GUEST BLOG: Relaxation Breathing, Stretching, and Initial Exercise Precautions

by Carol Michaels

Exercise is good for our physical and emotional health. It is one thing that you can control and do for yourself. It is empowering. Physical activity can decrease depression and anxiety, reduce stress, increase confidence, and build positive health habits. Exercise can improve endurance, increase energy level, and decrease the fatigue that may be caused by treatments.

Relaxation Breathing and Stretching
There is an emotional toll that cancer survivors face in addition to the physical one. A cancer diagnosis can cause depression, anger, anxiety, fear and stress. Proper breathing techniques and stretching can improve the psychological recovery.

Research has shown that breathing can help reduce stress and anxiety. When feeling stressed, we usually take shallow breaths. During these exercises we will use our full lung capacity and breathe slowly and deeply. You should be aware of your breathing as it has a calming effect. Inhale for 5 seconds and fill the torso up with air, then exhale from the lower abdomen for 5 seconds, pressing the navel in towards the spine. Imagine all of your tension and stress leaving your body with each exhalation.

You should begin relaxation breathing immediately after surgery, as it allows you to focus all of your energy on healing. The stretching program will restore mobility in the chest and back that allows for freer movement of the lungs and diaphragm. We will discuss stretching in a future article.

Cancer surgery and treatments affect many areas of the body. I hear numerous complaints of stiffness, pulling, tightness, and a lack of flexibility. Often this occurs when the muscles and skin are shortened because of the surgery, which can also leave scar tissue. Surgery can irritate the nerves. As a result, you may feel burning, tingling, or numbness.

When can you start an exercise program after having cancer surgery and treatments? You should start stretching exercises as soon as you get clearance from your doctor. It is important to talk to your doctor before starting to exercise. This way you can determine what program is right for you.

Initial Exercise Precautions:

1. Your immune system may be compromised, which places you at risk for infection. Gyms carry a high risk for infection. Exercise at home while your immune system is weak.
2. If you have poor balance, you may want to start with exercises that are safer for those who have balance problems. Poor balance may be due to the chemotherapy, weak muscles, neurological issues, or normal aging. A common side effect of chemotherapy is peripheral neuropathy, which changes the sensation in the legs or arms. It can last a short time or be long-lasting. This can affect the way you walk, your balance, and your general movement. If you have peripheral neuropathy, you should select activities that decrease your risk of falling. For example, we recommend avoiding uneven surfaces and exercising with a stationary bike instead of a treadmill without handles. Strengthening your core will help your balance. It is also a good idea to keep all the muscles strong to compensate for the ones that are affected by the neuropathy.
3. Be smart and safe by doing the exercises that are right for you at this particular time. You are exercising to get healthy, not to get hurt. This is an important point to keep in mind, particularly for those who were physically active before cancer. You will not be able to immediately resume the same level of pre-cancer activity.
4. Exercise in a temperature controlled environment. Cold temperature can crack your skin, while extreme heat can cause swelling or light-headedness.
5. At the start of your exercise program, you should warm up with deep breathing techniques and shoulder rolls. We recommend that you warm up before you stretch by walking, marching in place or using a stationary bike. You can also exercise after a warm shower, which may relax the muscles.
6. Never hold your breath during an activity. People often hold their breath during exercise, so remember to breathe deeply.
7. Drink plenty of water, especially when sweating.
8. If your blood count or the mineral levels (potassium and sodium) are low, check with your health professional before resuming exercise.
9. Some medications affect the heart rate, so your pulse rate is not a good indicator of the level of your exercise exertion.
10. Learn to move slowly and smoothly without jerky movements. Do not continue an activity if it causes pain or unusual fatigue. You should feel a gentle stretch, not pain.
11. Know your limits. You should be able to differentiate between discomfort and unusual pain. Stop if you feel pain.  Listen to your body and use common sense. If something does not feel right, do not do it. You should consult with your doctor if you are experiencing pain, swelling, or unusual fatigue.
12. Wear comfortable and loose clothing and appropriate footwear. For those with peripheral neuropathy affecting the feet, supportive footwear is particularly important.

Exercise Progression
Many variables determine the exercises that are effective and safe for your particular situation. Every day brings new challenges and new accomplishments for the cancer patient. It is important to be able to modify your exercises to fit your needs at a given time.

Pain and fatigue levels can change from day to day, and even from hour to hour. You may wake up feeling fine, but may have increased fatigue as the day progresses. Track your energy levels throughout the day to determine the best time to schedule your exercise sessions. For example, if you have more energy in the afternoons, you should exercise in the afternoons.

Exercise when your energy levels are high. Common sense and listening to your body are of utmost importance. You should not feel like you have to follow a set protocol or a strict schedule. Your routine must be customized due to the numerous physical and psychological side effects you may be experiencing.

Both healing times and pain tolerance can differ greatly from one person to the next. Speed of recovery depends on your pre-surgery fitness level and type of surgery and treatments. The progression and timing of a cancer exercise program can only be determined after a thorough discussion between the patient and her or his healthcare professional.

Carol Michaels is a cancer exercise specialist and creator of the Recovery Fitness cancer exercise program. Recovery Fitness is taking place at Morristown Medical Center and several other facilities in New Jersey. Michaels also wrote “Exercise for Cancer Survivors,” a resource for cancer patients going through surgery and treatment.