Key takeaways
- The benefits of engaging in regular movement during cancer treatment aren’t only physical, but also psychological and social
- People often think of pain as something that is inevitable after cancer, however a physiotherapist can support you to live more comfortably
- Regular physical activity can help you to avoid pauses or delays in your cancer treatment
- Strength training helps to avoid muscle deconditioning that can be a side-effect of treatment, while aerobic training helps to maintain heart and lung function
People going through cancer treatment often find they have to reevaluate their expectations of what they can do. However, evidence is clear that those living with cancer have a greater chance of coping with their diagnosis and taking care of themselves during treatment if they exercise. They are less likely to need to pause or delay their treatment cycle because of side-effects and they’re also less likely to have to give up work.
Clinical exercise coach Nick Michell says that, ‘Finding out that you have it within you to do your movement practice has a positive effect. It feels like you still have some control over your life.’ In this article, Nick shares his reasons for focusing on a strength-based programme during cancer treatment, while Physiotherapist Hannah Leach explains the importance of finding the right motivation.
The benefits of physical activity
Hannah Leach, Physiotherapist
Physiotherapists are experts in the human body. Our job is to help restore movement and function in anyone who has been affected by illness and injury. As a cancer specialist physiotherapist, I could be working with a keen cyclist to maintain function through chemotherapy, followed by someone who wants to remain as independent as possible towards the end of their life. Whatever a person’s goal is, it’s my job to break it down and support them to meet it, where possible.
A lot of people accept pain as an outcome of the treatment they have gone through, but there are often ways to improve things. I want people to understand that most side-effects can be treated or managed with the right support and expertise.
A lot of people accept pain as an outcome of the treatment they have gone through, but there are often ways to improve things. I want people to understand that most side-effects can be treated or managed with the right support and expertise.
Hannah Leach, Physiotherapist
How can patients find the motivation to be active?
One of the first things I do with a person going through cancer treatment is to work out what motivates them. Activity can feel contradictory when all you want to do is rest. Someone who has been very active in the past might not struggle so much, however, someone who isn’t used to exercising might think, ‘Why would I start now?’. A person’s personal, social and cultural background may also influence how physically active they are. It can often help a person who is new to exercise to understand the benefits of keeping active. I do this by looking at the benefits of movement from different perspectives:
1. Physical
From a physical perspective, the benefits of being active during cancer treatment are primarily about managing side-effects. For instance, we would expect someone going through chemotherapy to be very tired, and movement can help manage that. Physical activity also helps to manage a reduced range of movement, as well as muscle weakness and lack of fitness. It improves what’s called ‘exercise tolerance’, which helps you tolerate more movement day-to-day, so you can be more independent. Movement also reduces the risk of side-effects like cording, which is common in breast cancer, and can help surgery scars to heal so they don’t feel tight. A growing field of research is suggesting that movement during and after cancer treatment can reduce the risk of recurrence in some cancer types.
2. Psychological
It’s possible for people who have had a cancer diagnosis to feel that their body has let them down, and to feel frustrated that they’re not able to do what they were able to in the past. Being active during cancer treatment can show a person what they are still able to do. This can help to change that negative self-perception and build a more positive body image. Research inside and outside of cancer also shows that physical activity can improve mood. While this might not necessarily alter long-term mental health, it can help to manage it. Movement can also help to manage the cognitive changes and cognitive impairment that many people experience as a side-effect of treatment, and can help people to sleep better, which can also affect mood.
3. Social
From walking to cycling, golf and team sports, movement is a social activity for many people. It can bring joy and meaningful connections with family and friends, as well as a sense of being understood and accepted. If these social connections are taken away during cancer treatment, it can cause someone to withdraw and feel isolated. Staying as active as possible, in a safe way, can support these social ties and the confidence that comes with it. It also helps to foster a more positive self-image, which can help people maintain their social connections and confidence.
There is so much about cancer treatment that feels out of control. A movement practice can help people to find a sense of purpose, achievement and provide a helpful routine to rely on when they feel overwhelmed. People going through cancer treatment may also find that being physically active has a positive impact on them sexually. This in turn can help to maintain intimacy, where it is present, and a sense of connection and confidence.
What can someone expect when working with a physiotherapist?
Members come to me at any stage of their cancer journey, from diagnosis through to treatment and end of life. When we first meet I take an extensive history, including a person’s physical condition before cancer, where they are now, how they’re coping and any side-effects they might be experiencing. I’ll also look at how they are moving and work out a treatment plan or exercise prescription to help them meet their goals. While this isn’t hands-on treatment, my role is to look, listen, educate and monitor a person’s progress. I do this by explaining how the body works, often using diagrams, and by teaching behaviours to help manage their side-effects long-term. My goal is for a person to come away from our sessions feeling empowered to manage on their own.
The value of physical strength during cancer treatment
Nick Michell, Clinical exercise coach
For me, the main benefit of engaging in movement and physical activity during cancer treatment is that you have a better chance of finishing your treatment cycle, while feeling stronger and more in control. A number of clinical studies have highlighted that if you continue with a programme of aerobic and strength/resistance exercise during your treatment cycle, you have a greater chance of avoiding delays. Therefore, you can begin recovery on time, and be on the path to rebuilding your body’s losses, sooner. Those losses will be less if you’ve maintained activity during treatment.
For me, the main benefit of engaging in movement and physical activity during cancer treatment is that you have a better chance of finishing your treatment cycle, while feeling stronger and more in control.
Nick Michell, Clinical exercise coach
What should physical activity look like during cancer treatment?
I recommend doing both aerobic and strength training. Ideally, you want to maintain 150 minutes of moderate activity per week. This could be through any activity you can do while holding a conversation, such as walking, cycling, gardening or housework. It’s so important as lung function can be affected by treatment.
Strength training will help to maintain muscle mass during cancer treatment and protects against muscle wastage, which can cause problems with bone density and stability. As for the volume of strength training, this is very personal to the cancer. It depends on someone’s capabilities during treatment, but generally we’d be looking to work major muscle groups twice a week, favouring compound movements (those that engage different muscles together as opposed to one muscle only) like squats and lunges. This can help to maintain quality of life and the ability to do everyday activities. For example, squats help you stand up and sit down.
Doing something, however minor, is always better than doing nothing. As long as you keep your activity manageable, report any pain or new symptoms and are mindful of your fatigue and fitness levels, a few short sessions a week is going to be hugely beneficial, even when you don’t feel like it.
What’s the role of rest during cancer treatment?
To enhance muscle tissue growth and allow for positive hormonal changes, for example the release of serotonin and dopamine, which help with positivity and are especially important when going through treatment, it’s important to balance your activity with quality rest. The amount of rest you need during treatment is very personal and depends on where you are in your treatment cycle. A week after chemotherapy, you may find it very difficult to get off the sofa, so your rest period will be a lot longer. You have to allow for this. Even if you get out for five minutes, walking to the end of the road and back, that will have a benefit.
A physiotherapist, clinical exercise coach or other movement professional will be able to tailor a movement programme to your specific needs both during and after cancer treatment, supporting you to work safely. Find out more about Hannah Leach and Nick Michell, including their availability.
While we have ensured that every article is medically reviewed and approved, information presented here is not intended to be a substitute for professional medical advice, diagnosis, or treatment. If you have any questions or concerns, please talk to one of our healthcare professionals or your primary healthcare team.
References
Frank Christensen, et al, ‘Exercise training in Cancer control and treatment, Comprehensive physiology 9’, no. 1, 2018, p 165–205, Https://onlinelibrary.wiley.com/doi/abs/10.1002/cphy.c180016
Brown JC, Gilmore LA, ‘Physical Activity Reduces the Risk of Recurrence and Mortality in Cancer Patients’, Exerc Sport Sci Rev, April 2020, 48(2):67-73.
Moore SC et al, ‘Association of Leisure-Time Physical Activity With Risk of 26 Types of Cancer in 1.44 Million Adults’, JAMA Intern Med, 1st June 2016, 176(6):816-25.
Liska, T.M., Kolen, A.M. ‘The role of physical activity in cancer survivors’ quality of life’, Health Qual Life Outcomes 18, 197, 2020, https://doi.org/10.1186/s12955-020-01448-3