Brian Fricke, MD, shares 6 Steps to Starting Exercise After Cancer Treatment

Brian Fricke, MD

In honor of cancer survivor’s month, I thought I would share some tips about getting back to exercise after cancer treatment. I also would encourage anyone battling cancer to read these tips, as early research suggests that physical activity during cancer treatment may improve symptoms related to cancer and its treatment. It may also enhance recovery after surgery, and in some cases, may even improve the effectiveness of certain chemotherapy regimens.

I remind many of my patients that the cancer treatment process can sometimes feel very prescriptive. I go to my oncologist and am told that I need this chemo, my surgeon says I need that surgery, the radiation oncologist tells me after all of that, I might need radiation. All of this can sometimes feel like it is being done to you instead of for you. But physical activity, your diet, your sleep — these are all things you have absolute control over and can provide you with significant benefit along your cancer journey. With that in mind, let’s dive into some tips!

  1. Take it slow. The American College of Sports Medicine (ACSM) and the American Cancer Society (ACS) recommend 150 minutes per week of moderate-intensity aerobic exercise and two to three sessions each week of resistance training for people who are in the survivorship phase of their cancer journey. However, it is important to remember that these are goal exercise recommendations. Everyone’s journey is unique and your starting point with physical activity is influenced by a variety of factors. If you are an avid exerciser, 30 minutes of aerobic exercise five days a week may be too easy for you. However, if you’re one of many people who find the mere mention of the word “exercise” as anxiety-provoking, know that you’re not alone and that you are more than capable of gradually incorporating physical activity into your daily life. Studies show even brisk walking sessions as short as eight minutes are tremendously valuable to your overall heart and lung health. I often encourage my patients who are battling chronic fatigue or are severely deconditioned as a result of their cancer journey to begin with as short as five-minute walking sessions. All movement is medicine, and with time and sustained effort, you will get there.

2. Be consistent. I stress this concept with many of my patients, as well. There can sometimes be a temptation for people who were more physically active prior to their cancer diagnosis to try and return to their prior activities right away. Also, for those who also have a goal of exercising to lose weight, there can be a tendency to want to lose weight as fast as possible. So more exercise means more calories burned and you’ll lose weight faster, right? Well, not exactly. If you push your body too hard too fast, you run the risk of either injuring yourself or being so sore and worn out from your intense exercise session that you’re down for several days just trying to recover! This can also be very discouraging psychologically and serve as false validation of one’s supposed inability to exercise. Don’t bite off more than you can chew! Listen to your body, take it slow and steady. It’s better to do less intense daily workouts than a couple of intense sessions per week to fulfill your ultimate goal of improving your overall health and fitness.

3. Keep moving the bar. OK, so now we’re mentally prepared for exercise. Maybe we’ve started a bit with some walking in the mornings or evenings when it’s a bit cooler, taken up swimming during these warm summer months that we’re entering, or dusted off some of those resistance bands and light free weights we had stored in the back of our closet. Things are going steady for about a week or two and we’re feeling good about our ability to gradually increase our exercise capacity. Now, where do you go from here? The simple answer is, keep going up! The ultimate goal of a graded physical activity program is to continue to gradually increase the difficulty level to challenge yourself. Every week or two check-in with yourself: Is what I’m doing getting easier? Do I find that I have more energy after exercising? If so, it may be time to raise the intensity a bit. Add three to five minutes to your aerobic exercise sessions. Consider increasing the weight or number of repetitions you perform for your resistance training. If you’re feeling really spicy, even go up to the next color on your resistance bands! As always, remember points No. 1 and No. 2 any time you’re raising the bar. If it becomes too difficult, either go back down to the previous level or modify the type of exercise you are doing so that you are exercising all key muscle groups.

4. Finished stretching? Stretch more! One of the most common things I find with a lot of folks in my clinic is that they don’t stretch enough. Invariably, I’ll get the question, “How much stretching is enough?” It’s a relatively nuanced answer, but let me try to give some general principles. My rule of thumb is that for every minute of aerobic or resistance exercise that you do, you should be stretching the same muscle groups you just finished exercising for at least one to two minutes. The benefits of a good stretching program are extensive. It helps improve flexibility, enhances muscle recovery, cuts down on post-resistance training soreness, limits the risk of injury during future exercise and helps with building lean muscle. Whenever you engage in stretching, avoid “bouncing” in your stretch. Instead, stretch your intended muscle group to the point where it starts to feel uncomfortable and hold it there for 30 seconds. Stretches should never be painful, if they are, reduce the pull on the muscle to where it’s no longer painful and then hold it there. If you can follow these principles, you are well on your way to building a quality stretching program.

5. Food is fuel. This is perhaps one of the areas in which people struggle most with modifying their behavior. A lot of factors go into determining a person’s diet, not the least of which is nutritional value. There are a lot of fad diets out there (low carb, Keto, low residue, anti-inflammatory, etc.) that can be difficult to navigate. When it comes to how food should be thought of when considering an exercise program, protein is your best friend. Most studies recommend one to two grams of protein per body weight in kilograms per day. As an example, an average 70 kilogram person should be eating 70-140 grams of protein a day, divided up into separate meals of 30-40 grams of protein per meal. When selecting your choice of protein, plant-based is best as it is the least inflammatory to the body. After that, lean animal proteins such as chicken, fish and eggs, and dairy products like milk and yogurt, are also good sources of protein. Red meats are generally not recommended, as these kinds of animal proteins tend to be very inflammatory. However, having a steak or a burger once every two to four weeks is fine if you’re folks who can’t live without Texas barbeque!

Let food be thy medicine

6. Sleep is essential. And last, but certainly not least, is sleep. Getting good-quality sleep every night is one of the most important cornerstones of a successful exercise program. Your body needs that time to recover and build itself back up after exercise. My mantra with patients (I have a lot of them if you haven’t already noticed) is “rest is just as important as rehab.” Without good-quality sleep (this means sufficient hours and minimal or no interruptions), everything gets thrown off. Weight-loss goals get disrupted by high cortisol levels from lack of sleep, muscles aren’t granted sufficient time to repair the micro-damage done to them during exercise, pain is worsened, mood is negatively impacted, and worst of all, you feel that much more tired on top of any chronic fatigue you may already be carrying with you. Research some simple sleep hygiene techniques to implement, avoid alcohol and coffee in the evening after dinner, consider taking melatonin as a gentle sleep aide, and if you have any concern about sleep apnea, ask your doctor about ordering a sleep study so you can get tested and treated accordingly.

If you’ve gotten this far, I hope you have found some of these tips helpful for getting back into exercise and improving your overall health and fitness. If you have any safety concerns about starting an exercise program, ask your doctor before engaging in a home exercise program. If you ever feel that you may have sustained an injury during exercise, stop your exercise program and seek medical attention for evaluation, treatment and any further recommendations about exercise. For more complex questions or concerns regarding exercise counseling and pre-exercise clearance, ask your doctor for a referral to Cancer Rehabilitation here at the Mays Cancer Center, home to UT Health San Antonio MD Anderson Cancer Center. On behalf of all of us at the Mays Cancer Center, we’re all rooting for you. Good luck and make good choices!

Learn more about Cancer Rehabilitation.

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