Get Your Oomph Back E-Book

Carolyn Garritt

• Herausgeber: Hammersmith Health Books
• Kategorie: Ratgeber
• Sprache: Englisch
• Veröffentlichungsjahr: 2021

Beschreibung

Exercising after a cancer diagnosis can help people to feel better in many ways – stronger, calmer, less fatigued and more in control. Beyond this there is compelling evidence linking physical activity with improved outcomes. The risk of recurrence is lower, and ongoing treatment can often be better tolerated. It's not easy, however, to exercise when you're living with the myriad side effects of treatment, even though being active has been proven to help reduce them. This book offers practical information on safe, effective and appropriate exercise for anybody who has received a diagnosis of cancer, including those undergoing active treatment and those living with advanced cancer. It aims to support people to be active in whatever way they feel ready for and is written by a highly experienced cancer exercise specialist who has also had her own experience of cancer: while she was writing this book she was diagnosed with breast cancer herself. The book includes her approach to her own 'prehab' and 'rehab' along with the experiences of some of the people she has trained over the years.

Leseprobe

This book is dedicated to my dad:fit as a flea and active to the end.

Contents

List of figures

Foreword

About the author

Acknowledgements

Introduction

How to use this book

Cancer and exercise – the reasons ‘why’

Lifestyle, blame and cancer

Exercise/physical activity/moving/fitness – what do we mean?

Why we need to sit still less

Chapter 1 How exercise can help with the impact and side effects of cancer treatment

Cancer-related fatigue

Mental and emotional health, depression, anxiety

Bone density, osteopenia and osteoporosis

Weight gain, muscle loss, body fat and hormone treatments

Moving through prostate cancer

Lymphoedema

Lungs and breathing: climbing stairs

Exercising with an ostomy

Pelvic floor training for men and women

Exercising after breast reconstruction surgery

Exercising with peripheral neuropathy

Chapter 2 When: the different phases of cancer

Exercising straight after diagnosis – ‘prehab’

During treatment – what’s possible

While living with secondary cancer

After (primary) treatment – when the circus leaves town

Towards the end of life

My story – moving through mastectomy

Chapter 3 What to do, and how

How to start – walk a mile a day

Active daily living and exercise ‘snacks’

The exercise prescription – how much, how often?

Design your own training plan

For the reluctant, the self-conscious and the tired – barriers and how to overcome them

When not to exercise, what to avoid and when to be cautious

Do what you love

Nordic walking – perfect exercise

Upper body strength – a gentle start

HIIT – what’s it all about then?

Running: you can, honest

Active rest and recovery

When things go wrong: what to do if you get injured

Chapter 4 The practical section

Getting going

• Warm-up routines

• Becoming less ‘chair-shaped’ – sit-to-stand

• How to breathe more easily

• Pelvic floor exercises

Getting out of puff

• Chair-based cardio

• Roger’s dining table routine

• Weight bearing, no-equipment cardio training

• Exercising without squishing the belly

• Step-by-step guide to Nordic walking

• Couch to 5K plan: walk, jog or run

Getting strong

• Exercises to improve upper body strength, using a resistance band

• Strength training with a Hickman or PICC line or Portacath

• Strength training for those with lymphoedema

• Strength training after breast reconstruction

• Lower body strength training

• Back and core strength exercises

• Core strength exercises for those with cancer in the bones/spine

• Strength training with an ‘ostomy’

• Exercises to improve balance

• Full body stretch

Appendix: Cancer support organisations

References

Index

List of figures

Chapter 1

Figure 1    Jane storming towards the finish line

Figure 2    Hima simply used a chair

Figure 3    Renate wanted to get back to outdoor swimming

Chapter 2

Figure 4    Peter needed to get stronger

Figure 5    Odile running her first 10k race

Figure 6    Clare boxing

Figure 7    Roger and I used jazz

Figure 8    My first run after surgery

Chapter 3

Figure 9    Marie finishing her 5km Race for Life

Figure 10  Rita: retired greyhounds make great training buddies

Figure 11  Advice for people starting exercise

Figure 12  Some of the goals we’ve used

Figure 13  Deedee used a mallet and hoops to get her oomph back

Figure 14  Running the Honolulu marathon in Hawaii

Chapter 4

Figure 15  Standing warm-up moves

Figure 16  Sit-to-stand

Figure 17  Seated march

Figure 18  Seated knee lift and bicep curl

Figure 19  Seated toe tap and chest press

Figure 20  Seated heel tap and triceps press

Figure 21  Seated chair arm scissors

Figure 22  Seated heel raise and throw

Figure 23  Seated marching X

Figure 24  Seated sideways toe reach

Figure 25  Seated star jump

Figure 26  (a) Wall press; (b) Press up

Figure 27  (a) Squat; (b) Squat with knee drive

Figure 28  (a) Walk/punch; (b) Jog/punch

Figure 29  (a) Half star; (b) Star jumps

Figure 30  (a) Side-step to wide squat; (b) Side shuffle touch floor

Figure 31  Mountain climber

Figure 32  (a) Back lunge; (b) Walking lunge

Figure 33  Nordic walking: (a) pole height; (b) grip poles; (c) poles trail behind; (d) pole pushed down and back; (e) pick up pole; (f) move from the shoulder; (g) past your hip; (h) open and close fingers

Figure 34  Banded chest press

Figure 35  Lateral pulldown

Figure 36  Lateral raise

Figure 37  Triceps press

Figure 38  Shoulder press

Figure 39  Banded row

Figure 40  Upright row

Figure 41  Front raise

Figure 42  Chest fly

Figure 43  Jazz hands

Figure 44  Flex wrists

Figure 45  Ankle pumps

Figure 46  Knee bends

Figure 47  Seated leg extension with band

Figure 48  Neck and shoulder stretches

Figure 49  (a) Pelvic tilt side view; (b) Pelvic tilt – hands

Figure 50  Glute bridge

Figure 51  Hip flexor stretch

Figure 52  Bird dog

Figure 53  Dead bug

Figure 54  Plié squat

Figure 55  Wall sit

Figure 56  Banded crab walk

Figure 57  Banded leg curl

Figure 58  Glute kickback

Figure 59  Banded fire hydrant

Figure 60  Banded hamstring curl

Figure 61  Superman

Figure 62  Abdominal crunch (a) gentlest; (b) progress

Figure 63  Knee lift (a) gentlest; (b) progress

Figure 64  Adapted plank (a) gentlest; (b) progress

Figure 65  Side bends (a) gentlest; (b) progress

Figure 66  Bicycle twist (a) gentlest; (b) progress

Figure 67  Adapted shoulder tap (a) gentlest; (b) progress

Figure 68  Stand on one leg

Figure 69  Side steps

Figure 70  Knee raises

Figure 71  Grapevine

Figure 72  Step up

Figure 73  Heel-to-toe walking

Figure 74  Tree

Figure 75  Calf stretch

Figure 76  Hamstring stretch

Figure 77  Quadriceps stretch

Figure 78  Glute stretch

Figure 79  Mid-back stretch

Figure 80  Back of shoulder stretch

Figure 81  Triceps stretch

Figure 82  Front of shoulder stretch

Figure 83  Lower back stretch

Figure 84  Hip stretch

Foreword

I initially met Carolyn two years ago at the first ever 5K Your Way Ambassadors’ meeting, when she shared excitedly about her writing Get Your Oomph Back. Since then our contact has been a social media friendship. A few weeks ago I pre-ordered the book little expecting to hear any more about it until the published copy arrived. It was a privilege then, when Carolyn asked if, as a GP, 5K Your Way Ambassador and breast cancer survivor (13 years ago now), I would write the Foreword.

As a child I was fortunate never to have any personal experience of cancer, first learning about it as a medical student in the early ‘80s. I remember thinking how horrific chemotherapy seemed and wondered why anyone would choose it over quality of life for their last few months. My experience of exercise was limited too, having a lack of hand-eye co-ordination (why I am not a surgeon); I was always last to be picked for teams. I only started running as punishment, being sent cross-country running with the boys after arguing with our games teacher. I enjoyed it and intermittently carried on as the only way to exercise through the horrendous hours of a junior doctor in the late ’80s.

When diagnosed with breast cancer in 2008, I was convinced I would die as a GP’s experience of cancer is mainly in diagnosing, and then in palliative care, but nothing in between. I was completely unaware of the increasing number of people surviving as their care was from hospital oncology departments, and then being thrown out into the big wide world to just get on with it, without involving us. Three years before my own diagnosis, my 80-year-old mother had joined a gym to help with balance and invited me to go on a trial. I surprised myself by enjoying the strength work and so wanted to carry on exercise (albeit at home or outside rather than a germy gym) during treatment. Oncologists were shocked and discouraged me from doing weights, wanting me instead just to have a diet of broccoli and goji berries. I discovered the reality of chemo fatigue big time but found that walking (I couldn’t run) was helpful both mentally and physically, so after mastectomy, against all advice, started to lift weights. The only lymphoedema I have ever suffered was after catching a blow-away marquee on Lincoln Showground.

Over the 13 years since I have been fortunate to remain well and relatively unaffected by post-cancer side effects apart from menopause. During this time the thinking about exercise and movement, post cancer but also generally, has progressed. As I have read ‘Oomph’ things I discovered for myself by experimentation have now become recognised. Carolyn quotes the research in her free text, particularly in the first two chapters, and references it all in an appendix. She also addresses the fact that, though statistics are important, they give none of us an individual guarantee. This is always something I struggle with. I didn’t want to know my risk of recurrence as a statistic, I wanted to know would I, or would I not get a recurrence so that I could make the right (not just an informed) decision about future treatment.

In Chapter 2, Carolyn takes us through the different stages of cancer, from prehab (movement pre-treatment) to the end of life, in a compassionate, understanding and non-judgemental way. As a GP who sees patients with all sorts of medical conditions, I would also encourage all of us to move more, even before we get a diagnosis, and would encourage relatives and friends to read this book. Much of what is said is not just applicable to those with cancer but to everyone, and particularly those with chronic and long-term non-cancerous conditions. Find what you enjoy (this is crucial in order to maintain activity) and just move more. Also, to those with female genitalia (even when they have been removed), start early with pelvic floor exercises, even before any damage has been done. They are a sentence for life, and also be aware that some heavy gym exercises can cause harm. I will now get off my hobby horse!

In Chapter 3, Carolyn talks about how to get going with exercise. I had never met the concept of exercise snacks before, but realised that in our GP practice the decision to walk to the waiting room and call patients rather than use an intercom many years ago meant I was already doing this. My views on Nordic walking have changed too, now that I understand the theory behind it. I might even try it for myself one day.

Throughout the book Carolyn uses personal stories, so thank you to all those who have shared. I realised, as I was enthralled with reading, that I was becoming ‘chair shaped’ having been sitting too long. This caused me to move on to Chapter 4 which has all sorts of practical examples with some excellent pictorial descriptions. Fortunately no-one else was in as I found myself trying them out whilst reading in my home office.

In summary, this is a fantastic book that I wish had been around 13 years ago. As a GP I shall be recommending it to patients, and to colleagues who still don’t always ‘get it’ when I talk about the benefits of exercise. So many need to know that parkrun does not have to involve running. I shall be recommending it to 5K Your Way attendees, though of course they are already converted. I also hope to discuss more prehab, even pre possible diagnosis for those I refer under the UK’s NHS two-week rule for suspected cancer patients to be assessed.

And for me personally, when it is cold and rainy and unattractive outside, I will think of alternative ways of moving more inside.

Happy Movement.

Dr Jenny Wilson

GP, 5k Your Way Ambassador, Cancer Survivor

About the author

Carolyn Garritt MSc (Public Health and Health Promotion) is a cancer rehabilitation personal trainer and Exercise Lead for the West London Maggie’s Cancer Support Centre. She has been working in this relatively new field for more than seven years and is a qualified personal trainer and instructor in running, boxing, sports conditioning, chair-based exercise and Nordic walking. She has trained hundreds of people recovering from or living with cancer. She also has personal experience of cancer – she helped both her parents to become more active after their cancer diagnoses and in 2020, while she was writing this book, she was diagnosed with breast cancer herself.

Acknowledgments

Professor Jane Wills, LSBU, who sowed a seed and helped it germinate.

Jenny Jen and Mr Christopher for providing a stunning space for the seedling to grow.

Lynn, for bringing me sunshine.

Bernie Byrne and Tina Glynn for their faith at the very start that it would actually grow, Sinead, Louise and all the team at Maggie’s West London for their generous nurturing.

Huge thanks to my clients from whom I have learnt so blooming much. I am very grateful to everybody who has allowed me to tell their stories.

Particular thanks to Ren for initial direction, Chloe for reading, and Cindy, Deedee, Jane, Janet, Odile, Michelle and Vicky for listening so patiently.

Thanks too to Lynn Greenfield for her excellent photographs.

Introduction

I remember clearly the first time I heard the term ‘cancer survivor’ being properly described. It was in 2008 and Macmillan Cancer Support had published a report called Two million reasons. I listened to a presentation about it by Professor Sir Mike Richards, NHS Cancer Tsar, and one of my career heroes. He spoke eloquently and thoughtfully about some of the realities for the two million people living in the UK who had had a cancer diagnosis.

I had never really thought about what it was like to live with the consequences of cancer treatment – physical, mental and emotional. As I listened, I wondered why I hadn’t had this awareness already. I’d known loads of things about diagnosis, and a fair bit about what treatment entailed through working in the NHS cancer screening programmes, but what happened after treatment was something that I just hadn’t appreciated. That day, for me, a massive penny dropped.

Two million reasons described the broad impacts of living with and beyond cancer, and the wide range of unmet needs being experienced by people every day. It described the human perspective, rather than the clinical/medical one. At the time, cancer survival rates were increasing, but they weren’t good enough; the UK lagged behind other comparable countries. The report explained that, although people did survive cancer, their quality of life was often impacted significantly. They experienced poorer health and wellbeing than the general population. The reasons why were complex and multi-faceted.

The report made a totally credible, logical argument for service provision to change and to develop swiftly, in order to better serve the growing population of people who were living with and beyond cancer. It also predicted that, with rising cancer prevalence, increased awareness of symptoms, earlier diagnosis and ever improving treatment options, the number of survivors would double to four million by 2030.

Fast forward more than 13 years and much has changed. The realities of the consequences of cancer are more broadly understood and better supported – although there’s still a great deal of room for continued improvement, particularly for those living with advanced cancer. Some of the services I was offered during my own cancer treatment were the result of Macmillan’s earlier clarion call.

In the field that I work in, cancer and exercise, scientific evidence now abounds, and we understand a great deal more about how exercise can help. Many organisations provide specialist physical activity classes for people with a cancer diagnosis, and there is a growing army of cancer-specialist exercise instructors on hand to help.

The scientific evidence and working knowledge are being shared widely, and people living with and beyond cancer are increasingly aware of the role that exercise might play in their future.

Sometimes, however, what’s still not so apparent is ‘how’. How, before, during and after the rigours of cancer treatment can we actually find the confidence, the energy and the time to be more active? What’s safe? What will work? How much do we need to do?

How to use this book

This book is intended to support those who want to increase their understanding of ‘why’, and it hopefully explains the tremendous value of being active after a cancer diagnosis. It also shows readers ‘how’.

Chapter 1 describes how physical activity can help lessen the impact on our daily lives of some of the most commonly experienced consequences of cancer treatment.

Chapter 2 looks at exercise during the various phases of cancer treatment and beyond. As you are contemplating a more active life, I urge you to be gentle with yourself – comparison can be the thief of joy after all. If you feel you are not as active, or fit, as you were before your diagnosis then do, please, acknowledge that you are in the midst of a very difficult time.

Chapters 3 and 4 become more practical and are where we start to put together plans of what to do. These ‘how to’ sections are intended to be useful and used often. To that end, many of the types of exercise described or suggested are ones that you can do at home, in the garden or park, either on your own or with a training buddy. (We also talk about the lovely benefits of exercising in groups, with like-minded souls.) The exercises don’t require a lot of equipment and are chosen to be both safe and effective.

Chapter 3 has advice for those who are reluctant, time-strapped, tired or self-conscious – if this is you now, by all means go straight to those sections first. It’s really important that the need to exercise does not start to feel overwhelming and yet another thing to try to find the energy for. Nor is it intended to suggest that ‘one size fits all’ – I hope the book will help you to feel in control of what you choose to do, and when. Chapter 3 contains a section on how to design your own training plan – and again, choose things that feel right for you and that matter most to you at present. Your plan will develop over time.

Chapter 4 contains sample routines which can, and should, be customised according to your preferences and abilities, which will change over time. Many of the activities can be progressed as you become fitter and stronger.

How to read the book

I suggest that you read the book through once – there will be short sections in Chapters 1 and 2 that don’t apply to you, but most of it should have relevance to all.

Then go back to focus on the parts in Chapters 1 and 2 that affect you most directly, here and now, as this is the context in which you are beginning.

Then re-read the section in Chapter 3 entitled ‘Do what you love’, as I sincerely hope that we will find ways that you can actually enjoy getting your oomph back.

And then… start. The first section in Chapter 4 ‘Getting going’ is intended to help you do just that. Look for the right level for you, now, to start to get out of puff and to start to get strong. Don’t neglect the strength training: as you will come to read, it is more important than many think, and it is, I promise you, do-able.

If you can, include in your activities things that support your balance. Try to become someone who habitually does their cool down stretches. They will reduce your risk of injury and will help you keep going.

Do start small and start gently. Not wishing to quash any enthusiasm here, but I’ve learnt over the years that we need to spend our precious energy wisely. Aim for consistency, do little and often rather than one massive and exhausting session.

Take good rest periods – there’s a section in Chapter 3 (p. 124) about active rest and recovery.

You will find after a little time that exercising becomes a bit easier and you should steadily start to feel stronger. When you reach a plateau and don’t think you’re improving, move on and challenge yourself a little more.

Then re-re-read ‘Do what you love’ in Chapter 3, to see where your ideas can take you.

The book is written for all people with cancer, and for people with all types of cancer. Often it is the most common cancers that are mentioned, partly as many of the larger works of evidence focus on them. If your particular type of cancer or treatment isn’t featured, then please know that this book is still for you, and you are welcome to contact me, and I’ll see what I can find to add. I have written sections about specific cancers if they tend to benefit from specific considerations or moderation when exercising, and I’ve written about the side effects and consequences that people have asked me about in relation to exercise.

My hope is that this book will help to empower people with a cancer diagnosis to be active and strong, on our own terms, and for the rest of our lives.

Cancer and exercise – the reasons ‘why’

As outlined above, there is a growing and convincing body of evidence to describe the links between cancer and physical exercise. Much of this examines the multitude of ways in which exercise can help improve the lives, and indeed lifespan, of cancer patients and survivors.

Please note: when thinking about the links between exercise and cancer, the statistics are important, but they don’t bring with them any guarantees for anybody individually; I will therefore opt for the term ‘risk reduction’ rather than ‘prevention’.

Exercising across the whole cancer pathway

At first, exercise was only really considered, studied and suggested for people after treatment had ended. It was believed that ‘rest is best’ during treatment and there were concerns that exercising would be too much for the body to cope with. Increasingly though, the evidence shows that exercise can help people at every point in their cancer pathway, right from their day of diagnosis.

Cancer ‘prehab’, between diagnosis and the start of treatment, has been shown to have broad benefits and is being adopted across the NHS. Exercising mid-treatment – once unheard of – has been proven to be safe and to be advantageous. One clinical trial describes a chemo suite with an exercise bike in it for patients to use during their infusions.

Then, for many, comes the end of treatment – which can be a much more complex experience than many outside the world of cancer will realise. This was one of Macmillan’s observations in their Two million reasons report – people experience a tangible sense of abandonment once their clinic visits have stopped. Many people then live with worry and ‘scanxiety’ during follow up or active surveillance – just ask the men undergoing regular PSA testing.

Living and exercising with secondary, or advanced, cancer is now recognised as feasible and advantageous in helping people regain a sense of control and routine during their ongoing treatment. If you follow social media, you’ll find some well-known role models who are #busylivingwithcancer.

Many people probably don’t realise that some hospices now have fitness suites and perhaps a swimming pool. Exercise for those in supportive care has developed significantly in recent years. It is recognised for its immensely helpful contribution to pain management and in instilling a sense of wellbeing – emotional as well as physical, even for people coming to the end of their lives.

The big picture

Exercising after cancer can save lives. Now, this is a bold statement, and, as you’ll read later, I believe that we need to be cautious here because big studies of populations can give one picture but the individual stories of the people within them are myriad (i.e., it is very well established that smoking tobacco causes cancer, but most people know somebody who has smoked for all of their adult life and not developed it).

That said, evidence shows exercise can help reduce the risk of dying for people who have already had a primary cancer diagnosis. Multiple studies have shown this to be the case, and studies of the most common cancers have suggested that exercise can reduce breast, bowel and prostate cancer mortality by 30–40%.1

Exercise can also reduce the risk of cancer coming back and can help to slow down disease progression for people living with secondary or advanced cancer. An extensive academic review of all of the scientific knowledge in 2017 concluded that ‘cancer patients involved in greater levels of exercise have a lower relative risk of cancer mortality and a lower relative risk of cancer recurrence, and they experience fewer and/or less severe treatment-related adverse effects’.2

Lots of us who have had cancer, or are living with it, don’t know this.

What it feels like to have had cancer

Beyond the bigger picture statistics are people’s everyday experiences. For many of us there are long-term health issues, often from the effects of treatment rather than the cancer itself. Sixty per cent of people who’ve had cancer treatment say they have unmet physical and psychological needs. If you’ve been through it, you may have experienced:

• fatigue

• depression, anxiety

• weight loss or gain

• altered body image

• pain, nerve damage, neuropathy

• reduced bone density, bone and joint pain

• swelling and lymphoedema

• hot flushes and night sweats.

Evidence shows that exercise can help manage all of these symptoms.

Is exercise the next type of cancer care?

In cardiac care, getting fit is a routine part of recovery and rehabilitation. Patients are automatically referred to specialist-led fitness classes. Cancer care services are rapidly catching up with their cardiac counterparts and there is a view that exercise may well become a fourth mode of treatment, alongside surgery, radiotherapy and chemo/biological therapies.

’If exercise was a pill, it would be prescribed to every patient’3

Over recent years the term ‘exercise oncology’ has emerged, to describe the idea that exercise could be considered a form of cancer treatment. The clarity and persuasiveness of evidence around the idea was reinforced in 2018 when the Clinical Oncology Society of Australia produced a position statement4 that hit the headlines globally.

They advised, based on scientific evidence, that exercise should be prescribed to all cancer patients, just like a drug. They went further than this though: they stated that exercise should be embedded as part of standard practice in cancer care, and they said that to not do so would be harmful.

Here in the UK there was some superb work in Greater Manchester to spearhead the provision of cancer ‘prehab’ to all people at the time of their diagnosis.5 Prehab is now rolling out to more and more areas of cancer treatment. There are trials underway looking at exercise as a treatment option alongside chemotherapy and instead of some active surveillance in prostate cancer.

Cancer-related fatigue

Fatigue in cancer survivors is really significant – up to 95% report it. The tiredness can absolutely floor you.

Although it perhaps sounds counterintuitive, there is substantial evidence to show that exercise can help people to cope with cancer-related fatigue, and in some cases to reduce the risk of developing fatigue or lessen the severity. There are consistencies within the data – particularly in encouraging people to exercise regularly rather than occasionally and at a manageable intensity and duration. There is also evidence about the (positive) effects of higher intensity exercise.

It’ll help to sort your head out

There are many psychological and emotional advantages from taking regular exercise. It can help people cope with depression, anxiety, and weariness. Running and gardening were my absolute saviours during my diagnosis and treatment.

Part of the reason that exercise can be useful here is because it can help restore appetite, thus increasing our nutritional intake, and it can help promote good sleep. Both factors, in turn, can help increase our sense of stability and our ability to cope.

As discussed later in the mental health section in Chapter 1, exercising outdoors can add further beneficial dimensions, and so-called ‘green exercise’ is believed to offer even greater potential support to our mental and emotional wellbeing. Part of the reason for this is that exercise helps us generate endorphins – our ‘good time’ hormones that can give us a happy glow.

Muscular strength, bone density, joint mobility and lymphoedema

If you’ve been out of action for a while, the chances are you’ll have lost some of your muscular strength and this can be why simply climbing the stairs or getting out of a chair feels harder than it used to. Resistance training can help to rebuild our functional strength.

Alongside muscle loss, cancer treatments can leave us with stiff or painful joints and with a reduced range of motion, and exercise can be used to help diminish pain and to build strength in the connective tissue – the tendons and ligaments that support the joints and help them to remain mobile.

Some of the hormones used in cancer treatment are linked to lowered bone density, and there’s very good evidence to show that weight-bearing exercise can help to slow down bone mineral loss and, in some cases, to actually increase bone density.

Similarly there is specific evidence that exercise, when performed with good technique, can help prevent and manage lymphoedema.

Help through transition

In this book I talk about exercising through the entire cancer ‘pathway’, starting at diagnosis and then onwards, for the rest of our lives. Living with cancer involves much transition from one point to the next and exercise could, in this instance, become a constant and something that is part of what we are and what we do.

It’s hard to get back to work after a cancer diagnosis. Of those diagnosed in the UK, half are of working age, but cancer survivors are 1.4 times more likely to be out of work than average. Exercise increases return to work rates (although of course you may not want to go back!).

Exercise can also help you to get back to normal, to feel more like yourself or to build your own ‘new normal’. It can help you get your oomph back.

Lifestyle, blame and cancer

One thing that my own cancer diagnosis taught me – starkly – is that cancer is a random lottery. Why do some of us develop it and others not? One of the reactions I often heard when I told people my news was ‘but you’re so fit!’. Well, as we say in Yorkshire, that’s as maybe.

Despite our understanding of the statistics, it is incredibly natural to ask ‘why me?’ Was it luck, genes, bad timing, environmental? Who knows?

It can be perfectly possible to blame yourself, but in truth we cannot unpick our own behaviours to work out the cause.

I had a brief moment when I wondered, as a, ahem, well-built, gin-drinking, cake-eating, ex-smoker, how much I had contributed to my own diagnosis. Thankfully, I decided to put those thoughts away. I did grow to understand, and then make, some lifestyle changes, but I was clear in my mind that they would be positive developments, not self-admonishment.

And so I’m determined: exercise, or a lack of it, must not be used as a stick to beat people with. The same applies for body weight, body fat, BMI, diet and numerous other aspects of life that can be linked to exercise. That is simply unhelpful. What we need instead is the best information on risk reduction so that we can make our own informed choices. Self-efficacy is the aim: having the tools and methods to hand so that we can feel better and protect ourselves, on our own terms.

Exercise/physical activity/moving/fitness – what do we mean?

These terms are all broad, but in the context of this book, ‘exercise’ refers to any activity in which you purposefully move your body. Physical activity is defined as any movement that uses skeletal muscles and requires more energy than resting.6 ‘Exercise’ is normally implied as a deliberate action, whereas ‘physical activity’ could occur as a result of our daily lives. You might, for example, have a job that is so physically active that you don’t feel the need to exercise in your leisure time.

Exercise is often – but not exclusively – about getting a bit out of breath, doing something to deliberately raise your heart rate and make you feel a little warmer. It’s also about activities that move your muscles in a way that will cause them to tire; then when they rest afterwards, they repair, and that repair process allows them to increase in strength.

A third aspect is that it might involve stretching your muscles in order to help prevent them and your joints from losing their flexibility, and it might involve activities that challenge your brain in order to restore your balance and coordination.

So, I use the terms ‘exercise’, ‘physical activity’ and ‘movement’ quite freely as their application to our daily lives can vary enormously. They interchange: dancing could involve a little boogie while you’re cleaning with the radio on, or a full-on sweaty Zumba class. Activities such as gardening, dog-walking, picking toys up from the floor, all ‘count’ as exercise.

When we’re thinking about becoming more active, or fitter, I would urge anyone to try to integrate into their lives these four aspects:

1. Get out of puff

2. Get stronger

3. Be flexible

4. Work on your balance.

How should it feel?

Well, it’s nothing like PE at school (unless you particularly loved it, in which case you’ll find there are team sports that can be accessed whether you’re a beginner, a cancer patient, an older adult, or all three). It’s also not about being a muscle-bound beefcake in a gym (unless that’s your thing).

It definitely isn’t linked to punishment, or payback for earlier life choices. And as described, it absolutely is not a reason for you to feel bad if you are not currently as active as you want to be. If this is you, please try not to feel overwhelmed. There is advice later in the book about how you can break it all down into manageable bite-sized chunks.

Being more active in this context is really about learning a broad range of options that we can choose from so that we probably feel better on a daily basis and might offset some of the consequences of treatment in the longer term.

Exercise should, however, feel like you are definitely doing something – for example, walking as exercise should not be an amble. Regardless of the speed you can reach, walking should be as purposeful and as fast as is comfortable, for you. This is because the evidence that we’re using as a foundation for being more active is invariably based on ‘moderate exercise’ unless it states otherwise. For example, one study suggested a specific link between walking pace and cancer survival.7 (NB the paper didn’t distinguish between those who had finished treatment and those who were living with cancer.)

Exercise works best when it is an integrated part of your day, and of your life. It might take a bit of time to find that sense of integration, and hopefully this book will help with that. Exercise could and should be something that you enjoy and that you know brings you benefits.

Why we need to sit still less

A ‘sedentary’ lifestyle

‘Sedentary’ is the term used to describe a lifestyle that involves little, or no, exercise, of even the least strenuous type. It is associated with a significant risk of many health-related issues, including weight gain, obesity, diabetes and heart disease.8

Specifically, for those who have had a diagnosis of primary cancer, evidence shows that a sedentary life is linked to an increased risk of cancer recurrence.9

The term ‘sedentary lifestyle’ is sometimes used in a way that is derogatory, a bit ‘blamey’, which is not particularly helpful in the context of people who’ve undergone cancer treatment. That’s not my intention here.

Mobility

When thinking about any desire to move more, I think it is really important to acknowledge that everybody has their own starting point. For some, the idea of increasing their levels of activity will involve running and jumping. That’s fair enough, but the gains from exercise are equally pertinent to those with different levels of mobility. Your reality may well require you to spend a lot of time in a seated position, or only allow you to stay on your feet for brief spells, in which case I’m sure a lot of exercise guidance could seem completely irrelevant to you.

With that in mind, my aim is to support you to ‘sit still less’ and ‘sit less still’, rather than give the simplistic message to spend less time sitting down. We can ‘sit less still’ by exercising in a chair – and chair-based workouts are not exclusively gentle: some can be elevated enough to make you sweat.

Head to toe – the effects of sitting still

Many people wouldn’t realise the degree to which our health is impacted by a sedentary lifestyle, beyond the big headlines above. Starting from the top, sitting still for long periods (here defined as an average of 8 hours a day) is linked to:10

• brain fog

• neck strain

• sore shoulders and back

• weakened chest muscles

• inflexible spine

• disk damage

• weakened abdominal muscles

• inflexible hips

• weakened glutes (the muscles in the buttocks)

• poor circulation

• reduced bone density

• varicose veins

• deep vein thrombosis

• swollen ankles.

There is a section at the beginning of Chapter 4 (p. 129) dedicated to how we can become less chair-shaped.

Chapter 1

How exercise can help with the impact and side effects of cancer treatment

Cancer-related fatigue

‘Yes, that’s all very well, but I’m exhausted’…

Fatigue in cancer survivors is a significant issue – it is perhaps the most common side effect. Not everyone calls it fatigue, but tiredness, exhaustion and lack of energy are reported by up to 95% of people with cancer.1

It varies from person to person, of course, but most people with cancer find that they have low energy. Some experience debilitating fatigue that drags on for months.

If this is you, you are not alone.

What causes cancer-related fatigue?

Well, according to Cancer Research UK, each of the main forms of treatment can cause it:2