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Hello, my name's Nicola.
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I'm a Clinical Specialist Physiotherapist
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here at Cambridge University Hospitals.
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I work as a service lead
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for our cancer rehabilitation programme,
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which is called Rehabilitation and Exercise
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During Addenbrooke's Cancer Treatment,
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or REACT for short.
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At REACT, we provide individual physiotherapy input
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for patients experiencing musculoskeletal
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or neurological effects of their cancer treatment
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alongside providing safe opportunities
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for patients to exercise
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whilst undergoing their cancer treatment.
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We offer one-to-one exercise instruction and group exercise,
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including pre-habilitation, circuits, Pilates,
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yoga, tai chi, and more,
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as well as running education sessions
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for particular tumour types and conditions.
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Some patients will be referred to the service automatically,
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especially if they're undergoing
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a particular surgery or treatment.
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Other patients will be referred by their consultants,
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clinical nurse specialists,
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or other allied health professionals such as radiographers,
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occupational therapists, or dietitians.
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You're also welcome to self-refer to our service.
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The instructions and the contact details
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can be found on the CUH website.
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In the past,
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patients were regularly encouraged by their clinical teams
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to reduce physical activity and exercise participation
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following a cancer diagnosis.
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Patients would then avoid physical exertion,
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put exercise on hold and be far less active.
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Friends and family could sometimes exacerbate the problem
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by stepping in and carrying out activities
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around the house and garden,
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and this intention, although well-meaning,
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often contributed to the overall reduction in activity
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for that individual,
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which has since been found to have a negative effect.
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Observations in the early 2000s showed
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that physical activity and exercise
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were safe during cancer treatment
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and could actually reduce the chances of cancer survivors
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going on to develop diabetes,
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coronary heart disease, osteoporosis,
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and even becoming overweight.
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Since then, many studies have been looking
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at the effects of being physically active
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and participating in regular exercise
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whilst receiving cancer treatment
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and in those early months after finishing their treatment.
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The studies have shown a huge number of physical benefits
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for cancer patients,
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such as maintaining a healthy weight,
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improving physical functioning
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and maintaining strength, movement, and flexibility.
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Improvements have been seen in bone health and bone density,
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and there's also been shown a reduction
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in the development and the severity
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of cancer-related fatigue.
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A number of psychological benefits have also been noted,
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which include reduced levels of anxiety and depression,
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reduced levels of stress,
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mood improvement, better sleep,
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and an increased quality of life.
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Last but certainly not least is the potential
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that physical activity and exercise can have
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on disease progression and prognosis.
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Studies indicate that regular exercise participation
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can potentially improve survival rates in some tumour sites,
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including breast, colorectal, and prostate cancers,
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and it has the potential to improve the outcomes
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of many more types of cancers.
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The beneficial impact of exercise during cancer treatment
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is thought to be due to a number of different effects
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on the body.
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These include prevention of high levels of insulin,
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lowering levels of some types of hormones
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which drive tumour growth,
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reducing inflammation and improving our immune system,
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as well as helping individuals
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to maintain a healthy body weight.
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Our aim in REACT is to help you maintain
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and increase your physical and mental wellbeing
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throughout your treatment
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so that you can stay healthy, tolerate treatment,
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and hopefully reduce the incidence and severity
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of many of the common side effects of treatment.
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We work closely with other organisations such as Macmillan
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and our local Maggie's centre
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to offer a range of opportunities
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for patients to improve their physical and mental wellbeing
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during cancer treatment.
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We want you to develop a healthy relationship
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with physical activity and exercise
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during a time of uncertainty.
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The aim is to give you some control
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over an important part of your treatment journey
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and the confidence to exercise safely.
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Using the best available evidence
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around physical activity and exercise
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in cancer survivors,
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expert clinicians and researchers
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have put together guidelines and recommendations
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for the amount of exercise
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that individuals should try to meet.
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The key recommendation, however,
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is that adults should try and undertake at least 150 minutes
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of moderate intensity exercise per week,
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or 75 minutes of vigorous intensity exercise per week,
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or a combination of both.
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Whilst we do have patients undergoing cancer treatment
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who are incredibly fit and well,
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the majority of our patients would not feel comfortable
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exercising independently at a vigorous level.
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We will therefore focus on exercise
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at a moderate intensity level in this film.
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In REACT, we try to consider the individual
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from their previous exercise experience,
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current level of health,
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and the treatment that they will be undergoing.
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There are three key areas discussed with patients.
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Reducing sedentary behaviour,
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increasing physical activity,
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and then participating in regular exercise.
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Reducing the amount of time spent sitting at a desk,
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driving a car, watching television,
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or being on our phones and tablets
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is a great starting point for the majority of patients,
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as this inactivity can be detrimental for our health.
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It's really important to become less sedentary
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and more physically active in your day,
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and those habits should become part of your daily routine.
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The real benefits from physical activity
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during cancer treatment
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can be seen and felt once you begin to incorporate
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moderate intensity exercise into your weekly routine.
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Intensity is the individual perception
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of how much effort you have to put in
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to perform a certain activity.
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Light intensity exercise does not typically increase
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your heart rate or breathing
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as it does not cause any change
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in how hard your heart and your lungs are working.
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Moderate intensity physical activity
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should make you feel that you are working somewhat hard.
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Your heart rate might increase
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and you may start to feel warmer or begin to sweat.
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You should feel slightly short of breath,
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but you should still be able to talk in full sentences.
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The preferred method of gauging exercise intensity
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is by using the Borg scale,
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where the aim is to perform an activity or an exercise
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to an intensity where you feel you're working somewhat hard.
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It's important, however, to remember
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that it does not matter the actual activity or exercise
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that caused you to feel that way.
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What matters is how you're feeling at that point in time.
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For some of our cancer patients
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who are normally very fit and well,
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their moderate intensity activities
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may include aerobic exercise
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such as walking, running, cycling, circuit,
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or bootcamp sessions and classes like Zumba.
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For the majority of patients, however,
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it might instead be activities around the house,
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such as household chores, DIY, gardening,
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which could also have the same effect,
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and therefore the time taken to perform those exercises
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can all be taken into account
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when looking at that 150 minutes over the course of a week.
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The most frequently undertaken moderate intensity exercise
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is of course walking.
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It's free, it's accessible to most,
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and it doesn't require any equipment or a gym membership,
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and it can be a social activity
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that you can do with family and friends.
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The recommendations are 150 minutes
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of moderate intensity exercise per week.
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However, you can often see this recommendation worded
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as 30 minutes of moderate intensity exercise
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on five days of the week,
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which adds up to the same total of minutes per week.
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As therapists, we often prefer
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this 30 minutes a day recommendation
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because for many patients it does not seem so daunting
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and could be a much more realistic goal,
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and many prefer the little and often approach.
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For some patients, however,
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even 30 minutes of moderate intensity exercise
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in the form of a walk can seem off-putting
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either due to experiencing some of the associated
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side effects of cancer treatment
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or because they're struggling to fit exercise
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into their daily and weekly routine.
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The good news is that bite-sized chunks of exercise
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have been found to be just as effective
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as longer bouts of exercise
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and can improve cardio-respiratory fitness,
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reduce blood pressure and blood sugar levels,
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and be effective at helping people to lose weight, body fat,
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and lower cholesterol.
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Any length of exercise will count,
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but practically three 10-minute bouts work well for most.
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If 10 minutes is too much,
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then six 5-minute bouts will work just as well,
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and some patients will start
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with just two to three minutes of exercise at a time,
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especially when they're recovering from surgery.
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Work out what works best for you.
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The last exercise recommendations
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relate to strengthening and balance exercises.
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We recommend that you should try to build strength
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on at least two days of the week
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to keep muscles, bones, and joints strong,
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as well as performing activities
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which can improve your balance
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on at least two days of the week.
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We hope this film has encouraged you
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to remain physically active during your cancer treatment
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and given you the confidence
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to include exercise into your daily routines.
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Please remember, the best form of exercise
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is the one that you will keep doing every day,
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so try to find the exercise or activity that you enjoy.
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Don't forget, some movement is good, but more is better.
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Thank you for watching.
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If you would like to find out more information about REACT
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or other forms of exercise,
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please visit the REACT page on the CUH website
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or drop into the Cancer Support Service.
