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Maggies Nottingham: exercise and cancer

Maggies Nottingham: exercise and cancer

Recently I was approached to provide an exercise course for individuals recovering from cancer at Maggie’s Nottingham. Having never heard of this organisation before I went to meet with in-house Counselling Psychologist Tina Johnson to find out what it was all about. At that point I was unaware of the influence Maggie’s would have on me.

“There can be life after breast cancer; the prerequisite is early detection.” – Ann Jillian

Maggie’s is a not for profit organisation founded by Maggie Keswick Jencks. Maggie had a personal battle with cancer for two years and during that time developed the concept of Maggie’s Centres around her belief that one should not “lose the joy of living in the fear of dying”. Maggie’s Centres aim to provide practical, emotional and social support for all those affected by cancer, including friends and family. The first Maggie’s centre was opened in 1996 in Edinburgh and growth of this concept has seen a further 15 Maggie’s Centres open across the UK within NHS cancer hospitals, a centre in Hong Kong and an online support centre.

Based at the City Hospital in Nottingham, the Maggie’s Nottingham building itself is a quirky, modern design which was developed by architect Piers Gough. Upon approach to the centre the vivid green colour and round curves of the building provoked a smile from me. There is something fun about the design of the place that gives you a very positive feel. The interior of the centre, designed by Nottingham born designer Paul Smith, has a very colourful, homely feel that seems to put you at ease.

Stepping out of the January chill and into a warm bright atmosphere, I was instantly met with smiles and made to feel welcome. You can see how, for so many people, Maggie’s can become a home from home. At the centre of the building is a large kitchen, complete with a comfy dining area that creates the positive social atmosphere that Maggie’s is known for. Various other rooms around the outside of the building are split over two levels. There is a library (which is where I wrote this blog), a group room and relaxation areas which provide calm environments to just sit and reflect, or provide privacy to share thoughts, feelings and emotions with others.

“Cancer can take away all of my physical abilities. It cannot touch my mind, it cannot touch my heart, and it cannot touch my soul.” – Jim Valvano

Maggie’s provides various structured programmes, non-structured drop-in services and for many simply an empathetic ear and a calm oasis. My involvement with Maggie’s is linked to a seven week structured course called ‘Where Now?’. The Where Now? programme aims to help recovering patients begin to look beyond their treatment, bring some normality back into their lives and start to think about building a positive future for themselves. The group meets weekly to share experiences and take advice from various experts on psychology, fitness, nutrition and medicine. They begin to build a plan for life after cancer.

After visiting Maggie’s, meeting Tina and learning about the Where Now? course, I knew straight away that this was going to be a challenging but rewarding experience and I came away very motivated and determined to make a difference.

I was very clear about my goals and objectives for this course. I aimed to:

  • Promote the Triad of Health for a long, fulfilling life
  • Inspire motivation to change
  • Teach effective goal setting and healthy habit formation
  • Prove that exercise can be fun and enjoyable
  • Teach how to exercise safely following cancer treatment and explain the benefits of doing this
  • Improve participants’ functional capacity

What I didn’t anticipate was how challenging achieving this would be when considering the after effects of treatment and various other limitations that restrict exercise options:

Energy, enthusiasm

Treatment and medication can lead to high levels of fatigue. This can make just the thought of exercise very daunting. Many individuals recovering from cancer report issues with insomnia and so often feel like resting and sleeping during the day. Although exercise and physical activity can help to improve energy levels, it’s very hard to appreciate that when you feel like you have an empty tank.

Limited, painful movement

Post surgery it is likely that patients will experience a loss of movement in affected joints as well as painful movements leading to weakness. Breast cancer being the most common cancer, the majority will have stiff, painful shoulders for some time after treatment. This can limit their ability to support their own weight on their arms, making getting up and down from the ground difficult, which immediately limits exercise choices, particularly body weight exercises. Living with such symptoms makes daily tasks such as getting dressed or doing washing very uncomfortable and so choosing exercises that will improve functional capacity is important.

Nerve damage

In some cases, nerves may be damaged or severed during surgery, creating loss of strength, control and sensation, making exercise very challenging.

Lymphedema

This is a painful build up of fluid in the limbs, leading to swollen, sore and numb areas. Exercise can help to reduce the symptoms of lymphedema. However, it needs to be controlled. Overdoing exercise can induce or worsen this condition and so care needs to be taken to control intensity. Exercises should be performed in a specific order, starting from the thorax and working distally to encourage effective lymphatic fluid drainage.

Weight gain

Many factors can contribute to weight gain following cancer treatment. Clearly exercise and physical activity can help address this issue, although in the early stages it may make exercise feel more difficult and uncomfortable.

Osteoporosis

Following treatment, females in particular are at increased risk of osteoporosis. This means that impact activities and resistance training must be progressed systematically and with care.

Psychosocial issues

Individuals react to life after treatment in unique ways, but it is not uncommon for depression to set in. For some, leaving their home is a big step and finding motivation to start a fitness training programme is a big ask. Working in a group environment can help provide the motivation to overcome this.

The workout space

Designing an exercise programme to be performed in a non-gym environment means that you have either no equipment at all or equipment that has to be very portable. Body weight exercises are the most obvious solution, but considering that most participants may struggle to support their own weight on their arms, this also becomes a limited option.

Despite the challenges, I managed to develop what I thought was a safe, progressive and fun exercise course. My fitness equipment was a little unconventional, and included balloons, hacky sacks, resistance tubes and TRX RIP trainers. This kit helped me make the exercises fun, reactive and interactive, meaning the exercise classes felt more like play than a workout.

“When someone has cancer, the whole family and everyone who loves them does, too.” – Terri Clark

The feedback from the course was great and I really felt that I hit the objectives that I set out to achieve. The change I saw in the group over six weeks was fantastic. Smiles and laughter increased week on week and positive mindset was getting stronger. The group was clearly bonding and encouraging each other to change. Cardio fitness improved, as did average blood pressure, heart rate, balance and coordination, joint mobility and strength. The most satisfying change for me was seeing them enjoying the exercise program. The enjoyment factor will have a huge influence on whether they choose to continue to participate in exercise in the future. Here are a few quotes from the group on completing the Where Now? course:

“Exercise was excellent. The group exercise made us interact with the others and not feel shy about joining in.”

“I learned how to make new goals and make new friends.”

“A lot of variety to keep me interested.”

“Exercise was achievable but challenging and I will take a lot from it for the future.”

“Made you feel comfortable and not embarrassed if you were not able to do an exercise very well.”

“I loved every minute of exercise.”

As I predicted from first arriving at Maggie’s, I found great reward in getting involved with this charity and the programs that they offer. I now have a greater understanding of how traumatic living with cancer can be, both during and after treatment, for all involved. Seeing people bounce back and take control of their lives again after such a trauma is inspirational and makes my small contribution to the program feel very worthwhile. Maggie’s is both a coping mechanism and a catalyst for change to many people and it relies on volunteers and donations to continue running. Maggie’s is a charity that I wish to pledge more support to and so I will make it my aim to raise awareness and donations for them throughout 2014. See the links below for more details on Maggie’s.

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