chemotherapy

Stretching for cancer survivors is helpful to maintain muscle health – particularly after surgery [A how-to guide]

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Stretching is essential for many reasons in maintaining health & wellness. It can be done by anyone, at any time – and is very easy to do, and it is alright if you are unsure as I will show you how in this post. In general, the main benefits attained from stretching include:

  • Increased flexibility or Range of Motion (ROM)
  • Reduced likelihood of injury
  • Improved benefits when completing aerobic & resistance exercise

Before I go on, I would just like to let you know, I have created a new Facebook page called Exercise Cancer Community: Health & Wellness, to create a supportive environment for people to share their experiences. Please visit the page, click the Like button on the side of this page or on the FB site and pass it on.


Now, stretching is important for basically anybody to maintain or improve their physical health, but it is particularly important for cancer survivors who have undergone treatment such as a surgery. For example, women with breast cancer who have undergone a mastectomy tend to experienced reduced should flexibility, strength & mobility due to muscle and tendon tissue damage. In fact, here is a great article by Dr Robert Kilgour displaying that home-based stretching can assist in reversing these results, as published in the Journal of Breast Cancer Research Treatments. By engaging in stretching exercises (and eventually resistance training exercises), you will be able to achieve a level of health pre-surgery, or even greater. But if not, simple daily tasks around the house such as reaching into cupboards above the head, discomfort whilst driving or picking up a baby may become challenging.

Here is an example of a "spider-crawl" or "wall walk", where you slowly raise your arm up the wall to the level of your range (not to pain)

Here is an example of a “spider-crawl” or “wall walk”, where you slowly raise your arm up the wall to the level of your range (not to pain)

Before I show you individual stretches, here are the guidelines for stretching:

  • Stretches can be done daily or most days of the week (can do them up to 3-5 times/day)
  • Hold each stretch for 15-30 seconds
  • Repeat each stretch 1-3 times on each side
  • Have a deep breath in when commencing the stretch
  • Only complete the stretch to the full range of your joint (and not to a painful point)
  • Stretching is most effective when the muscles are warm, so after a walk is perfect

Here we go: If you are only a few weeks post surgery (1-3 weeks), you may consider doing “range of motion” exercises, that is just moving your joints to their point, and not pushing further.

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Above: Shoulder flexion & extension

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Above: Shoulder abduction

If these are simple, then lets move on to more stretches for the upper body:

Chest stretch:

  • Arm at 90 degrees against a wall, with forearm on the wall
  • Rotate body away from wall & hold

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Shoulder stretch:

  • Arm across the body
  • Other hand presses the elbow closer to the body & hold

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 Triceps stretch (only if your flexibility allows you to do so):

  • Arm above and behind your head, with elbow in the air
  • Hand above your opposite shoulder
  • Using your other hand, pull the elbow across your body & hold

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 Biceps & forearm stretch:

  • Arm directly in front, with fingers facing downwards
  • Using opposite hand, pull the fingers back & hold

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Do you see how simple some of these are? Definitely can be done at the office, in an elevator or at home! I constantly will be doing stretches to help aid my training sessions in the gym and at soccer around the office. Now here are some lower body stretches to do for the lower body:

Calf stretch:

  • Place hands on the wall
  • Take a step backwards with one leg, with foot placed flat on the ground
  • Bend the front leg, straighten the back leg and feel the stretch

With both feet flat, act as if you are trying to push the wall down. You should feel this in the back of your behind leg

Hamstring stretch:

  • (seated or on a yoga mat) put one leg out as straight as you are able to
  • Lean towards your foot, with your hands together
  • Aim to keep your back straight
  • Point your toe backwards for a greater stretch
  • Resistance bands can also be used for a greater stretch
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If less mobile, use a chair for support

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If you are more mobile and have progressed your flexibility, try a greater stretch using a resistance band

 Quadriceps stretches:

  • Find a stable object for support (wall, table, exercise bike!)
  • Grab your foot of the leg you are stretching
  • Keep legs in-line with each other and pull until you feel a stretch
  • You can also use a resistance band or rope around your foot to assist if you have limited flexibility

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Remember, every day you can partake in stretching, and before you know it, you will be improving your flexibility in no time. Combine this with your aerobic and resistance exercise and you are on your way to achieving a fantastic lifestyle.

Keep up the great work and please remember to provide encouragement to those in need, pass this resource on and keep continuing to send me questions and personal experiences.

 

Your Exercise Physiologist,

David

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Presenting ovarian cancer & physical activity research at the ESSA conference, Adelaide

Every two years sees the national Exercise & Sports Science Australia (ESSA) conference held, which brings together about a thousand researchers, clinicians, academics and some amazing presenters to discuss the latest in physical activity research, clinical guidelines and the opportunity to collaborate and bring forward great ideas to move the field forward and create the best possible outcomes for our patients.

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The highlights of this conference for me were:

* Prof Daniel Green – why exercise is better for the cardiovascular system than we first believed

* Prof Graham Kerr – Exercise in patients with neurodegenerative disorders

* Dr Kim Bennell – exercise as therapy for osteoarthritis

* A/Prof Lorimer Moseley – Exercise for the patient with chronic pain

These talks were inspirational and I managed to learn some great information. However, this conference was also more special for me as I was fortunate enough to present my research on exercise for women with advanced ovarian cancer.

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It was a great environment to discuss my findings, in which these patients who were undergoing chemotherapy who exercised for more than 90 minutes/week had reduced fatigue, slept better, improved quality of life, were stronger and had less anxiety.

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I also had a poster viewing session, which was a great way to interact with other researchers. Here I met an expert in chronic pain, Matthew Jones, and he was able to give me insight into how he helps to reduce pain by exercising in young healthy people, something of massive interest we seek to investigate in the future for cancer survivors.

I also managed to attend some great presentations of colleagues and experts in the field:

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Dr Fiona Naumann (above) spoke on the complex considerations for exercise physiologists working with cancer survivors, Carolina Sandler gave great insight to the Post-Cancer Fatigue experienced by survivors, and how exercise therapy can help manage this, whilst Simon Rosenbaum discussed his research improving the mental health issues for patients with Post Traumatic Stress Disorder.

In terms of cancer & exercise research, there was also other great talks on reducing side-effects of Prostate cancer treatment by Brad Wall and Tina Skinner, and a pre-surgery exercise program by Andrew Murnane. Anna Meares OAM, olympic medalist for cycling also presented her amazing story of recovering from a fractured neck vertibrae only to return and win a silver medal at the London games.

 

Overall, it was a fantastic few days – and to top it off, I was very surprised and honoured to be awarded a research award for my work.

 

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Check out the Twitter feed for the ESSA conference #ESSA14 

 

Now, I return to Sydney with a whole range of new ideas, more potential researchers to do further work with as I set the bar high with what we can achieve and assist as many future survivors as we can.

 

Please add me on twitter, ask questions, share our quest with other survivors, follow and most of all, just get out there and get active! We are here to help!

Your exercise physiologist,

David

Twitter – @Davemiz_EP

E-mail – d.mizrahi@unsw.edu.au

exerciseoncologyaustralia.wordpress.com

 

Weekly Walking Challenge – Day 4

So at the half way point of the weekly walking challenge that we have set for ourselves today, think to yourself if you are happy with your progress, and what will you achieve for both a) the rest of the week and b) next week.

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The general recommendation by the American Cancer Society and American College of Sports Medicine is 150 minutes/week – so 30 mins x 5 days a week is common.

Can you make time to go for 2x walks over the weekend? 

 

Here are some handy tips:

* plan the day before for when you will exercise

* go for morning walks, to avoid procrastination of leaving it until the afternoon

* take a friend/family member with and make it social

* get a pedometer and measure step count (aiming for 10,000 steps/day)

* get on/off the bus 2-3 stops early and walk to the stop

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Keep a tally of how many minutes you achieve each session and per week, write it on a piece of paper and stick it on the fridge as a reminder/motivator. Every week your goal is to maintain or increase the amount. 

 

You can do it! Get out there, feel good, be strong, live life, be empowered, be positive!

 

Your Exercise Physiologist,

David

Weekly walking challenge

Welcome everybody today, I hope this blog has been helpful in inspiring and motivating people throughout their journeys to take that step and engage in healthy lifestyles. 

I would firstly like to say that today is an important day for me, I have just submitted my thesis on my previous 2 years of work with the ovarian cancer ladies in Sydney, so I am a very happy camper! But that will not stop me writing!

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So I am feeling good and celebrated with a gym weights session, an indoor soccer match and a yum home-cooked dinner. 

I would like put forward to everyone here, a weekly exercise challenge. Now I must stress here, I cannot give specific targets to individuals without having a good chat with you, but I can provide general recommendations, such as the ones released by the American Cancer Society below:

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Moderate intensity = heart rate/breathing rate increases so having a conversation is challenging

Vigorous intensity = working hard enough that you cannot sustain conversation.

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Lets aim for moderate intensity. 150 minutes we can break up throughout the week, so we are generally looking at 30 minute walks on 5 days per week. But if its been a while since you’ve gone out there, try 10-15 minute sessions first and build up. You can do it.

Now to keep you accountable, keep an activity diary and fill it in daily like the one below:

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Simple. So you can plan and try a match/beat your previous weeks. I did this with the women in my study and once in a nice routine, they could increase their programs and make it more challenging.

Give it a week and see how you go, aim for that 150 for the week. Here’s how mine may look for the week 

Mon – indoor soccer pm (40 min)

Tues – gym weights (40 min)

Wed – run/cycle (30-40 min)

Thurs – gym weights (40 min)

Fri – rest

Sat – rest (or light jog on Bondi Beach)

Sun – Soccer match – 90 mins

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Now I do play a fair amount of sport, but a goal of mine – and a goal of YOURS is to AVOID inactivity. try avoid having too many days in the week with no exercise, even small walks are beneficial to how you may start to feel.

As a reminder, here are some of the possible benefits from partaking in regular exercise from the American Cancer Society:

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Get out there, small walks at a time and build up.

 

Now please get back to me with how you went as it would be great to encourage other survivors with your efforts! (comments or e-mails!)

 

As always, please share this with a loved one, or encourage a friend to walk, or like this page and tell yourself you can do it – because you can!

 

David

Exercise physiologist, blogger, researcher, soccer player

E: d.mizrahi@unsw.edu.au

Twitter: @davemiz_EP

Encourage a friend, a family member, a loved one

Thanks for the overwhelming response in readership I have received over the past few weeks from all around the world, it is great that there is growing interest in taking charge and moving forward after diagnosis. I would like to use this post to try and get the word out, to share some lifestyle tips and provide encouragement to those who have been affected by cancer. My previous posts have highlighted that exercise is safe and provides numerous evidence-based benefits during various treatment types and after treatment. 

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Today, I would like all of my readers to share this blog with somebody they know – a friend, a family member, a work colleague, through Facebook, Twitter, email or word of mouth, who has had somebody in their lives (as so many of us have) affected by cancer. I want them to know that they are not alone in their journey, that there are many people, including myself, a complete stranger, who is willing to help improve their quality of life. 

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By connecting the community, we can share each others stories, experiences, challenges and triumphs – and that can be valuable to encourage people. I wish to gain peoples stories from diagnosis and thereafter, including how they began to exercise, what routines they got in, their likes/dislikes etc. so people who come along earlier into their journey can have some inspiration. 

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In the chemotherapy suits last year at Prince of Wales Hospital, Sydney, one of my patients who I had trained, was telling other ladies with ovarian cancer in the clinic how she had built up over the previous 6 months and was attempting her first City2Surf run (14km charity run). I was so impressed with her, she was so proud of herself. Although she stopped halfway for a coffee to enjoy the beautiful Sydney harbour views, it was a most amazing accomplishment. 

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Recruitment for my study went through the roof after that. Women were asking around the clinics to sign up, it was a great advertisement for living a healthy lifestyle, despite undergoing chemotherapy every week, and an example of a great supportive network.

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It is this power that I want to use by connecting people so we can share stories, read stories, have the inspiration to try go for a long walk, to have the inspiration to try and jog on the beach, to be inspired to go to a yoga class or a gym class, to ask my doctor what exercise services are on offer. 

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Please follow and share this with somebody who can benefit, who can re-gain strength and get more out of life, and feel free to get in touch with any questions, comments or stories you may have. 

As always,

Your Exercise Physiologist,

David

Twitter: @davemiz_EP

E-mail: d.mizrahi@unsw.edu.au

 

 

The Benefits of Exercise during Radiotherapy for Breast Cancer

After receiving an overwhelming response for my recent post “Exercise to increase overall survival and reduce disease recurrence”, I was able to get in touch with some amazing people who were implementing positive healthy behaviours into their journey.

I would like to commend one poster, who during radiotherapy, despite having leg muscle impairments, was exercising 30-45 minutes daily, doing weights, yoga, physio and meditation – and feeling great!! Great inspiration. She gave me the idea to speak about exercise during radiotherapy (RT).

Common side-effects of RT are fatigue, pain, shoulder instability, cardiac damage and reduced quality of life. The majority of these I have previously mentioned will be improved by engaging in aerobic physical activity. An article published in 2008 by Ji Hyi Hwang in South Korea worked with breast cancer patients after surgery, who were about to commence RT.

Protocol:

Exercise consisted of 3x 50 minute sessions a week for 5 weeks

Each 50 minute session consisted of:

10 minute warm up

30 minutes exercise (treadmill walking, cycling, strength exercises, shoulder stretching)

10 minute cool down (relaxation)

The main results were as follows:

 

Exercise RT

 

On each figure, the left bars indicate the non-exercising control groups – who experienced reduced quality of life, increased fatigue and worse pain

The right bars indicate the exercising group – who experienced IMPROVED quality of life, IMPROVED fatigue and HIGHER pain threshold. This is a two-fold swing right here. Furthermore, the exercising group had better upper arm flexibility – which is vital to be able to continue doing normal activities at home – driving, washing, going to shops, lifting things etc!

Here is the link below to the article:

http://synapse.koreamed.org/Synapse/Data/PDFData/0069YMJ/ymj-49-443.pdf

If you or somebody you know is undergoing or about to undergo radiotherapy, provide support, ask them to go for a walk with you. Go at their pace, doesnt matter how fast, it is better than nothing. Once confident and building endurance, then you can start to go faster and you will start embracing some of the great benefits. Walking is safe and does not require supervision. If you wish to have a weights program prescribed to you, consider speaking with your physiotherapist, or certified exercise physiologist

As always, please comment, ask questions, go for a walk, share this blog with a friend or family member, follow me and stay positive.

David

Your exercise physiologist – Exercise Oncology Australia

Exercise to increase overall survival and reduce disease recurrence

I’d like to speak today about a great article published in 2006 in the Journal of Clinical Oncology, one of the top ranking oncology journals titled “Impact of Physical Activity on Cancer Recurrence and Survival in Patients With Stage III Colon Cancer” by Jeffery Meyerhardt. The study used patients with Stage 3 Colon cancer 6 months after chemotherapy treatment.

The study first asked patients how much activity they were engaging in per week. Each type of activity has an intensity, where a higher intensity allows for more energy exertion. The terminology used is called a MET or metabolic equivalent – so when we are resting, we exert 1 MET, brisk-walking is 4.5 METs or swimming is 7 METs.   I’ve included a table from the article below:

MET exercise intensities

As I’ve mentioned previously, “more is better than less and some is better than none”. This is a good place to start. Once you can get into a rhythm of regular exercise, it is time to train for longer and add in some challenging sessions.

What this study found was really interesting, and is a reason why there is more research in exercise oncology studies. Patients who engaged in at least 18 MET-hours/week (approx 6 hrs of normal pace walking or 1.5 hrs of running or 2.5 hrs of tennis per week) had a 47% improvement on disease-free survival than inactive patients. This is HUGE! The table below shows the survival rates by different levels of activity

reduced mortality

Personally, I think this is really ground breaking, with more and more oncologists now wishing to have their patients participating in exercise studies. There is emerging hard evidence, this isnt just fluff and games. Get out there and start to move, walk, shake that body. One step at a time. You can do it.

Here is the link to the article:

http://jco.ascopubs.org/content/24/22/3535.full.pdf+html

As always, please feel free to comment, share, like, follow me, ask questions or just go out for a long walk after reading this. 

Exercising during chemotherapy – you can do it!!

From what i’ve seen and heard from patients, chemotherapy is one of the toughest parts of cancer treatment. 6 months of hospital visits, sleepless nights, nausea, fatigue and uncertainty. Then walks into the clinic David, the Exercise Physiologist, every week to see if there are any new patients he can ask to come and join his studies..

Every week for all of last year, I would visit 2 hospitals in Sydney, each on two mornings per week to see if there were any patients eligible to recruit into my trials. Women with recurrent ovarian cancer undergoing chemo to be precise. This is a group of patients who’s cancer has returned and spread, requiring higher doses of chemo and as a result, having worse side-effects of treatment. This was the first study to date to include this patient group – so it was very challenging but exciting at the same time to try and assist these patients throughout treatment.

Here are some things we do know during chemotherapy:

* Patients (and their families) tend to  withdraw themselves during chemo (6 months of inactivity!)

* You may become weaker during this time, along with additional side-effects of treatment

* Recent exercise studies have displayed safety, as well as countless psychological and physical benefits

* Reaching recommended physical activity guidelines can decrease your risk of cancer recurrence and all-cause mortality by more than a third!

Back to my recruitment. I would speak with numerous patients about their lifestyles, the majority not doing anything due to excessive fatigue – with nearly all of them not knowing how exercise can help them. I had about a 50% uptake rate, which is about normal for studies such as these, with many women not willing to commit to a 3 month study. However I did not mind, I still provided them with advice and encouragement to walk whenever they can and build up their endurance during chemo.

Now to the ones that did join the study, firstly I did baseline health checks, with most of them having physical and mental function, low muscle strength and excessive fatigue – not surprising. Everyone received a different exercise program tailored to their needs and goals, but started at 90 minutes/week (about 15-20 mins/most days of the week). This would be a combination of aerobic exercise (mainly walking and gym cycling) and resistance training (gym weights and resistance bands). It was not without its challenges for these amazing women. Here is an example week for one:

Monday – walk 20 mins (including hills)

Tuesday – theraband resistance session – 25 mins

Wednesday – chemo day – light morning walk – 15 mins

Thursday – rest day (feeling ill)

Friday – rest day (feeling ill)

Saturday – rest day/light walk 15 mins

Sunday – resistance exercises and walk – 30 mins

No week would really be the same depending on how they responded to the treatment, but i’ll tell you this now, if they hadnt been exercising, they would be feeling a whole lot worse. Im very happy with a week looking like this if possible.

If you’re undergoing chemo – you can do it. Don’t aim for a marathon, set a realistic aim at giving it a go – because you can achieve that. 10 minute walks around the block will assist in alleviating the fatigue and sets a platform to increase this. Some is better than none and more is better than less. The aim is 150 minutes a week of moderate intensity exercise (increased breathing rate). But if you can only achieve half of this amount, that is more than fine, it is a start. You cant progress if you haven’t started. If you havent started your journey, let it start now….one step at a time.

I hope these posts provide support, motivation and guidance. Feel free to ask any questions or comments and again please forward to a friend or family member undergoing the cancer experience.

So you or somebody you know has been diagnosed with cancer – When do you start to exercise?

So you’ve been diagnosed with cancer and you want me to exercise?! I heard this frequently when I approached ovarian cancer patients in chemotherapy clinics to participate in my research. I would sometimes sit for hours in the waiting rooms just to wait for a two minute conversation with a patient, in the hope to assist them to become more active.

I have no doubt that being diagnosed with cancer and having treatment is one of the most challenging things a person can ever go through, and without having cancer myself, i cannot act like I know what they are going through. However, what I do know – an emerging field of exercise oncology – the majority of patients, families and a lot of doctors do not know about. More and more support has been given by oncologists to tell their patients to be active and get moving, when in the past they were wrapped in cotton wool and told to rest. In fact, this has been shown in prospective studies for patients when asked how much they exercised, the ones who engaged in more, lived for longer.

Now going back to the original theme of when do you start to exercise? before or after surgery? during chemo? after chemo?

The answer is now.

Think of it this way – the healthier your body is from being active, the better you will recover from surgery, the stronger you will be during chemo and the more likely you will be back and feeling normal after treatment.

I’ve spoken with oncologists from around Australia and the world and I have told them exactly that. There have been studies for patients before surgery, during chemo and radiotherapy and after treatment, all showing benefits from increased aerobic activity (walking, cycling, aqua aerobics etc) and resistance training (weights).

The time to be active is now.

A 5 minute walk around the block a day to start your regime. Next week aim at 10 minutes a day. The week after aim at 15 minutes. Before you know it, you have a larger endurance capacity, more energy and vitality again. Believe you can do it, because you can.

In my next post, I will give some insight to my work with women with ovarian cancer, who were involved in an exercise study whilst undergoing chemo. Ovarian cancer generally has a really tough outlook, but with some great courage and determination, I was able to work with a lot of amazing people who were able to reach some fantastic goals.

Please feel free to pass this blog onto any cancer survivor.