Transcript Disclaimer – Please note that the following transcription has been machine generated by an AI software and therefore may include errors and ommissions.

Robin Daly
Hi and welcome to the Yes to Life show on UK Health Radio. I’m Robin Daly, host to the show and founder of Yes to Life, the UK’s integrative cancer care charity. As part of our 20th anniversary celebrations, we’re focusing each month on a particular aspect of integrative cancer care. This month the topic is exercise, a relatively recent candidate for inclusion, but nonetheless a powerful and widely applicable one. Today I’m speaking to Sarah Newman, an experienced oncology exercise specialist and someone who has first -hand experience of the impact of exercise on her own diagnosis and treatment. Sarah, fabulous, I’ll be back on the Yes to Life show again.

Sarah Newman
Thank you for having me.

Robin Daly
So today’s a bit of a big picture show. I’m hoping to get an overview of the way that exercises have affected our approach to cancer care and indeed to the results of cancer care and who better to do it with than you, yes, to life’s lead advisor on exercise. So the whole concept of exercise being a good thing for people with cancer, particularly for people going through cancer treatment all seems very recent. There seems to be ever such a short while ago that the advice was rest, rest, rest, more rest. You just couldn’t get enough rest. And indeed the turnaround is so spectacularly radical that in general oncology in the UK is still lagging way by that it hasn’t caught up with this massive change. So do you actually know anything about where and where the exercise revolution first began?

Sarah Newman
Well, I think it’s been going on for a fair amount of time and very quietly behind the scenes. Unfortunately, as is with a lot of things, particularly with the NHS, it takes quite a long time to catch up. That tends to be a funding issue in some respects. So I think probably around 40 years ago, it started to be looked at as something that should be recommended to people. Maybe in their recovery, trying to rebuild some of the strength and fitness that they lose as a result of treatments like chemotherapy. Because a lot of those treatments are not just the cancer treatments themselves, but things like steroids that you’re given alongside chemo, for example, can be a real muscle waster. And you finish kind of six to nine months worth of chemotherapy, maybe longer, maybe shorter, but you become half the muscle mass that perhaps you were when you started.

Sarah Newman
And even as a young person, that can mean that it’s harder for you to do things at home, it’s harder for you to get around, and suddenly you feel that you’ve aged. And actually, if we were to maintain that muscle mass through our treatment as much as possible, and bearing in mind that it’s not always possible to exercise to a level that is going to help you gain muscle mass, but try and maintain as much of it as possible. It will mean that the deterioration of your body around that treatment time will be less. And I think from an exercise point of view, the recommendations coming out have been going on for a while. I was speaking to a physiotherapist the other day, and she was actually brought into the garden to introduce exercise to patients.

Sarah Newman
And she thought, she said to me, in 20 years’ time, I never thought I would be sat in this position when things had really not moved forward. And we need to do something about it, because there is more and more data coming out, which we’re going to talk about a bit more, about the actual molecular biology changes that happen when someone is exercising at different stages of their treatments. There are actual cell changes that happen. And I think this is where the research is going now, and perhaps where the research needed to go, so that we can provide scientific evidence that there is a justification behind this type of medicine that needs to be used within oncology.

Robin Daly
Absolutely, yeah. Okay, well I mean it seems that, you know, adoption’s better in some parts of the planet. I keep hearing about things that are going on in Australia which certainly happened to happen here. It’s good that people are pressing forward in some places and the kind of more globalised nature of things is at least we get to hear about it around here and we know there’s some way to go. So yeah, it’s fascinating territory. Probably the place where it’s the biggest turnaround in terms of thinking, the very idea that fatigue, which is like a common experience, lots of people have that either because of cancer or because of the treatments they’ve been going through and it really is pretty counter -intuitive to suggest that exercise is a great thing to do in order to tackle it. But it really is true. You’ve got some good examples of working with people who’ve got chronic fatigue.

Sarah Newman
Yeah, so cancer -related fatigue is very different as I’m sure many of your listeners will know than just feeling tired. Right. It’s learnedness that you cannot shift, that makes you feel very heavy even when you’ve had a good night’s sleep and you still feel tired the next day. And it is one of the most reported side effects of a lot of different cancer treatments. And actually, exercise has been researched in this area quite significantly. And the resulting evidence shows that actually exercise does help with fatigue. It can give you more energy. But like any medicine, it is dose -specific. Okay. And that dose for you, Robin, might be very different for me. And so there’s a little bit of finding out what your dose needs to be to give you that nice energy boost that you need for movement. And that might start with kind of a one or two minute walk outside just to get your heart rate up and to get you moving. And then it’s a slow increase from then on to help keep that level of energy rising.

Sarah Newman
And some days for those going through treatment, you might be able to do more than on the days where within your cycle where you have less energy. And that’s okay. So it’s very much a case of listening to your body, getting up, having a go, and seeing how it makes you feel. And when I went through my own cancer treatment, I knew if I’d done too much because I literally hit a wall very, very fast. And I was exhausted and I’d done too much. So I think your body will now, and you’re much more in tune with your body, I think, once you’ve had cancer. So you want to stop before you become completely exhausted, but you want to have a little try at getting up and getting about to see whether you can get some more energy from that. And then the next day doing a little bit more and the day after that a bit more, because as you slowly build, so will your fitness and so will your energy levels. And that will help counteract the fatigue that you’re experiencing.

Robin Daly
Amazingly the body, the way it responds to it, it actually likes a reasonable amount of stress, doesn’t it? Too much stress, bad news, but a bit of stress, it always responds in terms of getting stronger or bigger or fitter or whatever it needs to in order to deal with it.

Sarah Newman
It’s like the whole concept of strength training or muscle training is a tear of the muscle fibers and then a rebuild. And what your body does to build up muscle, but you also need to give it enough time to recover in between your exercise sessions to make sure those muscles join back together. And the same applies, you know, you shouldn’t be doing three or four workouts in a day because you do need that time to regenerate the muscle, to regenerate the energy and to get ready to go again. So you want to make sure you’re exercising on as much of your full tank of petrol as you can and not when you’ve got empty tanks and nothing left.

Robin Daly
Okay, so you already mentioned like the science behind this and where it’s going and I just wonder if you tell us in broad terms how you’d say the understanding of the biology, the biochemistry has changed for it to be seen. Rest and recovery is not necessarily a great strategy and exercise is far more helpful in getting you back to a normal healthy functioning.

Sarah Newman
So there’s a lot of different more molecular biology -based evidence coming out. I went to a talk not so long ago that was talking a little bit more about the immune response of exercise, so on your immunity. So lots of people who have any kind of chronic diseases have high levels of inflammation in their body, which means that they can’t necessarily fight off the additional disease that they are starting to develop, cancer for example. If you are fitter, your immune system is stronger, it’s able to fight things more effectively and therefore you kind of don’t necessarily get ill or you’re holding a warding off disease for longer. And what they’re looking at now is how exercise can affect that immunity and then in turn respond to the cancer in your body.

Sarah Newman
So when you are exercising, particularly cardiovascular, it’s pumping more blood around your body, more fluids around your body and therefore it’s moving around your immune system and all of the cells within your immune system so that they are able to regenerate, to target different cells around different parts of the body and therefore they work more effectively at attacking foreign bodies like tumours. So what they’re finding is that actually particularly at the time someone is exercising, the immune response to something in your body, to fighting something like cancer rises, so during actual exercise and then again within that hour afterwards in that recovery time, they’re also finding that that immune response is higher, so they’re responding better and breaking and killing and warding off all of the cancer that is in your body.

Sarah Newman
So the research at the moment is in quite early days, they’re looking at mouse models but they’re also looking in humans as well and testing different serums and tumour markers and finding in all the cancers that they’re working across that exercising is helping with that response to cancer. And so they’re trying to introduce it, for example, you know, you have immunotherapy to help bite your cancer in your body, so supporting your immune system with this additional immune response so that you can bite off the cancer that’s in your body, if exercise is doing that as well, you’ve got an even higher immune response, so actually what they’re showing is alongside immunotherapy, exercise is a really useful tool. I think there’s some studies happening at the University of Surrey where they’ve got people having immunotherapy whilst on exercise bikes, so they’re actually having their treatment whilst exercising and their response to that treatment is even greater than those that aren’t exercising at the time.

Sarah Newman
So we’re seeing that immunity has a huge part and the role of exercise within building that immune response in helping reduce tumour size, helping respond to the cancer within your body and that’s starting to become quite exciting, I think, in this exercise biology world. But what they’re also finding is that people who have a greater muscle mass, so generally those who tend to be stronger and fitter, will be able to tolerate treatment for longer, so they will be able to put up with those side effects, they’ll be able to have more treatment and therefore hopefully it’ll work for longer within that treatment regimen that they’ve been set. Many people have to stop early because the side effects are so severe, so actually coming into it even fitter can mean that you respond to it for longer and you get that full treatment regimen that you have been recommended.

Robin Daly
All right, it’s got to build the case for prehabilitation, doesn’t it?

Sarah Newman
Exactly, exactly. And particularly for surgery. So a lot of people, a lot of bowel cancer patients have quite major abdominal surgeries, quite long surgeries. When you’re preparing for an anaesthetic but also preparing for your actual surgery and the recovery that you’re going to need to make, the fitter that you are at the start of that, the faster you’ll get out of hospital, the faster that you’re going to start recovering and getting back up on your feet and doing the things that you want to do. And the same applies with chemotherapy, radiotherapy, all treatments that are going to give you some form of side effect. The fitter and stronger you are, the more likely you are to be able to tolerate them better and have fewer side effects as well.

Robin Daly
Brilliant, so all these things need to be looked at in much the same way as somebody might look at taking on a great physical sporting challenge in fact. You’ve got to train, you’ve got to get yourself in shape, ready.

Sarah Newman
Exactly, exactly. If you’re going to run a marathon, you’re not going to go into a cold turkey, make sure that you’re training for it. And, you know, we’re not all going to be given a huge amount of notice before we start going into that period. But even they’re showing with a very short amount of time, you know, a matter of weeks before treatment starts. So from your diagnosis, you can start to exercise and you can start to get yourself better and stronger, start to increase your exercise if you’re exercising already. And then you’re really going into that marathon as fit as you possibly could be.

Robin Daly
Right. So that’s the message. It’s never too early.

Sarah Newman
Never too late.

Robin Daly
Very good. I was thinking how interesting it is these days. I mean, the case for mind -body medicine has really gone from sort of woo -woo to being something that’s taken seriously because of the fact that nowadays the molecular biology, the actual figures for what happens to people when they undergo a certain practice of some kind or they do something, it can all be measured quite easily now and they can produce these figures. And you’re saying the same thing now as you can get them on an exercise program. I mean, you can actually show the effect it has on the things that directly affect the disease. And that’s extraordinary and it’s so empowering because these things which are, you know, many of the things are common sense and, you know, they fall under the bracket of common sense. There’s never been kind of proof of common sense before, but now there is. And it’s very heartening and very empowering for people that they know they can do stuff which will have a big effect on their situation.

Robin Daly
Very empowering and very important, I think. Great development. Okay, so one of the great things by exercise therapy is there’s lots of choice for people. There’s something for everyone there. So I’ve had people on this show, they range from fabulous Julia Bradbury, she’s banging on about the virtues of walking, Emily Jenkins on dance, yoga, Qigong, Pilates, all sorts. The list goes on. And by the way, listeners, they’re all still available to listen to. You just go to the SLI website, click the link to the radio show that’s on the homepage and where you get there, you search for exercise. But that said, it seems like not all exercise is equal. I think it’s fair to say that you may be able to say that all exercise is good, but different forms bring different benefits. So more than one type could make for a good mix. Am I right?

Sarah Newman
Yes, I think a rounded approach to exercise is important, making sure that you include some essential elements like something that works your heart and lungs, something cardiovascular, and that can be incorporated very easily into your day. It might be a walking the dog, it might be taking kids to school, grandchildren to school, or just going for a walk around the block. The second thing that a lot of people don’t necessarily incorporate is something that is strength filling. Because firstly, it was a little bit scary. So, you know, I’m not expecting you to be in the gym lifting an Olympic size weight. Your body weight and bean tins and water bottles are great tools to give you a little bit more resistance when you need it. But to create that decent bone density, that joint strength, that muscle mass, you do need to do some form of strength or resistance training. And these are movements that you do on a daily basis, but forget, because they’re just natural.

Sarah Newman
So like getting in and out of a chair, that’s a squat, bending down correctly to pick something off the floor, that’s a hinge, that’s a deadlift, pushing a door open. So any kind of push -based movement, if you imagine a press -up, that’s push, pushing something above your head. Again, those are all push -based movements. And then the opposite is the pull. So if you’re rowing or you’re pulling something from the ceiling down, all of those movements are strengthening movements, but they’re using resistance to add and build on that muscle mass. So adding a little bit of a strength routine a couple of times a week into your exercise regime is really important. And you can do that on your own, or you can do that with friends in an exercise class.

Sarah Newman
I think that the key about exercising is that it should be fun. And I don’t like to force people to do exercises that they don’t want to do, it has to be enjoyable. And so it’s about finding a way and finding a sport or a movement that you enjoy and trying to incorporate that within your day. So, you know, you’ve mentioned quite a few different examples. Walking, great cardiovascular fitness. If you want to build that up, you just add a few minutes each day, or you increase your distance, or you add a hill so that you’ve got a little bit more vigorous exercise coming up that hill. Dancing is a great one for cardio again, but also agility. There’s a little bit of strength and balance in that. And the same with yoga. And yoga and Kigong is kind of a lovely way to calm the nervous system.

Sarah Newman
There’s a lot of research coming out with yoga in terms of cancer and anxiety and mental health benefits, as well as physical health benefits. So there are types of yoga that have amazing strengthening practices and strengthening holds and different movements that you can do. But there are more gentle practices, which are great for breath work, which is very important to calm the mind. It’s very good in terms of lymphatic movement and drainage. So there’s lots of different benefits from all of those things. The recommendations that come from the World Health Organization, who kind of make these guidelines for the NHS and various other organizations, is that those that experience the cancer diagnosis form into the same bracket as any general adult. So anyone from 1864 should be recommended to do 150 minutes, at least, of cardiovascular activity. So that’s something like walking, or a gentle bike ride, or a swim, or something else dancing. And across your week, that works out about 20 to 30 minutes every day.

Sarah Newman
Anything more than that is, of course, more beneficial, but you can work your way up, particularly if you’re just recovering from treatment. And then also, as I mentioned before, the WHO does recommend two strength sessions a week. So this is something that I started looking at in snacks through the day. So people find it quite difficult to do a 20 minute workout, particularly when they’re just getting started. So using time when you’re waiting, like for the kettle to boil, the washing to finish, or you’re waiting for someone at the bus stop, or I don’t know, I know you might look a bit silly at a bus stop, but you know, you’re doing some doing some squats, getting in and out of your other chair, or without a chair, standing on one leg, practicing that balance, pushing, pulling doors or using some simple resistance bands, just doing one exercise in that five minute slot, a couple minutes slot that you’ve got there.

Sarah Newman
And that builds up through your day, you know, if you’ve got three five minute slots, you’ve done your legs, your arms and your in your chest, perhaps within within a full day doesn’t all have to be within one burst. So breaking it down becomes much easier. And then also makes it a little bit more of a habit, that when you’re waiting for the kettle to boil, you know, that’s your time that you need to do your squats. So I would imagine you make a tea a few times a day, most people do. And so there you go, you’ve got your squat time. And so making breaking it down into easier chunks, snacking chunks can be a simple way to introduce strength training into your daily routine.

Robin Daly
Okay. Yeah, it’s interesting what you’re saying about yoga. It’s kind of like, well, where does that sit in the kind of strength training? And of course, yeah, some types of yoga do have kind of poses you hold in there. And so that is definitely a strength training, isn’t it?

Sarah Newman
Exactly. I mean, if you’re in a down window… In a plank.

Robin Daly
This is pretty hard work, you know, so that would all get included. In fact, I assume that if you did, you know, a fulsome yoga discipline, you would actually cover a wide range of strength training.

Sarah Newman
I think, you know, you do get your heart rate raised through it. If you’re moving through different poses quite quickly, your heart rate is raised as well to a level that probably counts towards your 150 minutes to. So yeah, you’ve got a few ticks in the box there.

Robin Daly
That’s good. Yeah, so I mean you talked a little bit about your snacking there as ways to get started on things everything but yeah, I just want to address the listeners who are feeling like they’re definitely fitting the group who would describe themselves as unsporty and no time to spare and maybe feeling that it’s Getting started is actually a major hurdle to overcome I don’t think that or this is a small minority. There’s a lot of people this applies to and So well your best tips really for just ways of getting started on both types of exercise Which are quite different, you know, it could be so yeah, if you’ve got some good little tips instant tips

Sarah Newman
So I always say that the basis of all exercise programs is a daily walk. Okay. So not only are you getting your tick in the cardiovascular box, but you’re also helping with your mental health, you get a dose of vitamin D being outside, and you can go and do it with a friend or a family member as well, so there’s a social element to it. So getting outside for a daily walk, starting, you know, five minutes if that’s all that’s possible or less, and just adding a small amount of time each week so that you’re building up and building up your cardiovascular fitness. In terms of the strength element, you can start in a chair, you can start in the most comfortable place, but finding somebody who can give you some very basic strength moves, I’d be happy to provide that, and it will just help in short bursts to start to introduce a little bit strengthening to your day, because very quickly it becomes very effective.

Sarah Newman
And so something that you might have struggled to do, some people struggle with stairs, suddenly you’re walking up the stairs without the pain or the problem that you had before or not holding on, because you feel more confident. And I think when you start to see those benefits, you start to feel more motivated, and it is a big jump to get started. I do appreciate that, especially when you’re feeling at your lowest.

Robin Daly
Yeah.

Sarah Newman
But I think thinking about the reasons that you should and want to be exercising for your future is a different approach now after a cancer diagnosis. I found that a lot of my exercise was based around aesthetic reasons, perhaps before my cancer diagnosis. And now I exercise because I want to live longer, because I want to live effectively for longer. So I want to be able to get off the floor, pick up my child, pick up my grandchildren. And I want to be able to do that for as long as possible. And I had going through the menopause pre -40, I am now 40 now. But I had my first menopause experience in my early 30s. And so I know that my body is older than perhaps my age suggests. So I need to be doing all of this stuff.

Sarah Newman
And I know that it will help me more later in life. And I think knowing that and having that motivation can be a big driver in getting started. So having a think back to why you want to exercise, and going back to that reason, perhaps even writing it on your fridge, so that every time you open the fridge door, you just get a little bit of a reminder. But also always recommend that after a workout or after some exercise, when you’re feeling good, write that feeling down on a post -it note, stick it on your fridge too. Because you never really regret a workout, because it always makes you feel good. It’s always the thought of it.

Robin Daly
Yes.

Sarah Newman
You don’t want to do it. So if you can remind yourself how you’re going to feel at the end before you even start Just kind of helps helps get you going There were just other things like getting dressed in the morning putting your gym kit on or you know You track your B’s on and not taking them off until you’ve gone and done the thing that you said you were going to do Yeah, right So you know little sneaky cheats like that that are going to mean that you can’t get out of your exercise You are already ready to go and there are no excuses

Robin Daly
Well, this is where the information about what exercise can do is so important, isn’t it, to people? Because if they know that, then, of course, the motivation you described, which is right, okay, I may not be much of an exerciser up to now, but now I’ve really got a reason to do it. It can be a game changer, but, you know, if they don’t know that, it’s not going to happen, is it? They’re basically, they’re going to go from being a non -exerciser to feeling like they’ve got no energy. And it’s downhill, so it’s so important to get this message out about the potential of exercises in all this help.

Sarah Newman
You know, one of the leading reasons that I exercise now is to reduce my risk of recurrence. I know that there are lots of studies coming out now that those people who are exercising and host a primary diagnosis of cancer can potentially contribute to the recurrence of their cancer. So it can help reduce the risk of recurrence. It won’t hurt everybody, but there is now data to say that up to 30% of people can reduce their risk of their cancer coming back if they are fit and healthy and following their primary diagnosis.

Robin Daly
And, you know, in this world of cancer that there are no certainties, increasing your odds is the way to go. Yep. Yeah, brilliant. Okay, so a bit of inspiration is also a great thing, along with the good information. And I’m sure you’ve supported many people, some of whom would have come from nowhere, maybe with exercise, not thought of themselves as sporty at all, but have actually embraced it and have had some stunning results. I wondered if you’d give us maybe a good story.

Sarah Newman
Yeah, so many stories. So I mainly train women who are going through a breast cancer or gynecological cancer diagnosis, although I have trained men and women with various different cancers, and at different stages of disease as well. So I suppose from a primary point of view, I trained one lady who was absolutely crippled by her treatment. She’d been through chemotherapy, she finished her radiotherapy, and then she’d started hormone treatment. And she was in her early 60s. She was a very young woman who should have been very mobile, but she couldn’t get on and off the floor. She couldn’t walk up the stairs. She was so stiff every morning. And I couldn’t believe that she felt that way. And now I know a little bit more about aromatase inhibitors and tamoxifen and the treatments that people will continue on for various years, have these huge musculoskeletal side effects that aren’t always reported.

Sarah Newman
And I worked with this woman and we started very gently building up the strength in her legs, in her upper body as well, but focusing on trying to get her up the stairs, get her off the floor. And just working with resistance bands and her body weight, allowing her to hold onto the chair at the beginning because her balance was a bit off. And just slowly after about four weeks, I suddenly had an email and it was from this lady and she said, Sarah, I didn’t realize I was doing it at the time, but I just walked up the stairs without holding on. And that was a huge, huge step for her because she lived in a house. So she needed to get up and down the stairs. And suddenly she was able to do it without even realizing. And I think that’s where this kind of personalized approach to gentle progression of strength training really works.

Sarah Newman
We got the dose right, we got her legs stronger and suddenly she was up and down those stairs and she never went back. And she just got stronger and stronger from there. Amazing. I had a similar experience with a lady who had metastatic disease. She lived over in Spain actually. And because I trained a lot of people online, I was able to support her. And she was unable to do a lot of things. She had met in her bones. So we were limited on a few things, but we went back again through those functional movements. And she was really struggling to leave the house because she couldn’t climb stairs, not even one step. And so we worked a lot again on her leg strength and her mobility through her feet and lots of different areas. And suddenly, again, I had an email and she said, I went out. I went out with my husband, but I went out and there was a shop that I really wanted to go in, but there were two steps to get up to the shop and I managed to do it.

Sarah Newman
And then suddenly her confidence grew and she started to go out on her own. And I was so, so pleased because she didn’t have a huge amount of time remaining. But I was glad that those last few months she was able to do as much as she possibly could because she was only in her 30s and she really should have been able to do those things at that age. So we gave her back a little bit of freedom in those last months of her life.

Robin Daly
Yeah, it’s so easy to get into a rapidly shrinking world when your physical pastures go like that. Yeah. Or possibilities decrease so rapidly. So, one of the things you mentioned in regard to various sorts of exercise was the thing about doing it with other people. And I feel for myself that’s a very important aspect of the whole thing, particularly if you’ve got problems with motivation. Do you want to talk about that a little?

Sarah Newman
Yeah, so I think when you’ve got somebody to be accountable to, you’re more likely to turn up. And so making your date and a time and setting that time where you’re going to meet with somebody is a good way to kind of become accountable to that exercise session. And it not only gives you an opportunity to catch up with that person, but it also means that you’re doing your daily exercise. Now, when I was recovering from my treatment, I used to meet people for a walk in a coffee. And I wouldn’t be able to go very far to begin with. So we just do a very gentle walk. But I could see as time went on, I was able to increase the time I was walking. And then we started introducing a few hills to our walk. And, you know, I had time available to me at that point, I was off on sick leave. And so it was a great opportunity for me not only to get outside, but to catch up with people that I wanted to talk to.

Sarah Newman
And I could see physically and mentally the benefit that it had for me. And then after that, I joined an exercise class. And so I was able to interact with other people. And at that point, it wasn’t a cancer based class, and people didn’t know anything about me. And I did find that element hard. But since that happened, so that was six years ago, there were lots more classes available to people who have been through a cancer diagnosis, that will not make them feel alone. So by running classes online for people, and I know that they all turn that up, they don’t have to tell me what’s wrong with them, because I know. And it’s very difficult when you go to a mainstream exercise class.

Sarah Newman
And someone says at the start of the class, has anyone got anything that they need to, you know, run by me? And you’re like, how long have you got? Because it’s quite long. But you know, all of the classes that I do, and my counterparts, the cancer and exercise specialists will run, are suitable and relevant to the experience that you’ve been through. And so you know that you’re in safe hands, because you’re not going to be doing anything that is unsafe, you’re not going to be doing anything that is going into you. And so I think trying to find those types of classes, either locally or online, are really beneficial to know, and just to regain the confidence in your body. And then within that, you can meet a community of people around it as well, who have all been through a similar experience to you.

Robin Daly
Yeah, absolutely. And, you know, the power of community in situations where you’re physically, your health is challenged is, you know, it’s enormous. And it’s prompting us as, yes, like to do more and more communal things, just because, you know, people, when you’re in a group of people who all want the best for each other, is extraordinarily helpful. So, yeah, great. And I love that you just have, you know, a walking partner and you can see how you can get ambitions between you that you might never have on your own.

Sarah Newman
And I think also when you’re talking alongside somebody, when you’re not looking directly at them, you feel you can be a little bit more open. So it becomes quite like a quite an open conversation, I think you can be quite honest. And there’s a lot of kind of talking, walking therapies now. And I almost felt like sometimes I was, it was a very helpful tool to be walking and talking from an ecological point of view as well.

Robin Daly
Interesting. Okay, so we’re coming towards the end. I just want to summarize. It seems like exercise is like, well, everybody in the castor should be exercising. Is that actually true?

Sarah Newman
So there are some red flag things that we are warned as exercise professionals. If somebody has been refused chemotherapy one week, we tend to recommend that they don’t exercise. If someone is immunocompromised but to a level where their levels are too low, generally they would have been refused chemotherapy, so you all know. But we tend to refuse exercise then. If you have diarrhea, sickness, so you haven’t been able to hold any food down, we would say no. And I would say, generally, we try and recommend exercise as often as we can, and that can be a different ball of exercise. So if you’re not feeling so well, you can do something a little bit gentler, like yoga or something that feels a little bit more for a breath work point of view, but still with some movement. Those that have got metastatic disease, there is so much evidence coming out that is really helpful in recommending exercise and resistance training for people with metastatic disease.

Sarah Newman
It becomes a little bit harder when the meds are in the bones, but it’s still recommended because you need to be able to move every day, and you need to be able to do certain things around the house. So to be strong enough to do that is particularly important, but it just needs to be a little bit more guided for those with metastatic disease. So have a little bit more advice from a specialist trainer who knows what they’re doing so that you know that you’re doing the right type of exercise that’s going to benefit you. But on the whole, it’s quite logical if you’re not feeling well, if you haven’t been able to keep food down, if you’ve been refused chemotherapy, those types of areas we need to be much more cautious about, and just being aware if your treatment has some quite severe cardiotoxic effects. So on your heart, make sure that both your oncology and cardiology team are happy for you to exercise before you get started.

Robin Daly
Interesting, so if I’m not missing something it sounds like you’re saying well exercise is for everyone with cancer but there are some circumstances during the course of their treatment when it might not be.

Sarah Newman
Yeah, if you think about it, if you didn’t have cancer and you had the flu, or you had a sickness bug, you’re unlike exercise, same applies for those who have been through a cancer diagnosis. If you’re not well, or you’ve been refused treatment, it’s not the right time to exercise, waiting for those levels to go back up. When you’re not neutropenic anymore, when you’re able to have your chemotherapy, that’s when you can start to exercise again.

Robin Daly
Yeah makes sense. All right. That’s it. We’re out of time. Thanks so much, Sarah. Been brilliant to hear all your advice and I particularly like the inspirational stories. The great news about the Exercise Revolution is that it’s such an effective means for people to directly engage with their own recovery and also so completely accessible and affordable for everybody. It’s something that anybody can do to help themselves so that makes it an amazing asset. So thanks very much for coming on the show to tell us all about it.

Sarah Newman
Thank you for having me.

Robin Daly
Thank you.