Extensive research shows that regular exercise improves quality of life for people living with cancer, at every stage of the cancer journey from prevention, early detection, active treatment, and post treatment phases, and that exercise reduces the risk of recurrence for some cancers.
In the past, health professionals were concerned that exercise may be harmful and advised patients to rest as much as possible during treatment. No longer. Research shows that even small amounts of physical activity, as tolerated, can improve one’s ability to cope with cancer pain, fatigue and other symptoms. This improves treatment tolerance and outcomes.
Exercise is also the #1 recommendation for managing Cancer Related Fatigue, a common and often debilitating side effect of cancer treatment.
Nordic walking (NW) is an exceptional choice when considering your exercise options. With proper technique and pole fitting, NW improves posture, core strength, shoulder mobility & muscle endurance, provides an excellent cardiovascular workout, manages complications including lymphedema, and is fun and social.
This article outlines how NW can help manage various treatment side effects and other common complications experienced when living with cancer.
Breast Cancer
Following breast cancer treatment, people may develop a rounded forward posture and shortening of their chest muscles that may cause pain in the neck, shoulders, chest and other areas. NW encourages upright posture, helps lengthen the chest muscles and strengthens the entire shoulder girdle.
Breast cancer patients should consult a physiotherapist with expertise in oncology if they have had nerve or other damage to the shoulder area. They should also receive a professional bra fitting to support effective lymphatic drainage.
Lymphedema
NW activates the body’s natural muscle pumps (calves and arms) for enhanced lymphatic drainage. Research shows regular NW helps reduce swelling of the affected arm. The rhythmic arm movement when pushing actively through the poles prevents gravity-related fluid pooling in the arm.
People with risk factors for, or who have developed lymphedema of the arm, should receive a professional bra fitting to support effective drainage. Wear your compression garment as prescribed. If your compression garment is looking worn out, consult your therapist and/or professional fitter. This is important because you need proper support as your body adjusts to a more intense exercise regime. Deep breaths during warm up/cool down and throughout exercise can help clear the deep lymphatic vessels.
Avoid extreme temperatures (severe heat/cold), stay hydrated, avoid restrictive clothing/jewelry (including a ponytail elastic around the wrist of the affected arm), monitor your lymphedema signs and symptoms, and speak with your health professional as needed.
Weight management
Obesity is a risk factor developing cancer, for cancer recurrence, and for developing or worsening lymphedema. Fatty tissue can compromise lymphatic return. NW can help with weight loss or weight maintenance as this activity burns more calories and strengthens more muscles than does walking without poles. NW also reduces joint related pain and improves stability thereby enhancing enjoyment, comfort and confidence which may encourage increased walking time, pace, or distance.
Neuropathy
Chemotherapy treatment can cause peripheral neuropathy resulting in a loss of sensation in the feet; this may create a sense of reduced balance and stability. NW increases the base of support by creating 4 points on the ground and therefore adds stability with walking.
Good footwear and foot care are essential. Additional balance training exercises can be helpful. And happily, exercise can improve neuropathy symptoms.
Bone Health
Hormone therapy for some types of cancer (e.g., breast, prostate) has side effects impacting bone loss which increases the risk of osteoporosis and fracture risk. NW is a combined weight bearing and resistance exercise which are both critical to improve bone health and strength (see blog on NW and Bone Health).
Joint Protection
Many people living with cancer also have underlying conditions such as painful joints due to arthritis. NW reduces the impact on the lower body joints (low back, hips, knees and feet) thereby allowing you to walk farther, faster, and more safely so you can better enjoy all the physical and mental health benefits of exercise (See blog on NW and Joint Health).
Social and Mental Health
NW is a social, fun, and supportive activity that helps improve symptoms of isolation, depression and anxiety.
Bony Metastases
More and more people are living and exercising with metastatic cancer. Increased fracture risk is an important concern. NW poles increase safety by reducing impact and increasing stability thereby reducing fall risk.
Immune System Compromise
During chemotherapy treatment immune system compromise increases infection risk when attending public gyms and pools. NW is a safe full body outdoor activity which avoids this risk.
Radiation Treatment
Chlorinated pools can irritate skin that has been treated with radiation. A safe outdoor activity that, like water, decreases joint impact, NW won’t irritate the skin. Choose clothing that minimize skin rubbing when walking.
Anemia
Consult with your physician to confirm that a slow progression of low impact exercise is safe, or whether you should wait to start exercise when blood counts are normalized.
Getting Started:
Consult with your oncologist for medical clearance prior to beginning a new exercise program. You may wish to begin with a supervised program to increase your confidence and sense of safety. Always begin gradually, incorporate a warm up and cool down period of approximately 5 minutes each.
Maintain a relaxed grip on the pole handle – this is critical to ensure the upper body muscles are relaxed and don’t cause tension in the shoulder, neck or upper back. A tight, static grip is especially not helpful when lymphedema is present. It’s a good idea to open and close the hands a few times when taking a rest stop or at red lights to improve arm drainage. The Urban Poling brand has an ergonomic handle and ledge; this is an excellent pole choice as it encourages a relaxed hand. A simple tube shaped handle makes relaxation more difficult.
Proper pole height – this ensures muscle relaxation, fluid shoulder and hip movement as well as optimal posture support. There are different techniques depending on your purpose in using poles:
If you are using the poles in front of the body for extra support – the elbow should be bent to 90 degrees as the hands rest gently on the handles. The pole boot should be round and flat.
If you are pushing through the poles for propulsion (fitness style where the boot of the pole stays behind you) – the elbows should be bent to approximately 110 degrees. The pole boot should be angled.
Setting Goals:
Depending on your starting point, your goal should be 150 minutes of Moderate to Vigorous Physical Activity (MVPA) per week + 2-3 resistance training sessions/week. Seek support as needed from your physiotherapist or appropriately certified exercise professional. A one on one session with an Urban Poling instructor is an excellent way to begin to safely enjoy this life changing activity (See blog Setting Goals). Happy Nordic Walking!
See Expert Panel: Cancer Treatment Plans Should Include Tailored Exercise Prescriptions
