting if you have any of the following problems, as you may need a modified exercise program:

    • lymphoedema
    • fatigue
    • anaemia
    • shortness of breath
    • low platelet count
    • radiotherapy skin reactions
    • compromised immune function
    • damage to nerves (peripheral neuropathy)
    • primary or metastatic bone cancer

    You will need to delay the start of an exercise program if you have severe anaemia, fever or severe weight loss.

    Overcoming common treatment side effects

    Lymphoedema

    Starting an exercise program early in treatment may lower the risk of developing lymphoedema. For those with lymphoedema, regular exercise can reduce the severity of the condition and its symptoms. 

    Fatigue

    Many people experience fatigue (feeling tired even when rested) during and after cancer treatment. Carefully monitoring your condition and making adjustments to the exercise intensity and duration can help manage fatigue. It is important to keep doing some low-intensity exercise during times of excessive fatigue (unless you have severe anaemia, see opposite page). You may find that shorter, more frequent sessions are more manageable. By stopping all activity, you risk losing fitness and strength, which can make the fatigue worse. 

    Anaemia

    Low red blood cell and/or haemoglobin count is another common side effect of cancer treatment. Symptoms of anaemia include unexplained tiredness and fatigue. Combined with good nutrition, exercise has been shown to improve anaemia. For mild or moderate anaemia, try a low-intensity exercise program with gradual increases in intensity and/or duration. However, in cases of severe anaemia (when a blood test shows a haemoglobin level of less than 80 g/L), consult your doctor about whether you should avoid exercise until it improves.

    Compromised immunity

    Some cancers and treatments stop the immune system from working properly for a time. When your white blood cell count is low (neutropenia), there is an increased risk of infection, so it is important to limit physical contact with other people and clean any shared equipment before use. When your immunity is severely compromised, gyms, swimming pools and training venues should be avoided. 

    Skin irritation

    Areas of skin affected by radiotherapy can be extremely sensitive and often uncomfortable. Choose activities and clothing to minimise fabric rubbing affected areas. Chlorine can be irritating, so avoid pool-based exercise if your skin has a rash or is reddened after radiotherapy. 

    Poor balance and coordination

    If the cancer or its treatment has affected your coordination or causes dizziness, it is safer to avoid exercise that relies on balance and coordination, such as cycling outdoors or using a treadmill. It is also best not to lift free weights without a training partner.

    Bone weakness or pain

    Some hormone treatments for breast and prostate cancer can increase the risk of fractures, as can osteoporosis (bone thinning) or primary or secondary bone cancer. In these cases, it is best to avoid contact sports and high-impact activities such as running and jumping.

    Getting started

    After a cancer diagnosis, some people decide to make big changes to their lifestyle. Others take a more gradual approach. You will find the way forward that is right for you.

    Before taking part in any exercise program, either during or soon after your treatment, it is important to talk with your oncologist or general practitioner (GP) about any precautions you should take.

    If it has been a while since you have been active or your fitness level is low, start slowly and build up gradually. For example, you might start by doing five or 10 minutes of walking three days per week, and add a bit more every week until you have worked your way up to 30 minutes of walking five days per week.

    Exercise equipment

    You don’t need expensive equipment or special clothing to exercise, but appropriate shoes are vital. A podiatrist or reputable shoe shop can recommend shoes that will help you avoid injury. Wear loose, comfortable clothes, such as shorts and a T-shirt, when you are exercising. Other equipment, such as heart rate monitors and home-gym systems, can be useful but are not necessary.

    Exercise professionals

    Starting an exercise program can feel overwhelming. You may have lots of questions. It is important to realise that personal trainers and exercise scientists are trained to work with people who do not have any major health issues. People affected by cancer should see an exercise physiologist or a physiotherapist.

    Exercise physiologists are also called Accredited Exercise Physiologists (AEPs), and are allied health professionals who have completed at least a four-year university degree. They concentrate on using exercise as medicine to help with injury and chronic disease management.

    Physiotherapists are also allied health professionals who have completed at least a four-year university degree. They often concentrate on preventing and treating injuries using a variety of treatment methods, including exercise, massage, and joint manipulation.

    Medicare or your private health fund may provide limited cover for visits to an exercise physiologist or a physiotherapist. Ask your GP for a referral to an exercise professional, or visit the Exercise & Sports Science Australia website at essa.org.au or the Australian Physiotherapy Association at physiotherapy.asn.au.

    Your exercise professional can work with you and your doctor to develop an exercise program tailored for you. Many structured exercise programs offered at venues such as gyms will ask you for a medical clearance before starting.

    Choosing an exercise program

    Physical activity need not be costly or inconvenient. The exercise program that is right for you will depend on your current fitness level, what you want to do, and what your doctor says is safe for you. If you enjoy an activity, you are more likely to stick with it. To stay motivated, you could ask a friend or family member to join you.

    Exercise at home

    Home-based exercise and outdoor exercise are excellent ways to include physical activity in your daily routine. You can try aerobic activities such as walking, cycling or swimming, along with some strength-training exercises (see pages 20–34). If you haven’t exercised much before or are unsure about what you can safely do, talk to your GP about a referral to an exercise professional.

    Attend a group exercise program

    Many gyms and fitness centres run group exercise programs. When joining, let your gym know that you have cancer, and ask if they have someone who can help to ensure that the exercise program is right for you. Ideally, an exercise physiologist or physiotherapist will conduct an initial consultation and functional assessment so that the program can be tailored for your condition.

    You can search for an accredited exercise physiologist (AEP) by name, location or specialty at Exercise & Sports Science Australia’s website at essa.org.au, or for a physiotherapist at the Australian Physiotherapy Association’s website at physiotherapy.asn.au. To find an appropriate group exercise program, ask your GP for a referral or call Cancer Council 13 11 20.

    Mix it up

    You might choose a mix of exercising at home or outdoors and attending a group program. The structure and safety of a supervised program can be a great place to start, while your own activities can keep things interesting. Another option is to join a sporting club. Belonging to a group provides a social outlet as well as physical benefits, and often helps with motivation.

    Exercise sessions

    Warm-up

    The aim of warm-up activities is to make your muscles warm and ready to work, and to raise your heart rate slightly. This prepares your body for your exercise session.

    A warm-up should include five or 10 minutes of low-intensity aerobic work mixed with some light stretching. Walking outside or using indoor equipment are good warm-up activities. Before strength training, it is a good idea to use light weights in your warm-up.

    Training

    Training is the part of an exercise program when the work is done. Different types of training have specific effects on your body. A well-rounded weekly exercise program should include a variety of activities from the three types of exercise: aerobic exercise, strength-training exercises and flexibility exercises.

    It is also important to exercise your pelvic floor muscles several times a day, particularly if you have bladder or bowel issues, such as leaking or incontinence.

    Cool-down

    The cool-down allows your heart rate and blood pressure to gently return to normal. Also, a slow cool-down helps your body and muscles lose the heat gained during the activity.

    A cool-down should involve five to 10 minutes of relaxed activity and/or light stretching.

    If you have just finished an aerobic exercise session, slow walking or cycling is the best way to cool down. If you have done strength training, cool down with light stretching.

    Aerobic exercise

    Aerobic exercise uses large muscle groups and causes your heart rate to rise during the activity. Heart and lung fitness are improved, and strenuous tasks become easier.

    Popular forms of aerobic exercise include walking and cycling, but everyday activities such as digging in the garden also count. You can also build aerobic exercise into your daily routine, for example, by always walking up stairs instead of using a lift; parking some distance from your destination and walking the rest of the way; or riding a stationary bike while watching TV.

    How much?

    You need to find a balance between not working hard enough and working too hard. If you do not work hard enough, you may not achieve your exercise goals. If you work too hard, you risk injury.

    Exercise at a level you are comfortable with, but try to vary the duration and intensity (see box opposite for an explanation of exercise intensity).

    Adults should aim for at least 2.5 hours of moderate-intensity aerobic exercise per week (or 1.25 hours of vigorous-intensity aerobic exercise per week). If you have just completed cancer treatment, this may seem ambitious, but it is a goal to work towards steadily. Remember that some exercise is better than none.

    For extra health benefits, you can exercise beyond this recommendation by gradually increasing the frequency and duration of your exercise sessions and then increasing exercise intensity. If you were very fit before your cancer diagnosis, your goal may be to maintain or return to your weekly activity levels.

    measuring exercise intensity

    Strength-training exercises

    Strength training uses weights or resistance to increase the strength and endurance of your muscles, as well as the strength of your bones. It is sometimes called resistance training or weight training.

    The weights used in strength-training exercises include:

    • your own body weight, as in push-ups and squats
    • free weights, such as dumbbells and barbells, which you hold, or wrist and ankle weights, which you attach with straps
    • weight machines, which are devices that have adjustable seats with handles attached to either weights or hydraulics
    • elastic resistance bands, sometimes called TheraBands, which are like giant rubber bands that provide resistance when stretched, and are colour-coded according to the level of resistance

    An exercise professional can advise which weights and bands you should use. As a general guide, women might start with hand weights of 1 kg each and men might start with 2 kg. Once you can do 10–12 repetitions of an exercise easily and without strain, you can gradually add extra weight or use tighter bands.

    You can buy free weights and resistance bands at sporting goods stores and some major retailers. Some people make hand weights from everyday objects, such as plastic bottles filled with water or sand. If you try this, use scales to check they are equal weight.

    Some simple strength-training exercises are shown on the following pages. You may want to begin with exercises to develop your balance and strengthen your core muscles and then progress to the other strengthening exercises.

    How much?

    Try to do two or three sessions of strength training each week, on every other day. It is important to have rest days between the sessions. Strength-training exercises involve a number of variables:

    • repetition, or the completion of an exercise from starting position, through the movement, and back to the start
    • sets, which are a series of repetitions
    • rest, which is the time between sets

    During each training session, you will complete a number of sets of different exercises. An exercise professional can help design the best program for you. As a guide, you might aim for six to nine different exercises per session and choose exercises that target the major muscle groups of the arms, legs and torso. For each of the exercises in a session, you might do:

    • Six to 12 repetitions of the exercise per set
    • One to four sets of the exercise per session
    • 60–90 seconds of rest between sets.

    A program should challenge your muscles without straining them, so that may also guide how many repetitions you do in a set to begin with. Once you become comfortable with a program, you can make it more demanding, but do this by small increases.

    Check with your health care team before starting any new exercise program. Although we have provided strength-training exercises to suit most people, some of them may not be right for you.


    Flexibility exercises

    Flexibility exercises, also known as stretches or range-of-motion (ROM) exercises, lengthen muscles and tendons. They improve or maintain the flexibility of joints and muscles. We naturally lose joint and muscle flexibility as we get older, but cancer treatments can also have an impact. Regular stretching helps to overcome stiffness and can delay any loss of flexibility.

    Some simple flexibility exercises that can be done at home are described on the following pages. You could also join an exercise class that focuses on stretching, such as a yoga class. Remember to check with your health care team before beginning any exercise program. Although we have included flexibility exercises to suit most people, some may not be right for you.

    How much?

    Try to do flexibility exercises three to four times a week. Include stretches for arm, leg and torso (core) flexibility. In each session, you might do one to three sets of four to six different stretches.

    Exercise pull out timetable

    Pelvic floor exercises

    Your pelvic floor muscles span the bottom of your pelvis and support your bowel and bladder, and your uterus if you’re a woman. As well as providing support, strong pelvic floor muscles are important for control of urination and bowel movements, normal sexual function, and stability of the abdomen and spine.

    Like other muscles, your pelvic floor can become weak. Factors that can contribute to this include age, childbirth, constipation, obesity, chronic cough, heavy lifting, and abdominal or pelvic surgery.

    See a physiotherapist or continence nurse before doing pelvic floor exercises if you:

    • have had recent pelvic or abdominal surgery
    • problems with urine or faeces leaking when coughing, sneezing, laughing or
    • often need to go to the toilet urgently
    • have difficulty controlling bowel movements and wind
    • feel like you haven’t fully emptied your bowel after bowel movements
    • have dragging, heaviness or a bulge in the vagina
    • experience a lack of sensation during sex

    How to find your pelvic floor muscles

    To identify your pelvic floor muscles, try stopping your urine stream for a couple of seconds while emptying your bladder. You use your pelvic floor muscles to do this. Another way is to feel the muscles you use when you imagine stopping the flow of urine and holding in wind. This can be done standing, sitting or lying down.

    How to exercise your pelvic floor muscles

    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. The technique is the same for men and women.

    • Pelvic floor muscles exercises can be done standing, sitting or lying down.
    • Start by relaxing all of your pelvic floor and tummy (abdominal) muscles.
    • lift your pelvic floor muscles up and hold while you continue to
    • normally. Try to hold the contraction for up to 10 seconds.
    • Repeat the exercise up to 10 times, with a rest of 10–20 seconds between
    • contractions. Relax your pelvic floor muscles completely during the rest periods.

    Tips for good technique

    Poor technique can make pelvic floor exercises ineffective or even risk injury. Remember these points:

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

    What should I eat?

    Eating well means giving your body the food it needs to keep working properly.

    Cancer and its treatment place extra demands on your body, so eating well is more important than ever.

    There is no special eating plan that can cure cancer and, in most cases, there are no special foods or food groups to eat or avoid if you have cancer.

    For most people with cancer the best way to eat well is to eat a wide variety of foods from each of the food groups every day. For more nutritional information click here.

    It is important that you stay hydrated during and after exercise. Have a water bottle nearby when you are exercising and take regular small sips.

    Information updated April 2019

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