This transcript was extracted from the ‘Exercise after gynae cancer‘ video.

Thank you so much to Leah and as Leah said, she’s going to be over here, just with some information if anybody wants to take that away. And so now we’re on to our finale and bless her, she’s here from the very start, and she’s like, why do you make me the end talk? There’s a reason for it.

So over to Maeve, our physiotherapist. There we are. Thank you Amy. Some one of these days I will not be last Amy. So I don’t usually use notes but there’s a part of this talk I’m not just fully au fait with. So that’s there just to keep me right. So hello everybody, my name’s Maeve and I am an oncology and haematology physiotherapist in the Northern Trust.

I’m coming up now on 11 years working and I still feel like I qualified last year but I’ve been in this job now for three and a half years and I love working with cancer patients. Where is my wee beeper thingy? Oh, there so it’s just over back? This way and that way. Ok, so.

What time are we on? Ten past one is it? So we’ve been sitting for a few hours. Yeh. So I’m sorry I’m going to be that really annoying person, if you can everybody up onto your feet. I know, I know if you can. If you can’t, that’s fine if you need to stay sitting. Just to get you all moving and evidence shows that I think there’s some classes being taught somewhere in England where they’re learning on the move in primary schools. So we’ll just start marching on the spot. Just marching, good. Wee bit higher with the knees. Lovely. We’re going to sidestep over and back. To the right. To the left. Good. Lovely. Now we’re going to rotate the shoulders.

Some forwards, some backwards, if you can. Lovely. We’re going to do some punching. Don’t punch your spouse, I seen that. Some punching, lovely. We’ll shake out the hands. Good. Touch your nose, touch your head. Touch your knees. Touch your bum. Good and sit down. All right. Now, how do I? Ok so, I’m here to talk today about the importance of exercise and patients that have went through cancer treatments. And then I’ll talk a little bit at the end that’s a bit more specific to women’s health and pelvic health. So I’ll just start, physical activity can be defined as any bodily movement produced by skeletal muscles that requires energy expenditure.

So we are moving all the time, but it’s just making that conscious effort to move more. So your, all movement could be during leisure time, transport getting to and from places or as part of a person’s work, and both moderate and vigorous intensity physical activity improve health. So that’s from the World Health Organisation. Everything I’ve tried to talk about today, it all comes from science and research. We try our best that everything we do is backed by science and research.

So common challenges for patients that have went through treatment. So you’re living with a gynaecological cancer, many physical challenges. So I’m not going to go into too much detail on these because a lot of them we touched on already today, fatigue, pain, lack of energy, diminished appetite, loss of muscle mass. I mean, all of that is going to affect your ability to move and exercise.

And then obviously you have your treatments and their side effects, your surgery, radiotherapy, your multi-agent chemotherapies, your targeted therapies and hormonal therapies. So and exercise has been proven to help you know, all of all of these, all of these side effects and challenges. So what are the benefits? So light to moderate physical activity, can help people pre, during and living with cancer.

Energy, so if you’re moving more, you’re going to be building more calories and therefore, you know, you’re going to be using more energy, again with that then if you’re moving more using calories. Hopefully that will increase the amount of food that you want to intake, you know, to fuel your appetite. So that’s why we would encourage people to try and move more if they are struggling with their appetite. Mood.

So it is so well established now that movement and exercise improves your mental health. So there was multiple studies done, including MRI brains of people before and after exercise and it showed that increased activity in the part of your brain that you know, that works, you know that controls your mood and exercise is so well proven to increase those happy hormones, your endorphins.

And that’s so well established now. So and it is proven to improve, improve your mood and obviously your mood and your mental health can be effected going through a cancer journey. So your heart and we’ll include with that your lungs, you know, we try to encourage people, we talk about getting fitter. People maybe have a different thinking of understanding of what getting fitter means.

And when we say about getting fitter, we basically mean we want your heart and your lungs to become a better oiled machine. So you’re pumping oxygen and blood around your body to your muscles at a much more efficient rate. So that’s why when you start to exercise, you’re maybe sweating more, you’re maybe more out of breath but as you start to do it, your lungs and your heart start to adapt to get oxygen and blood flow around your body and it starts to get easier. So that’s your heart and your lungs adapting more to exercise. It improves your strength. So movement, we’ll talk, again I’ll probably a couple of slides sort of run into each other. So I may be already talking ahead of myself. It is, you know, exercise and physical activity will increase your strength because you’re using your muscles.

The more you move and use your muscles, the more you’re recruiting fibres, your muscles will get bigger, they will get stronger. Balance, anybody here good at parking their car? No, everybody, one. Does anybody rely on your beepers? I don’t know what the fancy name of them is for. Well, anyways, do you know the way you reverse and you get the beep beep beep?

They let you know where your car is when you’re reversing. So around your joints we have little nerves and sensors that are constantly feeding information to your brain as to where you are in yourself. So if you stray so much to one side or stray so much to the other, that sort of stimulates those little receptors to tell your brain, oh, straighten up a bit, woman.

Ok. But as you get older, like getting grey hair and wrinkles, those sensors kind of can dull a bit not be as sharp. So the sensors in your car kind of wearing a little bit. So that’s way we’ll talk about a little bit more about balance. So as you get older you know those sensors tend to not be as sharp as they once were.

So and exercise is proven to improve your balance and confidence. I mean we see it all over, in social media, everywhere we go now and it’s really trying to promote exercise and physical activity. It is proven, proven time and again to improve your confidence. So the benefits so so as I said earlier, if you can get your heart and your lungs working more efficiently, that is reducing your risk of sort of cardiovascular diseases.

Strengthens muscles and bones. So again and again, we’re talking about this clientele here, you know, with the, you know, the treatment it can bring on menopause. As you go through menopause you do get that thinning of your bones or youc can have osteoporosis. Your joints love to be loaded ok. If you want to keep your joints and you want to keep yourself strong, you need to load your joints because it improves the more you load your joints, the more you increase your bone density, ok? And as well as that, then you’re improving the strength of your muscles and your ligaments and tendons around your joints so they work as a better brace around your joints to keep you stronger.

All right. Reduces the risk of type two diabetes, weight control, so obviously we’ve had a lot of talks earlier about, you know, the benefits of, of you know, keeping your weight under control and the risk of increased body mass and the increase of oestrogen and the risk of cancer, and also increasing your weight ok, we do get patients that obviously, you know, through their chemo and the side effects and loss of appetite you’ve lost too much weight. Sleep, hopefully if you’re burning more energy, will hopefully make you tired. It’s proven time again, we’ve had the talk earlier. The exercise, and I think it’s through that, also through that release of your happy hormones and the endorphins that boost your energy, reduces your risk of dementia and less cognitive decline.

So is it safe? Yes. The international guidelines so for physical activity and cancer developed by the American College of Sports Medicine, supported by the National Cancer Institute and the British Association of Sport and Exercise Science. So it is safe. Ok. Safe at all stages, try to resume your normal activities ASAP. Will they have to be modified to a degree? Yes, but try to get back into your normal activities as soon as possible.

You’re building up slowly and the biggy is avoid being inactive. Particularly I work in the wards as well over in Antrim, hopefully you don’t experience any hospital admissions as a result of your treatment, but it’s trying to sit less and avoid being inactive. I’ve told this story before, I went to get a lady up out of bed, an elderly lady up out of bed who had just been going through chemo, so I knocked on the door I introduced myself, we’re going to get you up. The patient and the family looked horrified and they said, “Oh but do you know mummy has cancer? I said, “Oh yes, yes, yes, I’m the physiotherapist. I’m here to get your mummy up” “But she has chemo, she’s had chemo?” I says “Yes, yes, yes, I know I’ve been sent here. You know, we’re times have changed. We’re here to get patients up and moving” “What now? But but mummy’s going through chemo” Do you know and as well as that, things are changing. There’s also been studies done in England, but it’s a different cohort where they’re actually getting patients on static bikes while they’re receiving their chemo. But Northern Ireland is light years behind that.

So this is the guidelines you’ve maybe seen this on posters and things in and around chemo units and what not. So there it is there. So 150 minutes of, you know, sort of moderate exercise or 75 minutes of more vigorous. So you can have your walking, gardening, swimming, running, you know, sports, up and down stairs. In there now see the way were incorporating two sessions a week of building strength so that is anything over and above your body weight.

So perhaps going to the gym, aerobics classes, carrying bags, you know, how many of you in here be carrying grandchildren? You know, heavy shopping. So we’re trying to incorporate that back into your normal day to day, things that you were doing pre-cancer and we touched on earlier the importance of improving your balance. So this is all what is recommended.

And as we say there at the bottom, sitting less. I love a good series on Netflix, so it’s I suppose it’s just remembering to break it up and get up and move that we’re not sitting too long. So again, just touch briefly, types of activities; we have our 150 minutes of moderate activities, 75 minutes of vigorous activities that would be walking, running, gardening, swimming, sport (non-contact) or you know as I say, up and down stairs.

So more examples, you could have your strength you could do pilates, carrying objects, weights and even just doing body weight exercises, squats, lunges, press ups, getting up and off the chair and anybody here like to dance? A bit of dancing is super for you for your balance. A bit of Tai chi, bowling, yoga. So just examples of what you can be doing. So yes, exercise is safe, but there is just some little things we need to take into consideration that we will just want to act with a bit of caution.

Ok. So if you have previous fractures, a current fracture, bone thinning, osteoporosis, metastases of your on your bones or in your joints, please come and speak to someone. Exercise is safe, it might just be that you need a little bit more guidance. You know if you have a brain tumour or metastases, you know, that can affect your ability to do exercises, knock off your balance.

So again, safe but you might just need guidance. So peripheral neuropathy is that when you have the reduced sensation in your fingers and in your feet. So with that could become reduced balance and your ability to carry objects and feel objects. So again, safe, you just might need a wee bit of guidance. Lymphoedema touched on very briefly earlier, yes exercise is one of our four key pillars of managing lymphoedema. But what you may need is a bit of, a bit of input and a bit of treatment to perhaps get that limb to, get the and the oedema controlled. You may need to get into a compression garment, but definitely exercise is one of the key pillars of managing lymphoedema.

But as Patricia said earlier initially it can be a bit sore, a bit heavy. So that’s why we want to get you referred to come and see a trained lymphoedema therapist to get the swelling under control and get you educated, and if you have any pre-existing heart or lung problems, you know, check with the nurses, reach out to physiotherapy, speak to your GP.

It is safe and encouraged. You might just need a little bit of advice on what to avoid. Ok, so top tips. Start slowly, your gradually increasing, do it with company, keep a diary and seek advice if needed. So as I always say to people you’ll get going, but just start slowly and if you’re getting whatever it is that you want to get back into, gradually increase it.

So I would have got asked in a few of these previous events, what is the difference between moderate and vigorous activity. So moderate you’re really you know, it’s you’re talking about sort of, little exertion. You know, it should be easy. You should be able to do it for longer periods of time. Your breathing is comfortable.

You should be able to whistle. Ok. So that’s and then so your doing that you’re aiming for that sort of a level, 150 minutes over the talk or over the week. Then you’re moving on to light or harder more sort of vigorous activity, you’re starting to feel warmer, sweating, your breathing will increase, but you should still be able to hold a conversation.

But if you’re into more vigorous activity that’s when your speaking and your breathing becomes, your breathing will increase further and you’ll only be able to speak in short sentences. So it’s getting that mixture between moderate activity and vigorous activity. So barriers then. The treatment for gynae cancer can affect your bladder and bowel ok. So you’ve signed up to the gym.

You bought gear. You want to start to exercise. These are the barriers that you may come into contact with that can affect your ability to exercise. So urgency we’re talking about that aggressive need to urinate or go to the toilet in that short sudden period of time. Frequency is when you’re urinating or going to the toilet more often over the course of the day that what we would be considered normal and incontinence is leaking from the bladder or bowel. So treatment can affect how these systems work, so can you see there at the minute, the bottom that sort of peachy the pelvic floor muscles. What we want to do then is we want to get the pelvic muscles to work more and to work effectively to support those systems and how they work.

So basically, around your rectum there you have, which is your back passage. You have circular fibres. And what you want to do is you want to contract them, this is how we do our pelvic floor. We want to try it now. So we want you to squeeze your back passage, ok and I want you to draw it up.

And that feeling of drawing upwards and forwards and almost like you’re like sucking up a malteaser. Ok, I know have I just ruined malteasers for you? And, and then completely relax and let go. So we’re squeezing the back passage where that feeling of drawing up and forward and then hold it for a few seconds and then let go.

So we want to be doing our pelvic floor exercises to support these systems that could have been affected by the treatment and how they work. Ok. Lifestyle, I’m just going to fly through these, Bernie I promise. But no, just a few wee tips for lifestyle. So, optimising your bowel function, regular meals, trying to eat your meals at the same time every day, try not to miss breakfast. As the dietitian said, increasing your fruit and fibre, avoid restricting fluids, try to drink a litre and a half of fluids every day at the minimum. And try to avoid, try to avoid, going to the toilet more than three hours. Any teachers or retired nurses in the audience? They are notoriously bad for for not going to the toilet regularly enough.

And what you want, why you want to avoid doing this is because you could overextend the bladder, and therefore it loses its stretch and its ability to contract and empty. Do not hover over the toilet, ok. Just moving briefly on here to Squatty Potty. So what you want to do is you want to keep your knees higher than your hips, so your back passage is lower than your vagina.

You want to let your belly sag. Gently lean forward and do not push or strain. Ok, so just wee tips and all of this again is just to help your pelvic floor work a bit better to support your bladder and bowel that may have been affected by treatment. And nearly there, Squeezy app, it’s just a wee nudge to help to remember to how often you’re going to the toilet, it will not do your exercises for you, but it’s just something that you can use.

And just if you’re getting started, we have you can reach out to ourselves. There’s Macmillan support groups. You have MEA move more. There’s leisure there’s council initiatives that you can get reach out to and again speak to a health professional if you have any questions for getting started. Thank you very much. Sorry I went over time Bernie. Thank you so much Maeve, you can see now why Maeve’s at the end, a ball of energy to end. So that is a wrap and as Maeve had said, there are a few different exercise related programmes, that are usually linked with the different council areas.

So it is different per council, but some of them have 12 weeks free access to the leisure centre, there’s walking groups, there’s exercise related sort of cancer related exercise classes. So there’s lots of information, a lot of support about getting active. So please Macmillan Information and Support Service, we’re based in Fern House in Antrim Hospital. We cover all of the Northern Trust.

If any of you have any questions about the different charities, about different support that’s available, please do get in touch with us again at the table with the flowers. So like I said, that is a wrap. And before you leave, I just want to express our gratitude to our speakers today, to our Gynae cancer team, to our lovely patient rep Frances, we have a wee gift for you

it’s only something small but again a round of applause for Frances. It really was fantastic. There you are, Frances. Thank you. And at cancer services we are committed to providing the best care for our patients and their families and at the back of the key messages you’ll see in your pack, there’s ways to get involved in shaping the future of our services.

We’re hoping to do different task and finish groups, there’s a reader’s panel as well. So please, if you want to get involved, do let us know. We appreciate your participation and your engagement, and we value your feedback. So we do these events for you guys. And, you know, from feedback from previous years, that’s why we did the panel.

You know, we do try and take your feedback on. So please do let us know how you feel about how it went today. We won’t cry I promise. So you can, there’s an evaluation form in your pack. You can hand write that and just leave it on the table. Otherwise, if you are fancy with the smartphone, you can scan it. and please loved ones who’ve come along as well, we’d love your feedback too. So please do scan that and you can fill it out, up there as well. If anyone does think “gosh I would like to watch this again” and would like to see the information because it was a lot of information. We can give you the link to this event if you give us about six weeks, to get that onto the Cancer Services website, please again, go back to our table.

We’ll take your name and number and send that. Finally I just want to thank the production company. I want to thank Mark and Mark for being here today. I want to thank Bernie for all of your help. For Hilary, our volunteer as well. Hilary I don’t know honestly, what we would do without you. And then to Kathy, our support worker, couldn’t be here today.

She really was instrumental in organising and pulling all of this together. Kathy. Yeah. So I just want to thank Kathy. She couldn’t be here today, so I hope I didn’t forget anything or forget to thank anybody. And that’s it. Thank you for attending today’s event. And safe journey home, everybody. Thank you.