Exercise After Cancer When You Don’t Feel Like It

There are a lot of folks out there who manage to get back to their pre-cancer fitness after treatment. Some of them even exceed their pre-cancer fitness. They run marathons, practice yoga regularly, take up kick-boxing, do spin classes or zumba, or walk three miles a day. I admire these folks unreservedly, but I am not one of them. This post is not for them. This post is for the rest of us, for whom just getting out of bed in the morning is often a struggle.

Personally, my greatest athletic feat after cancer was going back to work. I used to work full-time. I’m not up to that anymore. First, I worked half-time, then eventually I crawled my way back to working four days a week instead of five. I had bills to pay, after all. I work as a homecare physical therapist. For a long time, I had to take neuro-stimulant drugs to combat fatigue and brain fog so I could get through my work day. Now, I manage on caffeine. I once got myself a pedometer to see how much running around I really did. The results were somewhat ambiguous. So, I got an accelerometer, but it burned through batteries too quickly. Basically, a pedometer measures movement in 2D, while an accelerometer measures it in 3D. My advice to the average person about getting such a device? Save your money. Here’s my own advice to patients about exercise: don’t fuss about how far you walk or how many exercise reps you do. Just do something, and keep track of how long you spend doing it. Time is the most pertinent measurement anyway when you’re just trying to mitigate the effects of all those hours that you can’t pry yourself off the couch.

As far as doing something goes, I will admit that my job has its advantages. I see six patients on an average day. I schlepp a heavy bag loaded with a laptop and medical accoutrements. When I visit someone at an apartment complex, I usually have to park far from the door and hoof it to the entrance. I take the stairs between floors when I can. I’m not one of those physical therapists who sits and watches her patients laboring away. I always do the stuff with them. One demo is worth a thousand words of instruction. Conservatively, I’d say that I spend at least a quarter of my average work day engaged in significant movement. That’s about two hours out of eight. And it’s probably more than that. No wonder I’m exhausted when I get home. Exercise after work? I don’t think so.

It’s what I do or don’t do on my three days off a week that’s the problem. All these years later, I still catch myself comparing my current energy level and activity tolerance with my pre-cancer self. Big mistake. I was a ball of fire before cancer. Now, when I’m not jacked up on coffee while slogging through work, I’m more of a limp noodle. I’ve tried all kinds of things to entice myself into getting more exercise on my days off. I get paid to invent exercise programs, after all. A few years ago, I even bought myself a rowing ergometer, which used to be my favorite cardio machine at the gym. I still enjoy it now and then, but there are a lot of days when I just don’t have the wherewithal to unfold it and turn on the monitor.

I also know I’m not alone. Not only am I not alone in the Cancer Club, but I spend every day figuring out how to teach recently-hospitalized people who don’t feel like getting out of bed how to get up and move. Finally, it occurred to me to take some of my own advice to them. And to pass it on to you. Hence this post. I should also say at this point that, if you’re at all unsure about what you can or should do, especially if you have pain or lymphedema, ask one of your doctors to send you to a physical therapist first. Or get one sent to you at home.

When You Don’t Feel Like Getting Out of Bed, Don’t.

You can do a lot of exercise while lying down. Really. Even without throwing the covers off. If you’re reluctant to get up, just lie on your back (which is supine, as we PTs call it), stretch your arms out sideways and inhale deeply. Then hug yourself while you exhale. Repeat a few times. Then, pump your ankles up and down, slowly and methodically, several times. Next, tighten your butt muscles, hold for a few seconds, relax, and repeat. Then do likewise with your knees, straightening them as much as you can. If you feel friskier by now, you can try sliding your legs apart and back together a few times. Next, you can try to bend one knee and slide your heel up. Then slide it down. Repeat with your other leg. You might think all this is no big deal, but this is basically what we PTs teach all our patients who have just had joint replacement surgery. And it works. If you feel capable of throwing off the covers, you can try the supine exercises diagrammed on these two PDF’s: (1) simple back/leg exercises and (2) slightly less simple back/leg exercises. I put them together for people with sore backs, but you don’t have to have a sore back to do them. If you do have a sore back, I’ve put the links to the original posts at the end of this one.

Upright and Taking Nourishment

If you’ve managed to get up, crawl to the kitchen, eat some breakfast, and sit in a chair, there are lots of other things you can do. One of them is to stand up and sit down again several times in a row. This is essentially a squat, but easier and safer than a full squat sans chair. It’s a great, effective strengthening exercise, and there are several versions. If you need to use your arms to push off, no problem. Just try to stand up as straight as possible for a few seconds before you sit down again. If you can do it without pushing off, you can brace your hands on your thighs to help you stand. You can also try standing up from your chair with your arms folded across your chest. Or with your arms raised straight out in front of you. The main thing is standing up straight once you’re on your feet, making sure you feel your back, butt, knees and lower legs doing their thing. The magic is in repeating it two or three or ten times in a row. Honest. Simply amazing.

Another thing you can try in a chair is to lean over your own lap, let your arms hang down, and try to touch the floor. Don’t worry if your belly gets in the way or your shoulders are too tight to reach that far. It works better if you sit with your knees and feet apart. It’s a great way to stretch out your back. Just hang there for ten or twenty seconds, and when you get over the headrush, suck in your belly muscles and roll yourself upright again. And, of course, try repeating a few times, reaching further each time, if possible. You can mix things up by stretching your arms over your head as you sit up. Sort of like doing the Wayne’s World ‘We’re not worthy’ wave, but without the rock stars.

Say you’ve been sitting up for a while, checking your email, your Facebook page, your Twitter feed, and uploading a few pix to Instagram. Probably an hour or two has gone by. Time to move again. Don’t be afraid: you can still stay in that chair. Just push that laptop away, let your arms hang down by your side, and shrug your shoulders up and down. Shrug them ALL the way up and ALL the way down, slowly and thoroughly. Five times or ten times. Then squeeze your shoulderblades together, hard, several times. Hang your head forward and let your neck stretch out for several seconds. Then look straight ahead and slowly, gently, turn your head to one side and stretch it, and then turn to the other side. Slide your feet forward so your heels are resting on the floor, and pump your ankles up and down methodically. No ‘flapping.’ You want to feel your calf muscles working. Maybe try standing up a few times. Maybe even try standing up, moving your laptop to the kitchen counter, and checking your social media while standing. Just for a few minutes anyway.

Taking A Stand

Don’t worry. I’m not going to go off on you and load you up with a lot of fancy standing exercises. Really, I’m just going to encourage you to stand. There have been a lot of articles published about the benefits of simply standing, so I’ll let you do your own search for them. In one article I found, a physician claimed that, over a year, standing for a cumulative total of three hours a day had the same health benefits as running 10 marathons. I’m not sure if I could pull off standing three hours a day myself, but the point is that being a couch potato is detrimental to our health. In an excellent post by Carolyn Thomas, who blogs about women and cardiac disease, she quotes a leading cardiologist who shares some astonishing info. Even if you manage to perform that much-touted 30 minutes of exercise a day, if you spend most of your day sitting and not moving, as many people do, you’re still in much worse shape overall than people who get off their butts periodically. The point is NOT to slump motionless on the couch all day, but to move around now and then.

I’m also not talking about standing rigidly in one position. In fact, I don’t recommend that, especially for people with back problems. I’m talking more about doing a little something when you stand, something you’d normally do while sitting, like sorting your snail mail. One of my tricks is to turn on the radio and see if I can stand for the duration of the average song or news story. You could just stand there and listen while texting your friends. If you feel ambitious, you can add some further movement by loading the dishwasher or unloading that carton of canned cat food you ordered for your favorite fur baby. In fact, any attempt at those much-dreaded household tasks while standing is helpful. Like sorting or folding laundry. Or polishing the silver. Whatever. I worked on some of this blog post while standing. You get the idea.

The Bottom Line

The point of this post is not to flog you into doing something you really can’t do. I’ll save the complicated stuff for a subsequent post. The point is that, whether you’re vertical or horizontal, using your muscles some of the time, even just a little, is better than not using them at all. Pretty much any and all movement of any joint larger than your thumb will work. Or just using most of your major muscles to fight gravity by standing will work. It all counts. It doesn’t have to take longer than a few minutes. In fact, the other point here is that lots of benefits accrue by doing a little at a time, but doing it several times a day. Do keep track of it, too, and add it all up at the end of the day. You might be surprised. Two minutes here, five minutes there, it adds up. Recently, I visited a patient just home from having a few stents placed to make it easier for her heart to pump blood through her body. She felt like she’d been run over by a truck. I got her to agree to take a five-minute walk around her house each day. By our next visit, she said she’d spent the last few days taking two five-minute walks around her house each day. It wasn’t exciting — it was a small house. But, she felt enormously better. In fact, we ended up taking a walk outside that day. It really doesn’t take much. Just move your bottom.


A few old posts:
Arm and Shoulder Pain After Breast Cancer
Sore Back 101
Sore Back 201


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This entry was written by Kathi, posted on Tuesday, March 24, 2015 at 11:03 am, filed under Fatigue, Health & Healthcare, My Work Life, Pain & Neuropathy and tagged , , , , , . Bookmark the permalink . Post a comment below or leave a trackback: Trackback URL.

20 Responses to “Exercise After Cancer When You Don’t Feel Like It”

  1. Fantastic post, Kathi. It’s so reassuring to get this kind of common sense information for real life patients from a real life physiotherapist (as opposed to some sweaty spandex-clad jock barking orders during a spin class…)

    Thanks also for including a link here to my Heart Sisters post. Your readers might find Dr. James Beckerman’s new book of interest, too. It’s called “Heart To Start” – highly recommended, and not just for heart patients who want to get back on their feet, but for anybody who needs to begin right where they are to “just move your bottom”, as you wisely suggest here.

    Keep up the great work!
    regards,
    C

  2. Thanks, Carolyn. I find your blog so useful for me and for my patients. We’re really on the same team here. Maybe we should do a road show together, huh? ๐Ÿ™‚

  3. I like these tips.
    As someone who has almost no energy post cancer on too many days, I could use these tips.
    I never knew standing up/down from a chair was like a squat either. I’m tucking that away because i surely could use it!

  4. Thanks for commenting, Brandie. It’s amazing how helpful many simple movements are. I hope to work on assembling several more.

  5. After cancer 2, I joined a gym for dilapidated people – one run by physical therapists – who can deal with me and my bad health easily. They give me a nice and easy exercise routine. That I am only capable of doing every other day. I could never do your job. I admire your abilities there. I also love your suggestions for exercises as well.

  6. Thanks, Caroline. It’s a tough job sometimes. Maybe most of the time. I love your describing it as the gym for ‘dilapidated’ people! I’m glad you got a routine you can tolerate. It takes a while to understand how to tone it down as a PT, for sure. I learned a lot by being a patient myself.

  7. Great tips, Kathi. There have been many days I could have used them… after spine surgery I did find walking around the house was helpful overall, even though I didn’t like the pain. ๐Ÿ˜‰ Thank you for your pdfs and link to your shoulder pain article as well. Love your stick people! Party on, Garth… xo

  8. Party on, Wayne! ๐Ÿ™‚

  9. […] it, and I can’t imagine ever getting out there to run. I moved from Britt’s blog to Kathi‘s and what a surprise to see a post on exercising, even when we don’t feel like it! I […]

  10. Kathi,

    I’m so glad I’m catching up on my blog reading! This is such a useful piece. There are definitely times I don’t feel like exercising, and your post gives wonderful tips on exercising but not in the extreme.

    Thank you, friend.

  11. Part Deux will be coming in the not too distant future. Thanks, Beth. ๐Ÿ˜‰

  12. It is so hard for me to exercise after cancer. I used to be very athletic for many years. Now I am simply lazy and don’t feel like moving around. I know there have been some studies that talk about survival rates for those who eat well as well as exercise. When combining both, apparently the rate increases to 50% (unbelievable).

    I am trying to walk around my office multiple times a day. This isn’t enough of course. It is more difficult to exercise during winter so these tips would be helpful for when I can’t get out. Right now it’s summer and I have no excuse. I usually bike during the summer.

    Thank you for sharing these tips.

  13. Rebecca, honest to gawd, you’re not lazy. Cancer related fatigue is a real thing, and even after we manage not to feel like road kill, we still have lingering, if perhaps lesser, fatigue for a long, long time after. I used to be quite athletic myself. Now, I have to gird my loins to spend a half hour mowing the lawn. Walking around your office definitely counts. Do what you can, even if it doesn’t seem like ‘much.’ I have to keep reminding myself not to compare myself now with myself before cancer. It’s a constant struggle, and it’s hard not to beat myself up, but that does NOT help. Hugs & hang in there. xoxo

  14. Oh thanks for this. I really have this problem too. I was a pet sitter/dog walker as a hobby while having a regular 60+/hr week job before cancer. I had to give up that up after treatment–no energy! Plus I thought walking dogs all day would be a way to trick myself into “exercise”. 3 years later and the job has morphed into caring primarily one client with Chronic Lyme. I still walk the dog, but in addition, I’m on my feet all day, cooking, cleaning, administering IV meds, running up and down a flight of stairs (she is bed-bound for the most part). My day starts at 6am and ends at 8pm (with some downtime during the day). But at the end of the day and on weekends I am just wiped out–doing exercise, well, it ain’t gonna happen!

  15. Well, you know, CC, that’s the thing. Between your job and mine, we’re probably getting ample exercise as it is! xoxo

  16. Three years ago I was diagnosed with Stage 3 breast cancer which had spread to the lymph nodes. After masyectomy, I had heavy duty chemo and radiation (2nd degree burns). Since then, I have had ongoing debilitating fatigue. Nine months ago I finally had some motivation to begin regular exercise. I see a trainer/physical therapist once a week, who is teaching me yoga stretches and strengthening exercises. I do 20 minutes on the elliptical, 3 times/week, and walk 3 times/week (at least that is my goal).
    It is a daily struggle for me to get out of bed and exercise. My neck, shoulder, and head aches (mastectomy side) following almost any exercise. Reading your blog encourages me that post-cancer fatigue (even 2-3 yrs later) is commom.

    I’m taking Anastrazole daily as a hormone inhibitor. I read that common side effects are weakness, fatigue, depression, joint pain, nausea, and appetite changes (I don’t feel like eating most foods), which are all a part of my “new normal”.

    Despite these side ffects, it’s important that I renewingly am reminded that any kind of movement counts. I tend to get frustrated and embarrassed of how much I struggle just to keep moving.

    Thank you for your blog. I look forward to future info, encouragement, and comments. Helps so much to know I’m not alone in my “new normal” challenges.

  17. Thanks for your kind comments, Pam. I’m glad my blog has been helpful. Hang in there. Yes, it does help to know we are not alone. xo

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