For Those of You Who May Be Reluctant Participants…

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Exercise. All of these things are exercise. I want to say something more intelligent, but I can’t, because I keep looking at Tom Hardy walking this dog. Oh yes! Exercise, Tom Hardy is exercising. Oh mah god, this man is gorgeous. And exercising. See? Exercise is fun! Tom Hardy photo by the incomparable Greg Williams Photography

The best way to get started with a movement program is just to move, but if it were that easy, based on all the research showing how imperative it is to a healthy lifestyle, everyone would already be doing it. Current data suggests that 50-70% of cancer patients do not meet the weekly recommendations for moderate intensity aerobic exercise (like walking), and the numbers for resistance training recommendations are abysmal. Therefore, if we want to encourage cancer patients to incorporate exercise into their lives as an added measure to improve prognosis and outcomes, then it’s important to make movement part of treatment protocols, and to do that we’re going to need to change the dialogue. For many, many years, many years ago, conventional wisdom said, “rest.” The unfortunate souls with cancer needed to conserve their energy, and most physical activity was considered simply too rigorous. The treatments were more savage, survivorship less common, and survivors themselves generally less vibrant. Quality of life took a backseat to quantity. Fast forward to the 1990’s with Lance Armstrong winning the Tour de France 7 consecutive times after being diagnosed and treated for metastatic testicular cancer in 1998. The treatments, while still brutal, were improving, patients were not only considered less fragile, but finishing a mini-triathlon became almost requisite in the first year after treatment, and survivorship was en vogue. The conversation turned to the extraordinary physical feats that someone could accomplish “in spite” of having a cancer diagnosis. This was excellent. It motivated people who might have been a little reluctant to get up and move to do so with enthusiasm and purpose. Today, I think it’s once again time to advance the conversation: we don’t exercise in spite of cancer, we exercise because of cancer. Instead of thinking of physical activity as simply being good for you, consider it as part of a treatment protocol initiated to increase your chances of survival and maximize outcomes. Remember, it’s science, and even the American Cancer Society and National Comprehensive Cancer Network recommend exercise as essential for people with cancer. I dream of a day when your oncologist says, “We’ll be prescribing 20 rounds of i.v. chemo, and 24 rounds of [insert movement option of choice].” Can you imagine?!? I can, and I get giddy at the thought.

It seems that the place to begin this conversation is with the word “exercise” itself. For some, the word is associated with an addictive endorphin release, for others, and that is who this post is for, not so much. I have a very dear friend who cringes every time I say the word, and respectfully begged me to use words like “movement” and “physical activity.” Because there are definitely many who share her sentiment, please note that exercise is movement, movement is exercise, and they both equate to physical activity. I read a study a number of years ago that was performed on the housekeeping staff in a hotel. During interviews, most of the housekeepers stated they did not believe they met the criteria for an active lifestyle, despite the nature of their job. Researchers took half of the participants and broke down how many calories were burned during different job related tasks performed each day, and explained to them that they actually met the surgeon general’s definition of an active lifestyle. One month later, this group saw a drop in systolic blood pressure, weight, and waist-to-hip ratio. They had been exercising all along and didn’t even know it! All it took for them to reap the rewards of their active lifestyle was the knowledge that they lived active lives. What’s the point of that story? You don’t have to slog away on a treadmill for an hour or sweat through a crossfit class to gain the benefits of physical activity. You do, however, need to move.

So, in the beginning you are told you have cancer, and it sucks. You are going  to be very, very, very busy with scans, doctors appointments, and blood draws. Once they know, they have a lot more to find out. Between medical visits and Google searches, you’ll feel as though you don’t have a moment to spare. If exercise is already part of your routine, keep at it, or get back to it. Now is not the moment to decide you don’t have time. If you haven’t been physically active, talk to your doctor about moving your body early on. Think about it this way: it will improve your treatment, and it is almost completely under your control. Take charge! Cancer treatments are brutal, so you want your muscle strength, cardiovascular endurance, and tolerance for physical stress to be good going in, and there is quite a bit of evidence to suggest that patients who move more have fewer complications and side effects in both the short and long term. The difficulty with trying to begin a movement program after treatments have started is that at some point you feel lousy, and then it becomes almost impossible to even motivate yourself to get from the couch to the kitchen. Physical activity is simply a habit like everything else we do, so start in the weeks after diagnosis and before beginning treatment, and by the time you start feeling the affects of whatever it is they do, you will already be enjoying the benefits of increased activity.

Some notes on getting started:

  • Discuss movement with your doctor! They will ask on forms if you are physically active, they might suggest that you walk, but this isn’t their primary concern. Make it part of your treatment plan, if appropriate, and make that an ongoing conversation you have with your oncologist. No matter what, make sure you are safe and cleared before beginning
  • Exercise recommendations are the same for cancer patients as they are for the general population: 30 minutes 5 times a week, and strength training 2 days a week
  • Don’t be afraid to start slowly. If 30 minutes at once seems like too much, break it down into 10 minute intervals. Research demonstrates that aerobic activity throughout the day is calculated cumulatively!
  • If you are new to exercise, or have been out of the loop for a bit, look for an oncology based physical therapist in your area, or even an exercise physiologists with an oncology background. As well, many personal trainers are certified in working with cancer patients, and your oncology provider should have some recommendations
  • Do it with a friend. Few things are more enjoyable than a nice walk and talk, and it’s harder to back out if you’ve made a plan. Also, this is a great way for your loved ones to feel like they are getting to be helpful. Many cities also have group programs for cancer patients, so look for one in your area
  • Find something you enjoy! I love bollywood dance, and wouldn’t you know that there are actually bollywood dance workout videos that I can access through YouTube. What I lack in skill, I make up for in style. One of my moms good friends used to put on her favorite music, and dance around the house as she dusted her furniture and vacuumed the floors. Walk out to your mailbox, clean out your closet, two-step with a partner, take your dog around the block, or get out in your garden, because gardening is excellent movement! It doesn’t have to be hard to be good, but if you could breathe a little heavily, that might be nice…

After getting the okay from your oncologist, the only way to proceed is to simply do something. Be unconventional in your approach, try everything, and learn what feels good. The only magic pill, potion, or spell that will make you want to move more is actually moving more.

One life on this earth is all that we get, whether it is enough or not enough, and the obvious conclusion would seem to be that at the very least we are fools if we do not live it as fully and bravely and beautifully as we can

Frederick Buechner

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