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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 or severity of lymphoedema. Stretching programs and range-of-motion (ROM) exercises are recommended. Appropriate aerobic and resistance training should not increase lymphoedema.

    Fatigue

    Carefully monitoring your condition and making adjustments to exercise intensity and volume can help manage fatigue. It is important to keep doing even a light amount of exercise during times of excessive fatigue. By stopping all activity you risk losing fitness and strength which can make the fatigue worse.

    Stretching, range-of-motion (ROM), yoga and tai chi style activities may be better tolerated during periods of fatigue.

    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.

    If anaemia is severe it is recommended that exercise is delayed. If anaemia is less severe you should participate in a low intensity exercise program with gradual increases. Aerobic activity has been shown to improve anaemia. Good nutrition is also important.

    Compromised immunity

    Some cancers and treatments stop the immune system from working properly. When this happens the immune system is compromised and there is an increased risk of infection. A modified exercise program can improve immunity without overloading the immune system.

    When white blood cell (neutrophil) count is low it is important to reduce the risk of cross-infection by limiting physical contact with other people and by cleaning any shared equipment before use. When immunity is severely compromised (neutropaenia), 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 that limit rubbing of clothing around affected parts of the body. If you are having radiotherapy avoid water-based exercise programs.

    Getting Started

    Before taking part in any exercise program - either during or soon after your treatment - it is important to talk with your oncologist or 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.

    Who to talk to

    Starting an exercise program can be overwhelming. Exercise professionals, such as exercise physiologists and physiotherapists, are specifically trained to give advice on exercise. Medicare or your private health fund may provide some limited cover for visits to an accredited exercise physiologist or physiotherapist. Ask your GP for a referral to an exercise professional or use the Exercise and Sports Science Australia website at www.essa.org.au.

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

    Exercise equipment

    You do not need expensive equipment or clothing to exercise or be physically active. Appropriate shoes are vital and help prevent injury later on. A podiatrist or reputable shoe shop can help you select the right shoes.

    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.

    Most exercises can be done without the need for any additional equipment.

    Choosing an exercise program

    There are many ways you can be physically active without too much cost or inconvenience. What you choose will depend on your current fitness level, what you want to do and what your doctor says is safe for you to do. It is also important to find a routine that suits you. If you enjoy an activity you are more likely to stick with it. Many people enjoy the social aspects of exercise so consider inviting a friend or family member to join you.

    Exercise at home

    Home-based and outdoor exercise are excellent ways to include exercise in your daily routine. You can try aerobic activities such as walking, cycling or swimming, or try some resistance exercises. If you are unsure about what to include in a home-based program ask your GP for a referral to an exercise professional for advice.

    Group exercise program

    Many gyms and fitness centres run group exercise programs. When joining ask about the level and quality of the supervision provided. Fitness professionals should hold current registration with Exercise and Sports Science Australia, see www.essa.org.au.

    Let your gym know that you have cancer and ask if they can modify programs and equipment if necessary. Check if your program will be designed and run by an accredited exercise physiologist. They have completed a four-year university degree, and are the most appropriate exercise professional to help design and supervise programs for people affected by cancer.

    An exercise program usually includes an initial consultation and functional assessment. You will receive an exercise program designed specifically for your abilities and condition, and consisting of aerobic, resistance and flexibility exercises.

    To find a group exercise program you can ask your GP, visit Fitness Australia on www.fitness.org.au.

    Mix it up

    You might choose a mix of exercising at home and attending a group exercise program. The structure and safety of a supervised program can be a great place to start exercising, and including home-based or outdoor activities on other days during the week can keep things interesting and help you reach your goals.

    Exercise tips

    Warm-up

    It is important to warm-up at the start of an exercise session. Warming up helps to get you going and reduces your risk of injury. After the warm-up your muscles are warm and loose and your heart rate is slightly higher than at rest.

    A warm-up should include five to ten minutes of low-intensity aerobic work mixed with some light stretching. Walking outside or using the indoor equipment are good warm-up activities. If you are going to do some weights it is a good idea to use light weights in your warm-up. A couple of lighter sets prepare the muscles and joints for the exercises to come.

    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 exercises
    • resistance exercises
    • flexibility exercises.

    Aerobic exercises

    Aerobic exercises use large muscle groups and cause your heart rate to rise during the exercise. Aerobic training improves heart and lung fitness and makes strenuous tasks easier. Examples include walking, cycling and swimming. Mowing the lawn or digging in the garden can also be beneficial.

    Everyone should aim for 30 minutes of low to moderate aerobic exercise, on most days of the week. This can be continuous or you can combine a few shorter sessions of around ten minutes each.

    Exercise at a level you are comfortable with but try to vary the duration and intensity. Exercise intensity refers to how hard your body is working during physical activity and is described as low, moderate or vigorous.

    Adults should aim for at least two and a half hours of moderate-intensity aerobic exercise each week or at least one hour of vigorous intensity aerobic exercise per week. This is a goal to work towards steadily; remember some exercise is better than none. Choose activities that you enjoy and try new activities to keep you motivated.

    For extra health benefits people should aim for up to five hours a week of moderate intensity exercise, or two and a half hours a week of vigorous exercise, or do an equal combination of both.

    Resistance exercises                    

    Resistance exercises use weights to increase muscle strength and endurance. It is also called weight training or strength training.

    The benefits of a resistance training program include:

    • increased muscle function and strength
    • improved body composition
    • increased muscle mass
    • increased bone mass and bone mineral density.

    Resistance training can be done using:

    • your own body weight – such as push-ups or squats
    • free weights – such as dumbbells or barbells
    • weight machines – devices that have adjustable seats with handles attached to either weights or hydraulics
    • elastic resistance – these are like giant rubber bands that provide resistance when stretched.

    Instructions

    Proper technique is essential as incorrect technique can be harmful. Follow instructions closely and stop immediately if you experience pain.

    • resistance exercises should be performed one to three times (sessions) each week, on alternative days
    • complete one to four sets of six to nine different exercises each session
    • choose exercises that target the major functional muscles of the arms, legs and trunk
    • each set should include six to twelve repetitions of the movement
    • rest for sixty to ninety seconds between sets.

    Once you are comfortable with the program try to (in this order):

    • increase the number of repetitions from six to twelve
    • increase the number of sets from one to three
    • each time a set is added reduce the number of repetitions back to six
    • increase the load or resistance and reduce the number of repetitions and sets.

    Flexibility exercises

    Flexibility exercises (stretches) lengthen muscles and tendons. Stretching improves or maintains the flexibility and strength of joints and muscles.

    Joint and muscle flexibility is reduced by some cancer treatments and naturally as we get older. Regular stretching helps to delay any reduction in flexibility and overcome stiffness.

    Try to stretch three to four times each week. Complete two to four sets of four to six different stretches. Include stretches for arm, leg and trunk flexibility. Hold each stretch for fifteen to thirty seconds

    Cool down

    Cooling down is just as important as warming up. 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 ten 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 resistance training light stretching is the best way to cool down.

    Techniques for resistance exercises


    Techniques for flexibility exercises

    Exercise pull out timetable

    Pelvic floor exercises

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

    Like other muscles your pelvic floor can become weak. Factors that can contribute to pelvic floor weakness or damage include: age, childbirth, straining on the toilet (constipation), obesity, chronic cough, heavy lifting and abdominal or pelvic surgery.

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

    • have had recent pelvic or abdominal surgery
    • have problems with urine or faeces leaking when coughing, sneezing, laughing or exercising
    • regularly need to go to the toilet urgently
    • have difficulty controlling bowel movements and wind
    • regularly feel like you haven’t emptied your bowel
    • have dragging, heaviness or a vaginal bulge
    • lack sexual sensation.

    How to identify your pelvic floor muscles

    You can feel your pelvic floor muscles working when you stop your urine stream midway through emptying your bladder. Try stopping the flow for a couple of seconds to identify the pelvic muscles.

    Another way is to feel the muscles you use when you imagine you are stopping the flow of urine and holding in wind (flatus). This can be done standing, sitting or lying.

    How to exercise your pelvic floor muscles

    Pelvic floor muscles exercises can be done standing, sitting or lying down.

    Start by relaxing all of your pelvic floor and abdominal (tummy) muscles.

    Squeeze and hold your pelvic floor muscles while you continue to breathe normally.

    Try and hold the contraction for up to ten seconds.

    Repeat the exercise up to ten times, with a ten to twenty second rest between contractions.

    Do it at different times throughout each day to improve the strength of your pelvic floor muscles.

    It is important that you have a good technique when you’re doing pelvic floor muscle exercises. If your technique is poor, the exercise may be ineffective or you may risk injury.

    Remember these points:

    • Do not hold your breath.
    • Do not tighten your tummy above the belly button. If your technique is correct you may notice some tensing or flattening of the tummy below the belly button.
    • Do not try too hard. You may end up contracting the muscles around the pelvic floor. Try changing positions if you can’t feel your pelvic floor muscles lifting and squeezing.

    Measuring exercise levels

    It is important 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. How hard your body is working during physical activity (exercise intensity) is often described as low, moderate or vigorous.

    Australia’s National Physical Activity Guidelines for Adults recommend working at moderate-intensity.

    Different ways to measure your exercise intensity include the talk test, rating of perceived exertion (RPE) and heart rate.

    Talk test

    This is a simple way to work out how hard an aerobic activity is.

    • if you are able to sing the activity is probably too light
    • f you are able to carry on a conversation but need to pause for breath from time-to-time, you’re doing a moderate-intensity activity
    • if you start to provide one-word answers the activity is becoming more vigorous
    • if you find it difficult to speak, this is vigorous activity.

    Rating of perceived exertion (RPE)

    RPE is often used by exercise professionals to assess the intensity of an activity. It is a tool you might find useful too. It can be used by all ages during aerobic and resistance training. To use RPE ask yourself ‘How hard am I working?’. Find the number that best describes what you feel in the table below.

    Heart rate

    Heart rate is another way of working out exercise intensity. Your heart rate will increase in proportion to the intensity of the exercise you are doing. See the next section for a simple way to measure your heart rate during physical activity.

    For people on some medications, heart rate may not be a good measure, so it is best to check with your doctor first. If your heart rate becomes too high, or drops too low during exercise, you should stop what you’re doing and consult your doctor again.

    How to measure your heart rate

    Measuring your heart rate is simple.

    Put the first three fingers of one hand against the inner part of your wrist or your neck. Count your pulse for fifteen seconds. Multiply this number of beats by four. This result gives you your heart rate in number of beats per minute (bpm).

    For example:

    31 beats x 4 = 124 bpm

    Your maximum heart rate depends on your age. Aim to exercise at around 70% of your maximum heart rate.

    Using the table in the next section, you can work out how hard you are working by matching your heart rate to your age.

    To calculate your maximum heart rate, subtract your age from 220.

    For example:

    If you are 45 years old 220-45 = 175 bpm

    This means, to work at 70% of your maximum heart rate your heart rate will need to be 123. This is moderate to hard exercise.

    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 last reviewed May 2013 by:  Dr Prue Cormie, Senior Research Fellow, Edith Cowan University Health and Wellness Institute WA; Steve Pratt, Nutrition and Physical Activity Manager, Cancer Council WA; Kate Aigner, Cancer Information Consultant, Cancer Council ACT; Simone Guise, Exercise Physiologist, Cancer Council WA; Christine Hygonnet, Education & Information, Cancer Council SA; Dr Amanda Horden, Bayside Healthy Living, VIC; Jenny Mothoneos, Publishing Editor, Cancer Council NSW; and Andrew Murnane, Exercise Physiologist, Peter MacCallum Cancer Centre, VIC.

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