Claire Parsons is the Senior Physiotherapist Oncology at Leeds Teaching Hospitals NHS Trust. Claire has worked in oncology for twelve years and works with people in early recovery after transplant.
Here she talks about the importance of being active before, during and after a stem cell or bone marrow transplant, and exercising safely.
Is it safe to exercise if you have a blood cancer or blood disorder?
Generally yes, however, it is very individual and often comes down to your blood counts. Your transplant team will be keeping a close eye on these – your platelet levels and haemoglobin in particular – and they’ll be in touch throughout your transplant journey about what’s safe for you to be doing.
You may be able to exercise as normal or stick with gentle activity such as light walking or cycling, and there are times when it’s safest to avoid exercise.
Your team will also be on the look-out for signs of infection, such as a fever. You should avoid exercise if you have an infection as it puts an extra strain on the body.
Just ask your team if you’re unsure what’s safe for you at the moment, and they’ll be able to advise you.
Why do my health professionals advise me to exercise while I’m in hospital?
Whether you’re in hospital or continuing your recovery at home, it’s generally good to be as active as you can at that time – not just for your physical health, but for your overall wellbeing, too.
People can get very bored while it hospital, so it’s good just to have a goal for every day. This could be sitting up to play a game or read a book rather than lying in bed, or walking around your room for a few minutes. It can improve your mood to know you’re doing something positive, and help you to maintain a sense of normality.
When you stop exercising completely, you very quickly lose your exercise tolerance. This means that you lose some of your muscle strength and cardiovascular fitness (how well your heart and lungs are working, so that oxygen can be carried around your body).
It takes time to recover your muscle and cardiovascular fitness once you get home, so you want to maintain these as much as possible. Doing less means that you become weaker, and simple things like getting dressed take a surprising amount of effort.
At first you may be nervous about building up your activities especially if you have been inactive for a while. Break it down into manageable chunks. Recent research shows that a little burst can be enough. You could aim for 10 or 20 minutes a day, but spread it out through the day in 3 to 5 minute bursts. Even one minute should help.
This will keep your strength up and help you to recover faster – and it can be good for your mood, too.
What types of exercise should I do while I’m in hospital?
It’s sometimes possible to have an exercise machine such as a bike in your room, but there are more simple day-to-day things you can do as well. Try gently moving your body through a range of movements, like going from sitting to standing, or circling your arms forwards and backwards. There’s also lots you can do while in a chair or bed. Have a look at the one-minute exercises from lying down, sitting or standing on page 39 of our booklet, Managing fatigue after a bone marrow or stem cell transplant.
You can ask your team if it’s suitable for you to use a thera-band (also known as resistance bands) – a stretchy piece of elastic you can use to work your arms. Your team may be able to supply one, or you can buy them for under £20.
Can exercise help me recover in the long term?
Being active in the long term is really important. There’s research showing that being active can improve your quality of life during and after treatment. It improves tiredness and even side effects. It improves your mood and helps with anxiety and depression. It strengthens your muscles, joints and bones, and lowers the risk of heart disease and other health problems in the future.
What types of exercise should I do while I’m recovering?
There are four different types of exercise to think about, and it’s good to do some of each.
Aerobic exercise – this is for your cardiovascular health, and includes things like walking and cycling that get your heart and lungs going.
Resistance – you don’t need to buy big, heavy weights. You can do simple exercises that work your muscles, like doing bicep curls, holding a bottle of water.
Flexibility – flexibility exercises lengthen your muscles and improve the movement in your joints. Yoga and Tai Chi are really good for this, and you can ask a physiotherapist to help you with a range of stretches. They can adapt them if you have any trouble with your joints.
Balance – simple exercises, like standing on one leg, can improve your balance and get your muscles working. You can buy ‘wobble cushions’ online for about £10; you place these on a chair, and they help you work your core muscles while you’re sitting down. Shift your weight to one side and back to the middle, or sit with your feet apart and then together to work different muscles.
Yoga and Tai Chi are excellent for gently building up muscle and improving your balance and flexibility; they allow your body to work through a full range of movement. Because they focus your mind as well as your body, they’re also a good way to just switch off.
What counts as exercise? Do I need to join a gym?
The most important thing is to fit activity into your usual day, and make sure it’s something you actually enjoy. Some people love going to the gym, but if that’s not you, walking to the shops, gardening, and even cleaning all count.
Ideally, you want to get your heart rate up so you’re breathing a bit more heavily than usual. Just put on a CD and dance around the kitchen! Or, while you’re waiting for the kettle to boil, go from sit to stand five times, or stand up on the balls of your feet and lower yourself back down five times.
How much exercise should I do?
In the long term, you can aim for the same amounts as the general population – so about 150 minutes over a week. That could be 30 minutes five times a week, or you could break it up into a couple of minutes several times a day; the main thing is to make sure your exercise goals are simple, achievable and enjoyable.
You could pick one or two of the one-minute exercises from our booklet about managing fatigue and do these a few times a day. Aim to reach your goals for frequency (how often you exercise) and duration (how long for) before you increase the intensity (how hard you work).
How can I find opportunities to be active?
- Local walking groups. Your county council will have information about walking groups in your area. These are a great way to be sociable, and you don’t have to tell anyone you’ve been ill or had a transplant if you don’t want to.
- Local exercise classes. You can also see what’s available in your area, and join in regular exercise classes that are at the right level for you. Please be aware that using a gym or swimming pool might not be a good option if your immune system is still recovering or if you’re on certain medications, so speak to your team about this.
- County council gyms. County councils often have gyms with affordable membership. Level 4 NVQ instructors are qualified to work with people recovering from cancer. Speak to your transplant team or GP to see if they have an exercise referral scheme, which allows them to organise an exercise programme for you with cheaper gym membership.
- Walkingforhealth.org.uk offers over free, short walks with a group every week, all over the country. The website makes it easy to find your nearest walking group.
- The Ramblers Association also organises free group walks around the country.
- Change for life schemes run all over the country, for example in Leeds we have Leeds Get Active. These provide free access to gyms, leisure centres and community sports, and your GP may be able to refer you so that you can use council facilities for free.
- Maggie’s Centres offer a range of free courses and classes around the country to people who’ve had cancer, including exercise classes.
- Macmillan Cancer Support has a range of resources to help you get active, including their Move More pack . There are also Macmillan centres around the country, which have information about groups you can join, and run exercise groups as well.
- The World Cancer Research Foundation has lots of information about diet and activity and cancer.
- NHS Choices has lots of information about the benefits of exercise and ideas for being more active and tips for exercising safely and effectively.
Find out more
You might find our interview with BMT Nurse Coordinator, Mandy Ellis, How to manage fatigue after a transplant , helpful. As well as our booklet Managing fatigue after a bone marrow or stem cell transplant.
If you’d like to receive more content like this in the future please sign up to Before, During, After, Anthony Nolan’s quarterly enewsletter for patients and their families.
The photographs in this blog were taken by Pavlos Mastiki. Read about how he uses photography to recover after a stem cell transplant in his blog.
DISCLAIMER: At Anthony Nolan we take great care to provide up-to-date and accurate facts about stem cell transplant. We hope the information here will help you to look after yourself. Each transplant centre will do things differently, so this blog is just a general guide and isn’t intended to replace advice from your doctor and transplant team. Please speak to your transplant team for more details about your own situation as they will be able to give you personalised, specific advice.