Published 8 July 2019. Reviewed 16 September 2022.

From the Ovacome Magazine Summer 2019

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In recent years there has been a significant shift from believing that rest is best during and after cancer treatment to experts suggesting that exercise should be prescribed as part of a recovery care package. Former oncology nurse and cancer exercise specialist Lizzy Davis explains why.

If you heard of a wonder drug which could instantly re-energise you, lift your mood and even lessen the chances of your cancer coming back, with no side effects when taken properly, it would be mad to not want to try it.

Well, says Lizzy Davis, a former oncology nurse at The Royal Marsden with 25 years clinical experience behind her, that drug - which also protects against other health conditions - is readily available to everyone and you don’t have to jump through the normal hoops to get it: it is exercise.

“To me exercise is medicine and increasingly health professionals are taking this on board,” says Lizzy. There are so many benefits, she explains, from helping with nausea, fatigue, peripheral neuropathy, lack of appetite and bone thinning, to improving self esteem and reducing anxiety.

“We need to see exercise as medicine for the whole body, improving our inner terrain and getting everything to work really well. It provides resilience for the brain as well as the body. Exercise dosed according to our fitness ability and taking into account issues from treatment and former injuries, will have only positive side effects,” she enthuses.

There are numerous ways of easing yourself into a realistic regime that is attainable and enjoyable for you, says Lizzy, who now runs the cancer rehabilitation exercise business, CanExercise.

“On the days that you can’t face getting up,” she says, “try stretching or breathing techniques from your bed or on the sofa. Just a minute or two of exercise, say walking to the kitchen and back a few times, will make all the difference. If you go outside, don’t go out of sight of the house so there is always an element of safety, knowing that you can get back.”

It is about pushing yourself as you feel able and not to be afraid when you are fresh out of treatment to take the plunge. “One of the best things is to start walking and building the confidence between our heads and bodies. If three or four days you do nothing then it is quite hard to move on. Even just something every hour just gives you something in the bank.

“There’s no need to do an hour body pump class, you will benefit from just pushing your grandchildren or kids on the swing,” says Lizzy. “You can still get fit, build strength and feel amazing without feeling agonising pain or burn. There are lots of apps to download for a five or 10 minute workout, modify exercise to work for you, if you can’t do a deep squat do a little one.”

Of course, it is important to be mindful while recovering from treatment and of any injuries. For instance, somebody on steroids should be aware not to overdo things because their body feels able to with a fake high. “At any stage during treatment, excercise should be tailored around energy and side effects post surgery,” says Lizzy.

Lizzy says there are numerous examples of how exercise can specifically help women diagnosed with ovarian cancer:

• In the early days after a hysterectomy, gentle stretching and exercises re-engaging the breath to breathe properly are recommended. “This gets that core awareness and wakes up those deep tummy muscles, while getting the body mobilised,” says Lizzy. Women should move on to exercises for mobility, their deep abdominal core muscles and pelvic floor, progressively introducing walking. The physiotherapist you see after surgery will be able to advise you.
• If your treatment has led to lymphoedema - when lymphatic fluid collects in the legs and causes swelling - Lizzy suggests an ankle mobilisation programme of toe flexing and pointing, laying on the bed cycling the legs in the air and using an abdominal breathing technique and connective breath work “to move the lymphatic system”. You should always talk to your lymphoedema specialist for individual advice on exercise.
• For bone pain, which could be caused by letrozole, for example, regular, but smaller and gentler sessions of exercise to promote blood flow as well as swimming can help, says Lizzy. But back off if you get any red flag warnings of increased pain.
• If you have a stoma, this is no reason why you should not exercise and even swim, says Lizzy, who has been working on a trial with UCLH and Bowel Cancer UK into what is safe for this group of people. “It’s always been a grey area, but by focusing on core work, stretching and getting the deep tummy muscles engaged has proved that people with a stoma can do really well with exercise,” says Lizzy. Your stoma nurse will be able to advise you on this.
• To prevent further bone thinning, resistance training with weights or your body weight is effective, as well as low impact work such as walking up and down the stairs. High impact exercise should be avoided.
• If you have scar tissue, stretching and balance - two of the most neglected areas of exercise, says Lizzy, - can help. You can stretch in the shower, or you can balance on one leg and make circles with your feet while waiting for the kettle to boil.

The target is to meet Department of Health guidelines, which urge people to avoid being sedentary and to be active every day, with at least 150 minutes of moderate intensity activity each week. Two to three sessions each week focusing on muscle build strength training is also “super important”, says Lizzy, with something like yoga doing the trick.

“Strength training is a must. Building more lean muscle mass burns more calories: the gift that keeps on giving! It can really help to reduce body fat and increase muscle mass,” says Lizzy.

Consistency and frequency are the most important thing, says Lizzy. Fit exercise in around your daily routine by walking up stairs instead of taking the lift, for example. And if you need to, break those guideline five chunks of 30 minute exercises into smaller more manageable slots, still amounting to the 150 minute total.

You will never regret having done exercise, concludes Lizzy. “You will always come back saying you feel better. It can put the spark back into your sex life as body image, confidence and energy levels improve, and it can relax you too. In a nutshell it is a wonder drug.”

Always talk to your medical team or specialist nurse before starting any new exercise during treatment. They can also refer you to a specialist physiotherapist for expert advice. Your GP may also be able to refer you to community programmes.