How To Begin An Exercise Routine (For Cancer Patients And Survivors): Part II

This is the second article in our series on “How To Begin An Exercise Routine (for cancer patients and survivors.)” In this article, we present some beginner approaches to walking, running, cycling and swimming. We also discuss ways to use heart rate and activity monitors to help you reach your exercise goals.

Authored By: Sophie Mc Greevy (Certified cancer exercise trainer / Health coach), Janette Powell (Physical Therapist, Orthopedic Certified Specialist, Sports Certified Specialist, MHSc) and Brian D. Lawenda, MD

Did you know that numerous studies have shown that by getting at least 150 minutes of moderate-intensity exercise each week (i.e. walking 30 minutes per day, 5 days per week) one can significantly reduce their risk of developing numerous cancers, cancer recurrences and cancer deaths? If you can walk, you can get these benefits too; most of the patients who were included in these studies simply walked at a moderate pace.

You can read more about exercise and cancer in a previous IOE post.

**Exercise Disclaimer**

Let’s Get Moving – Walking Routine:

You haven’t been active for some time? Then walking may be one of the best ways to make exercise a part of your lifestyle. Here are two example routines for beginner walkers:

• Example 1: Start by walking 15 minutes a day, three days a week. After a few days, increase your walks by one minute and start walking more frequently until you’ve worked up to five or six 30-minute walks per week.
• Example 2: Try to walk at least five times each week. Start with a five-minute, slower paced walk to warm up and end with a five-minute, slower paced walk to cool down. Start at a pace that’s comfortable for you. Then gradually pick up speed until you’re walking briskly — the equivalent of 3.5 miles an hour. You should be breathing hard, but still able to carry on a conversation. Each week, add two minutes to your walking time.

Additional walking programs can be found at the following links:

• Beginning a fitness walking program – The Walking Site
• Easy 12-week walking program – Better Homes and Gardens
• Sample walking program – National Heart, Lung and Blood Institute
• A walking program to try – Harvard Health Publications – Harvard
• Sample walking programs – ExRx
• Walking plan – Arthritis Today Magazine
• The 20% boost program: Fit walking into your life – America’s Walking
• Start walking plan (7 Weeks) – Runner’s World
• Six-week beginner walking guide – American Heart Association
• Get walking with this 12-week walking schedule – MayoClinic.com
• Beginner walking program – University of Michigan
• Advanced walking program – University of Michigan

Can’t walk for 30 minutes straight? No problem. 

Experts have discovered that by breaking up your 30 minute exercise routine into multiple sessions throughout the day (i.e. three, 10-minute sessions) you can get the same benefit as someone who does it all in one session. As long as you get in your 150 minutes total minutes each week (and it doesn’t matter how many individual sessions it takes) studies have shown that you will lower your triglycerides, decrease your waist circumference and body mass index, and improve your cholesterol scores…and likely your cancer risks and outcomes.

One recent study found that those who exercised for three, 15-minute sessions (10-15 minutes after each meal, breakfast/lunch/dinner) had better anti-cancer effects (improved glucose levels) than those who exercised for a single, 45-minute session. If you do break up your exercise sessions make sure to keep the activity level at a moderate pace during each session.

Looking for a little motivational trick? Get yourself a pedometer (activity monitoring device.)

This small instrument records the number of steps you take each day. It can help motivate you to walk every day (or most days). Pedometers are reasonably priced and available in sporting good and department stores. Newer devices, called “activity monitors” are the latest hot gadget in monitoring your personal health. These devices often include a step monitor and sleep tracker. Studies show that individuals who wear a pedometer on their body throughout the day, walk approximately 25% more. This is most likely due to the motivational aspect of looking at your progress during the day and realizing how close/far you are from your daily step goal. 

Read more about pedometers and activity monitoring devices on a prior IOE post.

Most experts recommend that you set a daily goal of 10,000 steps per day. The average number of steps per day is a good indicator of a person’s activity level:

• 4,999 steps or less per day (sedentary)
• 5,000 – 7,499  per day (mildly active)
• 7,500 – 9,999 per day (moderately active)
• 10,000 or more per day (active)
• 12,500 or more per day (very active)

Tips for beginners

• Start slowly. Don’t test your limits right away. You should feel good at the end of your walk, not exhausted.
• Add on time slowly. Never add more than 10 to 20 percent to the total number of minutes or miles you walk in a week.
• Remember that something is always better than nothing. Even if you intended to walk 20 minutes, a 10-minute walk is still vastly better for you than doing nothing.
• Add stretching to your daily habit to maintain your overall range of motion as well as muscle and joint health.
• Keep it fun. Make your daily walk something you look forward to.

And if walking isn’t quite enough…

Running

Want to work up a bit more sweat than you can get walking…Try running. If you run three times per week, at 20-30 minutes per run, you will be getting the same amount of exercise as recommended by numerous studies for optimum fitness (the equivalent of 150 minutes of moderate-intensity exercise.)

One of the best programs I’ve seen to help coach complete running novices from the coach to a 5K finish line is Cool Running’s ‘Couch to 5K’ running program. This program eases you into running 3.1 miles (5 Kilometers) by combining walking and running together. Over the course of 8-weeks you increase your running time and eventually run for 30 minutes straight – about the time it takes to run a 5K. They have a great mobile phone app that you can use to keep track of your progress. 

Additional running programs for beginners can be found at the following links:

• Beginner 5K running program – University of Michigan
• The 8-week beginner’s program – Runner’s World
• Start running: The beginner running plan – Women’s Health
• Full beginners running program – From Zero to Hero
• Couch to 5k, 10k, marathon program – Running for Beginners
• Beginner’s guide to running for weight loss – Fitbie/MSN

Cycling

If you are looking for a lower impact cardiovascular exercise than running you might want to give cycling a try. This is one of the best beginner cycling programs I’ve seen (from the University of Michigan). Their program takes you through a 16-week routine. The goal is to get you cycling 8 miles per day, 4-5 days per week, in under 30 minutes per session.

They recommend that before you start biking to consider these safety points:

1. Make sure your bike is in good working order: Clean it, inflate the tires and oil the chain. Make sure the gears and derailleur are adjusted and check the brakes. Also make sure the bike is properly fitted to allow a correct riding position. Proper shorts and shoes will also help.
2. Select a user-friendly course. Do your early rides on flat, smooth roads, with a minimum of intersections.
3. Warm up before you push hard. Cycling requires a limited range of motion. Make sure you warm up the muscles 3-5 minutes and then stretch them. Cold, stiff muscles are the easiest to injure. Make stretching part of your daily routine.
4. Don’t push yourself right away. Work into it. Don’t try to go as fast as you can until you have logged a few miles over several sessions and feel comfortable on the bike, both in terms of fitness and balance.

Additional biking programs for beginners can be found at the following links:

• How to get fit: cycling for beginners – NetDoctor.co.uk
• Cycling training schedule – British Heart Foundation
• A beginner’s guide to biking – Nerd Fitness
• Start cycling: Biking for beginners – iVillage
• Cycling exercise plan – Livestrong.com
• Intermediate cycling program – University of Michigan
• Advanced cycling program – University of Michigan

Swimming

One of the best, non-impact, whole body exercises is swimming. It is an excellent muscle toning and cardiovascular strengthening exercise that also helps you increase your flexibility. Similar to running, cycling and walking, swimming also takes time to build up the endurance and strength needed for lengthy workouts.

While runners have their first endurance benchmark, the 5K, the swimmer’s first endurance benchmark is the swimmer’s mile, which is 1,650 yards (1,500 meters).

Novice swimmers can reach this endurance benchmark using a 6-week training program called Zero to 1650: A Mile in Six Weeks (see weeks one-three, below.)

Since most pools are 25 yards long, this workout would be 14 laps (or 28 lengths.) Doable, right? Each week you add 50 to 200 yards to your workout. You slowly build up your endurance. Breaks in between swim sets are generally part of a swimming fitness plan. Looking for the mobile phone app for this program? They have versions for the Android and iPhone.

Additional beginner swimming programs can be found at the following links:

• Beginner swimming program – University of Michigan
• Intermediate swimming Program – University of Michigan
• Advanced swimming program – University of Michigan
• How to teach yourself to swim – A guide for adult beginners
• Swimming for beginners: Tone your body in 6 weeks! – iVillage
• 100 swimming workouts

Swimming Precautions:

• Swimming is not typically recommended for patients undergoing radiation therapy because the chlorine in the pool water can irritate the skin in the radiation treatment area.
• If you have a weakened immune system (i.e. from chemotherapy) swimming in pools, hot tubs, lakes and rivers may not be safe due to the increased risk of infection from organisms in the water. Consult your doctor before swimming. 

It’s Not Just The Amount Of Exercise You Do, It’s The Intensity Of That Exercise – Not Too High, Not Too Low

How do you know if you are exercising too hard or not hard enough? One of the most useful indicators is your heart rate.

The first step is determining your “resting heart rate” (in beats per minute.) The best time to check this is when you wake up in the morning before you get out of bed.

The second step is to calculate your “maximum heart rate” (maximum heart rate = 220 minus your age.)

The final step is to figure out your target heart rate zone (target heart rate zone = 50-80% of your maximum heart rate.) This is the heart rate zone you want to stay between while exercising (we call it the “sweet spot.”) In general, you can select your desired zone heart rate based on what you want to achieve with your exercise routine:

• Endurance zone (50%–70% of your maximum heart rate): Considered ideal for endurance and weight-loss programs. Develops cardiovascular and muscular efficiency. The body learns to use stored fat as fuel
• Aerobic zone (70%–80% of your maximum heart rate): Ideal for overall cardiovascular fitness, muscle strength and weight management. The body burns mostly fat and carbohydrates in this zone.

Example: Dr Lawenda’s resting heart rate is 65 beats per minute. He is 42 years old, so his maximum heart rate should be 220 minus 42 = 178 beats per minute. His target heart rate zone ranges from 50% of his maximum heart rate (0.5 times 178 = 89 beats per minute) to 80% of his maximum heart rate (0.8 times 178 = 142 beats per minute.)

The American Heart Association Recommends:

• “Important Note: A few high blood pressure medications lower the maximum heart rate and thus the target zone rate. If you’re taking such medicine, call your physician to find out if you need to use a lower target heart rate.”
• “If your target heart rate is too high, you’re straining. So slow down. If it’s too low, and the intensity feels ‘light’ or ‘moderate/brisk,’ push yourself to exercise a little harder. During the first few weeks of working out, aim for the lowest part of your target zone (50 percent). Then, gradually build up to the higher part (85 percent). After six months or more, you may be able to exercise comfortably at up to 85 percent of your maximum heart rate. But you don’t have to exercise that hard to stay in shape.” 
• “If you’re not able to carry on a conversation (while exercising), that may be a bit too much.”
• “If you have a heart condition or you’re in cardiac rehab, talk to a healthcare professional about what exercises you can engage in, what your target heart rate should be and whether you need to be monitored during physical activity.  This will also help you to choose the types of physical activity that are appropriate for your current fitness level and health goals, because some activities are safer than others.”

Heart rate monitors:

Learn more here about selecting and using a heart rate monitor (American College of Sports Medicine)

Stay tuned for:

• Beginning an Exercise Routine – Part III (we will discuss strength training, circuit training, dance classes, yoga programs, warm-up and stretching programs)
• Beginning an Exercise Routine – Part IV (we will discuss how to adapt exercise activities and programs when modifications are optimal due to health concerns/limitations)