You Finished Treatment, Now What? Part One*: Exercise

Amy Rothenberg ND
Jan 9 · 8 min read

A Ten Part Series for Cancer Survivors/Thrivers from Your Licensed Naturopathic Doctor

Photo by Ian Froome on Unsplash

You’d think the last day of chemo or the final radiation treatment would be a time to rejoice and celebrate. But for many cancer patients the last day of treatment is soon followed by sense of dread and despair. The fighting stance and the rallying cries end. The outpouring of support slows. It’s onto life “as usual,” not easy if you don’t feel well and medical “active surveillance” seems served up with a hefty portion of worry and anxiety.

I intimately know this terrain as a cancer survivor/thriver. I committed to daily proactive steps to regain health and now continue with recommendations to encourage physical vitality, mental clarity, emotional balance and do all I can to prevent recurrence.

As a licensed naturopathic doctor, this is the reason many patients show up at my door. I wrote widely on the topic of using natural medicine during cancer care to prevent side effects, address side effects that arise and to help support patients through treatment.

In this series, I break down the component parts of an evidence-based general treatment plan and share experience, information and examples, to optimize chances for regaining and maintaining health after conventional cancer treatment. I want to support and encourage people to be proactive with regard to health instead of only waiting around. And for the many people living with cancer most all these recommendations also pertain.

Like all good medicine, treatment plans are individualized to the patient. I want to know what type of cancer you had and where, approaches taken, side effects experienced or ongoing or residual from treatment, additional underlying health concerns, other medications currently prescribed, supplements and botanical medicines currently taken, your height and weight, history with exercise and other components of healthy living, capacity for compliance and resources you have to allocate to your health.

Understanding your ability for self-care, appreciating what kind, if any, support you have and your willingness to re-prioritize certain aspects of your life are important details for me. I work to integrate this information with sound natural medicine and lifestyle recommendations which have evidence to back them up and I believe are worthwhile doing.

I could create a plan a mile long but if you cannot afford it, will not remember to do certain parts or feel overwhelmed by the prospect, then my recommendations will fall short. The Internet is overflowing with information and testimonials, some of which may be helpful, some may do nothing at all and of course, some may do harm. Before embarking on creating a plan for yourself, I hope you will consult with a licensed naturopathic doctor or someone who has adequate training in this field.

Let’s break this down a little further. Some patients remain with side effects of treatment, from low blood counts to lymphedema, from chemo brain to skin issues, from weight loss to digestive disturbances, from anxiety and depression to insomnia and fatigue — and any other number of overlapping complaints. My treatments are aimed to help restore and rebuild, to support the innate resilience of the human body. Some are quite general, others more pointed to a specific complaint.

Natural medicine cannot help everything but I hate when I hear patients say, Well, I’m lucky to be alive, I can live with this. We’re all lucky to be alive. And quality of life matters, too. I want to try to help, without giving false hope by laying out all the different approaches available. I am interested in addressing the psycho-emotional elements of your story too, because for many, psychological symptoms clearly impact the way we move through life, in sickness and in health. When I do not have the knowledge or skills I describe in this series, I refer patients to other providers I trust for bodywork or talk therapy or acupuncture or whatever else I appreciate would be useful but I cannot adequately provide.

In this post I will share my list of approaches and we’ll dive into the first category together.

Here are the main categories:

1. Exercise

2. Nutrition and eating

3. Intermittent fasting

4. The head game ( the importance of addressing stress & taking care of emotions

5. Botanical medicine

6. Off-label use of pharmaceuticals

7. Nutritional supplements

8. Acupuncture & homeopathy

9. The role of social connection and community

10. How to Talk so Your Oncologist Listens and Listen so Your Oncologist Talks

Let’s jump right in with exercise which in my understanding and my personal experience remains the #1 recommendation I make to cancer survivors. Some things may interfere with regular exercise like lymphedema, ostomy, extreme fatigue, but most all survivors can tolerate at least some exercise. Research shows that regular activity appears to reduce all cause risk of death, recurrence of cancer and prevention of other common illnesses such as being overweight, cardiovascular disease and diabetes. There are also long term studies showing that consistent exercise improves quality of life. Exercise helps raise your threshold for feeling stress, helps dissipate stress you have and helps you be better perfused (gets the blood moving,) which amplifies other efforts you make. There is growing evidence that regular exercise helps to address the ongoing fatigue many cancer survivors complain about. This may be related to decreasing overall inflammation or upregulating certain hormonal pathways.

If treatments have you feeling weak, if you’ve lost muscle mass, if your balance is off, no worries, we start slow and build our way up. I think about exercise in three categories: aerobic, stretching and weightlifting and how trying for some of each every week is important. The YMCA in partnership with LIVESTRONG offers free or low cost programs for cancer patients and survivors and many of my patients have benefitted from participation.

I recommend that my patients get their exercise first thing in the morning. For many people, if exercise is left to the end of the day, it may never happen. Think of exercise as your number one medicine. The endorphins, or happy hormones, exercise releases impact your nervous system, which in turn impacts your immune system, which of course we want to support as much as possible. If you are in that group of people that just hate exercise, try something new. A dance class? Online yoga? Fencing? Circus arts? Or get a dog! Walking your dog 20 minutes once or twice a day counts, too.

For those who have a clear muscle and body memory of enjoyable times exercising, bicycling, working out, hiking in nature etc., it will not be as hard to get back into the swing of things. You may feel disappointed in what you can accomplish compared to a past time, but focus on the positive and have faith in your body’s ability to get better and stronger over time. Some abilities might be compromised but adjusting output, using assistive devices, modifying postures in yoga for instance, are all possible.

Some patients on hormone treatment need to take special care of the bones, with weight bearing exercise like walking, running, racquet sports and weight lifting. Remember that swimming, though terrific for a full body work out, for relaxation, coordination and cardiovascular improvement, is alas not weight bearing. So if you love it, but need the weight bearing, enjoy your swimming 1–2x a week and mix in other kinds of exercise. Bicycling is also not especially weight bearing (sorry). In fact long distance bicyclers and swimmers are both known to have lower bone density when compared to controls though suffer fewer fractures likely due to better coordination!

Of course ANY exercise is better than being sedentary. I love inviting patients, especially middle aged women into the world of weight lifting. It’s very satisfying and you can see progress pretty quickly. My only caveat is that my patients learn correct posture, form and appropriate weight and repetitions to avoid injury. It can be a good idea to have a conversation at a gym or with a private trainer, let them know you are just getting back into exercise after an illness and be sure your instructor is able to be sensitive to and mindful of your potentially unique needs.

Some patients have taken chemotherapy that is tough on the heart, so you want to be cleared for exercise before beginning a program and modify as needed. And for those with low iron from treatment you will have less energy and less endurance to start, but these are things, that for many people are helped gradually over time. Self-compassion and patience come in very handy.

After my last radiation treatment I set my mind to train for and complete my first triathlon. With my grown kids, husband and extended family on board, we made it into a family event and man, did I feel triumphant crossing that finish line! I’ve worked to complete one triathlon a year, which keeps me training around the calendar. In this year’s event I came in last. Literally! And of course, I felt like a winner.

I also participate in social ballroom dance, which is a fun, newer kind of exercise for me, and hits all high marks for the exercise, social connection, musical and sensual components.

Author dancing with husband, Paul Herscu ND, MPH

The studies about exercise and cancer survivorship are many and varied and all pretty much come to the same conclusion. You should take the exercise mandate seriously, take time finding something you enjoy that is sustainable, where you won’t get injured. Then, reorganize the taking-care-of-yourself-to-do list to bump exercise to spot number one.

Additional pieces in this series:

· *You Finished Treatment, Now What? Part One: Exercise #naturopathic #naturopathicmedicine #dramyrothenberg

See here to read more about naturopathic medicine. To find an ND near you see here.

FieldNotes From Natural Medicine

Stories from the World of Natural Medicine

Amy Rothenberg ND

Written by

American Association of Naturopathic Physician’s 2017 Physician of the Year. Teacher, writer and advocate for healthy living.

FieldNotes From Natural Medicine

Stories from the World of Natural Medicine

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