In an hour-long webinar, nationally recognized exercise specialist Carol Michaels, MBA, ACE, ACSM discussed how maintaining an exercise program during cancer treatment and recovery can help patients to minimize treatment side effects, increase energy levels, and reduce stress, along with many other benefits. Inspire produced the educational webinar in partnership with the Bladder Cancer Advocacy Network, US TOO International, and ThyCa: Thyroid Cancer Survivors' Association.

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Exercise and cancer: How
staying active can improve
your health and well-being
Bladder Cancer Advocacy Network, Us TOO
International, ThyCa: Thyroid Survivors’
Association, Inc., and Inspire have partnered
to bring patients and their caregivers this
free educational webinar

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Carol Michaels
MBA, ACE, ACSM
Carol is the founder of the Recovery Fitness® an exercise
program developed to improve the recovery from cancer surgery
and treatments. She is a nationally recognized Exercise Specialist,
consultant, author, and is the 2016 IDEA Fitness Personal Trainer
of the Year. Carol is a speaker for corporate wellness programs,
fitness organizations, and cancer related organizations, and created
the Cancer Specialist Recovery course in partnership with the
National Federation of Professional Trainers.

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Benefits of exercising during
and after treatment
Today We Will Discuss
The Potential Side Effects of Surgery and Treatment
ü Surgery can create adhesions
ü Chemotherapy may affect balance, immune system, cardiac function, as well as cause
nausea, fatigue, sarcopenia, anemia, and neuropathy
ü Radiation can cause fatigue, tightness, and increase the risk of lymphedema
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Exercise-related precautions2
Exercise components, including
specific exercise examples
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Tips for getting started4

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Benefits of Exercising During Treatment
• Increase energy and reduce fatigue
• Evidence supports this benefit for many cancers,
including bladder cancer
• Improve ability to tolerate cancer treatments
• Improve mood and well-being
• Evidence suggests exercise can reduce anxiety/
depression and improve well-being for many forms
of cancer
• Improve outcomes for certain cancers
• Prostate cancer and bladder cancer studies suggest a correlation between exercise and
survivorship
• Light exercise may improve prognosis by maintaining or improving lung capacity and
oxygen flow

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Benefits of Exercising After Treatment
• Increase strength and muscle mass
• Improve aerobic capacity
• Improve flexibility
• Prevent bone loss
• Improve mood and quality of life
• Improve survivorship for certain
cancers
• Maintain a healthy weight and
improve blood sugar control
• important for cancers of the
thyroid, prostate, and breast
• Decrease pain
• Decrease stress, anxiety and
depression
Research also suggests that exercise may decrease the risk
of recurrence for certain cancers (e.g., breast cancer and lung cancer)

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Exercise-Related Precautions
• Fatigue
• Neuropathy
• Myelosuppresion
• Neutropenia and anemia
• Avoid infections, wash hands often
• Osteoporosis
• Thyroid cancer, prostate cancer,
and breast cancer can increase risk
of bone loss
• Cardiopulmonary issues
• Lymphedema
• A lymphedema specialist, physical
therapist or cancer exercise
specialist can help you learn
exercises (also visit Lymphnet.org)

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Exercises
• Pain and fatigue levels change
• Common sense–routine should
be customized according to
physical and emotional side
effects
• Healing times and pain tolerance
differ greatly
• Listen to your body
Exercise Progression
• Relaxation breathing
• Aerobic exercise--cardiovascular
exercise improves circulation
which improves oxygen levels
and can help to decrease
symptoms of fatigue
• Stretching
• Strength training
• Balance training
Exercise Components

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Exercises
• American Cancer Society
recommends 150 minutes of
moderate intensity or 75 minutes
vigorous intensity each week
• Helps with weight management
• Helps prevent cardiac issues
• Start with a few minutes of walking,
bring a buddy, and gradually build
up (modify to fatigue level)
Aerobic Exercise
• Improves circulation
• Increases elasticity of the muscle
and brings oxygen to the muscle
• Active stretching: hold for 1-2
seconds and repeat 10 times
• Static stretching: hold for 10-30
seconds
Stretching

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Shoulder Stretch
Exercises
Shoulder Flexion
Source: Exercises for Cancer Survivors by Carol Michaels

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Pectoral and Shoulder Stretch
Exercises
Side Bend
Source: Exercises for Cancer Survivors by Carol Michaels

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Exercises
Corner Stretch
Shoulder Opener
Source: Exercises for Cancer Survivors by Carol Michaels

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Exercises
Knee Drops
Shoulder Flexion with Cane
Source: Exercises for Cancer Survivors by Carol Michaels

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Exercises
Shoulder Extension and Back Scratch Flexion and Butterfly Stretch
Source: Exercises for Cancer Survivors by Carol Michaels

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Exercises
Shoulder and Pectoral Stretch Hamstring Stretch
Source: Exercises for Cancer Survivors by Carol Michaels

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Exercises
Seated Stretching

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Benefits of Strength Training
• Increases muscle mass which decreases as we age
and is compounded by treatments
• Decreases risk of injury--start after having 80% ROM
• Use free weights - can improve by small increments-
machines work the large muscles
• Start with one set of 5-10 reps, rotate muscle groups
• If taking time off, start with lighter weight
• Pelvic floor exercises are especially important for
people with bladder and prostate cancer

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Exercises
Shoulder and Back Strengthening Group Strength Training
Source: Exercises for Cancer Survivors by Carol Michaels

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Balance
Balance and Strength
• Balance training can counter muscle
imbalances
• Neuropathy--can not feel feet (be safe)
Start the balance training with the
following exercises:
• Standing on one foot for 10 seconds
• Tightrope: put the heel in front of the toe
of the other foot
• Calf raise: raise each heel up and down
• Leg lifts: front, back, and side Source: Exercises for Cancer Survivors by Carol Michaels

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Exercises for Osteoporosis
• Include weight bearing, strength training, posture ,
and balance exercises
• Avoid forward bending from the waist and rotation
• Strengthen core with exercises that do not involve
forward flexion--no crunches
• Some yoga and Pilates exercises have to be
modified
• Single leg circle and the corkscrew are safe
• Spinal extension exercise such as Pilates
swimming and back extension may be performed

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Lymphedema
• Lymphedema is swelling produced by
an accumulation of lymph fluid in tissue
• Symptoms include a feeling of tightness
and heaviness
Safe Exercises for Lymphedema
• ROM exercises, elevate the area above the
heart, stretch the neck and shoulders
• e.g., pendulum arm swings ,stretches that
move the arm in flexion, extension and
abduction
• Walking, biking, swimming - water creates
compression but vary strokes
• Think of the lymphatic system as a road
system
• Can occur right after surgery or years later
• Strength Training - muscle can pump the lymph
fluid away from the affected area.
• Start with light weight
• Pilates - using deep breathing
• Some yoga poses can cause flare ups
• Monitor for fullness

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Exercises
Pendulum Exercise
Source: Exercises for Cancer Survivors by Carol Michaels

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Getting Started
• Contact your local hospital to see if they offer exercise
programs geared towards cancer patients and survivors
• Call National Federation of Professional Trainers at
(800) 729-6378
• They are currently working to get more personal trainers
trained as cancer recovery specialists
• Contact the American College of Sports Medicine
• https://certification.acsm.org and click on “Find a Pro”
at the top of the page:

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Summary of Key References
1. Steven Moore et al. Association of Leisure - Time Physical Activity With Risk of 26
Types of Cancer in 1.44 Million Adults. JAMA Intern Med. 2016.
2. Cramp F, Byron-Daniel J. Exercise for the management of cancer-related fatigue in
adults. Cochrane Database Syst Rev. 2012.
3. Rock, CL et al. Nutrition and physical activity guidelines for cancer survivors. A Cancer
Journal for Clinicians. 2012.
4. Kristina H Karvinen et al. Associations between Exercise and Quality of Life in Bladder
Cancer Survivors: A Population-Based Study. Cancer Epidemiology and Biomarkers.
2007.
5. Gopalakrishna et al. Lifestyle Factors and Health-Related Quality of Life in Bladder
Cancer Survivors: a systematic review. Journal of Cancer Survivorship. 2016.

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Summary of Key References
6. Stephanie Cash et al. Recreational physical activity and risk of papillary thyroid cancer
among women in the California Teachers Study. Cancer Epidemiology. 2013.
7. Hwang, Yunji MS et al. Annual Average Changes in Adult Obesity as a Risk Factor for
Papillary Thyroid Cancer: A Large-Scale Case-Control Study. Medicine. 2016.
8. Cao Y, Ma J. Body mass index, prostate cancer-specific mortality, and biochemical
recurrence: a systematic review and meta-analysis. Cancer Prev Res. 2011.
9. Winters-Stone KM, et al. Resistance training reduces disability in prostate cancer
survivors on androgen deprivation therapy: evidence from a randomized controlled trial.
Arch Phys Med Rehab. 2015.
10. Focht, Brian C et al. Medicine & Science in Sports & Exercise. Effects of a Combined
Exercise and Dietary Intervention on Mobility Performance in Prostate Cancer. 2016.

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If our speaker is not able to answer your questions today,
we encourage you to post them on Inspire.
Questions & Answers
ThyCa.inspire.comUsTOO.inspire.com BCAN.inspire.com

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Thank you for attention!
Carol Michaels 973-379-4779
caroljmichaels@gmail.com
www.CarolMichaelsFitness.com