Exercise advice for patients during and after bowel cancer treatment

Exercise can play a vital role during and after bowel cancer treatment but, understandably, it’s often easier said than done. Bowel cancer treatment can be physically and mentally challenging and, depending on your diagnosis, often includes a combination of treatments. Surgery, chemotherapy, radiotherapy and other treatments used to treat bowel cancer can all have side effects such as bowel symptoms, fatigue, pain and bloating, tingling/numbness/pain in your hands and feet and psychological distress, which aren’t always conducive to exercise.

Here, Abigail Fitzgerald, Senior Oncology Physiotherapist at HCA Healthcare UK, talks about the benefits of physical activity and shares her advice on getting started, and how to do this safely during and after bowel cancer treatment.

When it comes to exercise before, during and after treatment you could be experiencing a number of barriers which include, but aren’t limited to; pain, fatigue and weakness, breathlessness and peripheral neuropathy.

Perhaps you were incredibly active before your diagnosis and are frustrated that you aren’t at that same level now or you may be experiencing difficult side effects that are making you physically tired and uncomfortable.

Despite these challenges research has shown there are many benefits to being physically active during and after cancer treatment. Most importantly, it can make a big difference to your overall wellbeing and quality of life at a challenging time.

The impact of exercise

I have worked with many people with cancer and, whilst it can sometimes be tough to begin with, I have seen first-hand the positive impact physical activity can have on quality of life and wellbeing, it’s very empowering.

Regular exercise can reduce stress levels, improve your mood, reduce fatigue and increase energy levels, it can also increase your ability to tolerate treatment and aid in your recovery.

In addition, exercising after a diagnosis of colorectal cancer has also been associated with a reduced risk of recurrence and improved overall survival.

Don’t panic, it’s not time for your first marathon

When I say the word ‘exercise’ some people are concerned, they think I am about to suggest they join a gym or take on an advanced spin class.

Being physically active means any movement that uses your muscles and more energy than when you’re resting, it doesn’t necessarily have to include miles on the treadmill or an aerobics class. It can be walking to the shops, taking the stairs, gardening or dancing.

Physical activity falls into two categories and both are important:

  • Aerobic exercise: this type of activity uses more oxygen and improves the way your heart (cardiovascular system) works.
  • Anaerobic exercise: This type of activity increases your muscle strength and mass, for example, resistance training. 

And intensity will vary:

  • Moderate intensity: this level of activity makes you breathe quicker and raises your heart rate, but you should still be able to talk; for example, fast walking and swimming.
  • Vigorous intensity: this level of activity will raise your heart rate, making you sweat and feel out of breath, so think running, team sports and fast cycling.

Finding your own pace

There’s no one-size-fits-all approach when it comes to exercise during and after cancer treatment. The amount of physical activity you are able to do will vary based on the type of treatment you’re having, at what stage of that treatment you are, the side affects you are experiencing and your general fitness.

It’s important to talk with your medical team before beginning a new exercise regime. They will be able to give you advice about what’s right for you based on your diagnosis and treatment, so you can get started safely and effectively.

If you were very active before your diagnosis a physiotherapist like myself can work with you to safely adapt your exercise regime.

Start small

Starting and maintaining an exercise plan when you are tired from hospital visits and treatment can be difficult. You may not have the energy to do as much as you could before your diagnosis, but being as active as possible will still be good for your body.

Start small and work your way up, particularly if you are new to exercise. Even a small amount of movement can make a difference and the more you do it, the easier and more natural it will become. Even if you can only manage a short walk to begin with, you will build endurance and resistance over time which can lead to big results.

Is it safe to exercise on treatment?

Research has shown that exercise is safe, possible and helpful for many people with bowel cancer. Everyone is different in terms of how much exercise they can do and of course will depend on what treatment, such as surgery, you have had and how recently. Again, if you have cancer, check with your healthcare team or physiotherapist before starting any type of vigorous physical activity.

Knowing the difference between exercise soreness and other pain

It’s normal to feel a little achy and stiff after exercise, this means you have worked your muscles effectively. When you use your muscles, small tears are created which is how muscle is built and strengthened. DOMS (delayed onset muscle soreness) is the term used to describe that sore, achy feeling that occurs after exercise.

This soreness typically only lasts a couple of days and whilst it may not feel like it at the time, it’s actually a positive thing as it shows your body is adapting to your exercise routine and you are becoming fitter. And over time, as you repeat your workout, DOMS will decrease in severity.

Whilst the mild soreness and aches of DOMS is normal and expected, shooting, sharp and searing pains can be cause for concern. If you experience this type of pain stop exercising and contact your care team for advice. It might be that you need to stop or reduce certain types of exercise for a while and adapt your regime.

Neuropathy and balance

One of the common side effects of chemotherapy used to treat bowel cancer is peripheral neuropathy. Peripheral neuropathy develops when nerves in the hands, feet, arms are damaged by chemotherapy. Some of the symptoms include numbness and tingling in the hands, feet or both and loss of balance and co-ordination, all of which can impact physical activity.

It’s important to note that exercise doesn’t make neuropathy worse. But whilst exercise also doesn’t improve the condition it can have a big impact on strength and safety. 
If you are struggling with your balance as a result of peripheral neuropathy please inform your medical team or physiotherapist. Exercise on even surfaces where possible and wear appropriate footwear, like athletic, stable trainers with a rigid sole to begin with.

Exercising with a stoma bag

For some people who have bowel cancer surgery, they may need to have a temporary or permanent stoma. There are some challenges to exercising with a stoma but it’s still possible and plays an important role in recovery.

Bowel cancer surgery and ostomy surgery can weaken your core muscles, your abdominal wall, which are important for most movements. Everything from standing upright to walking, and even laughing, rely heavily on the core, so it’s important to regain that strength and stability through movement.

Starting exercise with a stoma should be done slowly. Begin with simple breathing exercises and walking for the first 2-3 weeks. Once you have gained some strength and feel more confident you can add gentle workouts into your exercise plan. At HCA Healthcare UK you will be guided by your physiotherapy team on the ward after your operation, who will provide you with all the advice and appropriate exercises you will need to get started.

Stoma support clothing

Not everyone requires a stoma or abdomen support post operatively. However, if you have had stoma surgery as part of your treatment plan, there are lots of ways to protect your stoma and abdomen during physical activity. There are a wide range of compression garments and exercise clothing available, stoma belts and waistbands are very popular, as are stoma support high waisted boxers and high waisted leggings. Waterproof dressings and stoma swimwear are also available.

You can also speak to a stoma nurse or oncology physiotherapist about issues with exercise. They will be able to suggest and modify exercises and activities to reduce abdominal pressure and reduce any pain you might be experiencing.

Read more about the common challenges of living with a stoma and the wealth of support available.


Getting the support that’s right for you

Whilst it may seem there are many potential barriers to exercise, we will work together to ensure you achieve your personal goal with a personalised physiotherapy treatment plan.

Ongoing support for cancer patients at HCA Healthcare UK

Everyone has their own unique experience of cancer, but you may find that after treatment you need some time and support to recover.

Whether it’s help with exercise or something else, at HCA Healthcare UK our team of clinical nurse specialists, clinical psychologists, dietitians, physiotherapists and other cancer specialists are available to support you in any way that they can, for as long as you need.

They’ll work with you to develop a care plan that fits your personal needs, so that you can get the support that’s right for you at the time that is right for you. Remember, everyone is different and we’re here to support you as an individual.

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