Cancer & Exercise Advice

Receiving a cancer diagnosis can be scary, for the individual and their loved ones. It is often followed by numerous appointments and information overload.

The research on the benefits of exercise during cancer is increasing, in this blog we break that information down to understandable terms. We will discuss the importance of exercise during treatment and life after cancer, plus some things to be mindful of when implementing an exercise program.

We will talk about the cancers which specific exercise precautions that need to be followed, and general advice for exercise and cancer.

We understand there are many types of cancer, not all of which are spoken about here. We hope the information provided on cancer and exercise helps with your specific diagnosis. If you have any questions we are always here to help!

Cancer is a disease of the cells, which are the building blocks of the body for tissues and organs. The body is continually producing new cells to aid in growth, heal injuries and replace worn out cells.

Normally, cells multiply and die in a controlled way so new cells replace old cells. However, sometimes cells become abnormal and grow in an uncontrolled way and invade nearby tissue. These are cancer cells, and can also spread to other parts of the body through blood and the lymphatic system.

Below is a diagram from the Cancer Institute NSW illustrating how cancer starts and spreads. The original diagram can be found here:

https://www.cancer.nsw.gov.au/learn-about-cancer/what-is-cancer

Risk Factors for Cancer

• Tobacco smoking
• Alcohol consumption
• Overweight and obesity
• Dietary factors
• Sedentary behaviour
• Low physical activity levels
• Exposure to UV radiation
• Infections
• Occupational exposure to chemicals
• Family history

In 2019 an average of 396 people are diagnosed each day, and 137 will die each day. This makes cancer a leading cause of death in Australia.

In females, breast cancer is the most prevalent with 19 371 cases. In males, prostate cancer is most prevalent with 19 508 cases. Colorectal cancer is the second most common for both sexes, followed by melanoma and lung.

An improvement in the understanding, earlier detection and treatment of cancers has led to increase in survival rates. In the period between 1986 to 1990, people diagnosed with cancer had a 50% chance of surviving for 5 years. In the period between 2011 to 2015 it increased to 69%.

https://www.aihw.gov.au/getmedia/8c9fcf52-0055-41a0-96d9-f81b0feb98cf/aihw-can-123.pdf.aspx?inline=true

It is well known exercise can help physical health, reduce the risk of developing chronic disease and rehabilitate following injury and surgery. There is increasing evidence that exercise in people diagnosed with cancer can improve function and quality life. Exercise may also increase long term survival rates, and help manage the side effects of many cancer treatments.

Exercise Physiology

What is an Exercise Physiologist?

An Accredited Exercise Physiologist is a university qualified allied health professional.They are equipped with the knowledge and skills to design, deliver and evaluate safe and effective exercise interventions for people with health conditions, including cancer. To gain accreditation they must graduate from a relevant minimum 4 year university degree, complete 400 hours of practical placement and complete continuing professional education each year.

As allied health professionals, Exercise Physiology services are recognised in government health funding including Medicare, DVA and the majority of workers compensation authorities and private health insurers.

https://www.essa.org.au/Public/Consumer_Information/What_is_an_Accredited_Exercise_Physiologist_.aspx#:~:text=Accredited%20Exercise%20Physiologists%20(AEPs),medical%20conditions%2C%20injuries%20or%20disabilities.

What to Expect in a Consultation

In an initial consultation the Exercise Physiologist will want to learn about you. This helps them to provide the most appropriate and safe exercise intervention. They may ask about;

• The type of cancer and treatment, including medications
• Side effects of treatment that has been completed, or is currently being delivered
• Current exercise and movement capacity
• Previous exercise
• Other medical conditions or injuries
• Goals

According to Exercise and Sports Science Australia (ESSA), the people who manage accreditation for Exercise Physiology, AEPs working within oncology should:

• understand cancer diagnosis, staging and treatments,
• understand the phases of cancer care from being first diagnosed through until end of life,
• understand the symptoms and side effects of cancer and cancer treatments,
• understand how cancer and its treatment may influence your ability to exercise,
• use clinical skills to review your health status before starting exercise,
• understand cancer-specific issues that need to be considered to ensure exercise is safe and suitable,
• use evidence-based practice to develop targeted exercise prescriptions which have been individualised to you,
• use appropriately selected types of exercise, intensities (i.e. how hard) and volumes (i.e. how much) throughout your treatment and recovery,
• maximise the safety and benefits of exercise even if you are going through difficult treatments or suffering serious side effects, and
• provide cancer-specific exercise education, advice and support to help improve your overall health and well-being through regular exercise.

https://www.essa.org.au/Public/Advocacy/industry_Reports/Public/Advocacy/Industry_Reports.aspx?hkey=e74923d2-9802-4d0f-b9a4-fbc578c418ac&WebsiteKey=b4460de9-2eb5-46f1-aeaa-3795ae70c687

How does all that help me?

An AEP will be able to prescribe and monitor an individualised exercise program that helps you through:

• improved fitness and strength,
• improved physical function to help you do everyday activities,
• reduced tiredness and fatigue,
• reduced distress, depression and anxiety,
• improved wellbeing that helps increase quality of life,
• helps maintain bone health, build muscle and stop or reduce increases in fat,
• may help to lower the chance of cancer returning and help patient’s live longer (for some types of cancer especially breast, prostate and bowel cancer), and
• reduce the chance of developing new cancers and other diseases such as cardiovascular disease, diabetes and osteoporosis.

Survival rate: a statistic that tells you the percentage of people that survive a certain type of cancer after a given amount of time after diagnosis, usually reported in 5 or 10 years. For example, a five-year survival rate of 90% means 90 out of 100 people diagnosed survive beyond 5 years. It is important to know that survival rates are based on previous outcomes of large groups of people, and each case is different. It also doesn’t mean there won’t be a cancer recurrence after that period.

Statistics can be confusing, that’s why there is a whole field dedicated to understanding it! If any of the statistics discussed with your doctor are confusing, ask them to clarify, they are there to help you understand the diagnosis, prognosis and treatment.

Range of motion: is the measurement of the amount of movement around a joint, measured in degrees.

Hormone therapy: is a type of cancer treatment used to stop or slow the growth of cancers that use hormones to grow. It works by stopping the body producing the hormone, or interfering with how hormones act in the body. It can be used as a standalone treatment, but is most often used in conjunction with other treatments.

Chemotherapy: is a treatment that uses drugs to stop the growth of cancer cells. It does this by either killing the cells or stopping them from dividing. It can be given through a vein (intravenously), orally through tablets, through a cream or as an injection. It can be administered as a stand-alone treatment, or in conjunction with other treatments.

Radiotherapy: is a treatment that uses x-rays to destroy or damage cancer cells, preventing them from multiplying. It can be administered as a stand-alone treatment, or in conjunction with other treatments.

Comorbidity: is having more than one health condition at the same time.

Metastasis: is when cancer cells from the original, primary, separate and travel through the blood stream or lymphatic system and form a new, secondary, tumour in another part of the body.

When thinking about exercise, the first image that pops into people’s mind is often working up a sweat running on the treadmill or lifting weights at the gym. While these are great ways to exercise, there are other things you can do, as long as you’re completing the two main types of exercise, aerobic and resistance.

Aerobic exercise is any activity that increases the heart rate. Some examples include walking, dancing or playing tennis.

Resistance exercise, or strength training, where joints are moved through range of motion against a resistance. The aim is to improve muscle size, strength and power. Some examples include body weight exercise like push ups and squats, dumbbells, weight machines and cable machines.

The Australian guidelines for physical activity recommend to:

• Doing any physical activity is better than doing none. If you currently do no physical activity, start by doing some, and gradually build up to the recommended amount.
• Be active on most, preferably all, days every week.
• Accumulate 150 to 300 minutes (2 ½ to 5 hours) of moderate intensity physical activity or 75 to 150 minutes (1 ¼ to 2 ½ hours) of vigorous intensity physical activity, or an equivalent combination of both moderate and vigorous activities, each week.
• Do muscle strengthening activities on at least 2 days each week.

https://www1.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-phys-act-guidelines#npa1864

Some examples of how to accumulate exercise is walking, dancing, swimming or playing tennis or other sport. The main thing is to do what you enjoy. If going to a gym really isn’t your thing, you can complete strengthening exercises at home. For some people, especially when just starting, body weight exercise may be challenging enough. For others, or after exercising for a little while, bodyweight exercises may become too easy. Purchasing a suspension trainer or an adjustable dumbbell set for home is a great way to increase the resistance and continue to improve!

For people who have cancer, side effects of treatment may make meeting the Australian Physical Activity Guidelines challenging, or not possible. And that’s okay! Doing some exercise is better than doing none. Seeing an AEP to put together a tailored exercise plan, and adjusting it alongside any new or changing side effects is really beneficial to help keep you moving!

Chemotherapy, radiation and hormone therapy are powerful tools in treating many cancers, it also has side effects during and following treatment cycles. These side effect can make exercise challenging, but the recommendation is to stay as active as possible during treatment. Research has shown that exercise helps reduce these side effects, during and after treatment cycles.

Exercise reduces cancer related fatigue

Feeling fatigued, physically and mentally, is the most common side effect of chemotherapy. It can include feeling exhausted, overwhelmed, weak, drowsy, confused or irritable. It can come on suddenly and may take some time to resolve after treatment completion. Our natural inclination when fatigued is to rest, but if you stop all activity you may lose fitness and strength, which will make the fatigue worse.

Exercise has been shown to reduce cancer related fatigue, even during times of excessive fatigue. You may find it more manageable to do shorter, more frequent bouts of exercise throughout the day, rather than doing one big bout. It also important to understand fatigue levels may vary day to day, making adjustments to duration and intensity necessary.

Exercise improves strength

During cancer treatment there are multiple factors that can contribute to a decrease in strength. As talked about above, chemotherapy can cause fatigue, and people tend to become less active in an attempt to manage it. The old saying “use it lose it” applies here. If you become less active and don’t lose your muscles, it is likely you will lose strength. Some hormone therapies such as ADT, and steroids can reduce muscle mass and strength. Doing some resistance training can help to reduce or prevent strength declines, and improve function in day to day activities.

Exercise improves bone density

Chemotherapy, radiation and hormone therapy can cause bones to weaken and become more brittle. This is known as osteoporosis. These treatments may also cause early menopause in women, which also leads to osteoporosis. Exercise helps to build bone strength, and can reduce this side effect of treatment.

Exercise reduces peripheral neuropathy

Peripheral neuropathy is when the peripheral nerves are damaged, that is the nervous outside of the brain and spinal cord. It can occur with some chronic conditions, such as diabetes. It can also occur when some chemotherapy drugs damage these nerves. Some symptoms are tingling, pins and needles or numbness in the hands and feet. It feels a bit like when you slept on your arm funny and you wake up with pins and needles.

This can affect strength with gripping and balance. If you experience this, you will need to adjust your exercise program accordingly. Exercise can reduce the intensity and frequency of neuropathic symptoms.

Exercise Improves completion rates of treatment

The oncologist will provide a treatment plan based on what they believe will be the most effective. However, the patient completing treatment will depend on their tolerance to the side effects. You now know that exercise can reduce pain, fatigue and peripheral neuropathy. This can help people to complete their full treatment, increasing their survival.

Exercise reduces the risk of cancer recurrence

A lot of cancer survivors live with worry of the cancer coming back (cancer recurrence), which is completely understandable. Studies in breast, prostate and bowel cancer survivors have shown that exercises reduce the risk of the cancer coming back.

Exercises reduces the risk of cardiovascular disease

Chemotherapy, radiation to the chest and some anti-cancer drugs can cause damage to the heart muscle, this is called cardiotoxicity. This leads to an increased risk of cardiovascular disease, such as stroke, heart failure and high blood pressure. Exercise after diagnosis has been shown to be effective at a reducing cardiovascular post diagnosis.

Exercise improves mood

Following diagnosis, many people who have cancer will experience symptoms of depression and anxiety. Exercise has been shown to decrease feelings of depression and anxiety, improving mood and wellbeing.

Cormie, P., Zopf, E.M., Zhang, X. and Schmitz, K.H., 2017. The impact of exercise on cancer mortality, recurrence, and treatment-related adverse effects. Epidemiologic reviews, 39(1), pp.71-92.

Jones, L.W., Habel, L.A., Weltzien, E., Castillo, A., Gupta, D., Kroenke, C.H., Kwan, M.L., Quesenberry Jr, C.P., Scott, J., Sternfeld, B. and Yu, A., 2016. Exercise and risk of cardiovascular events in women with nonmetastatic breast cancer. Journal of Clinical Oncology, 34(23), p.2743.

Mock, V., Pickett, M., Ropka, M.E., Lin, E.M., Stewart, K.J., Rhodes, V.A., McDaniel, R., Grimm, P.M., Krumm, S. and McCorkle, R., 2001. Fatigue and quality of life outcomes of exercise during cancer treatment. Cancer practice, 9(3), pp.119-127.

Shim, Y.J., Kim, H.J., Oh, S.C., Lee, S.I. and Choi, S.W., 2019. Exercise during adjuvant treatment for colorectal cancer: treatment completion, treatment-related toxicities, body composition, and serum level of adipokines. Cancer management and research, 11, p.5403.

Stene, G.B., Helbostad, J.L., Balstad, T.R., Riphagen, I.I., Kaasa, S. and Oldervoll, L.M., 2013. Effect of physical exercise on muscle mass and strength in cancer patients during treatment—a systematic review. Critical reviews in oncology/hematology, 88(3), pp.573-593.

This link is for a video from the Catalyst programme on ABC outlining the benefits of exercise and cancer.

You now know about all the benefits of exercise during treatment. It’s also important to be aware that if you experience any of the following you need to speak to your treatment team or Exercise Physiologist for guidance;

• Low blood cell counts
• Extreme fatigue or weakness
• Bone, neck or back pain
• Loss of more than 35% of premorbid weight
• Acute infection
• A fever greater than 38°C
• Unsteady gait, dizziness, disorientation, blurred vision or decline in cognitive performance
• Unusual breathlessness with exercise
• Severe nausea, dehydration or vomiting
• You have sores on your feet and ankles that won’t heal, or have recurring leg pain or cramps
• Symptoms of a heart problem develop, this can include chest pain, high or low heart rate or blood pressure, unusual shortness of breath or swelling in neck, legs or ankles
• Important: If you are undergoing radiotherapy do not participate in pool based rehabilitation because there is an increased risk of infection and irritation of the radiation site.

Stefani, L., Galanti, G. and Klika, R., 2017. Clinical implementation of exercise guidelines for cancer patients: adaptation of ACSM’s guidelines to the Italian model. Journal of Functional Morphology and Kinesiology, 2(1), p.4.

If you experience any of these you should speak to your treatment team or Exercise Physiologist to adjust your exercise program, or maybe take a temporary break from it.

Breast cancer is the most common cancer among Australian women. It can occur in men, although this is rare. Significant advances in early detection and treatment has led to an increase in five-year survival rates. In 1986 to 1990 five-year survival rate was 74%, in 2011to 2018 it was 90.8%.

https://www.aihw.gov.au/reports/cancer/breast-cancer-in-australia-an-overview/contents/summary

Common Treatment for Breast Cancer

• Chemotherapy
• Radiation
• Surgery, this could be whole or partial mastectomy, lumpectomy, removal of lymph nodes or breast reconstruction
• Targeted therapy
• Hormone therapy

Exercise After Surgery

The surgeon will give you post-surgical guidelines, it is important to follow these for optimal wound healing. Post-operative exercises may include gently moving your arm through its range of motion and gentle aerobic exercise such as walking or stationary cycling.

Once you have been cleared by the surgeon it is important to continue improving your arm range of motion, strength and cardiovascular fitness.

Exercise and Lymphedema

To understand what lymphedema is, and how it occurs it’s helpful to first start with learning about the lymphatic system.

The lymphatic system is part of the cardiovascular and immune system. It is made up of a large network of vessels called lymphatic vessels, that drain fluid, called lymph, that has leaked from the blood into the tissues, and empties it back into the bloodstream via the lymph nodes. The lymphatic system plays a part in;

• Maintaining fluid balance in the body
• Absorbing and transporting fatty acids and fats
• Fighting bacteria and other infections
• Destroying old or abnormal cells, such as cancer cells

Treatment for breast cancer may include removal of one or more lymph nodes, and/or radiation therapy, which may damage nearby lymph nodes. In breast cancer, this treatment is applied to the lymph nodes under the arm, which drain lymphatic vessels from the under arm, upper arm, most of the breast, chest and neck. This can leave that part of the body without a way to drain lymph fluid. The lymph vessels come across a “dead end”, and fluid can back up. This is Lymphodema. Symptoms of lymphodema are on the affected side, and include swelling, the skin feeling tight or hot, aching, pins and needles or pain.

Lymphodema can be a scary side effect of breast cancer treatment, and often people with lymphodema avoid using the affected arm. We know it is safe to participate in gradual progressive resistance and aerobic exercise during and after treatment. In most cases, exercise does not exacerbate lymphedema, with some cases reporting a reduction in lymphedema after exercise intervention. It also does not increase the risk of developing lymphedema.

Keilani, M., Hasenoehrl, T., Neubauer, M. and Crevenna, R., 2016. Resistance exercise and secondary lymphedema in breast cancer survivors—a systematic review. Supportive Care in Cancer, 24(4), pp.1907-1916.

Schmitz, K.H., Courneya, K.S., Matthews, C., Demark-Wahnefried, W., Galvão, D.A., Pinto, B.M., Irwin, M.L., Wolin, K.Y., Segal, R.J., Lucia, A. and Schneider, C.M., 2010. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Medicine & Science in Sports & Exercise, 42(7), pp.1409-1426.

Please seek advice from an Exercise Physiologist if you have any of the following;

• Lymphodema
• Bone metastases
• Comorbidities
• Limited range of movement

Key Exercise Guidelines

• Begin with a gentle program, and gradually increase the intensity as tolerated
• Avoid protecting an area that is affected by lymphedema, this can lead to other musculoskeletal problems
• If exercising with lymphedema, wear a well fitted compression garment or long sleeve top to prevent cuts and abrasions
• Fatigue levels can vary, that’s okay. Adjust exercise intensity accordingly and monitor recovery

Prostate cancer is the most common cancer among Australian Men. It is estimated that 1 in 6 men will be diagnosed with prostate cancer by his 85th birthday. It occurs when abnormal cells develop in the prostate, which can continue to multiply in an uncontrolled manner.

These cells may spread outside the prostate or metastasize to other parts of the body.

https://www.cancer.org.au/cancer-information/types-of-cancer/prostate-cancer

Only men have a prostate gland. It is situated below the bladder near the rectum, and surrounds the urethra (the tube urine and semen pass through to exit the body). It is part of the male reproductive system, and secretes fluid that nourishes and protects sperm.

Symptoms of Prostate Cancer

• Frequent or sudden need to urinate
• Difficulty urinating
• Discomfort urinating
• Blood in urine or semen
• Pain in lower back, groin or hips

Common Treatment for Prostate Cancer

• Prostatectomy
• Removal of lymph nodes
• Radiation
• Androgen deprivation therapy (ADT)

Exercise and ADT

Prostate cancer needs androgens, such as testosterone to grow. One of the main types of drug therapy for prostate cancer is ADT. The aim is to reduce the production of androgens, or limit the effect of androgens on cells and tissues, slowing the growth of the cancer, or even shrinking it. This can be an effective treatment, but unfortunately, reducing testosterone levels can have side effects.

Side effects may include;

• Fatigue
• Low libido
• Erectile dysfunction
• Changes in body composition through loss of muscle and increase in fat
• Decrease in strength
• Menopause like symptoms
• Loss of bone density, known as osteoporosis
• Increased risk of diabetes and heart disease
• Increased risk of falling
• Increased risk of fracture

At time of writing, research on exercise in managing side effects of ADT is limited, however, early research shows promising results. It is important to note exercise has not been shown to reduce the effectiveness of the treatment. Outlined below are the results of the current research on exercise and ADT

• Reduce cancer related fatigue
• Increase muscle mass, strength and endurance
• Reduce the risk osteoporosis
• Reduces the risk of cardiovascular disease
• Reduces adipose tissue

Cormie, P., Galvão, D.A., Spry, N., Joseph, D., Chee, R., Taaffe, D.R., Chambers, S.K. and Newton, R.U., 2015. Can supervised exercise prevent treatment toxicity in patients with prostate cancer initiating androgen‐deprivation therapy: a randomised controlled trial. BJU international, 115(2), pp.256-266.

Hvid, T., Lindegaard, B., Winding, K., Iversen, P., Brasso, K., Solomon, T.P., Pedersen, B.K. and Hojman, P., 2016. Effect of a 2-year home-based endurance training intervention on physiological function and PSA doubling time in prostate cancer patients. Cancer Causes & Control, 27(2), pp.165-174.

The name Hodgkin’s Lymphoma comes from the doctor who first identified the cancer, Thomas Hodgkins. Before talking about it further, it’s helpful to understand some simple anatomy and physiology. Let’s go over the lymphatic system and different types of blood cells.

The Lymphatic System

The lymphatic system is part of the cardiovascular and immune system. It is made up of a large network of vessels called lymphatic vessels. These vessels drain fluid, called lymph fluid, that has leaked from the blood into the tissues, and empties it back into the bloodstream via the lymph nodes. The lymphatic system plays a part in;

• Maintaining fluid balance in the body
• Absorbing and transporting fatty acids and fats
• Fighting bacteria and other infections
• Destroying old or abnormal cells, such as cancer cells

Other than lymph vessels, lymph fluid and lymph nodes, there are other tissues that are part of the lymphatic system. These are;

• Bone marrow
• Spleen
• Tonsils
• Thymus gland

Bone Marrow

Bone marrow is a sponge like tissue inside bones. This is where blood cells are made. The bone marrow produces stem cells, which are unspecialised blood cells, that develop into one of three main types of blood cells, red blood cells, white blood cells or platelets.

Blood Cells

About 7-8% of your body weight is blood, this means a 70kg person has 5-5.5L of blood. Blood cells have a limited lifespan, and are continually being replaced. Blood has many functions in the body, below are the main ones;

• transporting oxygen and nutrients
• transporting white cells and antibodies to fight infection
• forming blood clots to prevent bleeding
• carrying waste products to the liver and kidneys which assist in filtering and cleaning the blood
• helping to regulate body temperature.

The different parts of blood are plasma, platelets, red blood cells and white blood cells. As Hodgkins’ Lymphoma affects white blood cells, we will discuss this. If you would like to learn more about the other parts please visit: https://www.leukaemia.org.au/disease-information/blood-basics/blood/

White Blood Cells

White blood cells fight infection, and there are different types that all play a role in protecting your body. As Hodgkins’ Lymphoma affects lymphocytes, we will discuss this in more detail. If you would like to learn more about the other types of white blood cells please visit:

https://www.leukaemia.org.au/disease-information/blood-basics/blood/

Lymphocytes are a group of white blood cells that are part of the immune system. They reside in lymph nodes and circulate the blood stream to find antigens, produce antibodies and destroy cells that could cause damage. There are two types of lymphocytes, T- Lymphocytes and B-Lymphocytes.

T-Lymphocytes regulate the function of other immune cells, and directly attack infected cells and tumours. B-Lymphocytes are the “alarm bells” of the immune system. Rather than destroying invaders, they produce anti-bodies that recognise foreign viruses and bacteria, then mark them for destruction.

What is Hodgkin Lymphoma?

It is a type of blood cancer where abnormal lymphocytes grow and multiply uncontrollably and can form a lump, or tumour, in one or multiple lymph nodes. In rare cases it can also spread to other lymph tissue such as the spleen or bone marrow.

Symptoms

• Swelling of a lymph node, which is usually painless, in the neck, under the arms, chest or groin*
• Night sweats
• Fatigue
• Shortness of breath
• Fever
• Unexplained cough
• Unexplained weight loss

*Important note: most people who have swollen lymph nodes do not have Hodgkins’ Lymphoma. They often swell from the result of an infection, such as a sore throat or cold. This is because the lymphocytes multiply to fight the infection.

Exercise has many benefits during treatment as we discussed in the section “The Importance of Exercise During Treatment; Chemotherapy, Radiation and Hormone Therapy:, and after treatment as we discussed in the section “Exercise and Life After Cancer”. For people who have Hodgkins Lymphoma with bone lesions, it is important to understand there is a risk of fracture, and how to exercise safely. An Accredited Exercise Physiologist can help you with this.

Courneya, K.S., Sellar, C.M., Stevinson, C., McNeely, M.L., Peddle, C.J., Friedenreich, C.M., Tankel, K., Basi, S., Chua, N., Mazurek, A. and Reiman, T., 2009. Randomized controlled trial of the effects of aerobic exercise on physical functioning and quality of life in lymphoma patients. J Clin Oncol, 27(27), pp.4605-4612.

Colorectal cancer, also known as bowel cancer, is the second most common cancer in men and women, after prostate and breast cancer respectively. It develops in the inner lining of the bowel. It usually begins with growths, called polyps. Most polyps are benign, but some become malignant over time. If you do have polyps, your doctor will investigate if they are malignant or benign through a biopsy. Depending on where the cancer starts, it will be called either colon or rectal cancer.

https://www.cancer.org.au/cancer-information/types-of-cancer/bowel-cancer

After surgery a small number of cases (less than 10%), will require a permanent stoma. This occurs when surgery is required to remove the tumour and the bowel can’t be joined back together. The end of the bowel is brought out through an opening in the tummy, and sewn into the skin. This allows faeces to leave the body. A plastic bag, also known as a colostomy or stoma bag, is attached to the stoma to collect the faeces.

https://www.cancercouncil.com.au/bowel-cancer/after-cancer-treatment/stomas/

Exercising with a stoma bag

Having a stoma bag can have a significant impact on your lifestyle and day to day life. You may have been told you shouldn’t exercise, and the thought of it may seem a little daunting. It is safe to exercise with a stoma bag.

Following surgery, it is important to adhere to advice provided by your surgeon. This may include avoiding heavy lifting or exercise for the first 12 weeks or until your surgeon tells you it is safe to exercise. After this time, there may still be weaknesses in the abdominal wall from the surgery and stoma. It is important to see an Exercise Physiologist or Physiotherapist to build strength, and support you in a safe and gentle return to exercise. You will need to avoid increasing abdominal pressure, including using the Valsalva manoeuvre and breath holds, during exercise.

When getting ready for your exercise session, make sure you clean the stoma bag. You will need to do this again after exercise. You can protect the stoma bag when exercising by wearing high waisted underwear or tights, or stoma specific belts.

After cancer treatment many side effects will start to get better. Some can last a little longer, or emerge later on. You may have lost some strength and fitness too. As spoken about previously, exercise can help ease side effects and reduce loss of strength and fitness during treatment, it can also do the same after treatment. As well as reducing the risk of cancer recurrence, and the develop of any health issues from treatment. It may take some time to rebuild your strength after treatment, but it’s important to help you return to living the life you want.

It’s important to write a list of things you want to get back to. This could be returning to sport, running, being able to socialise more or return to work. You may even have some new goals that you never thought of before being diagnosed with cancer! Having goals helps to give you something to work towards, and to cater your program specifically to you.

Start small and aim to build to meeting the Australian Physical Activity Guidelines of accumulating 150-300 minutes of moderate exercise or 75-150 minutes of vigorous exercise per week.

Cancer Council Australia

Cancer Council is the only charity in Australia to work across every area of every cancer, from research to prevention and support. We help people from the point of diagnosis through to treatment and survivorship.

Cancer Council Australia works with its members the eight state and territory cancer organisations to:

• undertake and fund cancer research
• prevent and control cancer
• provide information and support for people affected by cancer

https://www.cancer.org.au/

Prostate Cancer Foundation of Australia

Prostate Cancer Foundation of Australia is a broad based community organisation and the peak national body for prostate cancer in Australia. They are dedicated to reducing the impact of prostate cancer on Australian men, their partners and families, recognising the diversity of the Australian community. Through their website you can find your nearest support group.

https://www.prostate.org.au/support/find-a-support-group/

Breast Cancer Network Australia

Breast Cancer Network Australia is Australia’s leading breast cancer consumer organisation. For the past 22 years, they have worked tirelessly to ensure that all Australians who are affected by breast cancer receive the very best care, treatment and support.

https://www.bcna.org.au/

Dragons Abreast Australia

Dragons Abreast Australia is a national organisation comprised of breast cancer survivors of various ages from a great variety of backgrounds, athletic abilities and interests. Dragons Abreast members spread the message of breast cancer awareness through participation in the sport of dragon boat racing.

https://www.dragonsabreast.com.au/

Bowel Cancer Australia

Bowel Cancer Australia is the leading community-funded charity dedicated to prevention, early diagnosis, research, quality treatment and the best care for everyone affected by bowel cancer.

https://www.bowelcanceraustralia.org/

Lung Foundation Australia

Lung Foundation Australia is the only charity and leading peak body of its kind in Australia that delivers life-changing research and programs that support and provide hope to people of all ages with a lung disease, and their families, at every stage of the journey.

https://lungfoundation.com.au/about/who-we-are/

CanTeen

CanTeen helps young people cope with cancer in their family. Through CanTeen, they learn to explore and deal with their feelings about cancer, connect with other young people in the same boat and if they’ve been diagnosed themselves, we also provide specialist, youth-specific treatment teams.

https://www.canteen.org.au/