PlanBe: BeActive

A regular physical activity programme will have a major positive impact on your health.

Overview

Physical activity means regular exercise: anything that increases your heart rate and breathing and works the muscles. It could mean going for a walk, swim, or even simple exercises you can do at home. Sports, dancing and activities like gardening also count. Regular exercise improves the fitness of your body and has a positive impact on your health.

Preparation: week 1 + 2

· Take our self-assessment test – see Self-Assessment below

· Complete a 2 week log (diary) of your current physical activity – see 2 Week PA Log below

· Check out local resources that would be appropriate for you (park, gym, swimming pool, etc.) – see Local Resources and Signposts below

· Make a list of the types of regular physical activity you would enjoy doing – see List of Physical Activities below

· Review if you need to get any kit (outdoor clothing, shoes, etc.) – see Kit and Equipment below

· Decide if you need to see a doctor or physiotherapist before you start. If you do, make the booking.

· Set at least one personal target – see Target Setting below

· Decide how frequently and how long each session will be and review your Daily and Weekly plan and decide where you can best fit in a regular session – see Session Planning below

· Prepare yourself mentally on the day before you start – see Getting Started below

Being Active

Keep a log / diary of each session - See Session Logging below
Review your progress by monitoring your achievements – see Achievement Monitoring
Keep motivated – see Keeping Motivated below

Background Information

How does this work?

Taking regular exercise means your heart and lungs will work more efficiently and your circulation is improved. These reactions can have a positive impact on your health helping you to manage better with your cancer.

Exercise is also a great way to work off stress. When we are stressed (worried, frightened) the body prepares itself for exertion, tensing the muscles, speeding up the heart, changing the blood flow. These reactions can have a negative impact on health over time: raising the blood pressure, putting strain on the heart etc. Exercise allows the body to wind down from stress, you feel better and your body can relax properly.

Thirdly, physical activity is an important part of fatigue management. This may seem upside down but when you feel as though you have little energy to do anything, doing a little physical activity can turn that fatigue into sleepiness and allow your body the restorative sleep it needs. Physical activity (if taken regularly and in correct amounts) will give you more energy.

What are the benefits of physical activity?

There is strong convincing evidence of benefit to health and it can be recommended widely.

There are many benefits to being active during and after treatment, including:

• Increased muscle strength

• Improved cardiovascular fitness

• Reduced fatigue

• Improved wellbeing and quality of life

• Improved physical function

• Helps with weight control

What is the evidence?

There are many clinical studies showing that exercise and physical activity are beneficial and safe. There is also evidence that maintaining a healthy weight and being active at the appropriate level may reduce the risk of some cancers returning. Take a look at the Macmillan Cancer Support resources on physical activity or Cancer Research UK.

Who would this be good for?

In recognition of the importance of physical activity for people living with cancer, The British Association of Sport and Exercise Sciences advises that ALL people with cancer should aim to be as active as their abilities and conditions allow. There are lots of ways of becoming more active and it’s important to do a range of activities that are enjoyable and fit in with your life.

If you are having radiotherapy or chemotherapy or after surgery you may not feel like being particularly active but once such treatment is complete, you should try and build up your physical activity gradually working towards the recommended levels for yourself.

Who should be careful?

If you want to become more active, it’s important to know what the right level of exercise is for you. This will be influenced by your cancer type, what treatment you’ve had and any other conditions you may have which may affect your health. In preparation for exercising you may note that if you have any of the below conditions, you would be advised to avoid certain types of exercise:

• If you have cancer affecting the bones, take care with exercises that put a strain on your bones. Instead you may prefer swimming or exercising in water. The water supports your body weight so the skeleton is not stressed. Exercise such as yoga generally appears safe for everyone.

• If your treatment has caused you to have altered sensation in your feet, take care with exercises where you could easily fall. Try to ensure that there is something you can hold on to.

• If you have swelling in any of your limbs (lymphoedema) it’s advisable to wear your compression garment when exercising. Exercise may make the swelling temporarily worse and you may need to elevate (raise) the limb during your rest period after the exercise.

• If you have pain that is not well controlled either due to your cancer or due to other medical conditions then you will need to be cautious but this doesn’t mean that you can’t enjoy the benefits of physical activity with a little care. First of all it will make sense to see if you pain control is as good as it can be. You’ll need to discuss this with your doctor. Secondly, you will need to start with very light exercise, listen carefully to your body and see what effects the exercise has. Gradually increase the exercise if you find you can and its making you feel better.

If you’re unsure about taking a particular activity, always check with a health care professional first.

Myth busting

Q: Can doing more exercise make the cancer worse?

A: No, there is no reason to think that physical activity will increase the rate of cancer growth

Q: If I feel tired, shouldn’t I simply rest

A: Rest is very important but you will find that a combination of some physical activity and proper rest will give you more energy over time

List of physical activities

Activity	Yes	No	Maybe
Walking, hiking, dog walking
At the Gym: cardio machines, weights (barbells, kettlebell etc.)
Gym at Home (body weight exercises, simple equipment)
Dancing
Running / Jogging
Cycling
Swimming
Tai Chi / Qi Gong (Chinese physical practice)
Yoga
Pilates
Gardening
Sport (tennis, golf, football, badmington, skiing
Feldenkrais (Awareness Through Movement) – suitable for people who find physical activity very difficult
Breathing exercises (Singing, Pandiculation, Yoga breathing)

Self-assessment:

Take our PlanBe Physical Activity self-assessment to help you decide what level of exercise to start with.

What was your highest level of physical activity since leaving school

No regular physical activity except daily living (shopping, housework).
Regular leisure related physical activity (dog walking, gym, active holidays, hiking)
Physically strenuous work (e.g. construction)
Regular fitness training for sport

How long ago was this?

Years
Months
Still active at this level

Which of the following best describes your current level of health

I feel generally well in myself, no significant symptoms or disabilities
I have some symptoms / disabilities but they do not restrict me from doing anything I want.
I have symptoms / disabilities which do restrict me a bit.
I have symptoms / disabilities which restrict me a lot.

Which of the following best describes your current level of physical activity?

1. I need to rest during the day and have little extra energy for physical activity

2. I am not currently taking any regular physical activity except what is required for daily living

3. I take regular leisure related physical activity

4. I am still in physically demanding work

5. I train regularly for sport

If you’re new to being active, it’s best to start slowly and build up to doing a little more each week. Below is a guide as to how you should be feeling depending on what level of activity you are doing

Light intensity exercise is when you’re breathing easily and can speak when you exercise

Moderate intensity exercise is when you’re still able to talk but you’re breathing is more rapid and deeper. You will feel yourself becoming warm and your heart racing faster

High intensity exercise is when you can no longer hold a conversation, your breathing and heart rate is rapid and you will probably be sweating

Session Planning

It can be a good idea to have regular sessions worked out in advance that fit if with your other daily routines.

Target setting

National guidance for all healthy adults is to complete 150 minutes of moderate intensity physical activity each week – this could be broken down into 30 minutes of activity on five days of the week or could be broken down into smaller units and done more often.

Another common target, again aimed at the general population is to complete 10,000 steps each day as measured on a smart phone.

Higher levels of physical activity (longer or more intense) can be beneficial if you are able to tolerate it but it is important not to do too much and put yourself off, exhaust yourself or injure yourself. Regular repetition is the desired goal.

Lower levels of physical activity are also helpful for those that are unable to make this target. More or less anything that you can do will be helpful, and if regularly practiced may well lead you to being able to do more. For example, for those who can walk with ease: walk briskly; for those who cannot walk briskly but can stand with ease: walk slowly; for those who cannot stand with ease, practice standing at least for a period of time each hour, for those who need to be in bed most of the time, try to sit out in a chair for at least some of the day.

An initial target should be to complete some form of planned physical activity three or four times a week. If you are doing this then congratulations!, this is an excellent basis whatever it is you are doing

Another early target should be to sustain the level of physical activity for at least 10 minutes per session.

Once you are managing 3 or 4 sessions of 10 minutes sustained effort each week, start increasing the duration of the sessions. Your next target is to keep the heart rate up in the moderate effort range for 20 minutes per session.

See the section below about Monitoring your progress to see how else you can measure the effects of Physical Activity and set personal targets

Getting Started

Getting started

• Decide on the level of exercise appropriate to you, and the type of exercise you’d like to do.

• Get in touch with any local resources which may be appropriate.

• Assess which tools, gadgets or apps you would like to use to help you with your exercise.

• Set personal goals as part of your PlanBe.

Top tips before you exercise

• Ensure correct footwear and loose clothing

• Make sure you don’t get dehydrated by having plenty of water handy

• Eat a healthy snack such as a banana or wholemeal toast at least one hour before exercise and within 30 minutes of finishing

• Check with your doctor if you’re unsure whether you should be exercising

Session Logging: Monitoring yourself and your progress

When exercising it is important to do so at an intensity that is right for you. Guidelines recommend a moderate intensity which means your breathing becomes deeper and quicker but you are able to talk. This is a good way of monitoring how hard you are working.

Here are some other things you can measure to check how you are progressing.

Resting heart rate

You can either measure your heart rate by finding a pulse at your wrist or neck and counting the number of heart beats in a fixed period of time. For example, if you count 20 beats in 15 seconds then your heart rate is 80 beats per minute. Alternatively you can use a heart rate monitor. Some smart phones can do this. Your resting heart rate is the lowest heart rate during the day and the best time to measure this is soon after you wake up, before you have got out of bed. Lie quietly for a few minutes after you wake and then measure your heart rate. This gives a good indication of health. (Some medication may artificially slow the heart and would interfere with this measurement, check with your doctor if any of your medication does this)

Blood pressure

To measure your blood pressure you would need a blood pressure monitor, these can be obtained from a chemist. If you are going to do this, measure your blood pressure at the same time each day: first thing in the morning is probably best.

Diary entries

It is important to monitor your progress to help keep you motivated. Keep a diary and record how long, what intensity, and how you felt. Set goals which are personal and important to you, for example being able to hoover the living room, or walk around the park without stopping.

By reviewing your goals on a regular basis you can track your progress and also set new more advanced goals if needed.

Activity diaries including planners for goal setting are available from Macmillan.

Other ways of ensuring you keep up with exercise are, by joining an activity group or association.

Track your progress regularly by using your PlanBe diary and any apps you have chosen to use.

Kit and Equipment

There are many tools to assist patients to plan their goals including the Macmillan activity diary as well as plenty of web-based tools and apps, such as from NHS Choices .

One of the latest devices is a wearable fitness device designed to automatically track physical activity, sleep patterns, mood and calorie intake, among others. This device, which comes in the form of wristbands, watches and earphones, can be a good option – albeit at a cost – for inactive people who need motivation to raise their game.

Many other internet tools and apps are free, easy to use and can be accessed using a smartphone, such as an Android or iPhone, or a basic home computer. These include:

· MyFitnessPal , available in iTunes, Google Play and Windows Phone

· Couch to 5k, a running podcast available through the NHS Choices website

· Fitocracy, an app available on iTunes and Google Play

· The Macmillan website provides a wide range of information and advice on being active during and after treatment .

· The following leaflets and information packs can be ordered or downloaded from the be.macmillan website:

Ø Get active, feel good DVD

Ø Move more, your complete guide to becoming active

Ø Walk this way – walking for health

Ø Physical activity and cancer treatment

· NHS–approved apps to help record and monitor your progress.

Local Resources and Signposting

· Your GP – can provide information on local exercise referral schemes which you may be able to access, and give individualised medical advice about exercising

· Your local leisure centre – for details on exercise classes, swimming and gym access. Some leisure centres have discounted rates for people claiming certain benefits

· Your local council website – details of local exercise facilities, activities and exercise referral schemes can be found under the “sports and leisure” section

· Ask your GP or oncologist for a referral to physiotherapy

Keeping Motivated

Keeping a regular physical activity programme going can be challenging and it’s good to recognise this from the outset.

If you are having no trouble then give yourself a pat on the back, most of us find it difficult from time to time.

Watch out for some of these things that can stop your programme:

· Boredom

· Losing momentum

· Not seeing progress

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