Yoga for People with Cancer
Since having trained for the CU Fitter Award in the Applied Delivery of Cancer Exercise, I have been creating a holistic course that addresses the different levels of a person, not just their body. We have all been to yoga classes where the practitioner is only interested in unlocking our bodies, but what about the psychotherapeutic aspects of body work. I do not claim to have psychotherapy qualifications, nor counselling, but I am interested in the whole person, and encouraging clients to listen to their body-minds, at their own pace. It is in the listening to our bodily sensations that John Stirk (2015) claims can allow our ‘deeper expression’ to come through.
I have been trained in how exercise can help cancer survivors, that is anyone diagnosed with cancer at any stage of their journey, but my interest here is looking at yoga, in particular.
‘Cancer cells are those that have forgotten how to die’ (Nurse, Royal Marsden Hospital)
Cancer cells evade the normal lifecycle of a cell, and just keep on going. This leads to growths and then tumours: benign or malign. In 2015, in the UK, there were 359, 960 new cancers diagnosed (Cancer Research UK, 2017). That means a new case every two minutes. Without wanting to send the frighteners up you, cancer is the second biggest cause of death behind heart disease, so these are not statistics we can ignore. Over 50% of these cancers are breast, lung, colo-rectal and prostate. Besides, more than 50% of the cancers diagnosed are in the 70+ age group. Survival rates for cancer in general is 50% at 10 years after diagnosis. In 2014, 163, 444 people died from cancer (Cancer Research UK, 2017). However, 38% could have been prevented. 38%. That’s a staggering figure. So, let’s look at what the risk factors are.
Our likelihood of developing cancer depends on our inherited genetics (10%), but mostly from outside influences, known as environmental factors, such as:
- Lifestyle factors (nutrition, tobacco use, physical activity, etc.)
- Naturally occurring exposures (ultraviolet light, radon gas, infectious agents, etc.)
- Medical treatments (radiation and medicines including chemotherapy, hormone drugs, drugs that suppress the immune system, etc.)
- Workplace exposures
- Household exposures
- Pollution. (American Cancer Society, 2017)
According to the American Cancer Society (2017), smoking causes 30% of all cancers in the United States, and 80% of all lung cancers. Research suggests that it is the ethanol in alcohol that leads to cancer; wine has more ethanol than beer, and spirits have more than wine. The good news is that we can do something about these environmental factors; it is within our control to be able to change our lives for the better.
Cancer is categorised by T = the size of the tumour, N = how many lymph nodes are involved and M = metastases, whether the cancer has spread and how far. So, the terminology goes something like this:
- Stage I cancer = T1/T2, N0
- Stage II = T1/T2, N1
- Stage IIIA = T3, N2
- Stage IIIB = T4, N3
- Stage IV = M1
Key: T1 = <2 cm, T2 = >2 cm and T3 = >4/5cm
N0 = no nodes, N1 = small amount, N2 is multiple and N3 = bilateral
M = metastases = the cancer has spread to other parts of the body
Stage IIIB is inoperable since the cancer is large, and there are lymph nodes on both sides of the body. The same applies for stage IV since the cancer has spread to other organs in the body. But, treatment is still possible, and people with stage IV can live for many, many years with a greatly improved existence through exercise and the right treatment. Catching the cancer at the early stages I and II is good news.
Treatment depends on the type of cancer, which stage and a person’s past medical history, lifestyle and performance status. Performance status (PS) 1 means you are fit and healthy where as a 4 means you are bedridden. The treatment advised for a PS1 will be different from that of a PS4 because the fitter you are, the more able you are to deal with the treatment, should you choose to go down that route.
This brings us to the choice of treatment. The medical teams can only advise based on their knowledge and experience; how someone chooses to go ahead is up to the individual. For instance, someone with prostate cancer with a Gleason score of 6 may not need surgery or treatment since it is a much less aggressive type. The negative side-effects of the treatment may far outweigh the benefits. However, a stage IIIA breast cancer, HER2 (hormone) positive, is more aggressive, and Paddock (2014) has shown an 84% survival rate for the combination of surgery, chemotherapy, radiotherapy and hormone therapy. These are the decisions a cancer survivor will face.
So, how can exercise or yoga help? A Macmillan (2012) review showed strong evidence that it positively affects physical function, fatigue, well-being, body composition and arm dysfunction. So, strangely, yes, exercise makes you feel less tired. Let’s be clear here, there are different levels of research. The grade A level is the best you can get, and that constitutes a meta-analysis of all the studies out there on a particular topic. There is grade A research on the benefits of exercise for cancer survivors.
Weekly moderate-intensity exercise can reduce the likelihood of a recurrence of cancer or death from the cancer by:
- >40% for breast cancer with 2½ hours
- >50% for colo-rectal cancer with 6 hours
- >30% for prostate cancer with 3 hours. (MacMillan Cancer Support, 2017)
These statistics alone should inspire us all to get moving! Just as it was for the research on a healthy heart and exercise, so it is becoming for cancer.
The idea is that we gradually build up to health-related physical activity. The UK guidelines state that exercise is safe during and after treatment, which is what we want to hear seeing that treatment can be weeks or months (radiotherapy and chemotherapy) or years (hormone therapy). (MacMillan Cancer Support, 2017). Exercise offsets the negative side effects of treatment, such as weight gain, fatigue, loss of function, lymphoedema, osteoporosis and increased cardiovascular disease risk. It can even improve the effectiveness of the treatment itself as the client is fitter and more able to withstand it. It only takes 3-4 weeks for prehabilitation exercise to work! Once diagnosed, it usually takes 4 weeks before treatment commences, so there is enough time.
Where possible, cancer survivors should follow the national guidelines for health-related physical activity:
To stay healthy, adults aged 19-64 should try to be active daily and should do: at least 150 minutes of moderate aerobic activity such as cycling or brisk walking every week, and. strength exercises on two or more days a week that work all the major muscles (legs, hips, back, abdomen, chest, shoulders and arms). (NHS, 2016).
However, exercise programmes will vary for different types of cancer, as shown above, and for the particular stage of their journey. What is important is to avoid inactivity. The basic message of this article is that if you have been diagnosed with cancer, see an exercise specialist and get moving. It is vital to have a pre-exercise assessment to obtain a full medical history for safety reasons and to create motivational goals about exactly what it is you want to get out of an exercise/yoga programme.
Dieli-Conwright and Orozoco (2015) argue that aerobic exercise can improve well-being, quality of life and psychological changes. They suggest a combination of low levels, such as walking, and vigorous exercise. Midtgaard et al.’s (2006) study showed that emotional, social and mental wellbeing improved after 6 weeks of 9 hours a week group aerobic classes. They claim that the group element adds to these improvements (Midtgaard et al., 2006). The group emphasised a togetherness during their activities, and as such, it allowed the participants to forget about their illness and be something other than a cancer patient. Floyd and Moyer’s (2009) study on the difference between individual and group activities for women with breast cancer showed no such advantage to group work, but that their activities did not emphasise cohesion as with the other study.
What can my classes offer you if you have been diagnosed with cancer?
There are many benefits to moving, as I name above, but moving with awareness and intelligence provides something more. So, my classes gently encourage staying present with our breath and inner sensations whilst we move. Why you may ask? Quite simply, as Peter Levine said, ‘pain is trapped sensation’. Our blocked, suppressed emotions can turn up as pain in the body. And, emotions just are sensations in the body that result from a thought, memory or perception of the world. Therefore, tapping into the felt sensations that underlie emotion, pain and experience is a way of unwinding our habitual selves and work our way back to health and ease in our bodies.
I have structured the class to incorporate breath awareness: can we be aware of how our breath changes as a result of stress or anxious thoughts, etc? The class also looks at certain energy releasing techniques to deal with our held emotions, such as anger, fear etc. Experiencing and expressing our emotional selves is generally a good thing, but when we hold on unnecessarily and feel unable to express these emotions, we can turn inwards. I will also base the class each week on a certain theme, from finding space in the joints, staying present with the breath to releasing the shoulders. As we find the fluidity in our movements, I will encourage an awareness of say, the sensations in our legs, arms, etc. I will finish the class with a short meditation.
If you feel tired, depressed, anxious or just want to feel fit again, then my classes are for you.