Please seek medical advice before starting any exercise during cancer treatment. As part of your treatment plan ask your treating team if they advise exercise and the extent. More important, please seek advice on what is NOT to be done.

It is commonly believed that patients should rest and limit physical activity during cancer treatment. Research now shows that when possible, it is actually beneficial for cancer patients to engage in normal to moderate physical activity during cancer treatment. Too much rest can lead to loss of muscle mass, reduced range of motion, joint stiffness (specifically for older patients), and loss of function.

Benefits of exercise during cancer treatment:

• Improves quality of life and helps you focus on something other than the disease
• Helps your emotional wellbeing. If you are able to get up and do things by yourself, you feel fulfilled and makes you less dependent on others for help with normal activities of daily living
• Aids in managing side effects like nausea and fatigue
• Keeps muscles and joints from wasting due to inactivity. Improves blood flow to your legs and lower the risk of blood clots

If and when you are able, you should aim to get on average 150 minutes (2.5 hours) per week of moderate intensity aerobic exercise along with muscle training and flexibility exercises.

If you were not exercising regularly before your diagnosis, take it slowly and carefully. Build up your level of activity in a step-by-step manner and keep your oncologist and other health providers informed. The level of supervision needed for individuals undergoing treatment to exercise safely varies you should talk to your Doctor about the appropriate level of exercise for you.

Tips to get started with your exercise regime during treatments:

• As part of your treatment plan ask your Doctor if he/she advises exercise.
• Take your time and don’t get frustrated if you tire easily or if you can’t reach your original fitness level
• Start small and slowly build your resistance to different levels of exercise
• Incorporate weight training and some mild aerobic exercise or walking in your routine
• Change up your daily exercise regimen to make it fun and to keep you motivated
• Use professional help like a trainer or physiotherapist. These professionals can create a tailored exercise program suited to your needs, aligning with your current physical health
• Consider side effects of treatments that may limit activity. Exercising during periods of extreme fatigue could injure the body.
• Exercise in small increments and take frequent breaks. Don’t push your body beyond what you can handle
• Decide what you would like to achieve through your exercise program to keep you motivated
• Exercise with a friend or family member to make it fun and to help you stick to your exercise program
• Make exercise easy and fun by listening to your favorite music or watch TV while exercising
• Get a massage to improve blood flow, manage aches and pains, and loosen knots
• Have a hot pack on hand to aid sore muscles after exercise
• Ask your Doctor or physical therapist about TENS or electric muscle stimulation to with pain relief and muscle re-education
  
  Exercises on the Bed

Ankle Exercises

• Raise ankles briskly up and down. Pointing toes outward and back. Repeat 10 times for each leg
• Rotate ankles clockwise and anti-clockwise. Repeat 10 times for each leg and direction

Knee Exercises

• Lift knees up and down. Try with ankle weights once you build resistance without weights. Alternate each leg with and repeat 20 times for each leg
• Keep your leg straight by pushing knee down into bed, pull your foot and toes up and lift leg approximately 20cm (8 inches) off the bed
• Bend and straighten your knee, 5 times each leg

Leg Exercises

• Pull your foot and toes up, push your knee firmly into the bed and tighten your thigh muscle allowing your heel to lift slightly off the bed. 5 times each leg
• Bring your leg out to the side as far as you can and then back to mid position. 10 times each leg. Use a resistance band or ankle weights once you build resistance without weights
• Place a pillow or rolled up blanket or towel under your knee. Pull your foot and toes up, tighten your thigh muscle and straighten your knee (keep knee on the pillow or blanket). Hold for a count of 5 and slowly relax your leg, 5 times each leg

Back and Gluteal Muscle Exercise

• Bend knees on bed and lift back as much as possible off the bed. Repeat 10 times
• Roll from one side of the bed to the other side. Repeat 5 times
• Lie face down on the bed and with your hands lift the upper half of your body. Repeat 5 times

Exercises Sitting on Chair

Leg Exercises

• Pull your toes up, tighten your thigh muscle and straighten your knee. Hold for a count of 3 and slowly relax your leg, 10 times each leg
• Sitting on a chair stand up and then sit down slowly. Repeat 10 times

Arm Exercises

• Lift both arms above your head and out and down. Repeat 10 times. You can add light weights once you build resistance without weights
• Hold a long rolled up newspaper or wand in both hands with your palms facing up. Lift the wand up over your head as far as you can. Hold for 5 seconds. Lower arms and repeat 5 to 7 times. Can be done lying down on the bed as well
• Sit in a chair very close to a table with your back against the back of the chair. Place your arms on the table with your palm down. You can use a small towel and without moving your trunk, slide the affected arm forward, toward the opposite side of the table. You should feel your shoulder blade move as you do this. Relax your arm and repeat 5 to 7 times

Neck Exercises

• Move neck from left to right and then up and down. Repeat 10 times
• Stretch neck from side to side and try and touch ear to shoulder stretching the neck. Repeat 10 times

Back Exercises

• Sit in a chair and clasp your hands together in front of you. Lift your arms slowly over your head, straightening your arms. When your arms are over your head, bend your trunk to the right keeping your arms overhead. Return to the starting position and bend to the left. Repeat 5 to 7 times
• Fold arms in front of chest and bend forward as much as possible and then back to the upright position. Repeat 10 times

Breathing Exercises

• Relax your shoulders, correct your posture by straightening your back, place hands on the sides of your chest, breathe in slowly through your nose, expanding your chest and feeling the movement under your hand, hold 3 seconds, then breathe out through your mouth. Practice by taking 3 deep breaths every 30 minutes
• Practice pranayama. Close one nostril with your thumb and breathe in through the other nostril, release from other nostril by closing the opposite nostril with other finger

Some exercise videos you can also look at to help you get started:

https://youtu.be/PTXMFMzIOsA
https://youtu.be/OVJfxG269Mg
https://youtu.be/LjDeex6uvLI
https://youtu.be/JrVwfoziFDQ
https://youtu.be/T_ip8hl7mSg

If you don’t think you can stick to a regimented exercise program, try and incorporate physical activity to your daily routine. You can do this in many ways including:

• If you enjoy cooking or baking, spend some time in the kitchen and whip up your favorite dishes
• Engage in light household chores like gardening, light cleaning, and vacuuming
• Do stationary exercises on the chair or bed. You can do leg, back, and arm exercises while lying down or sitting upright in 10 minute increments
• Use household items like towels, newspaper rolls, and bottles as resistance bands and light weights instead of investing in professional equipment
• It may be helpful to do the exercises after a warm shower when muscles are warm and relaxed.
• Be sure to take deep breaths, in and out, as you exercise
• Wear comfortable, loose clothing when doing the exercises.
• Take small walks throughout the day
• Walk to destinations instead of taking a car or taxi
• Consider doing yoga and meditation including chanting mantras to enhance wellness and improve mental well-being
• Use the stairs instead of the elevator
• Wear a pedometer and try and increase your steps

Physical Activity During Surgery

No matter what type of surgery you have, it’s important to exercise afterward to gain mobility again. Exercises help to decrease side effects of your surgery and help you get back to your usual activities.

It is very important to talk with your doctor before starting any exercises so that you can decide on a program that’s right for you. You might want to work with a physical therapist or occupational therapist to get started on exercises. These health professionals are specially trained to design an exercise program just for you.

Some exercises should not be done until drains and sutures (stitches) are removed. But some exercises can be done soon after surgery. The exercises to increase your range of motion and general mobility can usually be started in a few days after surgery. Exercises to increase strength can be added later.
General guidelines for exercises after surgery: Please seek medical advice before starting any exercise program.

• It is natural to feel some tightness and stiffness after surgery. This is normal and exercise will help with this tightness
• After breast cancer surgery, many women have burning, tingling, numbness, or soreness on the back of the arm and/or on the chest wall. This is because the surgery can irritate some of your nerves. These feelings might increase a few weeks after surgery. But keep doing your exercises unless you notice unusual swelling or tenderness. (If this happens, let your doctor know about it right away.) Sometimes rubbing or stroking the area with your hand or a soft cloth can help make the area less sensitive
• You can start exercises lying down, move to sitting, and finish standing up as your strength improves

Physical Activity During Radiation

If you’ve had radiation therapy, exercises are even more important to help keep your flexibility. Radiation has long-term effects on the area being treated. Because of this, it’s important to develop a regular habit of doing exercises to maintain mobility after radiation treatments. Gentle exercise that feels comfortable, such as walking, gentle stretching, yoga and pilates, is suitable.

Swimming during the treatment may not be recommended because chemicals in the water could react with your skin. Patients are usually advised to keep the area under radiation dry due to the possible skin reactions that radiotherapy can cause. If you do have a skin reaction after radiotherapy, it’s best to wait until it has settled down before you start swimming again.

Physical Activity during Chemotherapy

Side effects from chemotherapy vary from person to person. You may feel fatigued and nauseous during treatment and may not be able to be physically active. Gentle exercise, such as walking, can boost your energy and help make you feel less tired.

You may be advised to avoid swimming while having chemotherapy. If you do want to go swimming, discuss it with your Doctor first. This is because chemotherapy affects your immune system’s ability to fight infection, which might make you more susceptible to any germs in the water.
Things to consider when exercising during cancer treatment:

• Doctors will check your blood work throughout your treatment. Be cautious while exercising if you have low red blood cells, abnormal mineral levels, neutropenia (low white blood cell counts), or if you are on blood thinners. Avoid any risks of falls or injury while exercising
• If you have numbness in your feet or problems with balance, you are more prone to falls so stationary exercises maybe more beneficial
• Do not exercise if you have unrelieved pain, nausea/vomiting, or any other symptom that causes you concern.
• If you have a catheter or feeding tube, avoid exercises that would cause pressure in these areas
• Avoid swimming pools if you are undergoing radiation therapy or chemotherapy that lowers immunity
• Do not use heavy weights or do exercise that puts too much stress on your bones if you have osteoporosis, cancer that has spread to the bone, or arthritis. You may injure yourself and break a bone.
• Watch for swollen ankles, unexplained weight gain, or shortness of breath while at rest or with a small amount of activity. Discuss with your Doctor if you have any of these problems.

The ultimate goal of exercise is to keep you active and able to do the things you want and need to do. Exercise should be something you enjoy and should not feel like a burden. Always remember to understand and listen to your body. Know what you can and cannot do.
Sources:

https://www.cancer.org/treatment/survivorship-during-and-after-treatment/staying-active/physical-activity-and-the-cancer-patient.html
https://www.mdanderson.org/publications/cancerwise/2014/07/four-tips-for-exercising-during-cancer-treatment.
https://www.cancer.org/cancer/breast-cancer/treatment/surgery-for-breast-cancer/exercises-after-breast-cancer-surgery.html
http://www.christie.nhs.uk/media/2538/540.pdf

Article compiled by Ms Damini Yagnik