Contents of this article:

• Types of physical activity.
• Benefits of physical activity if you have cancer.
• Is it safe?
• Physical activity during treatment.
• Physical activity after treatment.
• How much do I need?
• A few tips on getting started.
• On offer at Penny Brohn UK.
• Useful resources and further reading.

Types of physical activity

Physical activity is categorised according to the level of intensity, which depends on how many calories are used.

Activities which make you feel warmer and slightly breathless, but you’re still able to talk easily, are moderate intensity. Vigorous activities make your heart beat very fast, it’s hard to catch your breath and you can’t talk comfortably.

Physical activity, including walking, is one of the best ways to maintain a healthy weight. Any activity you choose to do needs to be at least moderate for most health benefits, although any activity is better for you than being inactive.

Vigorous activities can provide additional health benefits. Weight training and weight-bearing activities are also beneficial for health, as they help to develop muscle strength, build bone and maintain functional ability. This can involve use of weights or using one’s own body weight as resistance. Exercises which increase flexibility and balance are useful for maintaining healthy joints and preventing falls.

Benefits of physical activity if you have cancer

There’s a large amount of high-quality evidence from randomised controlled trials, on the benefits of physical activity for people with cancer. Further research combining the statistics and outcomes of these trials was used to give an overall result. Cancer-related fatigue, depression, anxiety, quality of life and physical function were all assessed and resulted in positive outcomes.

Dr Duncan Still talks through the many benefits of physical activity in this video.

Is it safe?

On the whole, exercise is considered safe for people with cancer and the negative impact on health from being inactive outweighs any risks associated with physical activity.

Do bear in mind the following when taking up any exercise:

• To prevent pain, nausea or fatigue from worsening, don’t engage in high intensity exercise when you’re experiencing these or other debilitating symptoms.

• Consider the site of your treatment when planning activities and get advice before doing exercise involving the area; especially if you’re still healing or have any complications.

• If your immunity has been lowered, beware of the risk of infection from public fitness centres and swimming pools. We have a range of instructional videos and online exercise classes which you can practise from the comfort of your own home or garden.

• If your cancer has spread to the bone, you have osteoporosis or numbness in your feet, avoid high impact exercise, contact sport and be careful with exercises involving balance, such as running on a treadmill, in order to prevent falls and fractures.

• Avoid vigorous activity if you have a temperature, a deep vein thrombosis or if your platelet count is very low.

• If you’ve had your lymph nodes removed, build up upper body resistance exercises slowly, to avoid lymphoedema. To prevent lymphoedema from getting worse, during or after exercise wear a compression garment. Kate from MySimpleSteps has an instructional video on easing lymphoedema with gentle exercise.

If exercise is difficult because of cancer or cancer treatments, or if there’s any pain on exercising, advice should be sought from a health professional or a trained fitness instructor who has experience of working with people with cancer.

Physical activity during treatment for cancer

During treatment, doctors and nurses usually advise you to try to limit the time you spend sitting or lying down. They may encourage you to do some gentle activity such as short walks. If you are not active, you may feel more tired and lose muscle strength and cardiorespiratory fitness. Cardiorespiratory fitness is how well your heart and lungs deliver oxygen to muscles over longer periods of time.

Being physically active during treatment is generally safe. But, there may be activities you’ll need to avoid or be careful with. If you’re still concerned, you can speak to one of our doctors or physical activity session leaders for advice.

What you can manage will depend on your level of fitness and the treatment you are having. You can be the judge of this. It might just be reducing the amount of time you spend sitting down. You could try doing some light housework, making yourself a snack or going for a walk
with family or friends. Remember to pace yourself.

Try not to do too much on a good day. If you already exercise, you’ll need to do so at a lower intensity during treatment. You can gradually increase it again after treatment.

Chemotherapy

Chemotherapy lowers the number of blood cells in your blood. If your white blood cells are low, you are more at risk of getting an infection. Your cancer doctor might advise you to avoid public places such as swimming pools or gyms until your white blood cells are back to a normal level.

If you have a central or PICC line, avoid swimming because of the risk of infection. You should also avoid vigorous upper body exercises, which could displace your line. Platelets are cells that help the blood to clot. If your platelets are low, you are more at risk of bruising or bleeding. Your doctor may advise that you take gentle exercise until your platelets recover. If your red blood cells are very low (anaemia), you will feel very tired and sometimes breathless. Your doctor might ask you to only do day-to-day activities until the anaemia improves.

Radiotherapy

If you have a skin reaction or redness due to radiotherapy, avoid swimming as the chemicals in the water can irritate your skin. After treatment, when any redness or skin reaction has gone, it’s fine to swim again.

Surgery

It’s important to start moving around as soon as possible after surgery. This reduces the risk of complications such as blood clots and helps with recovery. Depending on the operation, your surgeon will tell you which activities you should avoid and for how long.

A physiotherapist or nurse may show you exercises to do when you get home. For example, women who have breast surgery need to do arm and shoulder exercises to improve their flexibility.

If you had surgery to your pelvis, you may be shown exercises to help strengthen your pelvic floor muscles. Try to do these for as long as you were advised to. If you have pain or discomfort that stops you doing them, tell the physiotherapist or nurse.

Physical activity after treatment

Being physically active after treatment is a positive step in your recovery. It may help to reduce the risk of:

• Late effects of treatment.
• Other health problems.
• Developing a new cancer.
• Certain cancers coming back.

Late effects

These are side effects that may develop months or years after treatment.

Heart health

Some treatments may slightly increase the risk of heart problems in the future. These include radiotherapy that’s given close to the heart and certain chemotherapy or targeted therapy drugs.

Aerobic activities, such as Nordic walking, running, swimming or cycling may help to protect your heart and reduce the risk of late effects developing.

Bone health

Hormonal therapies for breast and prostate cancer, and early menopause due to cancer treatments, can increase the risk of bone thinning (osteoporosis). Weight-bearing exercises (activities where you are supporting your body weight) will help keep bones strong.

They include walking, dancing or resistance training. If you have osteoporosis, get advice on exercise from your doctor, nurse, physiotherapist or exercise specialist. For more information on being safe if you have bone problems.

Keeping to a healthy weight

It’s not uncommon to gain weight during treatment. This may be because you’re less active than usual. Hormonal therapy drugs and steroids, which are sometimes given with chemotherapy, can also cause weight gain. Being active and eating healthily are major factors in controlling your weight.

Keeping to a healthy weight can help reduce the risk of:

1. Joint problems.
2. Other health problems.
3. Certain cancers coming back.
4. Developing a new (primary) cancer – the strongest evidence for this relates to breast, womb and bowel cancer.

Reducing the risk of cancer coming back

There is some emerging evidence that being active at the levels recommended and keeping to a healthy weight can reduce the risk of certain cancers coming back or progressing.

A review showed that women with breast cancer who walked at an average pace for 3–5 hours a week after treatment had a reduced risk of the cancer coming back. Studies have also shown that walking at an average pace for 3–6 hours a week reduced the risk of bowel cancer coming back. Another study showed that walking briskly for at least three hours a week may reduce the risk of early prostate cancer progressing.

Research in this area is still new and limited to certain cancers. We need more evidence before we can say exactly how much exercise is needed to get the benefits, and exactly how it may protect against a recurrence of cancer. But so far, the signs are that with certain cancers, being active can make a difference.

How much do I need?

Here at Penny Brohn UK, we follow the Department of Health guidelines, suggesting that people work towards achieving 30 minutes of moderate intensity exercise five times a week.

We recommend engaging in a form of exercise that brings enjoyment and it’s also worth bearing in mind that activities such as gardening, shopping or playing with children can be considered ‘exercise’.

A few tips on getting started

• Exercising in a group can provide social support, build confidence and increase motivation.

• Aerobic exercise, resistance training, balance and flexibility training are all useful in different ways and an ideal exercise programme will involve a little of all four.

• It’s very important that exercise is started in small amounts and only gradually increased.

• It’s best to start with a gentle warm-up and finish with a cool-down that involves some muscle stretches. Some mild muscle ache after starting or increasing exercise is normal and should resolve within 24-48 hours.

• Get a little digital help with an exercise app such as the Active 10 app.

On offer at Penny Brohn UK

At Penny Brohn UK, we offer aerobic exercise, Qi Gong, mindful movement, yoga, gentle stretching and Nordic walking sessions. These activities are suitable for people with varying levels of fitness and there are no expectations upon people to ‘perform’. At the moment these activities are online and can be accessed from the comfort of your own home or garden.