Wellbeing for bowel cancer

www.wellbeingexercise.co.uk

Get moving, feel better Getting active may be the last thing you feel like when you’re going through treatment but the effort really is worthwhile. If you can manage six hours a week of moderate intensity activity, your chances of recovery increase by 50%. Keep the effort up and the risk of a recurrence falls by a similar percentage1. Being active can also: • Reduce the side-effects of treatment • Make you less tired • Decrease depression and anxiety • Help to look after your heart and bones and keep you to a healthy weight That doesn’t mean hitting the gym or training to run a marathon. Walking to the fridge and back, round the garden or in the park counts. So does climbing stairs, doing the shopping, light gardening, loading and unloading the washing machine – even standing up and sitting down. Add in some simple stretching and a few exercises that can be done when you’re seated and the minutes soon mount up. Start gently and aim to build up to ten-minute chunks of activity that leave you breathing slightly faster than usual and feeling a bit warm. Before you start • Talk to your specialist nurse, GP or oncologist if you have any concerns or need specific advice about what you can and can’t do. • Wear loose, comfortable clothing and sturdy shoes, preferably trainers. • Remember that any kind of activity is better than none – even walking to the kitchen and back during an ad break on the tv is worth it. • Take it gently – you will make progress gradually. • Listen to your body. If there’s any hint of sharp pain, stop. A gentle muscular stretch is fine.

1 Macmillan Cancer Support (2011) The importance of physical activity for people living with and beyond cancer: A concise evidence review Meyerhardt, JA, Heseltine D, Niedzwiecki D, Hollis D, Saltz LB, Mayer RJ, Thomas J, Nelson H, Whittom R, Hantel A, • Schilsky RL, Fuchs CS. Impact of physical activity on cancer recurrence and survival in patients with stage III colon cancer: findings from CALGB 89803. Journal of Clinical Oncology. 2006. 24: 3535-3541. • Meyerhardt JA, Giovannucci EL, Holmes MD, Chan AT, Chan JA, Colditz GA, Fuchs CS (2006) Physical activity and survival after colorectal cancer diagnosis. Journal of Clinical Oncology. 24: 3527-3534.


• Remember to breathe – out when you’re making an effort, in when you’re body is relaxing before the next effort. • Ensure that you drink plenty of water and stay hydrated. Try cucumber water or lemon water if plain tap doesn’t taste right. For friends and family You can do so much to help the recovery process if you make a regular date to walk together, do some stretching or gentle exercises. Set targets – for example, to go up and down the stairs or to walk twice round the garden. Your encouragement and positive input can make a huge difference. Getting started You need to work on four aspects of your physical wellbeing: • Endurance (for example, walking or swimming until you’re very slightly out of breath), to lessen fatigue and strengthen your heart and lungs • Flexibility to stretch out your muscles and enable you to do ordinary things, such as reaching for a mug from a kitchen cupboard • Balance: some treatments can interfere with your sense of balance and being frightened of falling can stop you from leading the life you want • Strength: stronger muscles make life easier and help you to build stronger bones Here are a few ways of making activity part of life, through and beyond treatment. Chunk it It’s less daunting to build in a few minutes of activity several times throughout the day – for example, five minutes of stretching in the morning after breakfast, a ten minute walk before lunch, five minutes of strength exercises at tea time and some more flexibility or balance exercises in the evening. Bring in a buddy Enlist friends and family and walk together. Go as far as you comfortably can and take a rest when you need one. It doesn’t matter if you only make it to the next lamppost or the bottom of the garden at first. Swing your arms as you go. It will increase the flow of blood and lymph. Stretch Ill people often close in on themselves physically – it’s a form of self-protection that can leave you hunched and tight, which not only causes further discomfort but also affects your breathing and limits your range of motion, which means you can’t cope with ordinary life as well as you should.


Find something you enjoy If you like to dance, put some music on and move to it. If gardening is your thing, get outside. Now is also a great time to learn something new – you won’t be tempted to compare what you used to be capable of with what you can do now. Yoga and tai chi are excellent options – or you could join a walking club, take up golf, learn new dance routines and much more. Check your local authority website to see if they run classes and ask your GP if you might qualify for an exercise referral scheme. Get moving If you’re sitting down, ensure that your chair is stable and that your back is pushed up to the seat back for support. If you’re standing, have something to hold onto in case you need it – a sturdy table or chair, kitchen work surface or your human workout partner. This is about easing up your joints, taking the kinks out and improving your range of movement before you do anything more vigorous. – Shrug your shoulders up as high as you can, hold for a count of three, then let them drop. Repeat three times. – Tilt you head to one side, then the other. – Look as far as you can to the left, then straight ahead, then to the right. Repeat twice. – Roll your shoulders back in a circular motion three times. Then roll them forwards three times. – Raise your arms up as far as you comfortably can, then reach out to the left, then the right. Repeat three times. – Holding on to the seat of your chair or whatever form of support you’re using while standing, raise each leg in turn, pointing your toe down and then up. Repeat four times on each leg. – In the same position, circle each ankle three times in each direction. – Paint a rainbow with each arm, leaning out if you can. Do this twice in each direction. Remember to hold on to something if you feel unsteady. – Push your arms out as if you’re pushing a door open and bring them back as if they were waves returning to the beach. – Raise your arms as high as you can and lower slowly, three times. Warm up Put on some music and march in time to it, swinging your arms if you can – or one arm at a time if you need to hold on. If you can’t get up from a chair, move your feet and arms. Try taking small steps back and forward and side to side – just keep moving in time. Do this for one track at a time until your breathing has quickened and you’re feeling warmer.


Get stronger It may be more realistic to do some exercises for your upper body on one day, lower body on another and tummy and back on a third – try something new every time. Or pick and mix to make up your own workout. Take it at your own pace. And remember to breathe – out when you’re making an effort, in when you’re relaxing or on the return movement. Upper body You’ll need some light weights – try 0.5 litre bottles of water. If they’re too heavy, drink some of the contents. A couple of tins also work well (make sure they’re the same weight). Aim for five repetitions of each exercise. Take a short rest once you’ve completed all the repetitions. As you get stronger, you’ll be able to do more repetitions or a second set of five.

For the front of your upper arm (this helps when you need to carry stuff) Keeping your upper arms tight to your torso, cupping your weights in your palms, raise the weights slowly up towards your shoulders. Pause for a moment, then lower slowly. You can do this one arm at a time if that’s easier. Then take a short rest and do another five. For the front of your shoulders Pick up your weights with an overhand grip and raise your arms straight in front of you to shoulder height if you can manage it. If not, go as high as you can. Pause for a moment and lower slowly. For the back of your upper arms (helpful when you need to get up from a chair or bed) Raise one arm above your head, holding your bottle or can. Keeping your upper arm still, lower the weight behind you, then bring it back up to your starting position. Then do the same with the other arm.

Alternatively, holding your weight in one hand, lean forward onto a sturdy surface such as a kitchen work surface. Your upper body should form a diagonal line – be careful to keep your back straight and chest high. Tuck your elbow tightly into your side and push your lower arm back as far as you can. Then bring it back slowly, so your hand hangs down – keep your elbow tight against your side throughout. When you’ve done your repetitions, swap to the other arm.


For your shoulders Raise both arms to shoulder level, forearms bent at right angles to your upper arms, palms facing forward – each arm should be like an L on its side, with your forearms as the short stroke of the letter. Then push your arms up and bring your hands together over your head, straightening your elbows. Lower back to the starting position

For upper arms and shoulders (really good for bingo wings) Raise your arms to shoulder height out to the side, so there’s a straight line from your left hand to your right hand. Make small circles with your hands forwards and then backwards, five times each way.

For your chest Stand a few feet away from a wall and lean onto it, so your body forms a diagonal straight line, with your arms straight, palms against the wall. Bend your elbows slowly, lowering your upper body towards the wall, then push yourself slowly back to the start.

For the sides of your upper torso, shoulders and upper back Leave this one until last, as it needs the least weight (drink some water now!). Hold your weights with an overhand grip and let your arms hang down by your sides. Make sure your elbows are slightly bent, then raise both arms out to the side, aiming to reach shoulder height. Lower slowly and repeat.


Lower body

For your thighs Stand up, holding on to something at around waist height, with your feet hip width apart. Stride one foot out in front of the other and bend the knee until your thigh is at right angles to the ground. At the same time, bend the back knee and lower yourself down as far as you can manage. Make sure your front knee doesn’t go beyond your toes – it should be in a direct line down to your ankle. Tighten your tummy muscles and bring your front foot back to the starting position. Then do the same with the other leg.

For your inner and outer thighs and hips Stand, holding on to your chosen support and with feet hip width apart, and raise one leg out to the side, in line with your hips. Lower it slowly and repeat. Then do the same with the other leg. You can also do this sitting down but you’ll need to be at the edge of the seat, so hold on tight. It might be best to have somebody in front of you as a support. Another for your thighs and bottom Holding on again, this time at arm’s length, lower your bottom as if you’re sitting down. Push back up through your heels. If you’d rather be sitting, use a chair with arms, get to the front of the seat and hold on to the arms. Raise yourself as if you’re getting up – then lower down to sitting again. Try to use your leg muscles rather than your arms for this.

Balance Single leg stands Stand on one leg when you’re brushing your teeth – you can hold on with the non-toothbrush hand. At first, simply take the foot slightly off the floor, perhaps out to the side. Swap legs when you get wobbly. In time, you’ll be able to bend your knee and lift your heel towards your bottom. You can also do this when you’re waiting for the kettle to boil. Always make sure you have something to hold onto in case you need it.


Tummy and sides Be very careful in the weeks after surgery – you shouldn’t be putting stress on parts that are healing. If the movement causes pain, stop at once.

Stuck in the chair crunch Sit well back in a chair and hold on to either the seat or the arms. Raise one knee, exhaling as you do so, and hold for a breath, then lower your foot. Do the same with the other knee. To make it more difficult, raise both knees at once. When this becomes easy, try with straight legs.

Standing crunches Stand against a wall, with something to hold on to if necessary. Raise one knee towards your tummy, consciously tightening your tummy muscles. Do this five times on each side if you can.

Seated twists Sit deep in your chair with your feet parallel and knees lined up over your ankles. Lift your chest and roll your shoulders back. Turn your torso to the right, using your left hand to pull on the chair's right armrest (if you’ve got one) and your right hand to push on the chair's backrest. Hold for 30 seconds. Repeat on your left side. Try for three repetitions on each side. This is one you can do while watching tv.

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Wellbeing for bowel cancer