Isabelle Brough is providing mini-massages at the Wellness Day (Dorchester-on-Thames Friday April 12th).  She kindly sent me a copy of the Essay she wrote for her Oncology Massage Practitioner Diploma.  Whilst you lie back and let her work her magic with massage, you can ask her about her in-depth study of the way we move, and how much can also impact on our recovery.  
Oncologists around the world will generally say that France is probably the best country for treating cancer, and during my treatment there it was noticeable they treat us holistically.  When I went to for treatment at the massive rehabilitation centre attached to the University of Iena Hospital in Germany, they have six heated swimming pools, two of them Olympic sized. It was the same in Italy and Austria.  And here I found out that if you have Osteoporosis (a recognised side effect of drugs) your GP expects you to go for tailored exercise classes.
Isabelle’s approach is a thoughtful essay on how movement impacts on us, and provided me much ‘food for thought’.  So here is an extract : –
Cancer patients are encouraged to be physically active to manage their symptoms and improve their well-being, and with good reason.
The health benefits of physical activity for cancer patients, whether before, during or after treatment, are well established. Indeed, physical activity can help build fitness levels to prepare for surgery, radiotherapy or chemotherapy. During and after, it can help prevent muscle wasting, lessen the impact of side effects (lymphoedema, anxiety, depression and impaired mobility)[1], reduce fatigue and depression, improve fitness, heart health and quality of life[2].
As for cancer recurrence and long-term survival, studies of cancer patients show that physically active cancer survivors have a lower risk of recurrence and improved survival than those who are inactive.[3] A study on physical activity, sedentary behaviours and the prevention of endometrial cancer found that being active can reduce the risk of endometrial cancer, active women having around a 30% lower risk. It is believed that physical activity could lower the risk of womb cancer by reducing estrogen levels in the blood as well as the amount of circulating insulin.[4] MacMillan refers to physical activity as a “wonder drug with little cost”, stating its benefits for both physical and mental health.[5]
Exercise and physical activity seem to be used interchangeably in cancer support organisations: “In the past, people being treated for a chronic illness […] were often told by their doctor to rest and reduce their ‘physical activity’. This is good advice if movement causes pain, rapid heart rate or shortness of breath, however newer research has shown that ‘exercise is not only safe and possible during cancer treatment, but it can improve how well you function physically and your quality of life.”[6]
].
It is clear that we all need to move more. Tigbe et al (1977)[9] suggest over 7 hours of uprightness (stepping, standing or other non-sitting activity) may be an appropriate target to avoid risk of coronary heart disease. That is a lot more than current UK government recommendation of “at least 150 minutes of moderate intensity physical activity each week, in bouts of 10 minutes or more”[10] – which amounts to only around 20 minutes per day. Even in people considered “active”, isolated bouts of exercise leave people “unmoving” for the bulk of their day.
Bowman (2018) goes further and defines “movement” as “any motion that create a change in shape of a body or parts of a body”, adding that “it facilitates operations in almost every human system (e.g. immune, digestive, nervous).” She goes further by explaining that “While almost every disease lists ‘exercise’ as either a preventive or therapeutic treatment, the reason we need exercise in the first place is because movement is no longer provided by our environment. An animal in the zoo needs to be given an exercise program because their habitat limits their biological reflexes.” [11]
Bowman defines exercise as junk movement, i.e. as “a way of moving that provides short-term fitness at the expense of long-term health”, just like junk food is “something you eat that provides short-term satisfaction at the expense of long-term health”. [12] Fitness can be defined as “the ability to do physical activity” and health as “the amount of freedom from disease”. It is possible to be fit but unhealthy, or healthy but unfit[13]. “Time limitations have eaten away the space in our lives for the all-day, life-long varying whole-body movement required for biological function. In lieu of a “natural movement” diet, we partake of short, daily bouts trying to manipulate variables so that we might create a similar effect, in 60 minutes, to what we would have gotten over a 24-hour period.”[14] It is important to recognise that removing movement from everyday life for the sake of convenience comes at the cost of our mental and physical health.
Both MacMillan and the American Cancer Society make a positive contribution to this notion of being more active in everyday life, suggesting: walking in the neighbourhood after dinner, gardening (weeding, mowing the loan, raking leaves, digging), housework (scrubbing the bathroom, hoovering), playing active games with the children, going out dancing or dancing in your own home, parking the car a little further away or getting off the bus several stops before the destination to include more walking, using the stairs instead of the lift, joining a walking group.
Macmillan make available free resources to encourage cancer patients to become more active, including a booklet, some flyers about activity in daily life such as walking, swimming, gardening and sport, an activity chart and diary to plan to record and keep track of daily activities as well as a DVD of exercises to follow along with at home.[15]
All this promotional effort to get cancer patients to move more tends to indicate that they do not move enough. Macmillan has indeed estimated that there are 2 million cancer survivors in the UK and around 1.6 million do not meet the recommended levels of physically active (150 minutes of physical activity of moderate intensity per week).[16]
Our sedentary ways are of course a general issue not restricted to cancer patients. Movement used to be an integral part of our lives as we had to find food, grow it, prepare it and make our own tools and clothes. We are at a stage in human history where we hardly need to move at all – we can have practically everything done for us, from having our house cleaned to getting our shopping delivered to our door, our vegetables pre-cut and pre-cooked, our dog walked, our bodies entirely supported by furniture and transported from A to B in comfortable cars. From being a necessity, movement has become an option and for some a chore. People in the UK are around 20% less active now than in the 1960s. At the current rate, we will be 35% less active by 2030: “We are the first generation to need to make a conscious decision to build physical activity into our daily lives. Fewer of us have manual jobs. Technology dominates at home and at work, the two places where we spend most of our time. Societal changes have designed physical activity out of our lives.”[17]
Despite telling people that they can’t continue to sit all day, that they have to get up and move, most are not doing it. The message is simply not getting through. There could be several factors involved, including a lack of enjoyment because it may be uncomfortable or painful to move, or a lack of motivation – the notion that exercise is something which happens in the gym, in yoga classes or through jogging has become so ingrained in the psyche that people may subconsciously reject it. The focus of the current recommendations is on moving the whole body more for a number of hours per week. Instead of measuring physical activity in terms of quantity (number of hours or steps), the focus needs perhaps be on the quality of the movement in terms of enjoyment. It may be more fruitful to work on improving the movement in stiff, achy parts so people can enjoy moving more. People are more likely to be active if they find it pleasurable. It may also be helpful to have a precise goal in mind and believe that it is achievable with the right kind of support – being able to resume a favourite activity, being able to tie their shoe laces with ease, being able to take a child in their arms to console them, etc.
Simple suggestions could be made for three categories of movement that people already do because they have to: breathing, sitting and standing. If moving is changing positions, then people could start by varying the way they sit as well as getting up from their chair often.[18] 16 hours of changing positions often would be more beneficial than one hour of exercise and 15 hours of slouching in a chair in every 24-hour period (see Appendix for more details).
It might help to educate cancer patients about some of the overlooked benefits of moving more. Not everyone knows that movement is essential to our system of oxygen distribution. The heart doesn’t do all the work of the cardiovascular system. In reality, as we move, muscles pull oxygenated blood out of the arteries into the capillaries, the smallest blood vessels, to reach the surrounding tissues and feed the cells. “Blood moves like this: The mechanical stimulation of a muscle working causes the smooth-muscle walls of the arterioles to relax and open (vasodilation), causing a drop in pressure that pulls blood from the arteries to the capillaries.” [19] When used, each of our 600+ muscles pumps blood around the body. It is through the use of the musculoskeletal system that freshly oxygenated blood can reach the cells, which need a regular supply of oxygen to function well. As Bowman points out bluntly: “If you don’t move, your cells don’t get fed. If your cells don’t get fed, they die.”[20] “You can sit in a bed and have excellent-quality food brought to you every single day, and your cells will still die sooner than later. Why? Because movement is the vehicle for cellular feeding.”[21] Moreover, cells sense mechanical forces and convert them into changes in intracellular biochemistry and gene expression: this process is called mechanotransduction. “Physical therapies, dance, exercise and various forms of movement can indeed influence cellular activities, including cell growth, differentiation, and potentially even immune cell responses that are critical to human health.” [22] Research into the mechanical environment of cancer cells is new and the role mechano-sensing plays in inflammation is under investigation. It has now been established that “gentle daily stretching for 10 minutes can reduce local connective tissue inflammation and fibrosis”.[23] These interactions between musculoskeletal and immune systems could potentially have therapeutic applications. It may be helpful to define stretching. When a stretch is being felt in an area of the body it is because this particular area has been under-moved. For example, hamstrings become tight when maintained in a shortened position due to one of the following reasons: excessive sitting; pelvis tucking; wearing shoes with a heel, a tight psoas muscle due to psychological stress; lots of athletics or fitness; particular postural habits; underuse of hamstrings in gait due to the absence of natural gait pattern (involving hip extension).[24]
Movement is also very important for the lymphatic system. Drainage of cellular waste products contained in lymph depends on regular use of the muscles – every single muscle in the body, not just the larger ones which people work in the gym[25]. Cancer research UK include some very helpful exercises specifically designed to help with lymphoedema of the arm, the leg as well as the head and neck.[26] The Lymphoedema Support Network (LSN) have a very well-made DVD available for sale with specific exercises, guidance for diaphragmatic breathing and self-massage techniques to manage the condition of arm lymphoedema[27]. To help with “swelling due to stagnant lymph” (lymphoedema) of the armpit, arm or hand, Bowman recommends specific neck and shoulder exercises as well as “walking with natural arm swing” (pushing the arm back and letting it swing forward), which can easily be implemented in daily life.[28]
Health and fitness benefits may not be enough to motivate cancer patients to keep moving. Focusing on the benefits of movement beyond fitness and health would likely have a better chance of success. This could be done by recommending the addition of a non-exercise component to the time allocated to physical activity – whether it’s me-time, family time, couple time, friend time or nature time[29], to make it an enjoyable experience. There are several pleasurable reasons to move beside health and fitness: connection with the natural world (feeling the fresh air/sun/wind/rain on the bare skin, watching and listening to the birds, smelling different scents in the woods, gardens or parks) and social interaction (chatting to neighbours, connecting with like-minded folks, spending time with loved ones, meeting new people).

To conclude, it is clear that cancer patients need to move more – not just in isolated bouts of exercise but in many different, meaningful ways throughout the day. The long-term solution goes beyond doing something for so many minutes per week. A sea change in how we view movement throughout each and every day is needed in combating society’s shift to sedentary ways and the idea that hour-long exercise classes or bouts at the gym are an effective antidote. It is really about how we decide to live our lives. Adding movement to everyday life little and often can be simple and should start with the basics: moving stiff, achy parts, learning to breathe, sit and stand better before preparing the body for walking, focusing on quality over quantity of movement, with the aim of making moving pain-free and enjoyable. Education and awareness are key in promoting a movement-rich life. Adding a non-exercise component, such as social interaction and nature, to time allocated to physical activity would help keep cancer patients motivated. Moving needs to becomes less of a chore and more part of a normal, enjoyable and rewarding way of life.Appendix
To add more natural movement into daily life, I suggest starting by breathing, sitting and standing better and prepare for walking. These suggestions can be implemented even when walking is not an option because of treatment or fatigue.
Breathing better. Learning to breathe well is important. The floor of the mouth, the tongue, the heart, the lumbar spine, the pelvic floor and even the feet are connected to the fascia of the diaphragm.[30] Lois Laynee Optimal breathing[31] (silent breathing with lips gently together, teeth apart, tongue resting on roof of mouth, in and out through the nose) combined with diaphragmatic breathing (feeling the expansion of the ribcage on the outbreath, involving the intercostal muscles) are worth exploring.
Sitting better. Sit with an untucked pelvis on a chair, sitting on your sitting bones, not your sacrum. Use a rolled or folded towel to roll your pelvis forward. Sit on the edge of the chair, letting your own muscles hold you there. Start with a few seconds and gradually build up as your core muscles get stronger. Sit differently: different chairs, different heights, try a stool, a bench, the floor. Variety is important.
Standing better. Stand in your heels, with hip stacked over knees over ankles. If your toes are liftable, you know you are in the right place. Shift back and forth as it will not feel natural at first. Be aware of leaning forward in the kitchen or the bathroom, bring your hips back until they line up more vertically with your knees and ankles when looking from the side.
Preparing for walking. Sitting or standing next to a chair or table for balance, move your ankle by bringing your foot towards you and away from youSpread and wriggle your toesCrunch and straighten themCircle your ankle at different paces – slow, medium, fastPut with a soft tennis ball under the ball of your foot. Roll your whole foot on it.
Standing, prepare your joints for uphill motion by putting the ball of your foot on the apex of a rolled towel or other object (wedge, door stopper, stone). Your heel is down, and your toes are free to move, spread and wriggle. The other leg is slightly behind or level with the leg that’s on the rolled towel. This move will prepare your calves and ankles for walking.
Balance on one leg, have a chair near to hold on to – start with leg bent, then leg straight, without leaning to one side if you can and without locking the knees. Walking being a one-legged exercise, it’s important to practise balancing in this way.
Other suggestions for incorporating more movement into daily life, without making special time for exercise but simply by making some changes to movement habits and environment include:
·       Wearing minimal shoesThis should be done gradually, starting with just a few minutes, and while also making time to practise spreading and lifting the toes individually as well as stretching the calves.
·       Building a sit-stand desk. It does not take extra time to sometimes stand in front of your computer, loading your bones and muscles. How about sitting on the floor or a stool with your laptop or your writing material on a low table, regularly changing the angles of your hips and knees?
·       Going furniture free. As well as going to your favourite yoga or Pilates class to assume different positions for an hour, why not do it at home, on your floor, all evening long?
·       Walking short distances instead of always taking the car. Why not plan a longer walk at the weekend when time allows?
·       Getting a Squatty Potty. This is an easy way to add daily movement by assuming a different position to what your muscles and joints have been used to. Simply use a turned-over box or a stool to elevate the feet.
·     Other everyday movement ideas: Litter picking, baking (jam tartscrumble)
·       Carrying children or shopping. Change the way you carry them often so more of your parts participate in your movement, keeping your pelvis central (no shifting forward or back or to the side).[32
So after you have met Isabelle, find the Age UK stand and ask them about the very enjoyable exercise classes they organise right across the region.  There is something for every level, from sitting exercises to gentle sports. 
]References
[1] Macmillan cancer support. Move more. Physical activity the underrated ‘wonder drug’.https://www.macmillan.org.uk/documents/aboutus/health_professionals/physicalactivityunderatedwonderdrug.pdf
[2] Macmillan. Tools to help you move more.https://www.macmillan.org.uk/information-and-support/coping/maintaining-a-healthy-lifestyle/keeping-active/tools-help-move-more.html
[3] Cormie P, Zopf EM, Zhang X, Schmitz KH. The Impact of Exercise on Cancer Mortality, Recurrence, and Treatment-Related Adverse Effects. 27 April 2017. https://academic.oup.com/epirev/article/39/1/71/3760392
[4] Moore SC, Gierach GL, Schatzkin A, Matthews CE. Physical activity, sedentary behaviours, and the prevention of endometrial cancer. https://www.ncbi.nlm.nih.gov/pubmed/20877336
[5] Macmillan cancer support. Move more. Physical activity the underrated ‘wonder drug’.https://www.macmillan.org.uk/documents/aboutus/health_professionals/physicalactivityunderatedwonderdrug.pdf
[6] American cancer society. Physical activity and the cancer patient. https://www.cancer.org/treatment/survivorship-during-and-after-treatment/staying-active/physical-activity-and-the-cancer-patient.html
[7] Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Reports 1985; 100(2):126-131. PubMed PMID:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1424733/
[8] Bowman K, Move Your DNA: Movement Ecology and the Difference Between Exercise and Movement Katy Bowman California State University, Northridge, https://jevohealth.com/cgi/viewcontent.cgi?referer=https://www.ecosia.org/&httpsredir=1&article=1077&context=journal
[9] Tigbe WW, Granat MH, Sattar N, Lean MEJ. Time spent in sedentary posture is associated with waist circumference and cardiovascular risk. Int J Obes (Lond). 2017 May; 41(5):689-696. doi: 10.1038/ijo.2017.30. Epub 2017 Jan 31. PubMEd PMID: https://www.ncbi.nlm.nih.gov/pubmed/28138134
[10] Chief Medical Officers (2011). Physical activity guidelines for adults (19-64 years). Start Active, Stay Active: A report on physical activity for health from the four home countries’https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/213740/dh_128145.pdf
[11] Move Your DNA: Movement Ecology and the Difference Between Exercise and Movement Katy Bowman California State University, Northridge, katy@nutritiousmovement.comhttps://jevohealth.com/cgi/viewcontent.cgi?referer=https://www.ecosia.org/&httpsredir=1&article=1077&context=journal
[12] Katy Bowman. Junk food walking. https://www.nutritiousmovement.com/junk-food-walking/
[13] BBC GCSE bitesize. Science. Fitness and health.http://www.bbc.co.uk/schools/gcsebitesize/science/ocr_gateway/understanding_organisms/fitness_healthrev2.shtml
[14] Katy Bowman. Junk food walking. https://www.nutritiousmovement.com/junk-food-walking/
[15] Macmillan. Move more. A guide to becoming more active with ongoing digital support.https://be.macmillan.org.uk/be/s-840-move-more.aspx?_ga=2.176839269.1177735824.1543248109-501319829.1543248109
[16] Macmillan cancer support. Move more. Physical activity the underrated ‘wonder drug’.https://www.macmillan.org.uk/documents/aboutus/health_professionals/physicalactivityunderatedwonderdrug.pdf
[17] Public Health England. Guidance. Health matters: getting every adult active every day. 19 July 2016.https://www.gov.uk/government/publications/health-matters-getting-every-adult-active-every-day/health-matters-getting-every-adult-active-every-day
[18] Katy Bowman. Your position in life. https://www.nutritiousmovement.com/your-position-in-life/
[19] Katy Bowman. Move your DNA. https://www.nutritiousmovement.com/book-excerpt-move-your-dna/
[20] Katy Bowman. Move your DNA. https://www.nutritiousmovement.com/book-excerpt-move-your-dna/
[21]Katy Bowman. Junk food walking. https://www.nutritiousmovement.com/junk-food-walking/
[22] Ingber D E. Tensegrity and Mechanotransduction. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2614693/
[23] Berrueta L, Bergholz J Munoz D, Muzkaj I, Badger GJ, Shukla A, Kim HJ, Zhao JJ, Langevin HM. Stretching reduces tumor growth in a mouse breast cancer model (December 2018)https://www.ncbi.nlm.nih.gov/pubmed/29777149
[24] Bowman K. A users’ guide to hamstrings. https://www.nutritiousmovement.com/a-users-guide-to-hamstrings/
[25] Bowman K, Keeping you all abreast. https://www.nutritiousmovement.com/keeping-you-all-abreast/
[26] Exercise, positioning and lymphoedema https://www.cancerresearchuk.org/about-cancer/coping/physically/lymphoedema-and-cancer/treating/exercise
[27] The Lymphoedema Support Network. Self-management DVDhttps://www.lymphoedema.org/index.php/shop/lsn-products#dvd
[28] Bowman K, Keeping you all abreast. https://www.nutritiousmovement.com/keeping-you-all-abreast/
[29] Louv R. Vitamin N. http://richardlouv.com/books/vitamin-n/
[30] Anatomic connections of the diaphragm: influence of respiration on the body systemhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3731110/
[31] Laynee Restorative Breathing Method™. Lois breathing. https://www.youtube.com/watch?v=Ukg6fz1WSJM
[32] Bowman K. This year, exercise less. https://breakingmuscle.com/fitness/this-year-exercise-less
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