Simple Hope

How to Rebuild Your Energy Using The Climb Back from Cancer Protocol* and The American College of Sports Medicine Physical Activity Guidelines

The Climb Back from Cancer Protocol is simple. It consists of three activity sessions a week. Depending on your situation, you are free to start any time after diagnosis. You don’t have to wait until the end of treatment, although depending on the nature of your treatments, you may not necessarily be up to it. When I was having round-the-clock I.V. chemo, I didn’t necessarily feel up to it every day either. Some days I could and some days I couldn’t. So, just use your best judgment – as long as you’re not always using treatment as an excuse.According to the American College of Sports Medicine: “Evidence strongly suggests not only that exercise is safe and feasible during cancer treatment, but also that it can improve physical functioning and various aspects of quality of life..The principal goal should be to maintain activity as much as possible and increase levels after treatment has been completed.”

In Step 1, you’ll be asked to do 10 to 30 minutes of mild to moderate cardiovascular activity (e.g. walking, biking, hiking, swimming, using a manual wheelchair or hand cycler) every other day. This is essentially a “light” version of the general physical activity guidelines of the American College of Sports Medicine (ACSM) for cancer survivors¹ (anyone who has or has had cancer, from the moment of diagnosis through the rest of their lives – including treatment). This is the method I used to help me overcome my fatigue.

In Step 2, you can do one mild cardiovascular activity session of 30 minutes, one 15-minute session of more vigorous activity and one 20-minute session of moderate activity. Just as with the “light” version ACSM guidelines, there is to be a rest day between each session. This is The Climb Back from Cancer Protocol that was used by the participants in the pilot study.

Both phases should be tailored to each participant based on safety and effectiveness and a huge variety of other factors that include but are not limited to their type of cancer(s), treatments, reactions to treatments, mobility, strength, bone density, physical capacities, etc. Any form of safe and appropriate mild to moderate cardiovascular activity can be used, e.g. walking, jogging, hiking, cycling, swimming, using a manual wheelchair or hand cycler, etc. – as long as it raises your heart and respiration rates for 10 to 30 minutes. If you can talk while you’re doing your activities but you can’t sing, you’re likely being mild to moderately active. If you can only say a few words without stopping to catch your breath, you’re probably being vigorously physically active.

The 3-Minute Marvel

If you have never been consistently physically active or the very thought of exercise makes you almost as nauseous as the thought of chemotherapy, you now have a vitally important life decision to make. If your energy is lacking, you can either accept that and do your best to cope, or you can try starting with as little as three minutes of physical activity a day every other day and potentially find yourself on a road to energy recovery and life renewal that you never dreamed possible. That’s right – just three minutes per day every other day to start (the rest of a very gently increasing program follows here).Unless you have mobility challenges (and even if you do), chances are you can do three minutes of physical activity every other day. So, the choice is yours. Although I had been physically active before my illness, I made the choice to try to get my life energy back. What you are now reading is one of the many wonderful things that have happened because of that decision. I’d love for you to join me and many other survivors who have discovered the same thing. So come along with us – if only for just a few more minutes. Imagine what your life would be like if you just had more energy…

*The Climb Back from Cancer Protocol is in the experimental stages and hence this document is for discussion purposes only. Until full clinical trials of the protocol are completed and the results are peer-reviewed, approved and published, use of The Climb Back from Cancer Protocol must not be undertaken without proper supervision by qualified medical personnel and exercise physiologists with cancer-specific training, knowledge and experience in a controlled and properly equipped environment. If you wish to assume any and all risks in trying the protocol and/or The American College of Sports Medicine (ACSM) guidelines, you must first consult a physician. If your physician approves your participation, you must then professionally engage an exercise physiologist(s) with cancer-specific training, knowledge and experience before becoming involved in any activity related to the protocol or the ACSM physical activity guidelines. Thereafter, all activity sessions must be supervised by this/these professional(s) in a proper setting. Failure to comply with any of these directives could result in loss or change of health, accident, injury, or death to the participant and/or those around them. Therefore, all risks are those of the participant(s). Neither the author(s), Climb Back Inc., The Climb Back from Cancer Foundation, the Tom Baker Cancer Centre, the University of Calgary, any member of the Survivor Fatigue Study team, the ACSM, or any other associated individual(s), institution(s), entity(s) or body(s) whatsoever, whether named or unnamed, assumes any liability whatsoever. Any and all risks are entirely those of the participant(s).

Please feel free to share this information with others. If you do, please attribute it as follows:
© 2004 Alan Hobson (Updated December 2013)
2-Time Cancer Survivor,
Founder, The Climb Back from Cancer Survivorship Program
Protocol Co-Creator
SurviveCANcer.ca

Together, we can make a difference.
Many thanks!

Alan

At a Glance

Please Note: The type and intensity of each activity session (i.e. mild, moderate or vigorous) is tailored to each participant based on the results of a variety of evaluations conducted by qualified and trained exercise physiologists under the supervision of an oncologist or other qualified physician. Not all types of activities are suitable for all survivors — anyone who has or has had cancer from diagnosis through the rest of their lives, including those in treatment. Those with specific types of cancer, side effects of treatment and pre-existing conditions may not necessarily be able to safely engage in all types and intensities of physical activity. That is why it is extremely important that survivors be carefully evaluated by qualified professionals under proper medical supervision.

Step 1: A “Light” Version of the American College of Sports Medicine (ACSM) Physical Activity Guidelines¹ for Cancer Survivors

10 to 30 minutes of mild to moderate² cardiovascular activity every other day.

1.The ACSM physical activity guidelines for cancer survivors are that they should avoid inactivity and return to normal daily activities as soon as possible following diagnosis and aim to ultimately exercise at least 150 minutes per week. This should include strength training exercises at least 2 days per week.

Step 2: The Climb Back from Cancer Protocol

The Climb Back from Cancer Protocol

Session A: 30 minutes of mild³ cardiovascular activity
Session B: (2 days later) 15 minutes of vigorous³ cardiovascular activity
Session C: (2 days later) 20 minutes of moderate³ cardiovascular activity

Simple Beginnings

The Climb Back from Cancer Protocol began from my own experience climbing back from cancer. In August 2000, I was diagnosed with acute leukemia (an aggressive cancer of the blood) and given less than a year to live. At diagnosis, 90% of the cells in my bone marrow were cancerous. After three rounds of intensive, week-long 24-hour continuous infusion chemotherapy (over 500 hours) as an in-patient, on Nov. 15, 2000 I received the modern day equivalent of a bone marrow transplant, an adult blood cell transplant. The donor was my second eldest brother, Eric. After the transplant, I was so weak with fatigue that I could not stand for more than a minute. In fact, I timed it. It was 53 seconds.

Like many people in the developed world, I had been raised on the adage of “No Pain, No Gain.” To overcome an obstacle, all you needed was focus, discipline and hard work. And, if it didn’t work the first time, all you had to do was try harder. Unfortunately, in my experience, this approach doesn’t appear to be any better for regaining energy after cancer treatment than it does for playing better golf. Although I tried to rise above my fatigue with physical activity – a little at first, then a little more, then a lot more — through trial and error (mostly error), I did gain some ground but it was at a significant personal and interpersonal cost. After nearly every significant energy expenditure, I spent as long as a week on the couch trying to recover. I called this cycle “riding the couch coaster.” There were a lot of ups and downs (mostly downs). It was also at times extremely challenging for those around me. For my then fiancée, Cecilia, it was especially difficult. She actually had to live with me while I was angry, depressed and frustrated with my lack of consistent progress.

After months of this haphazard and exasperating approach, my hemoglobin levels (the part of the red blood cell that transports oxygen and energy to the body) had increased a little, but plateaued well below the levels I had had before cancer. My energy level was similarly flat. My oncologist was afraid to prescribe a red blood cell growth stimulant (to transport more oxygen and hopefully boost my energy) because he thought it might stimulate a recurrence of my leukemia. So, I struggled to make it through the day without having to take at least one two or three-hour nap. I was unable to return to work full-time and I had no reliable income aside from a modest monthly disability insurance payment. I feared I might never get my life, or my energy, back. It was not only frustrating, it was frightening.

Dissatisfied with my progress, with the help of one of my friends, Cal Zaryski (see the end of this document for more about him), Cecilia and I were able to convene a meeting of minds. It consisted of two of my oncologists from the Foothills Medical Centre in Calgary, Alberta, Canada (north of Montana) and two leading exercise physiologists from the University of Calgary’s Department of Kinesiology. We presented them with a challenge — if they could raise my hemoglobin and energy levels without drugs, perhaps we could help other cancer survivors do the same.

The physiologists put me through a very simple lying to standing heart rate assessment called a Rusko Test.  My results were distinctly similar to the results of over-trained, overly fatigued athletes with whom they had worked.

“So, I want you to do less intense cardiovascular activity less frequently,” advised Dr. David Smith, one of the finest exercise physiologists in the world. “Not more activity more intensely and more frequently, Alan. Less activity, less intensely and less frequently – less, less and less!” Dave prescribed a very mild level of cardiovascular activity three times a week – essentially a “light” version of the American College of Sports Medicine (ACSM) guidelines for cancer survivors.* Within three weeks of following this physical activity protocol, I noticed a sudden increase in my energy and hemoglobin levels. And, after just a few more weeks, I had returned to my pre-illness energy and hemoglobin levels. I was elated! So, the team thought, if it had worked for me, maybe it could work from others. That led to our Survivor Fatigue Study.

1As indicated earlier, the ACSM physical activity guidelines for cancer survivors (anyone who has or has had cancer, from the moment of diagnosis through the rest of their lives – including treatment) are that they should avoid inactivity. They should return to normal daily activities as soon as possible following diagnosis and aim to exercise at least 150 minutes per week. This should include strength training exercises at least 2 days per week.

I think just about anyone in treatment would say that that’s pretty ambitious. But take heart, there’s reason for optimism…

Today

At the time of this writing I have now been cancer-free for more than 13 years, am officially medically cured and have regained 100 percent of my health and fitness as well. It is my hope, and that of the study team, that the mild, individualized cardiovascular exercise approach to reenergizing cancer survivors after treatment will become the new gold standard for climbing back from cancer.

What Makes this Protocol Unique

You may have been introduced to other physical activity protocols associated with cancer recovery. Some of them may even appear to be similar to this one. What makes The Climb Back from Cancer Protocol unique is that it is individualized and it is targeted. This is great news, especially if you have never exercised a day in your life.

Individualized

The protocol is tailored to each participant, not just at the beginning, but throughout their recovery process so even someone who has been sedentary their whole life can still participate. Heart rates and blood lactate levels are carefully monitored (blood lactate is essentially a waste product of exercise). Based on these levels, the intensity and duration of your physical activity sessions are adjusted to maximize your return of energy in the minimum period of time with the minimum amount of effort. In other words, the protocol is designed to be effective and efficient. The objective is to take a lot of the guess-work out of the energy renewal component of your climb back – regardless of your physical activity history (or lack thereof).

Targeted

Through on-going research at the University of Calgary Thrive Centre and elsewhere, exercise physiologists and other researchers are targeting the optimal levels of physical activity required to help you regain your energy as quickly and efficiently as possible. While other physical activity protocols may be general in nature, The Climb Back from Cancer Protocol is very specific. It helps ensure that you do not overdo it or underdo it. The protocol’s objective is to maximize the return of your energy in the minimum period of time. Thus, it is custom-built around you and for you. As you change, it changes.

Where to Start

Our lives are full of competing interests – professional and parenting commitments, spouses, partners, aging parents, friends, relatives, financial affairs and recreation just to name a few. Yet there is one essential element that is central to all of them, without which none of these interests can be pursued – our personal health. Without it, we cannot work effectively, fully attend to the needs of others and sometimes our own.

Our health is our single greatest asset.

Anyone who has experienced chronic fatigue knows the devastating impact a significant loss of energy has on all aspects of our lives. It is more debilitating than pain and nausea and can be more challenging than loss of income or self-esteem. In extreme cases, we may not even have a life in the truest sense. That is why the first step in trying to recover our energy is to make our health and our activity sessions our #1 priority. This is imperative. No progress can be made without it.

If you are a parent, you owe it to your children to try to regain the energy you had before your illness. If you are a professional, you owe it to your colleagues. If you want a social life, you owe it to your friends. Most of all, you owe it to yourself. You have been through (and may very well still be going through) a traumatic life experience with treatment and recovery. You have struggled and may still be struggling hard. So, now you deserve a reward. You DO! It’s time to give yourself one – now! Here’s how…

Protocol Pointer #1: Put Your Health First

Making the Commitment

The first step toward trying to renew your life energy is to make a serious personal commitment — that you are going to follow Steps 1 & 2 of the protocol (see the earlier section, “The Protocol at a Glance”) unfailingly for at least 12 weeks. Put it in writing and post it in plain view for you and everyone around you to see. Make multiple copies of it and put them in the places you frequent most in your life — at home, at the office, on the dashboard of your car – the more numerous and prominent the places the better.

Here is one example of a Climb Back from Cancer Commitment:

I publicly and emphatically pronounce that from this date _____________forward for the next 12 weeks until this date ____________, I CAN and I WILL engage in 36 sessions of mild, individualized cardiovascular activity or at least 20 minutes each (or I will work up to that). Barring a true and genuine emergency, I will not miss any sessions because I am “too busy,” “too tired,” or “too over-extended.” I will make no excuses of any kind at any time to anyone, least of all myself, because above all else, I know the supreme importance and priceless value of my own personal health, energy and wellbeing to my life. It is my life. More than anything, I want my life and my energy back. I want to Climb Back!

Signature_________________________Witness_______________________

Protocol Pointer #2: Commit to the Protocol in Writing

The Basics

There are three keys to ensuring that your activity has the greatest chance of helping you regain energy:

Key #1: The physical activity you engage in must be Mild, Moderate or More Challenging (i.e. vigorous), depending on whether you’re following Step 1 (a “light” version of The American College of Sports Medicine physical activity guidelines for cancer patients/survivors) or Step 2 (The Climb Back from Cancer Protocol). Your exercise physiologist(s) can teach you how to determine these three levels of intensity.

Key #2: Your activity must be Aerobic (e.g. walking, jogging, swimming, cycling, hiking, etc. More about this in a moment.)

Key #3: Your sessions must be Consistent – three times a week — no excuses, no waffling, no ifs, ands or buts.

We call this “The M.A.C. Method” (Mild/Moderate/More Challenging, Aerobic and Consistent)

 Using “The M.A.C. Method”

The “M” in M.A.C. — What is Mild, Moderate and More Challenging Physical Activity?

There are three basic measurements of mild, moderate and more challenging physical activity:

1. Heart Rate
2. Level of Perceived Exertion
3. Physiological Testing

1. Using Heart Rate

Mild

The exact definition of mild physical activity varies from person to person, but generally it is the heart rate we achieve when we walk briskly so we can actually get a measure of our heart rate. To make things simpler, I bought a Polar® heart rate monitor similar to a wrist watch. www.polar.com It displayed exactly what my heart rate was at any moment. Although my respiration was elevated and I was breathing more heavily than I would have been at rest, I was always able to carry on a conversation while I was being mildly physically active. This is a good gauge of what constitutes mild physical activity and what doesn’t. If you can talk while you walk, jog, bike or hike, you are probably being mildly aerobically active.

Moderate

Again, there is no hard and fast rule here but essentially, during moderate physical activity, it starts to get more difficult to carry on a conversation because you’re breathing harder and more frequently. If you can talk while you do them but you can’t sing, you’re probably being moderately physically active.
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More Challenging (i.e. vigorous)

This is higher intensity activity, the kind during which you can only say a few words because you’re breathing hard. It’s vigorous. You’re pushing things and it’s more challenging. It may even feel like you’re pushing your limit.

2. Using Physiological Testing

If you really want to know what your “Mild,” “Moderate” and “More Challenging” (i.e. vigorous) target heart rate zones are, you may be able to visit an exercise physiology laboratory, perhaps in the physical education or kinesiology department of a local university, if you’re fortunate enough to live close to one. Some can be found in private fitness facilities such as those that cater to triathletes and other endurance competitors. But you don’t need to be an athlete! In fact, you don’t even need to have ever been involved in any physical activity program. Nonetheless, if you don’t live close to such a facility and/or you can’t afford to be evaluated at one, make the effort to find one and get measured by properly trained and knowledgeable professionals who ideally have experience working with cancer patients/survivors (they are one in the same). If you have to, save up your money or ask someone if they’ll cover the costs for you. It could be one of the best investments you (or they) ever make because there, properly trained and experienced exercise physiologists can determine your precise target heart rate activity zones using specialized techniques and equipment. This will maximize your chances of renewing your energy as quickly and easily as possible. This evaluation enables you to individualize your physical activity so you can maximize its effectiveness. It will also help you determine which activities are safe and most suitable for you given your cancer(s), treatment, pre-existing conditions and a host of other important individual considerations that your evaluators will take into account when designing your “activity prescription.”

The “A” in M.A.C. — What is Aerobic Physical Activity?

Aerobic physical activity is activity that requires our bodies to increase their intake of oxygen (in the air) and moderately increase our heart and respiration rates for at least 15 to 30 continuous minutes. Aerobic activity is also called “cardiovascular activity” (cardio meaning heart and vascular meaning blood vessels). Weight training, unless done by moving quickly from one weight station to the next, which is sometimes called circuit training, generally does not train our bodies’ aerobic (meaning with oxygen) energy delivery systems. It increases the strength of our skeletal muscles, mostly the ones we see from the outside. Activities such as brisk walking, jogging, swimming, biking, and hiking are examples of aerobic activities. They increase the strength of our heart muscle, not our biceps or triceps muscles. So, if you are huffing and puffing for 15 to 30 continuous minutes (not including a five to 10-minute warm-up and cool-down) you are probably being aerobically active.
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The “C” in M.A.C. — What is Consistent Physical Activity?

In the context of our re-energizing goals, consistent physical activity is three times a week for a minimum of 12 weeks — no excuses (barring an emergency or sudden change in your health).

Protocol Pointer #3: Follow the M.A.C. Method

(Mild/Moderate/More Challenging/Aerobic/Consistent)

Before You Begin

Before you start your re-energizing program, as well as periodically throughout it (every few months), you should consult a physician to determine if it is safe for you to engage, or to continue to engage, in mild to more challenging aerobic activity. For some survivors with heart conditions and other health challenges, it may not be.

As previously mentioned, it is important to understand that The Climb Back from Cancer Protocol is in the experimental stages and hence its safety and effectiveness are not proven. Until full clinical trials of the protocol are completed and the results are peer-reviewed, approved and published, it must not be undertaken without proper supervision by qualified medical personnel and exercise physiologists with cancer-specific training, knowledge and experience in a controlled and properly equipped environment. If you wish to assume any and all risks in trying the protocol and/or following the American College of Sports Medicine (ACSM) physical activity guidelines1 for cancer survivors in any way, you must first consult a physician. If your physician approves your participation, you must then professionally engage an exercise physiologist(s) with cancer-specific training, knowledge and experience before becoming involved in any activity related to the protocol or ACSM guidelines.1 Thereafter, all activity sessions must be supervised by this/these professional(s) in a proper setting. Failure to comply with any of these directives could result in loss or change of health, accident, injury, or death to the participant and/or those around them. Therefore, all risks are those of the participant(s). Neither the author(s), Climb Back Inc., The Climb Back from Cancer Foundation, the Tom Baker Cancer Centre, the University of Calgary, any member of the Survivor Fatigue Study team, the ACSM, or any other associated individual(s), institution(s), entity(s) or body(s) whatsoever, whether named or unnamed, assumes any liability whatsoever. Any and all risks are entirely those of the participant(s).

So, it is your complete and total responsibility to ensure that it is safe for you to participate in the protocol or any other physical activity program. You are also completely responsible for whatever happens to you before, during, and after your participation in these activities. The risks are 100 percent yours. Fortunately, however, so are the potential benefits.
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Previous Success

Mild individualized aerobic activity worked for me and for the other 13 people who participated in our two-year pilot study. That is hardly a huge research pool — and with no control group that didn’t do any exercise and with whom results could be compared. However, because of the consistency of the results and the fact that prior to entry into the study our participants were experiencing some of the highest levels of fatigue, although we obviously cannot offer any guarantees, we are very excited about the possibilities ahead.

Getting Started

As the saying goes, “The journey of a thousand miles begins with a single step.” One of your first steps is to purchase a heart rate monitor. As I’ve mentioned, I used one made by Polar™, www.polar.com. Depending on your personal circumstances and level of fatigue, you may choose to walk, jog, swim, cycle, hike, row, push yourself in your wheelchair or use an arm bike, etc. – as long as it is aerobic activity. If you cannot manage 30 minutes of continuous activity at first, start with whatever you can manage and gradually (emphasis on gradually) build it up over several weeks until you can do 30 continuous minutes. If all you can manage is a minute at first, that’s fine. The most important thing is to start and once having started, to stay with it. If you try to increase the duration of your activity too quickly, you risk becoming injured, demoralized or exhausted.

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“The journey of a thousand miles begins with a single step” – in this case onto a stationary bike and from there, potentially back to a new life of increased energy, vitality and meaning.

Below is one example of how you might begin. You need not follow this plan exactly. The most important thing is to start conservatively. This may be the hardest part. It was for me.

Here’s a Possible Plan

Begin with three short activity sessions per day of a few minutes each. If that sounds like too much, start with one activity session of a few minutes each day and slowly increase it to three activity sessions per day over a period of a few weeks. Track your activity sessions on a calendar so you don’t get ahead or fall behind. If you are falling behind schedule, get right back on schedule until you are able to stay on schedule.

Staying on schedule is 90% of the game!

Once you are able to do three short activity sessions of a few minutes per day, try combining them into one session every other day, for a week. Your goal is to be able to be easily (as opposed to moderately or vigorously) aerobically active for 20 to 30 continuous minutes three times a week.

Try to resist the urge to go too hard or too long too soon. If we try to climb back too fast, we could fall back into despair by becoming too tired, too sore (and thus lose motivation), or worse still, injured. Treatment doesn’t happen overnight. It takes months and sometimes years. It may still be happening. Hopefully, your climb back won’t take years, but it will take some time, at least a few months. Remember the simple but sage words of the legendary Himalayan Sherpas, the mountain people of Nepal who can carry incredibly heavy loads at high altitude, “Slowly, slowly – no hurry.”

Choose any three days during the week to which you’re able to commit time. Then, make sure that you have a rest day after each one. Each week, you can choose the three days that best fit your schedule.

Here’s just one example of a very gentle and gradual progression. An exercise physiologist or personal trainer with cancer-related training, knowledge and experience can design one that best fits for you.

Phase I: Establishing your Climb Back Base Camp

Week 1: Once a day for 3 minutes every other day (9 minutes total/week)
Week 2: Twice a day for 2 minutes every other day (12 minutes total/week)
Week 3: Twice a day for 3 minutes every other day (18 minutes total/week)

Phase II: Moving Up the Mountain

Week 4: Once a day for 5 minutes every other day (15 minutes total/week)
Week 5: Once a day for 7 minutes every other day (21 minutes total/week)
Week 6: Once a day for 9 minutes every other day (27 minutes/week)

Phase III: Going for the Top!

Week 7: Once a day for 12 minutes every other day (36 minutes/week)
Week 8: Once a day for 15 minutes every other day (45 minutes/week)
Week 9: Once a day for 18 minutes every other day (54 minutes/week)
Week 10: Once a day for 21 minutes every other day (60 minutes/week)
Week 11: Once a day for 25 minutes every other day (69 minutes/week)
Week 12: Once a day for 30 minutes every other day (90 minutes/week)

Now you’re really making progress! In fact, you may already be feeling so much more energetic that you may not feel like you need to do any more. Stick around though. Things can get even better!

Fatigue can be our Friend

When you first start being physically active, expect to feel tired. That’s right – expect to feel tired. Don’t let yourself be disappointed by it. In fact, you can feel encouraged. After all, you have begun to ask your body to do something it either has never done before, or has not been able to do in a while. Fatigue can be our friend. What we want to avoid is letting fatigue become our lifelong friend, or having it turn into exhaustion. So, give your body time to adapt. Chances are very good that it will. If it doesn’t, you may need to consult a physician again. Other health issues could require your attention.

Protocol Pointer #4: Expect to Feel Tired – at First

Consistency is Key

Consistency is the key to any re-energizing program. To repeat: The key to getting your energy back is the consistency of your activity. You want to be aerobically active three times a week for 15 to 30 continuous minutes each time. Barring illness, emergency or absolute exhaustion (i.e. you’re flat on your back pretty much incapable of moving), suit up and show up for your activity session, every other day, every week for a minimum of 12 weeks without fail. We’re talking about your life and your life energy. What could be more important? If you answer, “my children, my parents, my relatives, my work, my associates or my friends, etc., etc., etc.,” I applaud your commitment, but you may be selling yourself short. After what you’ve been through, you deserve to maximize your energy and quality of life. The more energy you regain, the more you will have to give to others. This is one time in your life when you need to put you and your life first. It’s okay to be “selfish” while you try to get your energy back. I prefer to call it focused – focused on your #1 priority – your health. If you give yourself permission to focus on your health first, you will maximize your quality of life. You may even maximize your quantity of life, your longevity, too.

The key to your climb back is the consistency of the frequency of your activity.

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The Energy Investment Equation

Activity is not always energy-reducing. The right kind of activity is actually energy-producing, the same way that some bank accounts are interest-bearing and some are not.

Our energy bank is our body. Like a bank account, to see our energy balance increase, we have to keep investing in it. It is the same for physical activity — with one very important difference. Unlike a bank account, if we do not keep our physical activity account active at least three times a week for 15 to 30 minutes, the account eventually returns to its opening balance or less. So, to realize a return on our energy investment we must consistently keep investing in our body. It’s “use it or lose it.” So keep investing in your energy account every other day. The return on your investment could be a better life.

Protocol Pointer #5: Be Consistent – Suit Up and Show Up

Moments of Truth

The moments of truth in your climb back will come when you do not want to be active. All you want to do is skip your activity session, lie down, have a nap, or do something else, anything else than be active. These are the defining moments and they are pivotally important to you and your future. If we fail these tests, we could lose all the ground we have gained and everything we have invested to that point. Watch for these moments and overcome them by remembering what your life was like when you had all the energy you wanted. If you’ve never experienced that, this could be your chance. So suit up and show up – every other day, every time.

The moments of truth in your climb back will come when you do not want to be active. These will be the separators between existing and living. Steel your resolve.

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The study in progress.

Reprogramming Our Minds

As human beings, we are conditioned to believe that we should rest when we are tired. That’s fine – to a point. If we have had 10 or 12 hours of sleep and we still feel tired, it may be that we do not require any more rest. Now, we require activity. We need to oxygenate our bodies and in so doing re-energize them.

Resist the Enticing Arms of Fatigue

Because our bodies are masters of adaptation, if we ask them to do just a little more than they have done before, they adapt to that level of demand. But if we just lie around, our bodies move in the other direction – our muscles atrophy from lack of use and we lose energy and motivation. So, inactivity breeds inactivity. The more we lie around thinking about how weak and tired we are feeling, the more likely we are to stay that way. If we want to get our energy back we have to climb back. And, we are the only ones who can do it. No one can do it for us. We alone are the masters and makers of our destiny.

Activity can create energy.

CAN/WILL® Yourself to Move

If you still feel tired two days after your activity, it is important for you to be active anyway. Don’t skip your scheduled activity session unless you absolutely have to. Force yourself to move. WILL yourself to move. You can.

In Climb Back from Cancer I tell the story of how I prepared to walk up hills. For every step I took on the treadmill I used for some of my preparation, I repeated my training mantra – CAN/WILL … I CAN get better, I WILL get better. When I actually got to the hills, there were many times when I continued to use CAN/WILL not only to force myself to take one more step, but more often to force myself to get out there in the first place. I used my mind to overcome the matter and to get on with the only thing that really mattered to me at that time – getting one step closer to the hope of more energy and a better life.

Climbing the Medical Mountain

When I was in bed in hospital during treatment, I did the same thing. First, I threw back the sheets and blankets. Second, I sat up in bed. Third, I pivoted my feet onto the floor and fourth, I stood up. Then I took my first step. After that, the rest of the steps naturally followed not because of will power but because I had taken the first step — my body was in motion. And, as the renowned scientist and mathematician, Sir Isaac Newton, declared as his famous 1st Law of Motion: “A body in motion tends to stay in motion. A body at rest tends to stay at rest.” It applies just as well to cancer recovery as it does to Newtonian physics. Even if all I did was walk a few feet across the hospital room to the bathroom and back to the bed, that was good enough because that was forward progress – I had got out of bed. As long as I didn’t stay in bed for the rest of the day, as long as I continued to get out of bed until I was eventually walking down the hall and back, then to the nursing station and back, then around the ward, then down the elevator and outside the front door of the hospital…then I was winning.

Protocol Pointer #6: CAN/WILL® Yourself to Move

“No Brain, No Gain”

Once you are in motion, I caution again…try to resist the urge to push harder too soon. To achieve the results we want, we must eliminate the phrase “No Pain, No Gain” from our vocabulary. In my climb back, I pushed too hard, too soon, too often. As a result I paid the price by spending unnecessary and pointlessly long hours and days in bed or on the sofa feeling like I’d been hit by a truck. It usually took me as much as a week or more before I had enough energy to do much of anything again. That made my activity sessions sporadic and inconsistent, substantially reducing the speed and efficiency of my recovery and making it all that more difficult to climb back. And, it was disheartening.

I don’t want that to happen to you. You might consider replacing “No Pain, No Gain” with one of the adages of the world’s finest program for adult swimmers, Total Immersion. Its slogan is “No Brain, No Gain.” I describe it in Climb Back from Cancer. It’s the ideal program for survivors and caregivers because even if we’re so weak we can hardly walk, even if it’s all we can do just to put our face in the water and we don’t even know how to swim, we can still benefit from the program. For more information, visit www.totalimmersion.net.

In the case of mild to moderate cardiovascular activity during and after treatment, less can be more – more productive, more healthy and hopefully for you, more energy-producing. Any time you find yourself thinking you’d like to increase the intensity or duration of your pre-determined activity ahead of schedule, please reconsider. To succeed in trying to regain energy, we must be patient, self-restrained and self-disciplined. We must not let our ambition get the better of us. We want to move forward gradually, not backward suddenly. To do that, we can use the power of our minds to work for us.

Protocol Pointer #7: Resist the Urge to Push Harder, Faster

Patience, Patience, Patience

If you try being active for three or four sessions but you’re still tired or exhausted and you conclude that the protocol isn’t working, you’re right. It’s not working — not yet anyway. You won’t see results overnight. But, if you’re patient, persistent and consistent, it can work for you over time. If you commit to sticking with it for at least 12 weeks, you may see big changes in your energy level. If you don’t commit for at least 12 weeks, you give up early or you are inconsistent in your activity sessions, you will probably see little if any change. The program is likely not to blame. We’ve got to find the strength to re-energize our bodies and renew our lives. And, we need to tap into that strength – even if we think it’s not there anymore or we’re sure it left for good a long time ago. It might very well still be there. It may just need help from us to get started and to keep going.

Protocol Pointer #8: Results Come Over Time, Not Overnight

 The Calendar Calculation

At the end of each day during your 12 weeks, on a scale of 1 to 10 (one being lowest and 10 highest), jot down the number that best reflects your energy level that day. At the end of each week of activity, add up your total energy score for the week. The next week, do the same.

What you should notice is that at first, your energy level may remain flat, or even decline. The reason for this is simple. You’ve suddenly started to ask your body to be more active and it hasn’t had the time to adapt yet. However, as the weeks progress, if you’re consistent in your activity sessions you should see a gradual increase in your weekly energy totals. They will not increase every week. The climb back from cancer is a series of peaks and valleys that gradually trend upwards. If you chart your progress on a graph, you will not see a straight line between where you start and where you end up. What you will likely see is a zigzagging line like this…

The climb back to greater energy is not a steady uphill hike but a series of peaks and valleys trending towards the top.

A climb back is very much like climbing a hill. Sometimes, we take two steps forward and one step back. But if we persevere, over time we gain elevation. It is the overall trend that is most important. Overall, it should be upwards. If it’s not, you may be pushing too hard, or you may need to consult a physician to see if there is anything else going on. You might wish to try backing off a bit on your intensity, but not on the consistency of your frequency. Stay in the game. If you do, you may see the trend change. Your objective is to climb back as safely and steadily as you can.

Make haste slowly.

Protocol Pointer #9: Chart Your Progress

Image

A study participant pinpointing his level of perceived exertion.

Getting There from Here

No matter what your goal, you may be able to get there if you are patient, persistent, and consistent. The Climb Back from Cancer Protocol and the American College of Sports Medicine guidelines offer no guarantee, but the guidelines worked exceptionally well for me and the protocol worked equally well for other survivors experiencing some of the most debilitating levels of fatigue. I hope you will soon join us in experiencing more energy and vitality in your life. Nothing would make us happier. It all starts with making a passionate personal commitment and consistently living up to it for just 12 weeks. We encourage you to make that commitment. Whatever happens, remember…

Protocol Pointer #10: Keep Climbing!

In Summary

Here are 10 tips to help you get back on top…

1. Put Your Health First
2. Commit to Your Activity in Writing
3. Keep Your Activity Mild and Aerobic
4. Expect to Feel Tired – at First
5. Be Consistent — Suit Up and Show Up
6. CAN/WILL® Yourself to Move
7. Resist the Urge to Push Harder
8. Results Come Over Time, Not Overnight
9. Chart Your Progress
10. Keep Climbing!

My Theory about How Aerobic Energy Regeneration May Work

We don’t yet know why The Climb Back from Cancer Protocol was so effective for the participants in the pilot study or why the general physical activity guidelines of the American College of Sports Medicine (ACSM) were so effective for me. I can only give you my theory on why I believe it worked, especially for those participants with significant and sometimes almost debilitating levels of fatigue. At the time of this writing it is just a theory and is, therefore, pure conjecture. However, perhaps someday we may be able to investigate it further.

My theory is that invasive cancer treatments, particularly chemo and radiation therapy, damage the body’s oxygen and energy delivery systems. Our bodies require oxygen not only to live, but to help produce the energy needed for daily living.

Oxygen enters the body when we inhale air into our lungs. In the lungs there are tiny air sacks called “alveoli” where the exchange of oxygen takes place between the lungs and the blood stream through the tiniest of blood vessels – the capillaries. In medical terms, this is called the “alveolar-capillary membrane” and this is how oxygen enters our bodies. Capillaries also exist throughout our bodies at the end of our blood vessels. This is where the exchange of the blood-borne oxygen takes place between our blood and the rest of our bodies. It is where the oxygen that entered our bodies through our lungs actually gets to the muscles, tissues and bones. So, in very simple terms, the alveoli are at the start of the energy delivery road and the capillaries are at the end.

Because the capillaries are so small and delicate, my theory is that they are significantly damaged by harsh and invasive treatments like chemo and radiation. So are the energy production centers of our cells, the mitochondria. So, without these vitally important structures and building blocks working properly, the body’s primary source of energy, oxygen, simply cannot get to the muscles, organs and tissues of the body as efficiently as it normally would. Without oxygen, we cannot even convert our food into energy. So, those of us who go through radiation and chemotherapy are, I hypothesize, actually like high altitude climbers – we are not getting enough oxygen. This is known as being “hypoxic,” or in a state of low (hypo) oxygen, a.k.a. “hypoxia.” And, the more chemo and radiation we’ve had, the greater our fatigue. We’re also tired because our immune systems have been working overtime trying to overcome the rapidly reproducing cancer cells. That’s an energy requirement over and above that of healthy daily living.

To rebuild ourselves after treatment, we need to rebuild the components of our oxygen-powered energy delivery systems like the alveoli, capillaries and mitochondria. They are not unlike the components of a vehicle’s fuel system that has a clogged air filter and dirty spark plugs. The problem is, we can’t just swap in new parts. We have to recondition our existing parts. The components of the fuel delivery system of our bodies have been so adversely affected by treatment that they are not fully able to rebuild themselves on their own.

To do this, if we try too hard too early in our recovery by engaging in physical activity that is either too vigorous or not aerobic/cardiovascular, the alveoli, capillaries and mitochondria don’t get what they need to recover, i.e. largely mild to moderate aerobic activity. Conversely, if we are not physically active enough, there is no need for the alveoli, capillaries and mitochondria to regenerate and they remain at or near their post-treatment levels of performance and capability. In fact, as I mentioned earlier, due to a lack of proper stimulation, challenge and use, their performance may even drop to below what it was after treatment.

The key to reversing this trend lies is knowing what kind of physical activity is required and with what frequency, intensity and duration. This is where the American College of Sports Medicine (ACSM) guidelines and The Climb Back from Cancer Protocol come in. They gently and systematically stimulate the alveoli, capillaries, mitochondria and other elements of our energy delivery systems with the right…

1. Type of Activity (mostly mild to moderate, individualized and aerobic)
2. Frequency (every other day)
3. Intensity (as determined by heart rate and blood lactate levels) and…
4. Duration (15 to 30 minutes depending on the intensity – although the ACSM guidelines recommend at least 50 minutes)…

…so the body’s oxygen delivery system can rebuild itself. The result, hopefully, is a life renewed, re-energized and transformed.

Climb Back from Cancer Climbers

The side effects experienced by most chemotherapy and radiation survivors – fatigue, weakness, nausea and vomiting — mirror those of high altitude climbers. For weeks and months, these mountaineers live and work in low oxygen pressure environments. They therefore spend a lot of their time feeling “hypoxic” (low oxygen). Cancer patients and survivors are the same. They are climbers scaling a medical mountain and an energy Everest.
…more

Where to Get Help

The University of Calgary’s Thrive Centre

If you’d like to see if physical activity can help you in your own climb back, you may wish to contact The Thrive Centre at the University of Calgary (in the Canadian province of Alberta, north of Montana). There, exercise physiologists who specialize in working with cancer patients and survivors can determine the kind of physical activity you need to rebuild your body, regain your energy and re-capture your life.
http://www.ucalgary.ca/healthandwellnesslab/programs/thrive-centre-free-fitness-centre /

Criticalspeed.com

To help me in my climb back from cancer, I worked with my friend and exercise physiologist, Cal Zaryski, a professional on-line endurance coach (www.criticalspeed.com; coachcal@criticalspeed.com). From the beginning, Cal monitored my progress and the progress of other cancer survivors with whom he worked. Eventually, he was able to take me beyond recapturing my energy to a high level of fitness. Today, in addition to working with cancer survivors, he also works with everyone from non-athletes wishing to reduce stress and lose weight to busy professionals and parents wanting a healthier life balance. Whether your goal is to recover enough energy to return to work, play again with your children or grandchildren, walk a block or run a marathon, Cal may be able to help you. He certainly helped me.

The American College of Sports Medicine (ACSM)

The ACSM has a Certified Cancer Exercise Trainer (CET) program. For more information, contact:

The American College of Sports Medicine,
401 West Michigan Street,
Indianapolis, IN, 46202-3233
Tel. 317-637-9200
Fax. 317-634-7817
www.acsm.org