There are more than 150,000 people living with and recovering from cancer treatment in Ireland today. Thankfully, more and more are surviving the illness. There is also growing awareness of the need to help recovery from and living with the consequences of cancer and its treatments - and not just focusing on treatments such as surgery, radiotherapy and chemotherapy. As a chartered physiotherapist specialising in cancer rehabilitation, Ailish Daly enjoys helping people achieve their activity goals during and after cancer treatment.
1 Why is exercise important in recovery from cancer treatment?
Cancer treatments can result in many side effects such as tiredness, decreased energy, weight gain and decreased confidence (to name a few). Many cancer survivors get out of the habit of exercising while they are having their treatment and struggle to start exercising when they finish treatment. They are often unsure of what to do or how to start. The ironic thing is that exercise might be the one thing that will help overcome the side effects of cancer treatment, and research is increasingly showing how important exercise is in the recovery process.
Regular exercise will help you maintain a healthy weight, reduce risk of heart disease and diabetes and will help your mental health and mood as you recover from cancer. There is ongoing research investigating whether regular exercise has a direct impact on cancer recurrence - could exercising regularly actually reduce the risk of cancer coming back?
2 Make a good start
If at all possible, try to stay active even during treatment. Traditionally doctors, nurses and physiotherapists have advised people to rest and take it easy during their treatment period. We now know that trying to stay active at this time will help improve recovery from cancer.
There is no doubt that going through treatment for cancer is hugely demanding on the body and there may be days when you don't even feel like getting out of bed. However, we are learning more and more that even trying a short five-minute walk most days during your treatment will help your recovery.
3 Choose an activity that you enjoy
When people ask me about what exercise they should do, whether it is during or after cancer treatment, the first piece of advice I give is to choose something that they enjoy. It sounds so simple, but I think a lot of people think that starting exercise means joining a gym or signing up for a spinning class. It doesn't - even choosing to go for a daily 20-minute walk or joining a dance class is a great start. Choosing something you enjoy means you are more likely to stick with it.
4 Set a realistic goal
A common mistake when starting to exercise is setting unrealistic goals - for example, going for an hour-long run on your first go. Setting goals that are too high can lead to exercise being a negative experience as frustration and disappointment set in if goals aren't achieved. A better strategy is to identify something very achievable and enjoy doing the exercise; that way, you are more likely to stick with it in the long term. The "magic" exercise target for healthy lifestyle is 30 minutes of moderate activity five times a week.
Making your exercise plan not hard enough can be equally damaging. If you are investing time and effort into exercise, you want to see the benefits, but keep it mind that overdoing it might lead to an increase in tiredness levels. There are lots of simple apps, step counters and smart watches available that will monitor and track your exercise progress. However, a simple rule to follow is to push yourself to be moderately breathless, but you can still hold a conversation with someone. If you are exercising at such a comfortable level that you could sing a song, you probably need to push yourself a bit harder!
5 Phone a friend
Having a friend or family member join you can make all the difference. They will help keep you motivated on difficult days. Remember that you should set the pace and not the other way around.
6 Is there any type of exercise that is specifically important for recovery from cancer?
There is no one exercise or activity that results in best recovery from cancer treatment. Go with what you enjoy. Many people start with walking and then go on to take up (or go back to) other activities such as cycling, tennis or golf. I also find Pilates or yoga very popular. Sometimes cancer treatment can result in joint stiffness or muscle weakness. This seems to impact postural muscles in particular, which can lead to long-term problems such as neck and back pain. Pilates and yoga can be really effective in targeting these symptoms. Sometimes a specific exercise programme may be recommended by a chartered physiotherapist after surgery. It is important to follow this until you have recovered fully from your surgery.
7 Lymphoedema and exercise
There is a lot of confusion and mixed messages regarding exercise and lymphoedmea. Lymphoedema is a chronic swelling which can affect any part of the body. It is a common side effect of cancer treatment involving surgery or radiotherapy to lymph nodes in the arm pit or groin. Surgery involving lymph nodes may reduce the lymphatic system's ability to filter and drain fluid from the arm or leg, which will result in a build-up of oedema - called lymphoedema.
Common advice regarding lymphoedema management was to avoid repeated activities and exercise such as tennis or golf. More recent evidence suggests that a gradual return to exercise can actually be an important element of managing lympheodema. However, it is important to start at a very easy level and build up gradually. You may also need a support sleeve or stocking known as a compression sleeve - seek advice from your chartered physiotherapist or registered lympheodema therapist.
8 Are there any times to avoid exercise?
Exercise is a really important element of recovery from cancer treatment. However, in certain situations, you may need to check in with your oncology team, GP or chartered physiotherapist. If you experience a new symptom such as pain, temperature, nausea or vomiting, you should check in with your oncology team or GP. A lot of people are unsure if they can continue to exercise if their cancer has returned. Hearing the news that cancer has come back is devastating and of course the main priority is to agree a treatment plan. However, once a plan is in place, taking part in regular exercise can play an important role in staying well during treatment.
9 Is it just about movement?
Exercise is one really important part of recovery from cancer treatment. However, maintaining a healthy diet and looking after your mental recovery are equally important. If you are eating well and feeling positive, achieving your goals will come easier.
10 Know your local resources
There are lot of local resources aimed at helping cancer survivors exercise during and after their treatment. For example, the Plurabelle Paddlers is a dragon boat team based in Dublin's Grand Canal Dock. All team members have been diagnosed with breast cancer and have set up a team to get fit, enjoy the mutual support of team mates and to raise awareness of breast cancer.
Meanwhile The Medex Wellness Programmes at DCU also offer a variety of programmes for people with or recovering from cancer. This includes 'Move On', a 12-week programme which helps people to return to a normal lifestyle after completing cancer treatment; 'Living Life', which offers an exercise programme to people with advanced cancer; and 'Cancer Prepare', which offers intense exercise to people preparing for cancer surgery. At the Beacon Hospital, we offer the 'Fit for Life' programme, which is a six-week rehabilitation scheme offering a combination of exercise and education sessions - including healthy diet, relaxation and coping strategies.
Also, Breast Cancer Ireland are once again holding their Great Pink Run in Dublin and Kilkenny on September 9 and September 10 respectively. The race caters for people of all levels and you can opt for a 5k or 10k walk or run. I'll be heading up the Dublin physio tent, which is sponsored by Beacon Hospital, so please pace yourselves and make sure I don't see you there!
11 The future
There is lots of research ongoing both nationally and internationally into the role of exercise and activity during and after cancer treatment. We are trying to get a better understanding of the impact of exercise on cancer cells and how they grow. There is also growing research in the area of using technology to encourage exercise and activity during and after cancer treatment. In Ireland, UCD and Beacon Hospital are part of the CATCH research project, which is a Europe-wide research programme funding eight PHD students to identify how technology can improve cancer rehabilitation and quality of life. ÷ For more, see www.catchitn.eu
Health & Living
When Martha Tiernan went to her doctor about a fairly minor ailment, she never for a second imagined a much more serious condition would be diagnosed as a consequence of this seemingly routine visit.