“We do not stop exercising because we grow old – we grow old because we stop exercising.”
– Dr. Kenneth Cooper, founder of the concept of aerobic exercise for health
The purpose of an exercise program is to improve or maintain fitness, health status, and ability to function independently. Exercising increases confidence in your body after cancer treatment, by allowing you to exert control over what you do and how you move. If you have been treated for cancer, always get clearance from your oncologist and any other doctors or surgeons involved in your treatment before you begin an exercise program (Irwin, 2012).
This module is designed to give you an overall understanding of the basic concepts and components of an exercise program that will be effective in providing health benefits without injury. Exercising for performance in a sport or activity is beyond the scope of this section.
Defining the dimensions of fitness
What is fitness anyway? Physical fitness is simply being in an adequate state of health to be able to perform whatever task you are trying to do.
To be more specific, when we talk about fitness here, we are talking about being healthy enough to function independently and avoid placing yourself at undue risk for additional health problems or recurrence of cancer.
Fitness is a broad topic, but we can break it down into different aspects of health-related fitness, including flexibility, strength, balance, cardio-respiratory endurance, and function (Bryant, Green & Merrill, 2013).
Flexibility is the ability to move joints through a full range of motion. It is usually achieved through stretching. Stretching makes all movement easier. It increases range of motion, prevents injuries like muscle strains, and when done after a warm-up, it prepares your body for activity and helps circulation.
Many people make the mistake of stretching before their bodies are warmed up. You should always do 5 to 10 minutes of light activity before stretching, to reduce the chance of injuring your muscles.
Stretches should be held for at least 30 seconds, with no bouncing. You should feel a mild stretch but never force a stretch to a point of discomfort or pain. Always breathe normally during the stretch. For areas of general tightness, gently repeat the stretch. If you suspect that you have strained something (“pulled a muscle”), DO NOT attempt to stretch it out. This increases the chance that you will tear the muscle fibers further. It is better to rest that muscle instead of stretching it.
Strength training decreases the chance of injury to bones, muscles, and other soft tissue. It preserves function, prevents muscle loss and loss of lean body mass, increases your metabolic rate, builds bone mass to prevent bone loss, and improves balance, posture, and endurance.
Always warm up and stretch before beginning strength training. Never hold your breath; always breathe throughout an exercise. Exhale while raising the weight and inhale while lowering it. If using weight equipment, you should have someone spot you for safety. Move slowly and smoothly, raising the weight and lowering it over approximately twice as much time as it took to raise it.
Weight train two to three times per week, doing about 12-15 repetitions of each set. Refer to the Cancer Harbors module on Understanding the Language of Exercise for clarification on these terms. Cool down and stretch at the end of your workout. If the last two or three reps of a set are easy to complete, it is time to slightly increase the weight (no more than 10% at a time). It’s best to train the largest muscles first and move to the smaller muscles. (Start with upper legs, chest, and back, then move on to shoulders, calves, arms, and abdominals.)
Balance training prevents falls and injuries, improves posture, builds strength in the core muscle groups, and promotes independence, especially for older adults. Yoga is good for strength flexibility and balance. Pilates is also good for flexibility, balance, and core strength. Always have someone stand close by when doing balance exercises, or have a sturdy, stable object within arm’s reach that will support your body weight if you lose your balance.
Endurance is simply the ability to perform an activity for a desired amount of time. Cardio-respiratory endurance (sometimes called “cardio”) is the ability to perform an activity that challenges the heart and lungs to work harder, which improves overall health.
Cardio exercise should be done five days a week, at a moderate intensity, which means at approximately a 6 on a scale of 0 to 10 in difficulty. It should be hard enough that you break a sweat, but you should still be able to carry on a conversation. You should be able to talk continuously with a little deeper breathing.
It is a fine line, but if you need to take extra breaths to finish a sentence, then you are working too hard. If you are an athlete or trying to improve your fitness level beyond beginner status, you can work at a 7 or 8 out of 10 during planned workout sessions, but that is beyond what we are discussing here. Exercise at a pace that feels comfortable for you and keeps your effort at the proper level for an amount of time adequate to produce an improvement in endurance.
At lower intensities, around 6 out of 10 and below, fats are the major fuel burned. At higher intensities (generally 7 and above), more glycogen (a stored form of carbohydrate) is burned.
Do 30 minutes or more of cardio activity 5 days a week. If this seems like a lot, work it in gradually. That’s 150 minutes a week, which is a minimum recommendation for health by the American Heart Association and government health agencies. It needs to become a habit, a regular part of your day, like eating, sleeping, and brushing your teeth. You’d be surprised how many places you can fit it in. For example, if you do any TV watching at all, you have just found the time!
Thirty minutes is a minimum recommendation for health, but it is NOT enough. You can’t expect to be sedentary the other 23½ hours of the day and be healthy!
Do not exercise if you have shortness of breath or chest pain, but should seek medical attention immediately. If you have cardiovascular disease or any heart or lung problems, get a physician’s clearance to exercise before you start.
Warm up, do gentle stretching before the activity, keep your effort at 6 on a scale of 0 to 10 for at least 30 minutes, then cool down, and stretch again.
Functional fitness refers to being able to perform normal daily activities independently, without the need for help. Opening a jar, climbing a flight of stairs, lifting a package from the front doorstep, and pulling a door open to enter a store, are typically independent tasks.
Functional fitness consists of five basic movements: pulling, pushing, lifting objects, rotation (or twisting), and stepping forward. The entire FIERCE video library contains functional activities, described in the beginning of each video.
Wear proper clothing and shoes for any activity. Moisture-wicking fabrics and layers are better than cotton and heavy sweat suits. Dress appropriately for the weather if exercising outside.
“There is no such thing as bad weather, only bad clothing choices.”
-Sir Ranulph Fiennes, World-Renowned Explorer
You can exercise outdoors year-round in most parts of the United States. Be careful of icy surfaces and be sure you are visible. Wear reflective clothing in traffic and use caution in choosing where you work out.
Sturdy shoes are most important! Consult with a specialty shoe store to get the right type of shoe for your activity. You rely on your feet for everything; do not skimp on shoe quality. You should have a small amount of room between your feet and the toe box of the shoe, even when the shoe is new. The shoe should not crowd or squeeze your feet or toes together. Breaking in the shoe will soften the material of the upper, but will not stretch it to accommodate feet that are already touching the edges. Try a half size bigger if your feet are crowded in a new shoe.
Use caution with shoes that feel too lightweight or flimsy, and beware of sales gimmicks. There should be solid, sturdy material used to make the shoe and it should provide support while you walk around in it at the shoe store. Just because a shoe is brightly colored, has unusual features, or is marketed with claims of being unique does not mean it is good for your feet. You don’t want to add the podiatrist or orthopedic surgeon to the list of doctors you already see!
How to Progress to Increase the Benefits, Improve Fitness, and See Results
Unless you have been exercising for a long time or are an experienced athlete, it’s a good idea to have someone knowledgeable about fitness programming, like a personal trainer or coach, to design a program for you, or at least give you feedback on the one you develop. A good health coach or fitness trainer who understands where you are and works with you to rebuild slowly can help you progress with fewer setbacks.
There are a variety of ways to get a workout, and you do not have to spend a lot of money. Look for free classes, senior centers, and community centers. They often provide weight rooms, aerobics, water exercise, walking tracks, fitness machines, and yoga, Pilates, martial arts, dance, and other classes.
How hard do I need to work?
See above in the Strength and Cardiorespiratory Endurance section for descriptions of how to judge your effort.
Always warm up first. You will know you are warmed up when you break a sweat or feel warmer than when you started. Also, cool down at the end of your workout by gradually reducing the effort in the final minutes. This is important because your heart is beating hard, and the sudden drop in heart rate and blood pressure could cause you to feel dizzy and pass out. This also allows your body to continue circulating blood, carrying waste products away from your muscles and reducing soreness.
Soreness: When do I need to back off?
New exercisers often do not know how to determine if the soreness they feel is an indicator they have exercised well, an indication they have done too much, or an injury. If you are mildly sore the day or two after a new type of exercise, or after increasing the intensity or duration of exercise, that is okay. It is a part of working out. Mild soreness means you can feel the muscles when you move, and it goes away within two days. You should not feel sharp pain. This soreness is normal, and it results from the muscle tissue as it rebuilds.
Ice is a great anti-inflammatory, and it is okay to put ice on a sore area for 15 minutes at a time several times a day. If soreness does not go away after three days, stop the activity. If there is lingering pain, see your doctor. See above on stretching and when to avoid stretching a suspected strained muscle.
What should I do to get started? What kinds of exercise are best?
There are so many different ways to work out, so it comes down to finding an activity you like and enjoy. You can work out with others, or alone, or in a class. Indoors or outdoors. Using machines or powered by only your body. Programs like FIERCE can introduce you to a variety of ways to exercise until you find something you love.
“The best exercise is the one you’ll do!”
- Irwin, M.L. 2012. ACSM’s Guide to Exercise and Cancer Survivorship. American College of Sports Medicine. Human Kinetics. Champaign, IL.
- Bryant, C.X., Green, D.J., & Merrill, S. 2013. ACE Health Coach Manual. American Council on Exercise. San Diego, CA.
Not all exercise is suitable for everyone. Before attempting any new exercise, flexibility, strength, and overall health must be considered to determine if a specific exercise is appropriate for you. Any exercise is inherently dangerous and can result in personal injury. Any injury sustained from proper or improper use of the exercises in this video is solely the responsibility of the exerciser. Cancer Harbors™, Sunspirit Wellness Services LLC and their staff, representatives, successors and assigns disclaim any liability from injury sustained from the use of the exercises in this video and suggest that you consult your physician before attempting any exercise or exercise program.
As with any exercise program, if at any point during your workout using the exercises in this video you begin to feel dizzy, faint, lightheaded, or have physical discomfort, you should stop immediately. You are responsible for exercising within your limits and seeking medical advice and attention as appropriate. The content in this video and the exercise tips and instructions are not a substitute for medical advice. If you are concerned about whether the exercises in this or any exercise program are right for you, do not do them until you have received clearance from your physician.