I’ve thought a lot about where the motivation to be physically active throughout cancer treatment comes from. At some point, and maybe multiple points, you are going to feel like absolute garbage. If you’ve had radiation, you might have burns, if you’ve had surgery, you will have incisions and bruised insides, and if you’re undergoing chemo, there are a whole hosts of side effects that could potentially arise, none of them desirous. If you’re doing any combination of the above, along with a number of treatments I have absolutely no experience with, well then, as we say in Texas, bless your sweet heart. So how, and even more importantly, why, in the midst of all this, will you find yourself motivated to move? Because movement is medicine.

Hopefully, you’ve already been practicing pre-hab, i.e., pre-rehabilitation meant to strengthen the body and improve endurance in preparation for a surgery, illness, or medical procedure that will likely require re-hab. You’re already in the habit of moving in a way you enjoy, and it makes both your brain and body feel good. But, the big but, you’ve hit the point where you don’t feel well in ways that you didn’t know you could feel bad, and you don’t want to do anything, let alone exercise! Do it anyways. Are you feeling muddled from chemo? Have you already forgotten two appointments today, and can’t remember why you’re standing in the middle of your bedroom holding a pair of shoes and socks? Chemo brain is real. Research says so. Best treatment? Physical activity, as if you didn’t already know the answer. A recent study published online on July 4, 2017 (“The effects of physical activity and fatigue on cognitive performance in breast cancer survivors.”) involving 300 breast cancer patients during active treatment, revealed that the participants who engaged in more physical activity each day than their counterparts demonstrated better performance on cognitive tasks measuring attention, memory, and multi-tasking. They also reported less fatigue. Depression and anxiety are among the most taxing side effects of cancer and its treatments, and a 2012 study directed by Dr. Karen Mustian, showed that 10-45 minutes of aerobic exercise 4-6 days per week was enough to significantly reduce not only anxiety and depression, but sleep disruption, too, which is also a common side effect of cancer treatment. As well, a more recent study by Dr. Mustian showed that a walking program and gentle resistance-band training at home reduced the chronic inflammation that’s common in cancer patients receiving chemotherapy. Starting to feel the effects of neuropathy? Maybe your extremities are always tingling, asleep, burning, aching, numb, or clumsy? Studies show that exercise is one of the best ways to reduce the effects of peripheral neuropathy. And, as I’ve mentioned before, most importantly of all, research also indicates that physical activity during and after infusion helps to deliver chemo drugs to the tumors when they are most readily available in your body by increasing vascular normalization. Huh? The researchers say it best, “Tumor vessels are highly disorganized with disrupted blood flow impeding drug delivery to cancer cells… We show that moderate aerobic exercise with chemotherapy caused a significantly greater decrease in tumor growth than chemotherapy alone through improved chemotherapy delivery after tumor vascular normalization.” (Tumor vessel normalization after aerobic exercise enhances chemotherapeutic efficacy). Could “greater decrease in tumor growth” possibly be so simple as taking a few short walks a week? Yes, apparently it is.

Importantly, each side effect that you are effectively able to improve increases your chances of completing your entire treatment protocol, thereby improving your overall response to treatment AND your cancer experience. Trying to have a decent cancer experience should be a thing, and movement is a huge part of that thing. Physical activity is kind of like that wonder drug that we always want, the one pill that will address multiple issues at once without creating more unwanted reactions. There are pills for neuropathy, sleep, depression, and fatigue, but I can promise you they don’t work as well as exercise. It is low cost, self-driven, simple, and one less foreign substance moving through your body. And the absolutely, positively, most fantastical finding about physical activity in cancer patients, is that it doesn’t have to be hard or vigorous to be effective! This is not an ass-kicking, no pain no gain, harder/faster/tougher mentality. At all. Consistent and moderate are the words you see over and over. This is an act of kindness for your mind and body, so treat it as such. The majority of this research has been done utilizing moderate aerobic activity, like walking, and gentle resistance band exercises, and most often given as a home exercise program to patients. The key to unlocking the treasure trove of benefits as you go through treatment is simply to stay physically active.

If you are unsure of where to begin, always discuss starting a program with your oncologist(s), and if you’ve started feeling generally funky and don’t know how to safely continue, once again, speak with your doctor, and maybe schedule a few visits with a cancer rehabilitation PT, or an exercise physiologist who has expertise in working with cancer patients. There are so many resources available! Here are a few ideas to get you started:

• In the infusion clinic, at least once an hour, get up and take a couple of laps. If you feel unsteady have a friend join you, or grab a volunteer, but help your body move all those drugs through your system! Personally, I found that this helped my nausea a bit, but that might not hold true for everyone
• Purchase a pedometer. I’ve found multiple online for less than $10. Whether you set a goal of 10,000 steps a day, or 5,000, research indicates that most cancer patients are walking far less each day than they were prior to diagnosis, so check your steps!
• Theraband is also relatively inexpensive and can be purchased online. Buy a couple of resistance bands, and take them to the infusion clinic with you, or keep them at home. Sign up on the Thera-band Academy website for a gazillion exercises that may be done in sitting with a resistance band. This is a great way to maintain strength and flexibility.
• Do it yourself. Put laundry in the washing machine, go to the grocery store, plant gardenias, dust your furniture. These count as physical activity, and you’ll watch yourself racking up the steps!
• Rest as necessary, none of this is meant to wear you down further.
• Don’t rest all the time.
• Remember that movement is medicine.

November 2015. In the studio 1 day after chemo, and looking a little nauseated. In fact, I’m quite sure I was nauseated, but moving around always lessened it a bit.

It will come as a shock to no one that I’m a huge believer that movement heals, and should be considered an integral part of almost all cancer treatment programs with rare exception. The human body is a dynamic machine whose mechanisms thrive on the power derived from the processes initiated by physical activity. Last year, the following headline validated much of what I have preached throughout my cancer experience: Exercise is the Best Cure for Fatigue Caused by Cancer. I believe my exact response was an eloquent “duh,” and from there I dove down the rabbit hole of investigating the importance of exercise before, during, and after cancer treatment. What a thrill it was to find myriad scientific articles and studies proclaiming that not only was exercise a good thing for cancer patients, but that oncology rehabilitation “must” be a component of survivorship programs.

I learned that in places like New Zealand and Australia, depending on the chemo drug administered, they will escort patients directly from the infusion clinic to physical therapy because there is evidence to show that exercise may increase blood flow to tumors at the time when the drugs are most readily available in your body. That there is irrefutable evidence that exercising during treatment reduces the severity of side effects with certain types of cancer, increases the likelihood that the full treatment regimen will be completed, and increases life expectancy by up to 28-44% after particular cancer diagnoses. On multiple occasions, I have been nonchalantly informed that because of the 29 rounds of radiation to my pelvis during the summer of 2015 and subsequent chemotherapy, I have an almost 100% chance of suffering a spontaneous hip fracture by the time I’m 75. This sounds horrifically painful. Apparently, chemotherapy may cause a woman to lose as much bone density in one year as she would in a decade. What is the best way to maintain or improve bone density? Weight bearing exercises. Many patients suffer from peripheral neuropathy, an uncomfortable and potentially dangerous side effect of chemotherapy, in their hands and feet. The condition may cause tingling or burning in the extremities, making sleep elusive, and/or loss of sensation leading to falls and fall-related injuries. One of the best ways to treat peripheral neuropathy, especially early on, are exercises that increase blood flow to the peripheral nerves to improve sensation, and activities that improve strength and mobility to decrease fall risk. Infinitely more simple than the drugs often prescribed with side effects like drowsiness and dizziness. Cancer patients don’t really need anymore of that.

To boot, exercise may also lessen nausea (woohoo!), decrease feelings of anxiety and depression, improve your ability to maintain a social life, decrease fatigue, and improve your ability to take care of your own needs. While it is always lovely and heart warming to have friends and family care for us, it’s important to your spirit and sanity to maintain a sense of independence, even if it’s just doing your own laundry and grocery shopping. Exercise is proactive, and inspires a sense of self care and personal empowerment that helped me to feel in control in a situation that often makes you feel vulnerable and helpless. And please keep in mind, that while I have written the word “exercise” roughly 1,001 times in this post, that could mean a languid walk around the block, or perhaps even the infusion clinic. It’s all relative, but as you can see, the clinical evidence for oncology rehab is screaming at us, and it’s screaming at us to move.

January 7, 2016. I was wearing my chemo pump this day. I can see that blurry, dulled look in my eyes, but it was a beautiful winter afternoon, and those should always be given the appreciation they deserve.

To most people all this jumping up and down (haha) about movement seems like a no-brainer. Of course it makes sense, but for many, many years of cancer treatment, patients were told not to tax themselves, and everyone knows the treatments make you profoundly exhausted. Exercise becomes counterintuitive, but the less you move the less you want to move. I really, really love Sir Isaac Newton’s first law of motion:

Every object will remain at rest or in uniform motion in a straight line unless compelled to change its state by the action of an external force.

Or, bodies at rest stay at rest, bodies in motion stay in motion. If you’ve been at rest too long, you must exert a little external force to get moving again. It’s science. As well, in the midst of the insanity following a cancer diagnosis, exercise often takes a back seat to all of your appointments, treatments, and general life management. Hear me when I say that in many cases exercise is NOT a luxury, it’s treatment. Refer to clinical evidence above.

It is important to consult with your doctor before beginning any exercise program, and this is even more true for cancer patients. Certain types of bone cancers increase risk of fractures, some chemo’s are known to lower blood pressure for a few days following infusion, some people develop peripheral neuropathy that may increase risk of falls or injury, and some people might have compromised immune systems that preclude time in the gym. For these and numerous other reasons, you want to speak with your doctor and make sure you’re safe, but once that’s done, there are many advantages to implementing a program, keeping in mind that for the cancer patient the intensity and/or types of activities may change daily based on their ever changing cancer body.

In the following weeks we will look at how to get started, different types of exercise that might benefit you or your friend with cancer, and some general guidelines on movement.

As always, thank you for reading!