Exercise for People Living with Cancer

Exercise for People
Living with Cancer
A guide for people with cancer,
their families and friends
Practical
and support
information
For information & support, call
Exercise for People Living with Cancer
A guide for people with cancer, their families and friends
First published October 2007. This edition April 2016.
© Cancer Council Australia 2016. ISBN 978 1 925136 86 9
Exercise for People Living with Cancer is reviewed approximately every three years. Check the publication
date above to ensure this copy is up to date.
Editor: Jenni Bruce. Designer: Eleonora Pelosi. Printer: SOS Print + Media Group.
Acknowledgements
This edition has been developed by Cancer Council NSW on behalf of all other state and territory
Cancer Councils as part of a National Publications Working Group initiative.
We thank the reviewers of this booklet: Prof Sandi Hayes, Senior Research Fellow, ihop Research Group,
School of Public Health, Queensland University of Technology, QLD; Polly Baldwin, 13 11 20 Consultant,
Cancer Council SA, SA; Chris Pidd, Consumer; Steve Pratt, Nutrition and Physical Activity Manager, Cancer
Council WA, WA; Kellie Toohey, Accredited Exercise Physiologist, University of Canberra, ACT.
Cancer Council Queensland kindly permitted its booklet Exercise for people living with cancer to be
used as source material, including the use of many of the exercise illustrations. Additional illustrations
by Eleonora Pelosi.
This booklet is funded through the generosity of the people of Australia.
Note to reader
Always consult your doctor about matters that affect your health. This booklet is intended as a general
introduction to the topic and should not be seen as a substitute for medical, legal or financial advice.
You should obtain independent advice relevant to your specific situation from appropriate professionals,
and you may wish to discuss issues raised in this book with them.
All care is taken to ensure that the information in this booklet is accurate at the time of publication.
Please note that information on cancer, including the diagnosis, treatment and prevention of cancer,
is constantly being updated and revised by medical professionals and the research community.
Cancer Council Australia and its members exclude all liability for any injury, loss or damage incurred
by use of or reliance on the information provided in this booklet.
Cancer Council
Cancer Council is Australia’s peak non-government cancer control organisation. Through the eight state
and territory Cancer Councils, we provide a broad range of programs and services to help improve the
quality of life of people living with cancer, their families and friends. Cancer Councils also invest heavily
in research and prevention. To make a donation and help us beat cancer, visit cancer.org.au or call your
local Cancer Council.
Cancer Council Australia
Level 14, 477 Pitt Street, Sydney NSW 2000
Telephone 02 8063 4100 Facsimile 02 8063 4101
Email info@cancer.org.au Website cancer.org.au
ABN 91 130 793 725
Introduction
This booklet has been prepared to help you understand the
importance of exercise, and to provide information about
the benefits of exercise during and after cancer treatment. We
have included tips on exercise preparation, plus some examples
of exercise techniques that you can do at home. There is also
information about support services that may assist you.
We cannot give advice about the best exercise program for you.
You will need to discuss this with your doctors and exercise
professionals. However, we hope this information helps you think
about questions to ask them.
This booklet does not need to be read from cover to cover – just
read the parts that are useful to you. Some terms that may be
unfamiliar are explained in the glossary. You may also like to pass
this booklet to your family and friends for their information.
How this booklet was developed
This information was developed with help from a range of exercise
and health professionals and people affected by cancer. It is based
on guidelines for exercise programs for people living with cancer.1,2
If you or your family have any questions,
call Cancer Council 13 11 20. We can send
you more information and connect you with
support services in your area. Turn to the
last page of this book for more details.
Contents
Why exercise?.................................................................... 4
Should people with cancer exercise?................................................... 5
Question checklist................................................................................. 7
Treatment side effects and exercise...................................................... 8
Getting started................................................................. 10
Exercise equipment............................................................................. 10
Exercise professionals......................................................................... 11
Choosing an exercise program........................................................... 12
Exercise sessions................................................................................ 14
Muscle groups..................................................................................... 16
Aerobic exercise.............................................................. 18
How much?......................................................................................... 18
Strength-training exercises............................................ 20
How much?......................................................................................... 21
One-leg balance.................................................................................. 22
Clamshell............................................................................................. 23
Pelvic tilt.............................................................................................. 24
Bird-dog.............................................................................................. 25
Standing push-up................................................................................ 26
Modified push-up................................................................................ 27
Calf raise............................................................................................. 28
Standing row....................................................................................... 29
Chair rise............................................................................................. 30
Wall squat............................................................................................ 31
Shoulder press.................................................................................... 32
Upright row.......................................................................................... 33
Biceps curl........................................................................................... 34
Flexibility exercises......................................................... 35
How much?......................................................................................... 35
Shoulder stretch.................................................................................. 36
Triceps stretch..................................................................................... 37
Pectoral and biceps stretch................................................................ 38
Quadriceps stretch.............................................................................. 39
Calf stretch.......................................................................................... 40
Hamstrings stretch.............................................................................. 41
Lower back stretch ............................................................................. 42
Pelvic floor exercises...................................................... 43
How to find your pelvic floor muscles................................................. 43
How to exercise your pelvic floor muscles.......................................... 44
Seeking support.............................................................. 46
Practical and financial help............................................................... 46
Talk to someone who’s been there...................................................... 46
Caring for someone with cancer................................... 48
Useful websites............................................................... 49
Glossary......................................................................... 50
Why exercise?
Exercise has many general benefits for your physical and mental
wellbeing. It can:
•strengthen muscles and bones and improve circulation
•help you maintain or achieve a healthy weight
•improve your energy levels
•improve your mobility and balance
•improve appearance and self-esteem
•help you cope with stress, anxiety and depression
•provide new opportunities to meet people and socialise
•reduce the risk of, or help manage, high blood pressure, heart
disease, stroke, diabetes, osteoporosis and some cancers.
Australia’s Physical Activity and Sedentary Behaviour Guidelines for
Adults3 urge everyone to move more and sit less. Physical activity
is any activity that gets your body moving and speeds up your
breathing and heartbeat. It includes not only structured exercise
sessions, but also everyday activities such as housework.
Adults should usually aim to be active for at least 30 minutes on
most, preferably all, days of the week. The guidelines recommend a
weekly total of 2½ to 5 hours of moderate-intensity exercise, along
with strength-training (resistance) activities twice a week. It is also
important to break up long periods of sitting as often as you can.
I was not as active before cancer as I am now. I walk
three or four times a week. It gives me extra energy and
helps clear my mind. If I don’t do any walking, I really notice
the difference in my energy levels and my mood.
Rima
4
Cancer Council
Safety tips for exercising with cancer
•If you are going out to
exercise, let someone know
when you will be back or take
a phone with you in case you
become fatigued or unwell.
•Start any new exercise
program slowly, and increase
your activity gradually.
•You may get sore muscles
when you start a new form
of exercise, but the soreness
should go away in a few days.
If it doesn’t, tell your doctor.
•Some symptoms are warning
signs. If you experience any
of the following symptoms
while exercising, stop the
activity immediately and
call 000 for urgent medical
assistance: pain or pressure
in your chest or pain down
your arms; severe shortness
of breath; dizziness or fainting;
irregular or unusually rapid
heartbeat; nausea and/or
vomiting; extreme weakness
or extreme fatigue.
Should people with cancer exercise?
Recent research suggests that exercise benefits most people both
during and after cancer treatment. It can help manage some of the
common side effects of treatment (see pages 8–9), speed up your
return to your usual activities, and improve your quality of life. The
evidence also shows there is little risk of exercise causing harm if
care is taken and professional exercise advice is followed closely. For
some cancers, exercise may even improve treatment outcomes.
People with cancer should be as physically active as their abilities
and condition allow. Some days may be harder than others, but even
a few minutes of light exercise is better than no exercise at all. You
Why exercise? 5
may want to work out two different exercise plans – one for your
good days, and another for those days when you are experiencing
strong side effects.
Talk to your doctor before starting an exercise program,
particularly if you have bone cancer or if you have any persistent
treatment-related side effects, such as lymphoedema (swelling
caused by a build-up of lymph fluid), shortness of breath, nerve
damage, skin irritation, fatigue or pain. Your doctor can advise
whether you need a modified exercise program.
See pages 8–9 for some general information about the impact of
exercise on common side effects of cancer treatment. If you have
severe anaemia, high fever or severe weight loss, your doctor may
recommend you delay starting an exercise program until your
condition improves.
To help your doctors and exercise professionals fine-tune your
exercise program, you could try keeping a diary to record your
physical activity, other activities (such as work or socialising),
and side effects. Over time, this will help them recommend the
best exercise program for you. See page 13 for ways you can
track your physical activity.
If you are already very active at the time of the cancer diagnosis,
talk to your doctor and an exercise professional (see page 11) about
how you can retain your fitness during and after treatment.
6
Cancer Council
Question checklist
You may find this checklist helpful when thinking about the
questions you want to ask your doctors and exercise professionals
about exercise during or after cancer treatment. If they give you
answers that you don’t understand, ask for clarification.
Questions for your doctors
•Can I exercise while I’m
having this treatment?
•Are there any types of
exercise I should avoid?
•I have a port/PICC line
and/or chemo pump. What
precautions should I take?
•I haven’t exercised much
before. Do I need to have any
general health checks first?
•Can you recommend an
exercise professional who
has experience helping
people with cancer?
Questions for your exercise professionals
•What are your qualifications?
•How will I know that I
Are you accredited? By
which organisation?
am doing the exercises
correctly?
•Have you completed any
•What should I do if I feel
training focused on exercise
for people with cancer?
•Can you talk to my medical
team about my exercise
program?
•What will you consider
when preparing an exercise
program for someone with
my medical history?
pain when exercising?
•Can I start slowly?
•What if I feel too unwell
to exercise?
•How long might it be before
I start to see some benefits
from this exercise program?
•How many appointments
are we likely to need?
Why exercise? 7
Treatment side effects and exercise
Cancer treatment causes a range of physical effects that are different for different
people. Exercise has been shown to help people cope with many of the common side
effects, including fatigue, feeling sick (nausea), loss of appetite, anaemia, depression
and anxiety, weight changes and loss of muscle tone. Some side effects need extra
care if you are starting an exercise program.
Z
Z
Z
Lymphoedema
Starting an exercise program early in
treatment may lower the risk of developing
lymphoedema. For those with lymphoedema,
regular exercise can reduce the severity of
the condition and its symptoms.
Fatigue
Many people experience fatigue
(feeling tired even when rested)
during and after cancer treatment.
Carefully monitoring your condition
and making adjustments to the
exercise intensity and duration can
help manage fatigue. It is important
to keep doing some low-intensity
exercise during times of excessive
fatigue (unless you have severe
anaemia, see opposite page). You
may find that shorter, more frequent
sessions are more manageable. By
stopping all activity you risk losing
fitness and strength, which can
make the fatigue worse.
8
Cancer Council
Compromised immunity
Some cancers and treatments stop the
immune system from working properly
for a time. When your white blood
cell count is low (neutropenia), there is
an increased risk of infection, so it
is important to limit physical contact
with other people and clean any shared
equipment before use. When your
immunity is severely compromised,
gyms, swimming pools and training
venues should be avoided.
Anaemia
Low red blood cell and/or haemoglobin
count is another common side effect of
cancer treatment. Symptoms of anaemia
include unexplained tiredness and fatigue.
Combined with good nutrition, exercise has
been shown to improve anaemia. For mild
or moderate anaemia, try a low-intensity
exercise program, with gradual increases in
intensity and/or duration. However, in cases
of severe anaemia (when a blood test shows
a haemoglobin level of less than 80 g/L),
consult your doctor about whether you
should avoid exercise until it improves.
Skin irritation
Areas of skin affected
by radiotherapy can be
extremely sensitive and
often uncomfortable.
Choose activities and
clothing to minimise fabric
rubbing affected areas.
Chlorine can be irritating, so
avoid pool-based exercise
if your skin has a rash or is
reddened after radiotherapy.
Poor balance and
coordination
If the cancer or its treatment
has affected your coordination
or causes dizziness, it is safer
to avoid exercise that relies
on balance and coordination,
such as cycling outdoors or
using a treadmill. It is also best
not to lift free weights without
a training partner.
Bone weakness
or pain
Some hormone treatments
for breast and prostate
cancer can increase the
risk of fractures, as can
osteoporosis (bone thinning)
or primary or secondary bone
cancer. In these cases, it is
best to avoid contact sports
and high-impact activities
such as running and jumping.
Why exercise? 9
Getting started
After a cancer diagnosis, some people decide to make big changes
to their lifestyle. Others take a more gradual approach. You will
find the way forward that is right for you.
Before taking part in any exercise program, either during or soon
after your treatment, it is important to talk with your oncologist or
general practitioner (GP) about any precautions you should take.
If it has been a while since you have been active or your fitness
level is low, start slowly and build up gradually. For example, you
might start by doing 5–10 minutes of walking three days per week,
and add a bit more every week until you have worked your way up
to 30 minutes of walking five days per week.
Exercise equipment
You don’t need expensive equipment or special clothing to
exercise, but appropriate shoes are vital. A podiatrist or reputable
shoe shop can recommend shoes that will help you avoid injury.
Wear loose, comfortable clothes, such as shorts and a T-shirt, when
you are exercising. Other equipment, such as heart rate monitors
and home-gym systems, can be useful but are not necessary.
If you are exercising outside, remember to be SunSmart: slip on
sun-protective clothing, slop on SPF 30+ sunscreen, slap on a
broad-brimmed hat, seek shade, and slide on some sunglasses.
By law, cyclists also need to wear an approved safety helmet.
10 Cancer Council
Exercise professionals
Starting an exercise program can feel overwhelming. You may
have lots of questions. It is important to realise that personal
trainers and exercise scientists are trained to work with people
who do not have any major health issues. People affected by
cancer should see an exercise physiologist or a physiotherapist.
Exercise physiologists – Also called Accredited Exercise
Physiologists (AEPs), these allied health professionals have
completed at least a four-year university degree. Because they
concentrate on using exercise as medicine to help with injury
and chronic disease management, they are the most appropriate
exercise professionals to advise people affected by cancer.
Physiotherapists – These are allied health professionals who
have completed at least a four-year university degree. They often
concentrate on preventing and treating injuries using a variety
of treatment methods, including exercise, massage, and joint
manipulation. They can also advise people affected by cancer.
Medicare or your private health fund may provide limited cover
for visits to an exercise physiologist or a physiotherapist. Ask your
GP for a referral to an exercise professional, or use the Exercise &
Sports Science Australia website at essa.org.au.
Your exercise physiologist can work with you and your doctor to
develop an exercise program tailored for you. Many structured
exercise programs offered at venues such as gyms will ask you for
a medical clearance before starting.
Getting started 11
Choosing an exercise program
Physical activity need not be costly or inconvenient. The exercise
program that is right for you will depend on your current fitness
level, what you want to do, and what your doctor says is safe for you.
If you enjoy an activity, you are more likely to stick with it. To stay
motivated, you could ask a friend or family member to join you.
Exercise at home and outdoors
Home-based exercise and outdoor exercise are excellent ways to
include physical activity in your daily routine. You can try aerobic
activities such as walking, cycling or swimming, along with some
strength-training exercises (see pages 20–34). If you haven’t
exercised much before or are unsure about what you can safely
do, talk to your GP about a referral to an exercise professional.
Attend a group exercise program
Many gyms and fitness centres run group exercise programs.
When joining, let your gym know that you have cancer, and ask
if they have someone who can help to ensure that the exercise
program is right for you.
An exercise professional should conduct an initial consultation
and functional assessment so that the group exercise program is
tailored for your abilities and condition. Ideally, this person will be
an exercise physiologist accredited with Exercise & Sports Science
Australia. You can search for an accredited exercise physiologist
(AEP) by name, location or specialty at essa.org.au. To find an
appropriate group exercise program, ask your GP for a referral
or call Cancer Council 13 11 20.
12 Cancer Council
Mix it up
You might choose a mix of exercising at home or outdoors
and attending a group program. The structure and safety of a
supervised program can be a great place to start, while your own
activities can keep things interesting. Another option is to join
a sporting club. Belonging to a group provides a social outlet as
well as physical benefits, and often helps with motivation.
Keep track
Some people are motivated by recording their physical activity
and tracking their progress. There are a number of ways to do this:
Exercise diary – Record every day’s physical activity in a paper
diary or calendar. List the activity type, intensity and duration.
Online – Websites such as myfitnesspal.com allow you to record
your food intake and exercise sessions for free.
Apps – Free smartphone apps such as Runkeeper or MyFitnessPal
track your movement if you keep your phone on you while you are
exercising, or you can record your activity later.
Gadgets – Also called wearables, devices such as those from
Fitbit and Jawbone are worn like a watch. They can track your
activity and transfer the data to your smartphone or computer.
Telephone support program – Your local Cancer Council may
provide information on telephone health coaching for people who
have completed cancer treatment – call 13 11 20 to find out more.
Getting started 13
What should I eat?
Eating well means giving your
body the food it needs to
keep working properly. Cancer
and its treatment place extra
demands on your body, so
eating well is more important
than ever.
There is no special eating plan
that can cure cancer and,
in most cases, there are no
special foods or food groups to
eat or avoid if you have cancer.
For most people living with
cancer, the best approach is
to eat a wide variety of foods
from each of the food groups
every day. It is also important to
stay hydrated during and after
exercise. Have a water bottle
nearby when you are exercising
and take regular small sips.
Cancer Council has a Nutrition
and Cancer booklet. Call
13 11 20 to order a free copy,
or download it from your local
Cancer Council website.
Exercise sessions
To help avoid injury, it is important to begin each exercise session
with a warm-up and finish with a cool-down.
Warm-up
The aim of warm-up activities is to make your muscles warm and
ready to work, and to raise your heart rate slightly. This prepares
your body for your exercise session.
A warm-up should include 5–10 minutes of low-intensity aerobic
work mixed with some light stretching. Walking outside or using
indoor equipment are good warm-up activities. Before strength
training, it is a good idea to use light weights in your warm-up.
14 Cancer Council
Training
Training is the part of an exercise program when the work is done.
Different types of training have specific effects on your body. A
well-rounded weekly exercise program should include a variety of
activities from the three types of exercise:
•aerobic exercises – these raise your heart rate during the
activity and improve heart and lung fitness, see pages 18–19
•strength-training exercises – also known as resistance or
weight-training exercises, these use weights (including your own
body weight) or a form of resistance to strengthen your muscles,
see pages 20–34
•flexibility exercises – these use stretching to lengthen muscles
and tendons, see pages 35–42.
It is also important to exercise your pelvic floor muscles several
times a day, particularly if you have bladder or bowel issues, such
as leaking or incontinence, see pages 43–45.
Cool-down
The cool-down allows your heart rate and blood pressure to gently
return to normal. Also, a slow cool-down helps your body and
muscles lose the heat gained during the activity.
A cool-down should involve 5–10 minutes of relaxed activity
and/or light stretching.
If you have just finished an aerobic exercise session, slow walking
or cycling is the best way to cool down. If you have done strength
training, cool down with light stretching.
Getting started 15
Muscle groups
These diagrams show the major muscle groups of the human body. Aerobic
exercise focuses on improving your heart and lung fitness, but also works many
of your body’s muscles. Strength-training and flexibility exercises both focus on
the muscles, with individual exercises usually targeting specific muscle groups.
Shoulder
Deltoids
Chest
Pectorals
Upper arm
Biceps
Side*
Obliques
Front of thigh
Quadriceps
* Core muscles
16 Cancer Council
Stomach*
Abdominals
Forearm
Wrist flexors and
extensors
Exercises key
The strength-training
and flexibility exercises
on pages 20–42 indicate
which muscle groups are
worked by each exercise
and whether it uses
any equipment. Some
exercises include easier
or harder variations.
The exercises in this booklet cover a range of muscle groups (see key
below). An exercise professional can help you plan a weekly program
that covers all the muscle groups and concentrates on any areas that
need particular attention.
Upper back
Shoulders
Trapezius
Deltoids
Middle back
Back of arm
Latissimus dorsi
Triceps
Lower back
Erector spinae
Buttocks
Gluteals (glutes)
Back of thigh
Hamstrings
Look for these symbols
on the exercises:
Muscle group
Calf
Equipment
Ankle flexors
and extensors
Make it easier
Make it harder
Getting started 17
Aerobic exercise
Aerobic exercise uses large muscle groups and causes your
heart rate to rise during the activity. Heart and lung fitness are
improved, and strenuous tasks become easier.
Popular forms of aerobic exercise include walking and cycling,
but everyday activities such as digging in the garden also count.
You can also build aerobic exercise into your daily routine, for
example, by always walking up stairs instead of using a lift;
parking some distance from your destination and walking the
rest of the way; or riding a stationary bike while watching TV.
Types of aerobic exercise
•Aerobics/cardio
classes
•Aquarobics
•Boxing training
•Bushwalking
•Cleaning
•Cycling
•Dancing
•Gardening
•Golf
•Jogging
•Lawn mowing
•Rowing
•Running
•Swimming
•Team sports
•Tennis
•Walking
How much?
You need to find a balance between not working hard enough and
working too hard. If you do not work hard enough, you may not
achieve your exercise goals. If you work too hard, you risk injury.
Exercise at a level you are comfortable with, but try to vary the
duration and intensity (see box opposite for an explanation
of exercise intensity).
18 Cancer Council
Adults should aim for at least 2½ hours of moderate-intensity
aerobic exercise per week (or 1¼ hours of vigorous-intensity aerobic
exercise per week). If you have just completed cancer treatment,
this may seem ambitious, but it is a goal to work towards steadily.
Remember that some exercise is better than none.
For extra health benefits, you can exercise beyond this
recommendation by gradually increasing the frequency and
duration of your exercise sessions and then increasing exercise
intensity. If you were very fit before your cancer diagnosis, your
goal may be to maintain or return to your weekly activity levels.
Measuring exercise intensity
How hard your body is working during physical activity is known
as exercise intensity and is often described as low, moderate or
vigorous. There are different ways to measure the intensity of your
aerobic exercise. A simple method is the talk test.
How easy is it to talk?
Exercise intensity
You are able to sing
Light
You can carry on a conversation
but need to pause for breath
from time to time
Moderate
You are huffing and puffing and
keeping conversation short
Moderate to vigorous
You find it difficult to speak
Vigorous
Aerobic exercise 19
Strength-training
exercises
Strength training uses weights or resistance to increase the strength
and endurance of your muscles, as well as the strength of your
bones. It is sometimes called resistance training or weight training.
The weights used in strength-training exercises include:
•your own body weight – as in push-ups and squats
•free weights – such as dumbbells and barbells, which you hold,
or wrist and ankle weights, which you attach with straps
•weight machines – devices that have adjustable seats with
handles attached to either weights or hydraulics
•elastic resistance bands – sometimes called TheraBands, these
are like giant rubber bands that provide resistance when stretched;
they are colour-coded according to the level of resistance.
An exercise professional can advise which weights and bands you
should use. As a general guide, women might start with hand
weights of 1 kg each and men might start with 2 kg. Once you can
do 10–12 repetitions of an exercise easily and without strain, you
can gradually add extra weight or use tighter bands.
You can buy free weights and resistance bands at sporting goods
stores and some major retailers. Some people make hand weights
from everyday objects, such as plastic bottles filled with water or
sand. If you try this, use scales to check they are equal weight.
Some simple strength-training exercises are shown on the
following pages. You may want to begin with exercises to develop
your balance (see page 22) and strengthen your core muscles (see
pages 23–25) and then progress to the other strengthening exercises.
20 Cancer Council
How much?
Try to do 2–3 sessions of strength training each week, on every
other day. It is important to have rest days between the sessions.
Strength-training exercises involve a number of variables:
•repetition – the completion of an exercise from starting
position, through the movement, and back to the start
•set – a series of repetitions
•rest – the time between sets.
During each training session, you will complete a number of sets
of different exercises. An exercise professional can help design the
best program for you. As a guide, you might aim for 6–9 different
exercises per session and choose exercises that target the major
muscle groups of the arms, legs and torso (see pages 16–17). For
each of the exercises in a session, you might do:
•6–12 repetitions of the exercise per set
•1–4 sets of the exercise per session
•60–90 seconds of rest between sets.
A program should challenge your muscles without straining them,
so that may also guide how many repetitions you do in a set to
begin with. Once you become comfortable with a program, you
can make it more demanding, but do this by small increases.
Check with your health care team before starting any new exercise
program. Although we have provided strength-training exercises to
suit most people, some of them may not be right for you.
Strength-training exercises 21
One-leg balance
Overall balance
1
2
Stand on a soft but firm
surface, such as an
exercise mat or carpet.
Slowly bend one knee to
lift the foot off the ground
so that you are balancing
on the other leg. Keep
your eyes on a fixed point
in front of you and breathe
slowly and deeply. Hold
the pose for several
seconds if you can.
3
Lower your leg and
put your foot back
on the ground. Repeat
the exercise with the
other leg.
You may want to start near a chair or wall so you can steady yourself.
For a challenge, put your hands on your head as you balance and/or close your eyes.
22 Cancer Council
Clamshell
Core (torso and pelvis)
1
2
Lie on your back with
knees bent and your feet
flat on the floor about
hip width apart. Place
your hands on your lower
abdomen and lift your
pelvic floor muscles
(see pages 43–45). Keep
breathing normally.
Slowly lower one knee
out to the side, without
moving the hips. Hold
for 15–30 seconds.
3
Return to starting
position. Repeat with
the other knee.
Strength-training exercises 23
Pelvic tilt
Core (torso and pelvis)
1
Lie on your back
with your knees bent
and your feet flat
on the floor about
hip width apart.
24 Cancer Council
2
Flatten your back by
tightening the muscles
in your abdomen
and buttocks. This
will tilt your pelvis
up slightly. Hold for
several seconds.
3
Relax the muscles
and rest for a few
seconds, then repeat
the pelvic tilt.
Bird-dog
Core (torso and pelvis)
1
2
Start on all fours, with
legs hip width apart,
knees directly under
hips, hands directly
under shoulders, and
back in a straight
line. Do not lock the
shoulders.
Keeping your back flat
and steady, extend one
leg while supporting
the torso with both
hands on the floor. Once
balanced, slowly extend
the opposite arm. Pause
for 5–10 seconds.
3
Maintain normal
breathing. Slowly return
to all fours. Change
sides and repeat the
bird-dog pose.
If you find it hard to keep your balance, leave both hands on the floor and just extend one leg at a time. The bird-dog can also be performed lying over a fitball, which can be
a useful alternative for people with bad knees who find it difficult to kneel.
Strength-training exercises 25
Standing push-up
Chest and shoulders
1
Stand with your feet
shoulder width apart.
Lean slightly against
the wall with your
arms outstretched at
shoulder height and
your hands on the
wall. Do not lock your
elbows or knees.
26 Cancer Council
2
Slowly move your
body towards the wall,
bending your arms at
the elbow.
3
Once your nose is
close to the wall, push
away, against your body
weight. Breathe out as
you push back to the
starting position. Repeat
the standing push-up.
Modified push-up
Chest, shoulders and arms
1
2
Start with your knees
and hands on the
floor and your arms
extended. Keep your
back and bottom as
straight as possible,
and keep your head in
line with your spine.
Lower your torso slowly,
bending your arms at
the elbow.
3
Push up – try not to lock
your elbows at the top.
Breathe out as you push
back up to the starting
position. Repeat the
modified push-up.
If you feel any pain in your back doing this exercise, bring your hands closer to your body.
Strength-training exercises 27
Calf raise
Calves (back of lower leg)
1
2
Stand upright, with a
wall or chair as support
if necessary.
28 Step, hand weights (optional)
Lift your heels off the
ground, keeping your
knees and body straight.
Breathe out while lifting.
3
Hold the position for a
moment. Return to the
starting position, then
repeat the calf raise.
Increase the difficulty slightly by standing with the balls of your feet on a small step
(so that your heels hang over the edge) and/or holding weights in your hands. You can
also add challenge by doing the exercise one leg at a time.
Cancer Council
Standing row
Shoulders, back and
triceps (back of arm)
1
Elastic resistance band
2
Attach the resistance
band to a fixed point,
ensuring it is well
secured. Stand with
your arms outstretched
at waist height.
Pull the resistance
band by drawing your
elbows backwards and
maintaining hands at
waist height. Breathe out
while pulling the band.
Make sure your spine
does not move, but keep
your neck and upper
shoulders relaxed.
3
Slowly return to the
starting position, then
repeat the standing row.
Strength-training exercises 29
Chair rise
Quadriceps (front of thigh) and gluteals (buttocks)
1
2
Sit towards the middle or
front of a chair with your
hands on your knees.
30 Stand up, using your
hands on your knees for
assistance if necessary.
Keep your back straight
as you stand up. Breathe
out while standing.
Chair
3
Sit back down slowly,
then repeat the chair rise.
Add a challenge by standing without using your hands to assist, then try with your arms across your chest. When standing unassisted, stand in one movement without rocking.
Cancer Council
Wall squat
Quadriceps (front of thigh) and gluteals (buttocks)
1
2
Stand 30–40 cm from a
wall with feet shoulder
width apart. Slightly bend
your knees and lean back
into the wall, placing your
arms and palms against
the wall. Tilt your pelvis
so your back is flat to the
wall. Tuck your chin in.
Keeping your body in
contact with the wall,
slide down (as if to sit)
until you can feel your
legs working – this may
not be very far. Hold
for 10–30 seconds if
you can.
3
Slowly slide up until you
are back into starting
position, then repeat the
wall squat.
Add a challenge by sliding further down the wall, but stop before the knees go over and in front of the toes (there should be no more than a 90-degree angle between hip and knee).
Strength-training exercises 31
Shoulder press
Shoulders
1
Gymstick, barbell, pole, broomstick
or hand weights
2
Stand with your feet
shoulder width apart.
Hold the bar at chest
height with your elbows
almost completely bent
(so they are almost
touching your sides).
Push the bar up until
it is above and slightly
in front of your head.
Breathe out during the
lift and maintain good
posture – don’t raise
your shoulders.
3
Pause, then lower the
bar back to the starting
position. Repeat the lift.
Increase the difficulty by adding weight or elastic resistance to the bar.
32 Cancer Council
Upright row
Shoulders and trapezius (upper back)
1
2
Stand with your arms
by your side and your
feet shoulder width
apart. Hold the weights
with palms facing
your thighs. Tighten
the tummy muscles
(abdominals).
Bending your arms, raise
both weights slowly
up to shoulder height.
Breathe out when lifting
the weights and avoid
jerking them up. Maintain
your head and neck
position, looking straight
ahead. Feel the exercise
work the muscles in your
shoulders and not in
your neck.
Hand weights
3
Pause, then lower
both weights back to
the starting position.
Repeat the lift.
Strength-training exercises 33
Biceps curl
Biceps (upper arm)
1
Stand with your arms
by your side. Hold the
weights with your palms
pointing forward.
34 Cancer Council
Hand weights, Gymstick or barbell
2
Bend your elbows
to lift the weights to
shoulder height. Keep
your elbows tucked
in, avoid moving your
shoulders and make
sure your body does
not sway. Breathe out
during the lift.
3
Slowly return almost to
the starting position but
do not fully straighten
your elbows – keep
them slightly bent.
Repeat the lift.
Flexibility exercises
Flexibility exercises, also known as stretches or range-of-motion
(ROM) exercises, lengthen muscles and tendons. They improve
or maintain the flexibility of joints and muscles. We naturally lose
joint and muscle flexibility as we get older, but cancer treatments
can also have an impact. Regular stretching helps to overcome
stiffness and can delay any loss of flexibility.
Some simple flexibility exercises that can be done at home are
described on the following pages. You could also join an exercise
class that focuses on stretching, such as a yoga class. Remember
to check with your health care team before beginning any exercise
program. Although we have included flexibility exercises to suit
most people, some may not be right for you.
How much?
Try to do flexibility exercises three to four times a week. Include
stretches for arm, leg and torso (core) flexibility. In each session,
you might do 1–3 sets of 4–6 different stretches.
Tips for stretching
•Warm up your muscles first.
An ideal time to stretch is
during the cool-down phase.
•Maintain good posture, and
stretch slowly and steadily.
Do not bounce.
•Keep breathing normally.
Do not hold your breath.
•Know your limitations – you
should feel a stretch and
possibly mild discomfort, but
you should not feel pain.
Flexibility exercises 35
Shoulder stretch
Shoulders
1
Stand with your feet
about hip width apart.
36 Cancer Council
2
Pull one arm across
your chest. Keep your
elbow just below
your shoulder-line.
Hold the stretch for
15–30 seconds.
3
Repeat the stretch on
the other side.
Triceps stretch
Triceps (back of arm)
1
2
Lift one arm and bend
your elbow with your
forearm down your back.
Using the elbow as a
lever, use your other
arm to gently push
the arm down your
back. Hold the stretch
for 15–30 seconds.
3
Repeat the stretch on
the other side.
Flexibility exercises 37
Pectoral and biceps stretch
Pectoral (chest) and biceps (upper arm)
1
Stand near a wall or
a pole. Raise one arm
out to the side so it is
parallel to the floor, and
hold the wall or pole
with your hand.
38 Cancer Council
2
Without moving your
feet, partially turn your
body away from the arm
that is holding the wall/
pole. Hold the stretch
for 15–30 seconds.
3
Repeat the stretch on
the other side.
Quadriceps stretch
Quadriceps (front of thigh)
1
2
Stand on one leg, with a
wall or chair for support
if necessary.
Hold your foot with your
hand and pull the leg
towards your buttocks
by the ankle. Make sure
you keep your torso
straight. Hold the stretch
for 15–30 seconds.
3
Repeat the stretch on
the other side.
You can use a towel to help bring your foot up towards your buttock. Another option is to do this stretch lying down on your stomach.
Flexibility exercises 39
Calf stretch
Calves (back of lower leg)
1
Stand facing a wall
with your arms straight
and hands flat against
the wall. Step one of
your feet straight back,
placing the heel flat
on the floor.
40 Cancer Council
2
Lean forward against the
wall and partially bend
your front leg. Keep your
back leg (stretching leg)
completely extended
and your foot flat on the
floor – move the foot
backwards until you
feel the stretch. Hold for
15–30 seconds.
3
Repeat the stretch
on the other side.
Hamstrings stretch
Hamstrings (back of thigh)
1
Step or box (about 30 cm high)
2
Stand on one leg with
the other foot on the
step. At first, you may
want to do this near
a wall in case you need
to steady yourself.
Lean forward from the
hips, pushing your chest
towards your knee.
Keep your back straight.
Hold the stretch for
15–30 seconds.
3
Repeat the stretch
on the other side.
For more of a stretch, place the foot of the leg being stretched flat on the step.
Flexibility exercises 41
Lower back stretch
Lower back
1
Sit on a chair or bench.
Keep your feet on the
ground and your knees
partly bent.
42 Cancer Council
2
Curl your torso forward
and hold the stretch for
15–30 seconds.
3
Slowly sit back up and
pause, then repeat
the stretch.
Pelvic floor exercises
Your pelvic floor muscles span the bottom of your pelvis and
support your bowel and bladder, and your uterus if you’re a
woman. As well as providing support, strong pelvic floor muscles
are important for control of urination and bowel movements,
normal sexual function, and stability of the abdomen and spine.
Like other muscles, your pelvic floor can become weak. Factors that
can contribute to this include age, childbirth, constipation, obesity,
chronic cough, heavy lifting, and abdominal or pelvic surgery.
See a physiotherapist or continence nurse before doing pelvic floor
exercises if you:
•have had recent pelvic or abdominal surgery
•have problems with urine or faeces leaking when coughing,
sneezing, laughing or exercising
•often need to go to the toilet urgently
•have difficulty controlling bowel movements and wind
•feel like you haven’t fully emptied your bowel after
bowel movements
•have dragging, heaviness or a bulge in the vagina
•experience a lack of sensation during sex.
How to find your pelvic floor muscles
To identify your pelvic floor muscles, try stopping your urine
stream for a couple of seconds while emptying your bladder. You
use your pelvic floor muscles to do this. Another way is to feel the
muscles you use when you imagine stopping the flow of urine and
holding in wind. This can be done standing, sitting or lying down.
Pelvic floor exercises 43
How to exercise your pelvic floor muscles
Pelvic floor exercises should be done several times a day. You can be
standing, sitting or lying down. You can even do them while watching TV
or waiting at traffic lights. The technique is the same for men and women.
Male
Spine
Bladder
Prostate
Bowel
Pubic bone
Pelvic floor
muscles in men
Anus
Urethra
1
Start by relaxing all of
your pelvic floor and
tummy (abdominal)
muscles.
44 Cancer Council
2
Gently lift your pelvic
floor muscles up
and hold while you
continue to breathe
normally. Try to hold
the contraction for
up to 10 seconds.
3
Repeat the exercise
up to 10 times, with a
rest of 10–20 seconds
between contractions.
Relax your pelvic floor
muscles completely
during the rest periods.
Female
Spine
Bladder
Uterus
Pubic bone
Pelvic floor
muscles in
women
Bowel
Urethra
Anus
Tips for good technique
Poor technique can make pelvic floor exercises ineffective
or even risk injury. Remember these points:
Do not hold your breath.

Do not tighten your tummy above the belly button. Focus on 
pulling up and holding onto urine and wind.
Do not try too hard. You may end up contracting nearby

muscles rather than the pelvic floor muscles themselves. Try
changing positions if you can’t feel the pelvic floor muscles
lifting and squeezing.
Pelvic floor exercises 45
Seeking support
Cancer may cause you to experience a range of emotions, such
as fear, sadness, anxiety, anger or frustration. It can also cause
practical and financial problems.
Practical and financial help
There are many services that can help deal with practical or
financial problems caused by the cancer. Benefits, pensions and
programs can help pay for prescription medicines, transport costs
or utility bills. Home care services, aids and appliances can also be
arranged to help make life easier.
Ask the hospital social worker which services are available in your
local area and if you are eligible to receive them.
If you need legal or financial advice, you should talk to a qualified
professional about your situation. Cancer Council offers free legal
and financial services in some states and territories for people who
can’t afford to pay – call 13 11 20 to ask if you are eligible.
Talk to someone who’s been there
Coming into contact with other people who have had similar
experiences to you can be beneficial. You may feel supported
and relieved to know that others understand what you are going
through and that you are not alone.
People often feel they can speak openly and share tips with others
who have gone through a similar experience.
46 Cancer Council
In a support setting, you may find that you are comfortable talking
about your diagnosis and treatment, relationships with friends and
family, and hopes and fears for the future. Some people say they
can be even more open and honest because they aren’t trying to
protect their loved ones.
Types of support
There are many ways to connect with others for mutual support
and to share information. These include:
•face-to-face support groups – often held in community
centres or hospitals
•telephone support groups – facilitated by trained counsellors
•peer support programs – match you with someone who has
had a similar cancer experience, e.g. Cancer Connect
•online forums – such as cancerconnections.com.au.
Talk to your nurse, social worker or Cancer Council 13 11 20
about what is available in your area.
My family members don’t really understand what it’s
like to have cancer thrown at you, but in my support group,
I don’t feel like I have to explain.
Sam
Seeking support 47
Caring for someone
with cancer
You may be reading this booklet because you are caring for
someone with cancer. Being a carer can be stressful and cause you
much anxiety. Try to look after yourself – give yourself some time
out and share your worries and concerns with somebody neutral,
such as a counsellor or your doctor. Exercise can also help, so the
information in this booklet may be relevant for you too.
Many cancer support groups and cancer education programs are
open to carers, as well as people with cancer. Support groups and
programs can offer valuable opportunities to share experiences
and ways of coping.
Support services such as Home Help, Meals on Wheels or visiting
nurses can help you in your caring role. You can find local support
services, as well as practical information and resources, through
the Carer Gateway. Visit carergateway.gov.au or call 1800 422 737.
Carers Australia is the national body representing carers in
Australia. It works with the Carers Associations in each of the
states and territories. Phone 1800 242 636 or visit their website
at carersaustralia.com.au. You can also call Cancer Council
13 11 20 to find out more about carers’ services and get a copy
of the Caring for Someone with Cancer booklet.
Caring for my mum was deeply emotional. It was
difficult, but it gave me a tremendous sense of caring
and giving.
Sharyn
48 Cancer Council
Useful websites
The internet has many useful resources, although not all websites
are reliable. The websites below are good sources of information.
Australian
Cancer Council Australia��������������������������������������������������cancer.org.au
Cancer Australia................................................ canceraustralia.gov.au
Cancer Connections...................................cancerconnections.com.au
Carers Australia.................................................carersaustralia.com.au
Department of Health������������������������������������������������������� health.gov.au
Department of Human Services
(including Centrelink and Medicare)������������������humanservices.gov.au
healthdirect Australia���������������������������������������������� healthdirect.gov.au
Exercise & Sports Science Australia����������������������������������� essa.org.au
International
American Cancer Society������������������������������������������������������cancer.org
Macmillan Cancer Support (UK)�������������������������������� macmillan.org.uk
National Cancer Institute (US)���������������������������������������������� cancer.gov
Cancer Research UK����������������������������������������� cancerresearchuk.org
Useful websites 49
Glossary
abdomen
The part of the body between the chest
and hips, which contains the stomach,
liver, bowel, bladder and kidneys.
aerobic
Exercises that cause heart and
breathing rates to rise.
anaemia
Deficiency in the number and quality
of blood cells in the body.
anaerobic
Exercises that focus on single muscles
or muscle groups.
biceps
The muscles on the top of the arm
between the elbow and the shoulder.
chemotherapy
The use of cytotoxic drugs to treat
cancer by killing cancer cells or
slowing their growth.
continence
The control over bladder and bowel
movements. See also incontinence.
core stability
The stomach and lower back muscles
that stabilise the body as it moves.
exercise physiologist
A university-trained professional
who specialises in using exercise as
medicine, particularly for people with
medical conditions. Also known as an
Accredited Exercise Physiologist (AEP).
exercise scientist
A university-trained professional who
specialises in designing exercise
programs for healthy people.
50 Cancer Council
flexibility
The range of movement in a joint
(e.g. knee) or series of joints (e.g. leg).
gluteals
The muscles of the bottom.
hamstrings
The muscles on the back of the leg
between the knee and the hip.
incontinence
Inability to control the loss of urine
or faeces.
low intensity
Activity that is easy and doesn’t cause
much exertion.
lymphoedema
Swelling caused by a build-up
of lymph fluid, which can happen
when lymph vessels or nodes don’t
drain properly.
moderate intensity
Activity that isn’t too hard, but is
hard enough to be of benefit.
Breathing and heart rates increase
during moderate-intensity activity.
nausea
Feeling sick or wanting to be sick.
neutropenia
A drop in the number of white blood
cells called neutrophils.
oncologist
A doctor who specialises in the study
and treatment of cancer.
pectorals
Muscles on the front of the upper
chest, behind the breasts in women.
pelvic floor exercises
Exercises to strengthen the muscles
that control the bladder and bowel.
personal trainer
A person who can plan and supervise
exercise programs, but has not been
trained to prescribe exercise for people
with chronic medical conditions.
physiotherapist
A university-trained professional who
treats injury, disease or disability with
physical methods such as massage
and exercise.
platelets
Blood cells that help the blood to clot
and stop bleeding.
quadriceps
The muscles on the front of the leg
between the knee and the hip.
radiotherapy (radiation therapy)
The use of radiation, usually x-rays
or gamma rays, to kill cancer cells or
injure them so they cannot multiply.
red blood cells
Blood cells that carry oxygen around
the body.
strength training
Using muscles to move weight with the
aim of increasing muscle strength. Also
called resistance or weight training.
trapezius
The muscles of the upper back.
triceps
The muscles on the back of the arm
between the elbow and the shoulder.
vigorous intensity
Hard exercise that can usually only
be done for short periods of time.
white blood cells
Blood cells that help fight infection.
Can’t find a word here?
For more cancer-related words, visit:
• cancercouncil.com.au/words
• cancervic.org.au/glossary
• cancersa.org.au/glossary.
References
1. LM Buffart et al., ‘Evidence-based physical activity guidelines for cancer
survivors: Current guidelines, knowledge gaps and future research directions’,
Cancer Treatment Reviews, vol. 40, no. 2, 2014, pp. 327–40.
2. SC Hayes et al., ‘Australian Association for Exercise and Sport Science
position stand: Optimising cancer outcomes through exercise’, Journal of
Science and Medicine in Sport, vol. 12, no. 4, 2009, pp. 428–34.
3. Australian Government Department of Health, Australia’s Physical Activity and
Sedentary Behaviour Guidelines for Adults (18–64 years), Commonwealth of
Australia, Canberra, 2014.
Glossary 51
How you can help
At Cancer Council, we’re dedicated to improving cancer
control. As well as funding millions of dollars in cancer research
every year, we advocate for the highest quality care for cancer
patients and their families. We create cancer-smart communities
by educating people about cancer, its prevention and early
detection. We offer a range of practical and support services for
people and families affected by cancer. All these programs would
not be possible without community support, great and small.
Join a Cancer Council event: Join one of our community
fundraising events such as Daffodil Day, Australia’s Biggest
Morning Tea, Relay For Life, Girls’ Night In and Pink Ribbon Day,
or hold your own fundraiser or become a volunteer.
Make a donation: Any gift, large or small, makes a meaningful
contribution to our work in supporting people with cancer and
their families now and in the future.
Buy Cancer Council sun protection products: Every purchase
helps you prevent cancer and contribute financially to our goals.
Help us speak out for a cancer-smart community: We are a
leading advocate for cancer prevention and improved patient
services. You can help us speak out on important cancer issues
and help us improve cancer awareness by living and promoting
a cancer-smart lifestyle.
Join a research study: Cancer Council funds and carries out
research investigating the causes, management, outcomes and
impacts of different cancers. You may be able to join a study.
To find out more about how you, your family and friends can
help, please call your local Cancer Council.
52 Cancer Council
Cancer Council
13 11 20
Being diagnosed with cancer can be overwhelming. At
Cancer Council, we understand it isn’t just about the treatment
or prognosis. Having cancer affects the way you live, work and
think. It can also affect our most important relationships.
When disruption and change happen in our lives, talking to
someone who understands can make a big difference.
Cancer Council has been providing information and support
to people affected by cancer for over 50 years.
Calling 13 11 20 gives you access to trustworthy information
that is relevant to you. Our cancer nurses are available to answer
your questions and link you to services in your area, such as
transport, accommodation and home help. We can also help
with other matters, such as legal and financial advice.
If you are finding it hard to navigate through the health care
system, or just need someone to listen to your immediate
concerns, call 13 11 20 and find out how we can support you,
your family and friends.
Cancer Council services and programs vary in each area.
13 11 20 is charged at a local call rate throughout Australia (except from mobiles).
If you need information
in a language other
than English, an
interpreting service is
available. Call 13 14 50.
If you are deaf, or have
a hearing or speech
impairment, contact us
through the National
Relay Service.
www.relayservice.gov.au
EXERCISE FOR PEOPLE LIVING WITH CANCER
For information and support
on cancer-related issues,
call Cancer Council 13 11 20.
This is a confidential service.
Visit your local Cancer Council website
Cancer Council Queensland
cancerqld.org.au
Cancer Council Victoria
cancervic.org.au
Cancer Council NSW
cancercouncil.com.au
Cancer Council SA
cancersa.org.au
Cancer Council WA
cancerwa.asn.au
Cancer Council NT
nt.cancer.org.au
Cancer Council Tasmania
cancertas.org.au
Cancer Council Australia
cancer.org.au
This booklet is funded through the generosity of the people of Australia.
To support Cancer Council, call your local Cancer Council or visit your local website.
APR 2016 CAN4152
Cancer Council ACT
actcancer.org
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