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