I saw a patient yesterday who was in a lot of pain.  She said, “When I feel this bad, I can’t exercise”.

That made me lean in a bit more and ask some questions.  I needed to get to the bottom of this because, “Come on!  Doesn’t movement cure everything?”  (spoken like a true Rehabilitation Therapist!).

We sat and chatted for a while and I was able to discover what she really meant.

When her body hurts, when she’s in pain, what she’s not able to do are her strengthening exercises.

WELL.  Doesn’t this just point out the obvious.  

The word ‘exercise’ has a lot of meanings.  

So as we reviewed my patient’s techniques for handling her ‘pain days’ we determined that she’s doing exactly what she should be to get the most benefit and decrease her pain.  

My patient is supporting her body through movement with walking and stretching.   These types of exercise actually help decrease her pain, help her to focus on her breathing, ease her stress caused by the pain, and work to support a better state of relaxation.

What is Exercise?

We need to get on the same page about exercise.  Is stretching exercise?  Is yoga exercise?  And is there a difference between the term ‘physical activity’ and exercise?

We hear the statement all the time – we need to be more physically active.  But what exactly does that mean?

I went to the source, the  Bible of Exercise Prescription.  I pulled out my latest copy of the ACSM Guidelines for Exercise Testing and Prescription.  Most people in sports physiology, Kinesiology, and athletic therapy would agree that the ACSM (American College of Sports Medicine) provides the ‘Bible’ for exercise prescription.

Physical activity and exercise are not actually the same thing.  When we talk about physical activity, we’re talking about the baseline stuff – any movement of the body that’s made by using our muscles and requires substantial energy over our resting state.

Exercise is a type of physical activity that has rules, repetitive body movements, and the goal of improving or maintaining your physical fitness. 

Since that’s maybe a little hard to digest (and boring) think about it this way. If you were running up the stairs because your son or daughter fell and hurt themselves – that’s physical activity. If you’re on the elliptical machine – it’s exercise – something you’re doing to help with heart health.

There are lots of health related components of physical fitness such as keeping our heart healthy, keeping a good balance between our fat and muscle, being strong enough for our daily activities, being flexible enough to complete our required AND enjoyable daily activities.

Cancer Exercise from a Patient Perspective

So let’s regroup and look at wording from a patient perspective; a patient diagnosed with cancer.

As a cancer patient, what do you think when you hear the work exercise?  Does it immediately make you think of long distance running?  Something so daunting, like a marathon, that you dismiss the idea of exercise altogether and believe you can’t even get started?

What about your rehab routine after surgery.  The stretches you reviewed with your rehabilitation therapist.

Is that exercise?  Well you’re doing those stretches every day (well you should be!)  Does this mean you’re actually exercising.

Yes it does!

Exercise has too many meanings and it gets confusing, especially if you’re hearing the word exercise from your trainer at the gym compared to your rehabilitation therapist at a treatment clinic.  

Research proves that ‘exercise’ provides many benefits for cancer patients so it’s important to dig a little deeper and define what that means.  It’s also important to note that not all types of cancers have had the benefit of in depth research so there are guidelines established by a number of cancer organizations based on the research that’s available.

Components of Exercise

As I mentioned above, the American College of Sports Medicine (ACSM) has provided guidelines that most of us, as health care professionals, refer to when we’re defining the specifics of exercise and physical activity.

According to the ACSM, exercise helps to support our physical fitness, our ability to carry out daily tasks and enjoy leisure activities.

So what we need to have is a solid exercise program.  One that helps our body be able to perform our daily tasks AND enjoy our leisure activities.  Included in your Cancer Exercise Program should be components to address:

• cardio-vascular fitness
• maintaining good body composition
• muscle strength
• muscle endurance
• flexibility

Depending on where you’re at with your level of physical fitness, some of these components may be really easy for you and you’ll be in a maintenance mode for these exercises.

On the other hand, if you’ve been through injury, illness, or surgery, you’re body is going to need support to improve one or more of these components.

That’s why it’s important to use the expertise and guidance of a Rehabilitation Therapist.  As health care professionals trained in supporting the body when it’s in recovery mode, the basis of programming is to support progression towards recovery.  Then, we can define an appropriate set of exercises to get you back to your activity goals.

What Type of Exercise Is Best for Cancer Patients?

This is a question that I get asked a lot.  And my answer is terrible, but true.

It depends.

Your fitness level before diagnosis will play a big role in defining your body’s needs.  If you just had surgery, your rehabilitative needs will be more important that your muscular endurance.

If you’re over weight, one of the important issues, especially to reduce the risk of recurrence will be to work on your body composition.

So it’s important to establish a protocol, a way cancer patients can determine what the most important aspect of exercise they should be working on first.

That’s why I use the Foundations First Framework.  It’s a framework that guides exercise based on the way the body develops and heals.  By starting at the bottom, with stretching and movement, you create the foundation that’s needed for the next phase of your body’s recovery and development.

The pyramid below shows you exactly where you need to focus, if you have deficits in these areas, before moving to the next level.

For more information on cancer exercise, specifically for breast cancer survivors, check out this post.

Exercise Guidelines May Be Too Much for Breast Cancer Patients