Exercise after cancer will reduce your chances of a relapse. And you’ll also feel mentally stronger. But don’t just launch yourself into it. Take things step by step. And listen to your body! So what is the best way to exercise when your body feels exhausted and you are worried sick? We asked Sarah Soenen, a physiotherapist who has specialised in cancer rehabilitation for many years.
Sarah, you had leukaemia when you were four years old and now you specialise in cancer rehabilitation. Is that a coincidence?
"No, because after my cancer treatment I already knew what I wanted to be when I grew up, although I was only a little girl. A professional cyclist in the summer and a doctor in winter! (She laughs.) Many years later, I chose a combination of the two – something medical and something sporty – and became a physiotherapist. I wrote my master’s thesis on the impact of sport and exercise on quality of life for adolescents after cancer.
The subject has always fascinated me. Then I was given the opportunity to set up the rehabilitation programme for breast cancer patients at Sint-Lucas hospital in Ghent (Belgium). And that’s how it all started. Now I also offer individual cancer rehabilitation services outside the hospital. You wouldn’t believe how satisfying my job is. I’d be lost without it!"
Why is exercise so important after cancer?
"We all know that your quality of life suffers after such gruelling treatment. Physically, fatigue is the main thing that people with cancer have to deal with. Many people also complain of sore muscles and joints caused by the medication. And don’t forget the psychological impact: the fear of relapse, typical questions such as ‘what happens next?’ caring for your family, work and so on.
By exercising, you build up a basic level of fitness, with all the physical benefits that come with it. But you will also feel more self-confident when you’re fitter. You will start to believe in your own abilities again and worry less. Exercising also helps you get your life back on the rails. It restores structure. You know, many people don’t exercise because they think it will tire them out, but the opposite is true: exercising makes you feel mentally stronger, and when you feel mentally stronger, you’re more inclined to exercise."
Exercising reduces your chances of the cancer recurring, according to studies.
"Exactly. Various studies have shown that you can significantly reduce your chances of the cancer coming back by exercising regularly. This is also the reason why so many people come to me themselves for rehabilitation after their treatment. It gives them a sense of control. They feel that they should grab the opportunity with both hands if it improves their prospects."
Do you have any tips for people who want to start exercising and stick with it? Because this often is a problem.
"The thing I try to teach people day in, day out, is: take it slowly! Set yourself realistic goals and don’t overexert yourself. People tend to forget what a debilitating effect cancer and chemo can have on your body, how it can deplete your reserves. Start to exercise as soon as possible after your treatment. The longer you wait, the deeper the hole that you will have to climb out of. I often see this in my practice: people who haven’t exercised for over a year struggle to achieve a basic level of fitness. It takes them longer than other people whose treatment has just ended.
And I have a very simple tip to help you stick with your exercise programme: choose a form of exercise or sport that you really like. Exercising with others can also be a good motivator. No one can stick to something they hate and that they’re struggling with all on their own. It also helps to set a fixed time for exercise in your schedule."
Many people find it hardest to take things slowly, right? Everyone constantly tells you to ‘listen to your body’. But how do you do this?
"It’s not easy, I agree. It’s even more difficult for people who have never exercised in the past. But even the most experienced athletes find it difficult to understand and cope with their ‘new’ limitations after cancer. I apply two principles in my practice. ‘How does exercise affect your heart rate?’ and just as importantly: ‘how did you feel afterwards?”. Everyone has to wear a heart rate monitor at my practice. We calculate the ideal heart rate zone for them during exercise. Sometimes letting them stay in the red line zone for just a short time is enough for them to understand when they’re going too far. They soon realise where their limits are because of the way that I organise my classes.
“How do you feel afterwards?” is a way of enquiring whether they feel stiff, sore or tired. How stiff were you after your hour of rehabilitation and how long did it take for this stiffness to go away? How tired were you and for how long? Most patients feel the typical ‘cancer-related’ exhaustion. Unlike 'ordinary’ fatigue, it doesn’t go away after resting. This exhaustion comes out of nowhere and will knock you out flat.
That’s why we teach people in cancer rehabilitation to listen to their bodies and recognise the signs that they need to look out for. But it’s fair to say that a lot of people find this very difficult. It’s a quest, with a ‘new’ body. And that is one of my most important tasks as a coach. I often have to protect people from themselves. They come out of their treatment feeling very combative and ready to get stuck in, but their body won’t let them. That can be really hard to face."
Learning to take things slowly: is that the greatest benefit of a special cancer rehabilitation programme? There must be many other benefits.
"You’re right that the emphasis is on achieving a basic level of fitness and making progress, while always listening to your body. We also focus on the extra attention points that have to do with cancer, but that has to do with my role as a physiotherapist. It’s also important to me that people like coming to my classes and stay motivated. And don’t forget that a rehabilitation appointment once a fortnight also adds structure to your life. People often refer to the big black hole after cancer treatment. The fixed rhythm of chemo or radiation treatment stops, leaving a huge emptiness behind. Exercising helps fill the void and prepares you for your return to work.
And don’t underestimate the positive effect of talking to fellow patients. Only people who’ve had or still have cancer will fully understand your journey, your experience. Although there are plenty of patients who don’t want that kind of contact. They prefer individual support, and that’s fine too."
What are the best sports to do if you want to start exercising again after cancer without overextending yourself?
"Walking, cycling and swimming. People often reply, ‘oh, the most boring sports’. But it doesn’t have to be boring! There are so many ways of making things more fun and ensuring that you can continue to enjoy yourself. Exercise with friends, have a drink afterwards, map out some great hiking or cycling routes, set yourself challenges in the pool... And if you can’t manage on your own, there are plenty of ways to get coaching and support. Another tip: I often give my patients a pedometer to motivate them to walk 10,000 steps every day."
You advise patients to start exercising as soon as possible after their treatment. But what about exercise DURING treatment?
"Not everyone can do it, but to be honest, starting to exercise during your cancer treatment, or continuing to exercise if you already did prior to your treatment, is actually even better for you. Obviously, an experienced athlete will find this easier than a newbie. And you don’t always have to make a huge effort. Going for a bike ride or a walk can work miracles. We have noticed that people’s fitness improves faster after their treatment when they do this. You don’t have as much lost time to make up for. And exercise gets you out of the house, out of your isolation."
Can everyone exercise after cancer?
"Everyone is different and some people have to get used to limitations after their operation, chemo, or the side-effects of post-treatment or medication. Patients with a colostomy bag for example, as well as women who have to take hormone inhibitors or blockers after breast cancer. My job is to help them find a form of exercise that is feasible for them.
People’s expectations are also a factor. What do they actually want? Some are just happy to be able to walk up the stairs again without feeling exhausted, while others want to cycle up Mont Ventoux in three years from now. Everything hinges on realistic expectations. Cancer patients are often forced to adjust their expectations. Lowering the bar is never easy.
But accepting your limitations and finding something that you like to do within your limitations is always healthier for your mind and body than sitting in your armchair and brooding about all the things that you can’t do any longer. I see this every day in my practice."
Has this blog post motivated you to exercise?
Talk about it with your doctor or nurse. Many hospitals have specialised rehabilitation programmes. Some insurers also offer specific exercise programmes.
Did you finish your cancer treatment some time ago? Or do you want to recover under your own steam with personal coaching? There are bound to be specialised physiotherapists, exercise coaches or other professionals near where you live. Your doctor will surely be able to recommend someone.