lifestyle

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

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.

“Some is better than none, more is better than less”

It is common for cancer patients to reduce their physical activity during and after cancer treatment. It is also common for many patients to experience side effects such as debilitating fatigue, poor sleep, anxiety and reduced quality of life. However, emerging research has shown that the type and amount of exercise will influence what benefits are possible. The most common type is aerobic exercise, anything getting the heart rate higher. This could be walking, cycling, jogging or aqua aerobics.

Generally, the harder you work, the fitter and healthier your heart and other organs become. Resistance training is a type of exercise that promotes muscle and bone health by lifting against force. Types of resistance exercise can be with body weight (squats, pushups etc.), resistance bands or weights. Resistance training is very important for re-gaining strength during a time when there has been a large decline. The American College of Sports Medicine recommends 150 minutes a week of moderate intensity aerobic exercise (30 minutes on most days of the week) and two sessions of resistance exercise.

I will write posts on exercise oncology studies by cancer site, today I will go over a few studies completed in patients with breast cancer:

Post menopausal breast cancer survivors improved their cardiac function and quality of life by cycling 3 times a week for 40 minutes in a study in 2008 by Kerry Courneya. A walking intervention during radiation therapy by Mock in 1997 demonstrated reductions in fatigue and anxiety, as well as improvements in sleep quality. Another study by McNeeley in 2006 of patients during chemotherapy showed that aerobic training improved self esteem and reduced body fat, whilst resistance training improved self-esteem, muscular strength and lean body mass. Lymphedema was not worsened in any of these studies, in fact there was even mild improvements in the condition. This is not the first study of patients exercising during chemotherapy and radiation therapy, with more and more emerging every year showing not only that exercise is safe, but there are numerous benefits.

At a recent cancer conference in Adelaide in which I presented a study I ran for patients with advanced ovarian cancer, I met another researcher, Dr Sandi Hayes from Queensland University, who does some amazing work with patients around Australia. I remember she mentioned a quote that really stuck with me that she has used to help motivate patients who are enduring tough times. Some is better than none, more is better than less. Not reaching the recommended guidelines is not the be all and end all, but any amount of physical movement is a start and something to build up on. A 5 minute walk in the morning, 5 minutes at night – not a whole lot, but something to build on. Some is better than none, more is better than less. Remember it next time.