So, then, how to start?

We know the reasons to do it, we know that it’s generally A Good Thing, and that for you, here, today, it’s a particularly good idea. We also know that almost without exception, and despite any caution or trepidation you might be feeling, the chances are that you WILL feel better once you’ve done it.

I think that the best first step in trying to get fit after cancer is simply that: take a first step by going walking. Aim to leave the house and walk as briskly as you can for a little while, take a rest midway then walk back. Most people would walk a mile in 20 minutes or so, and it can be a manageable and quite a neat goal to walk a mile every day – briskly, mind, no dawdling.

I’ve trained many people who’d find this a breeze, and others for whom a mile a day would be a significant challenge.

Marie

When I first met Marie, she’d recently finished chemo after breast surgery. The treatment had left her exceptionally tired, and she found that it was all that she could do to walk to the post box at the end of her street. She began to walk every day, and, wisely, recruited a neighbour to walk with her. They didn’t go far at first, but they went out, reliably, every day. As I’m sure you can imagine, their walks built up gradually. The walks were also a lovely opportunity for them to seal their friendship, and the daily walk offered a sense of routine after a period of complete upheaval.

After a while, Marie came along to a Nordic Walking class at the Maggie’s Centre. At first, she took it very gently, and would have a rest on a bench along the towpath as her buddies went ahead a little and then came back to pick her up. Marie stuck at it and bought herself a pair of walking poles so she could go Nordic walking on other days as well as with the group. Over the weeks and months she became steadily fitter. She would be at the front of the pack, chatting, and wouldn’t be completely pooped by the end of the walk.

The photo is one of my favourite images from my work so far: Marie completing her first Race for Life in Hyde Park.

So, here’s the plan: a good, brisk, purposeful walk, every day. A full 20 minutes of active walking, more if you can. This can be a very simple thing to do, but it can have a profound effect.

It might be that it’s part of a regular commute (imagine how wonderful it would be if we could all walk to work). I stress that the walk needs to be brisk – try to walk at a pace that feels as fast as you can comfortably manage. You should become a little warmer as you walk. Feel your breathing change so it becomes a bit deeper – but stay comfortable enough that you can still speak in sentences.

 

How hard should you be working?

Most people say that cancer treatment leaves a legacy of tiredness[1]. It varies from person to person of course, but most people find they have low energy. Some have debilitating fatigue that drags on for months. If this is you, you’re not alone. Evidence show that exercise can be used effectively to help overcome fatigue, and one of the best ways to exercise is at a ‘moderate’, level of exertion[2].  Too little and it won’t have as much of an impact as it could. But if you overdo it, you may end up more tired than you were when you started.

There’s a scale, adjusted for people’s age, that gauges the maximum number of beats that your heart can safely take per minute, known as your Maximum Heart Rate or HRM. It’s thought that exercising at 70% of that level is particularly helpful, specifically for tackling cancer-related tiredness and fatigue.[3] For most people, it’d feel like 7 out of 10 in terms of effort (0 being sitting still, 10 being flat out and you want to stop).

There’s more about 70% HRM in the section dedicated to fatigue, but broadly speaking, as you walk, or indeed as you start any cardio-based exercise, try to get used to maintaining a pace where you feel warm and lightly out of puff, 7 out of 10, for as much of your time exercising as you can.

This may, of course, feel like waaaay too much exertion for you, especially in the earlier days of getting fitter. If that’s the case, don’t worry, just make sure that to continue to push yourself (gently) and go as quickly as you can, as if you were in a bit of a hurry. Aim for consistency first – so you’re doing something most days. This will help to build you stamina, and strength, so you will in time be able to do more.

Mindfully as you go

As you walk, look around you. Soaking up nature and the beauty around you can do wonders for your state of mind. If you’re walking daily you’ll see things progress as the seasons change – buds become blossom, leaves change colour. Whatever changes are going on, try to notice them, even if you feel you’re walking somewhere that’s not particularly special. Some of my Nordic walkers recently spent 20 minutes or so, in November, in Central London, mindfully spotting all the flowers and seeds they could see as we walked. It was a lovely, enriching experience – there were, of course, all sorts of treasures to find that otherwise we’d have overlooked.

We know that mindfulness can have a significant effect on our immediate mood and on our long-term mental and emotional wellbeing. Making your daily mile a little mindful could reap more benefit than you might expect: one study found that ‘mindful walking in nature may be an effective way to maintain mindfulness practice and further improve psychological functioning’[4]. So, more bang for your buck.

Get a friend. Borrow My Doggy

Some people love to walk alone – it offers solitude and a time for a bit of reflection, to let your mind wander. As a keen runner, I particularly love to go for a long steady run along the Thames path, on my own. It just gives a bit of mental space to mull things over, or to watch the birds, look at the tide, watch things pass by.

Some people however find it doubly difficult to motivate themselves to exercise if they’re on their own and so a cunning plan is to have a training buddy, like Marie did. They’ll help you to commit to a time to go out, and you’ll egg each other on.

I think ‘Borrow My Doggy’ www.borrowmydoggy.com is a marvellous idea for those of us who’d love a dog but can’t have one full time. BMD matches dog lovers who have a bit of spare time, with nearby dog owners who have a hairy friend available for extra walks. Sounds like a win-win situation to me. And scientists would approve: a study looked at activity levels of people who had a dog and compared them with those that did not. Guess which group walked the most and walked more briskly[5]?

Too tame for you?

It might be that the idea of walking daily feels a bit too tame for you, especially if you were very active before cancer. That’s fair enough. My best advice is to try it, especially if it’s still early days during or after treatment. Make this your foundation to build on, and once a brisk 20 minute walk doesn’t feel like enough to challenge you, then move on. Build in extra exertion by adding in hills or going faster in spurts. You might build in some bursts of jogging. Or, try using Nordic walking poles. Their benefits, especially for people getting active after cancer, are immense and there’s a section below about how marvellous Nordic walking can be.

As soon as you feel ready, start doing exercises that help to make your muscles stronger. I can’t emphasise strongly enough how important strength training is, and the effects of improved strength are substantial, so much so that government guidelines have recently been updated to reflect the benefits[6]. You can train your whole body to be stronger with minimal equipment (and you can do it outdoors without looking too odd).

Keep reading for information on how to start running, how to build in higher impact exercises, how to use Nordic walking to maximise your time on your feet, and how to make yourself stronger. We’ll also the section on fatigue which looks at how to exercise, and keep your pecker up, on low-energy days.

 

[1] http://www.cancerresearchuk.org/about-cancer/coping/physically/fatigue/what-is-cancer-fatigue

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3647480/

[3] http://www.journalofphysiotherapy.com/article/S1836-9553(16)00021-7/fulltext

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5010615/

[5] http://www.health.com/pets/dog-owners-walk-more-moderate-exercise

[6] Department of Health ‘UK Chief Medical Officers’ Physical Activity Guidelines’ 2019

Copyright  copyright Carolyn Garritt

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