In this episode, I’m talking to Kate Williams, exercise physiologist who the creator of Movement Against Cancer program. Kate specialises in exercise oncology and gives some fantastic, real world advice on how you can use exercise to support you during and after cancer. In the interview with Kate we get to find out more about:
- how exercise helps crush cancer during treatment and recovery
- the importance of regular evidence-based prescriptive exercise
- how to find the sweet spot by pushing yourself far enough without exhaustion
- practical ideas on healthy habits including nutrition and mindfulness
- types of exercise that are most helpful when dealing with cancer
Joe: Hey, Kate. Thanks very much for taking the time to speak to me, I really appreciate it. Can you please tell us a little bit about yourself, what you do and what are you passionate about?
Kate: Sure, well, thanks very much for having me on today, Joe. The first thing is, I’m an accredited exercise physiologist. I’ve been practicing for about eight years now, working with people with a whole range of different chronic medical issues. At the moment, I work at DNA Health Group, which is a private practice based in Cheltenham, in the Bay Side Suburbs of Melbourne. About four years ago, I realized that I had a bit of a passion and an interest in exercise oncology and co-founded the movement: Against Cancer Program around that time. Yes, really specializing a bit more in that area. In terms of work, that’s what keeps me ticking. Personally, I like keeping active myself. Lot of road cycling particularly. I like taking my little dog down to the beach and having a bit of run around. Other than that, what am I passionate about? All the typical Melbourne things, food and coffee and my football team.
Joe: Yes, which is?
Kate: Hawthorn. Big Hawks fan.
Joe: Fantastic, Kate. In your experience, what are the most common misconceptions that people have around cancer? Is it even a good idea to exercise when you have cancer? If it is, what are some of the benefits of exercise during cancer?
Kate: The biggest misconception is probably a pretty obvious one, is that people feel that it’s not safe, which is understandable in a way, because historically cancer patients have been told to take it easy and rest. Why would someone who feels sick, why would they feel like the best thing to do is a workout and spend what little energy they feel like they have right now. The thing is, we certainly have plenty of evidence to say that exercise is perfectly safe. In fact, to my knowledge, I’m yet to see a study that suggests exercise isn’t safe. There are definitely very good arguments to suggest that anyone who is undergoing treatment for cancer or has undergone treatment for cancer in the past should be doing exercise. The list is very long in terms of benefits. I don’t know how much time we’ve got.
Certainly, we know that it really helps people to cope better with treatments, particularly with things, common side effects, fatigue is a big one, pain and nausea. It also can really help to stabilize some of the body composition changes that patients go through. For example, a lot of men who undergo hormone treatment, they lose a lot of muscle mass and they gain a lot of body fat. We know that exercise can help to basically reverse that process, or at least maintain it. Bone density can be a big issue with these treatments, as well. We know that exercise can help maintain bone density. This obviously could increase strength and fitness and improve people’s everyday function. All of those activities they do on a daily basis can become a bit easier with the right exercise program. It also has a wonderful effect on mental health, and I think that’s a really important one to state.
Obviously, depression and anxiety are quite common for people that are going through cancer or have been through cancer, and exercise has been proven to help keep these things at bay, or a release for these things. It’s really important that we mention again that it can actually help to improve patient’s life expectancy, both in regard to the cancer itself but also through some of the other chronic issues that come from cancer treatments. Unfortunately, cancer survivors are more prone to things like heart disease and diabetes. We know that exercise can help keep those away, as well. Really excitingly, perhaps, we need a bit more evidence around this, but that exercise can actually help the efficacy of cancer treatment, as well.
Particularly with chemotherapy. That’s a bit of a watch this space one, but yes, there’s some very exciting research happening in that field. With all these long lists of benefits with exercise, I think the thing about it is, if it was a pill, if you could get exercise in a pill, pretty much every doctor, every oncologist would be prescribing it, if it was that easy. Yes, we really think of it as medicine.
Joe: Yes, that’s fantastic, Kate. I know that when I was going through chemotherapy and my uncle had recommended me to do walking every single night, even though I was really down, really feeling really flat. I know that that alone has helped me tremendously. Like you mentioned, the mental side of this, but also physically. It gave me more energy and I actually felt better over the long-term. That’s really cool. How do you know, Kate, you know, when you’ve pushed yourself far enough with exercise, but not too much? How do you find that sweet spot?
Kate: That is a great question and it’s a really important one and one that I get asked quite often, actually. Exercise intensity is really important because if you push yourself too much, you could leave yourself feeling sore and tired, which we don’t want, obviously, but if you don’t push yourself enough, then you’re potentially not going to get the benefits of what it is you’re trying to achieve. It’s important we find that balance and that happy medium with intensity. In the clinic here, we use tools like heartrate monitors and ratings of exertion to measure whether people are working at their right intensity. When my clients are working out independently at home, I get them to use a really simple test called the Talk Test.
Basically, what that means is, when you’re exercising, so whether you’d be going for a walk, or going for a swim or whatever it is that you’re doing, you should be able to, if you were with someone, hold a short conversation with them. If you’re finding that you’re having to stop and take a breath and it’s becoming quite hard to hold that conversation, or if you could imagine that you were, you’re probably pushing too hard. On the flipside to that, if you could breakout into a song, if you could sing, then you’re actually not working hard enough. That’s a really good basic test that you can use to find the right level of intensity.
Joe: That’s a great tool. Is there any specific type of exercise that someone can do right now that will help them get better with treatment?
Kate: Look, it’s going to be different for everyone, that’s a really important thing to say. As exercise physiologists, we’re very much focused on prescribing exercise for the individual. Everyone’s situation will be different depending on the type of cancer that they have, the type of treatment that they’re going through or have been through, among lots of different things. The exercise that they used to do previously and all of that stuff. It’s important that I say that, as well, when we’re talking about the safety of exercise, that’s if it’s prescribed appropriately. Certainly, one of the best things that people can do is just try and continue on with their day-to-day activities.
A lot of people stop these when they’re going through treatment and that can really feed into the fatigue and actually make it worse. It’s important that we try and keep those going. Those things that keep you off the couch and just keep your moving, they’re what we call: Incidental physical activity. That’s really important for keeping fatigue and also, depression and mental health in a good space. A really great mantra that I use around this, as well, is something is better than nothing and more is better than less. If you’re achieving those two things. If you’re achieving those two things, then you’re probably in the right zone for yourself.
Joe: Perfect, that makes sense. Kate, many of us face challenges after treatment, like the lingering side effects, or things like cardiovascular disease and also, mental health and dealing with anxiety. What if the cancer has come back? That sort of thing? What can a cancer survivor do to get into good shape physically?
Kate: Well, I think if we can break down the exercise a little bit further into some more specific guidelines. It’s talking about keeping up your incidental physical activity, but there are three different kinds of main exercises that I get most of my patients to do. I emphasize, again, that things need to be individual but when we talk about exercise, we often talk about cardiovascular exercise, which is what you’re doing with your walking, so it’s very important to get a form of that happening because that’s the one that, again, is very important for keeping your energy levels up, keeping heart disease away.
The second type of exercise that we prescribe often, and this is one that a lot of people are often missing, which is resistance exercise or strengthening exercises, that’s to help you maintain a good muscle mass. You won’t get that from walking, but you can get it, obviously, from doing things like lifting weights. You don’t need to have any equipment, a lot of things you can do at home, you don’t need any equipment, or you can just use things around the house. Things where you’re basically putting your muscles under a bit of stress, such that they’re forced to adapt and to grow to be able to manage that stress on a continuing basis. We know, again, that those exercises are very effective for helping you stay in good shape but keeping those fatigue and those other side effects at bay. The third type of exercise that we prescribe, as well, often is some flexibility-based exercises.
They’re really good for keeping your joints nice and mobile, keeping the limberness in the muscles and reducing a lot of that stiffness that a lot of people tend to feel, as well. A lot of people might already be doing this through things like yoga or Pilates. It’s a fantastic form of exercise, as well, just for a bit of stress relief and good for mental health, as well. They are three types of exercises that you should definitely try and include in your general routine for, as you say, maintaining shape.
Joe: Is there any specific type of exercise that someone can do right now that will help them get more energy, maybe lose weight, or maybe they’re two separate things?
Kate: Yes, again, probably the main two that I would suggest from those two perspectives. The combination of the cardiovascular and resistance exercise is going to be very important for both of those things. If you’ve got more muscles there, your body is going to find it less taxing and not have to use as much energy to perform a task. Whether that be picking up potted plants in the garden or carrying the groceries around, you’re not going to find that as tiring if you’ve got the muscles and the strength to be able to do that. Likewise, if you’ve got more cardiovascular fitness from doing your walking, your swimming, your cycling, dancing, whatever it is, you’re going to find it easier to be able to things throughout your day, and that’s not going to drain your energy bank as much. In regard to weight loss, which is a different aim, but the exercise modalities that we would prescribe for that are actually fairly similar.
Obviously, diet needs to come into that side of things, as well, certainly, resistance training is actually very important for people trying to lose weight as well, because lean muscle tissue is what burns fat. If you’ve got more of that, that’s going to raise your metabolism and actually make it easier for you to lose weight, or even it might be for some people just helping to maintain a healthy weight. That’s a really important point, if you’re just doing some cardiovascular exercise and trying to lose weight, to make sure that you’re including some form of weight training in your week, that’s going to be more effective.
Joe: Speaking of diet, I know it’s a completely different area and we could probably spend hours talking about that alone, but what in your opinion are some specific and also, realistic things that you could recommend to someone who is facing cancer?
Kate: In terms of diet?
Joe: Yes, in terms of diet. Yes, just broadly speaking.
Kate: Yes, that’s okay. Look, I’m a really firm believer in utilizing food as medicine. I think a really great place to start for a lot of cancer patients and people that have been through treatment is just with the food pyramid that we all probably would have seen, but whether we could name all of the sections of it. It’s easy to look up. The thing is, a balance diet, really, whichever stage of treatment you’re at I think is a good place to start. In terms of helping your energy levels and whether you’re looking to maintain weight or lose weight. I would like to highlight particularly that protein is very important. Particularly if you are doing those strength training exercises and trying to build a little bit of lean muscle mass, whether that be for weight loss or to maintain bone density or strength, the amino acids that protein contains are the building blocks to helping you build that muscle or maintain that muscle. It’s very important that you consume different sources of protein throughout the day.
I think that’s an important point. Obviously, it can be a little bit tricky for some people with different medication that can affect appetite. There can be a few other issues in there, as well. I think if it’s something you want a little bit more help with, exercise physiologists can give you some general guidelines, but certainly I’d recommend getting some guidance of a current practicing dietitian, when you want a bit more guidance or struggling with weight in some form. They’re the experts in their field. It’s relatively easy to find one on the DAA website. They’re a great place to find that information.
Joe: Okay, that’s great. Many of us would also benefit from changes in our lifestyle. What would you say would be some of the habits that you could put in place to make your life better, but in a way that is sustainable, that really isn’t torture, for want of a better word?
Kate: I love that word, “Torture.”
Joe: You must get that a lot.
Kate: Sometimes. I think the first one to outline is particularly for people who haven’t really done much exercise in the past, or they’re just starting out after a long break, is not to think to put too much pressure on yourself and that it’s not going to be really hard slope to start out with. If someone’s getting you to do that right off the bat, then you’re probably not quite in the right place. It should just be starting with moving more. I think that’s a good way to think about it initially. It doesn’t have to necessarily be structured sessions, but just if you’re not really doing a lot right now, consider that if you’ve got some shops that are ten minutes away and you need to get some milk, maybe that’s a great place to start, with just walking there.
For some people, even just going to the letterbox might be enough. It might be just getting off the tram line one station earlier and including movement in your day that way or taking the stairs. All of that counts towards that incidental physical activity that I was talking about. I think another one that’s really important is prior planning, particularly if you are suffering from a bit of fatigue, and a bit of a lack of motivation, as well, just planning some steps through your day can really help. Even in the exercise physiology world, this is what we often term as pacing. If you’re having a busy day doing something and it might be you’ve got some family stuff on, and you’re already on your feet a lot, that might not be the day to do a big exercise session or go for a longer walk that day. Or you might be looking at that day thinking, “I’m probably not going to feel like cooking a healthy meal that night.” Maybe you’ll put your exercise off until the next day or maybe the day before, you’ll have prepared some sort of meal and you can pop that in the freezer so that’s ready to go for that night.
I think that’s where keeping a diary can be quite useful for a lot of people. We do that with a lot of our patients here. They can put those steps in place to help manage life, as a whole, better. The other thing I was going to mention, actually, in regard to physical activity. Something that can be quite useful for people, pedometers or Fit Bits. They’re really good. If you’re lacking a bit of motivation because they’ll show you if you’re hitting targets and they give you something to work towards, but at your own pace, as well, which is very important.
Joe: Yes, because it’s really important to see progress, right?
Kate: Yes, absolutely. They give you that measurement, they show you how you’re going, which is if you’re not really motivated, that can really help when you see that in front of you.
Joe: That makes a lot of sense. Is there anything else, Kate, that you would recommend to someone to stay in good shape, physically but also mentally and socially, as well?
Kate: Diet is a really big one, obviously. We already touched on that. Got a lot to do with energy levels and that holistic health. Staying in contact with family and friends, absolutely, and letting them in with what’s going on as much as you can, if you feel comfortable. A support network is very important, I think. Having those people around you. If you don’t have a lot of those people around you, you may find – I know in talking to David, he mentioned a couple of times the Cancer Council and they have some fantastic resources that you can use if you don’t have those people to call on immediately around you.
Psychologists are fantastic if you’re not coping, as well. I can’t recommend their services highly enough. The other thing that I think is coming to the fore more recently is mindfulness, which I think maybe you touched on with David, as well. I haven’t seen a lot of research specifically on mindfulness and cancer, but I do have a few patients that have been certainly practicing it. I’m an advocate of it myself, a practicing advocate. Certainly, they report very positive benefits out of it, in terms of managing anxiety and particularly around times of treatment or when they’re coming up to scans, it can really help them cope. The research that I have seen, does show that it helps slow aging down. That’s got to be a benefit for anyone, right?
Joe: Yes, absolutely.
Kate: That’s a winner. I think, again, watch this space, I think this is something that will come more to the fore in some research about cancer. If you’re interested in it, there are some great apps out there that you can just simply download to your phone for free, which you can pick it up from those.
Joe: That’s fantastic. When it comes to exercise and also, creating healthy habits in general, is there something that people tend to overlook or perhaps it’s something that people are not doing right?
Kate: I think just on a general level, I think often people just don’t seek the advice that they perhaps need, or they’re too afraid to seek the advice from different people. Whether that be about exercise. I know a lot of people often they’ll come in and say, “I wish I did this earlier.” That’s a really common one. I’m sure that’s not just about exercise but also, diet. If they’re struggling emotionally or with mental health, to find that support because there are so many sources out there. I think that’s why it’s great that you’re doing this service for people because sometimes it’s just that people aren’t aware of them. Certainly, again, the Cancer Counsel is a great place to start in seeking support for whichever types of these issues that you feel need addressing.
There’s an expert in essentially everything today, they’re out there and they’re willing to assist, but it’s just finding the right one for you, but certainly don’t be afraid to start with your oncologist as a starting point for asking those questions, if you’re wanting to get started with exercise, you can always bridge that with them and say, “Well, who should I see?” Put in place some steps to find an exercise physiologist.
Joe: Absolutely. Speaking of that, I know you’ve started your own program called: Movement Against Cancer, can you please tell us a bit more about that?
Kate: Yes, sure. Movement Against Cancer, or MAC as we call it for short, is the program that we developed here at DNA Health Group. Completely developed and run by our own accredited exercise physiologists. Basically, it was coming to fruition because we were seeing a lot of people with cancer and we just saw this gap. We knew that there were so many benefits for cancer patients, for them to undertake exercise. We didn’t really have any programs for that, that we knew of. We thought the process should be fairly similar or my philosophy is that there’s stage one, two, and three programs for people that have heart disease or heart issues. The benefits are similar if not stronger for cancer patients, so why should there not be a program the same, when there are one in two people now being diagnosed with cancer.
We feel like this is something we really need. That’s how MAC came about, and obviously through my own interest in oncology, we see people through any real stage of their cancer journey, I suppose. Whether they’ve just been diagnosed, if they’re currently undergoing treatment or a couple of years after treatment. The sooner the better, though. Our practitioners basically work to determine with these people, what do you want to get out of the program. Do they just want to feel better? Do they want to get back to running 5km for some people? Depending on what those goals are and what their condition is, we can put together and individualized program to help them achieve this. That can be an involvement in one or a combination or different streams. We have one-on-one sessions with an exercise physiologist.
We have supervised group classes, where the exercise physiologist is in the room with the participants the whole time. In those group classes, these people still perform their own exercise program but they’re in there with other people. That’s a fantastic social environment, a lot of people enjoy that one. We also can devise home programs or programs for other gym facilities, if people are already enrolled with other gym facilities. We can even take our services to home. It’s a very flexible broad program. We’ve had great success with it so far, which is good.
Joe: That’s fantastic, Kate. Good on you. I know you’re big on having an exercise program that is evidence based. Can you tell us a little bit more about what that is and how that’s important?
Kate: Definitely. As accredited EPs, we’re working under a code of conduct when we do our accreditation each year and this code of conduct states that we must keep up to date with the most current research. We do that to prescribe what is essentially optimal for the individual person. If it’s not proven safe by research, basically, we won’t do it. It’s really important that we state that because it’s a good thing, but the research particularly based around cancer is constantly being updated. There’s new stuff happening all the time, which is fantastic. It very much means that we need to keep abreast of it, so that whenever we see a person, we can definitely say, “We can show that this works, and we can tell you that this doesn’t. We’re going to only give you what works.” Yes, it just means that it’s a sound program all the time. Yes, that’s how it works pretty much.
Joe: If someone wanted to be a part of the program, or to work with your individually, what would they do to get in touch or find out more information about you?
Kate: Yes, the best thing to do is probably jump onto our website which is: www.movementagainstcancer.com.au. Our contact number and emails are in there. There’s also, obviously, a fair bit of information about the MAC program on the website. We have Facebook and Instagram accounts, which are constantly being updated with research articles in relation to exercise oncology. They’re well worth a look, if you’re interested. The other thing I’ll just mention is, because hopefully, presumably, you have listeners from all over the place and they’re not necessarily all close to us here, that if you’re interested in getting in touch with an accredited exercise physiologist, you can of course ask your oncologist.
The other thing you can do is jump onto the ESSA website. ESSA.org.au. That’s our national accrediting body. On there, there’s actually a search engine for exercise physiologists, so you can pop in your postcode. You even have the ability to search EPs who specialize in cancer and find one that is close to you. It’s got to be convenient, right? Yes, that’s a really good thing to do, as well, if you’re not Melbourne based.
Joe: Cool, fantastic. Well, thank you so much, Kate. It’s been fantastic. I really appreciate your time.
Kate: Pleasure. Thanks for having me, Joe.