The following information was presented at the ThymicUK in-person patient meeting on 24th May 2023 by one of their specialist oncology physiotherapists.
It outlines recommended steps for keeping active with thymic cancer.
Below is the visual presentation itself and a text write-up outlining the key information:
Presentation Summary Notes:
“My name is Emma, I work in the thoracic oncology team. I am a physio.
I am going to talk today about physical activity. I am sure somewhere on your cancer journey you have been told about the importance of physical activity.
Being active has so many benefits.
It improves any cancer-related fatigue
Helps with mental wellbeing
Helps with sleep
Helps with relaxation
Helps with swellings, if you have lymphodema for instance it can help with that.
There’s a significant amount of evidence for it.
How much exercise should I do?
According to the national guidance you should aim for 150 minutes per week of moderate-intensity exercise: such as a brisk walk, swimming or cycling.
This is the minimum amount of exercise that the government recommends adults get each week.
What does intensity in physical activity mean?
An idea of what a moderate-intensity exercise feels like is when you can feel your heart and lungs working.
You shouldn’t be meandering along the path.
Try to get a little bit of a walk on, so that you can hold a conversation but not sing for instance.
When people say “I am active around the house, I do a bit of cleaning etc..” You may be doing moderate exercise but not for a significant amount of time. We would describe this as light exercise. To get the benefits from exercise it needs to be a moderate type of activity.
Types of Physical Activity Recommended for Thymic Cancer Patients
Building strength – Try to complete a resistance-based activity at least twice per week, such as going to the gym, yoga, pilates, carrying heavy bags or using resistance bands. Strength-building exercises can help to maintain and improve bone health meaning we are at less risk of falls and breaking bones.
Balance-based exercises -It’s very good to do things to improve your balance – Such as dance, yoga and tai chi. For older adults this can help to reduce the chance of frailty.
Try to Minimise Sedentary Time
Such as sitting down on the sofa, at a desk.
Many adults spend 9 hours being sedentary every day – NHS.
On average people with cancer spend more than 10 hours being sedentary a day.
Lack of physical activity is the fourth leading risk factor for mortality. – World Health Organisation
We want to aim to break up periods of inactivity and reduce the time being still.
Where do we Start?
Essentially anything is better than nothing. So try to break up your more sedentary tasks with walking, doing some sit-to-stand movement or going up/down the stairs.
After standing up and sitting down 15 times you’ll feel a bit of a puff, it’s good for your whole body.
For anyone who experiences back pain you want to try and keep yourself moving, keep your joints oiled.
Try to break it up. Don’t try to be a weekend warrior trying to do everything in one day; start small.
If you can’t do 30 of physical activity that’s fine, do 15 minutes in the morning and 15 minutes in the afternoon.
Do small amounts throughout the day to make it manageable to you.
Build up slowly. Keep your goals manageable for you.
When Undergoing Treatment
You may be experiencing treatment-related side effects. On the days you might have a bit more energy, use those days to your advantage, but try and balance it. We don’t want to have big booms of exercise and suddenly be really fatigued the next day.
Physical Activity is the Number 1 Treatment for Fatigue.
What tends to happen is that we get stuck in a fatigue spiral. So we need to break that cycle, and that is by increasing your physical activity. Even if it is just sitting to standing, if that’s more than you did yesterday then that’s on the right step.
Try and break up your day with a little bit of physical activity.
If you want to hoover the whole house the next day and you know this is exhausting, you can break this up by doing room by room over 2 days.
This may seem counter-productive because we like to complete a task as humans, but we need to make it more manageable for ourselves. If you have an activity that is energy-sucking, break it up, allow yourself time to rest.
How should I exercise?
It’s really important to do a warm-up and a cool-down. If your body is quite cold for instance you want to warm up, get the body moving. Try some slower activity and then ramp up to a bit more.
Equally, when you get to the end of your exercise try and do some slower walking, gentler exercise to ensure you aren’t too sore after.
Listen to your body in terms of breathlessness. If you think of a scale from 0-10, a moderate-intensity exercise is about 3-4.
If you are really huffing and puffing it’s ok to stop, get your breath. We don’t want people to feel so breathless they can’t catch their breath.
A simple exercise to try
Stand up and sit down for 1 minute. You can go as slow or fast as you want. If it’s too east for you then pick up the pace. If you’re finding it difficult you can slow it down.
This achieves moderate intensity, it gets you up and moving and you can do it anywhere. It’s really simple. It doesn’t take very long and you are achieving a minute towards your 30 minutes a day of physical exercise.
If you enjoy walking
Try the NHS Active 10 app, it’s an excellent walking app. It can show you how active you are throughout the day and whether you are reaching moderate-intensity exercise. The Active 10 app is available on iPhone and Android app stores.
There are step-counting apps for your smartphone, walking groups and the walking program from mayoclinic.org.
Group-based well-being walks and longer walks are available from: ramblers.org.uk and nordicwalking.co.uk.
Home exercise support resources:
NHS exi app – “EXI uses a science-backed exercise prescription to optimise your workouts at the correct intensity for you, raising your heart rate at a safe pace.” – Available on Android and iPhone smartphone devices.
Couch to Fitness app – Well-known free tailored fitness plans from 4-9 weeks on average, with 30-minute sessions three times per week, tailored to your fitness level. Learn More.
Marsden exercise videos – Specifically designed for people with cancer the Royal Marsden offers three exercise “circuits” starting at low-level intensity and gradually building up towards the recommended amount of exercise the NHS recommends. Features 30-40 minute videos you can follow at home.
Cancer Care Map – Type in your postcode and it shows you services available to you in your local area. It could be physical activity, support groups and lots more. Learn More.
What to do if you need motivation
Try and think about what we know about exercise and how it can be really beneficial to your body.
Try to set realistic, small goals that are achievable for you.
If you can’t get to the bus stop that’s 150 yards down the road, then you’re thinking about getting to the end of the street, and back, or halfway and back.
- Try to break the long-term goal into bite-sized chunks; you feel good when you’ve achieved a goal.
- If you set a goal and don’t quite achieve it, don’t be disheartened, change it, think about what went wrong and set a new goal.
- Keep a record of how well you’ve done any progress you achieve.
- Share your plans with others who are supportive.
- If you enjoy it a group environment or class can help.
- Pick things that are fun and enjoyable for you.
Do I need to ask my Dr before I exercise?
Most physical activity is generally safe for most people. You are encouraged to start low intensity aerobic exercise and strength-training.
Question: Does breathlessness go away?
It depends what the breathlessness is from. It can certainly improve.
You should practice being at a higher level of breathlessness and getting your body used to it again, and then it can become more normal to your body again.
(This advice is for those suffering with chronic breathlessness.)
If you are having new onset, acute breathlessness at rest or a significant increase to your breathlessness despite not changing your activity, this should be discussed with your medical team, AOS or with 999/111 as soon as possible.
Slowly push the boundaries and you may find that that level of breathlessness comes on a bit later, after 50 meters as opposed to 20 for instance.
When you experience breathlessness
One of the things I teach really regularly to patients is rectangular breathing.
Looking at a standard wide-screen TV or monitor for instance. When you take your in breath, you take the shorter path, and when you breath out, you take the longer path and have a longer breath out. It’s better however to practice this when you are relaxed, to help make it easier for when you are exercising.
Questions: Some people with Thymic cancer have MG (Myasthenia Gravis), fatigue is a different issue, are there any tips for dealing with that, alongside the general fatigue?
I think overall listening to your body is the most important one. If you do something and the next day you’re absolutely knackered, that’s probably an indication you’re doing too much. Don’t give up but just don’t try to do too much.