Bounce

bounce | lift | fuel | chill Thank you for coming (back) to read the second instalment of my plan for self-care for everyone affected by cancer and menopause.

Bounce

By ‘bounce’ I mean weight bearing exercise, and weight bearing exercise that is as bouncy as is possible, for you, for now. It’s important for the health of our hearts, lungs, bones and for our mood because it’s one way to generate endorphins (our happy hormones). Weight bearing exercise is important throughout our lives but is worth revising how we approach it after a cancer diagnosis, so that we get the most from it.

Weight bearing exercise is the term given to physical activity where you transfer your bodyweight from one limb to another against gravity – usually we’d think of movement on our feet, walking, running, dancing. Forms of exercise where we sit or float don’t have the same value here although swimming, cycling etc are wonderful ways to move. Seated exercise is incredibly useful, and is a really good way for many people to become or stay active as part of their cancer rehab. If seated exercise is your bag then there are ways that we can add bounce simply by making moves bigger, by marching or jumping in a chair as vigorously as possible.

Bones

Weight bearing exercise is one proven way to help minimise bone density loss – which is crucial if we are going to reduce our risk of developing osteopenia and osteoporosis. Or indeed if we are going to try to slow either condition from progressing.

We lose bone density when we go through menopause and produce less oestrogen. This is the case for women going through menopause when it occurs naturally, and those for whom it is an immediate impact of surgery or cancer treatment,

We can also lose bone density as a direct side effect of some drugs – especially the aromatase inhibitors prescribed after hormone positive breast cancer and through some chemo regimens administered across different types of cancer.

Hearts and lungs

So, bounce is for our bones, and the bouncier, the better. It’s also for our hearts, and lungs. Heart disease is a significant killer, and its impact on women often given far less attention that it is for men. It’s arguably our biggest health risk as menopausal women and is possibly a greater risk to some of us than the cancer was.

HRT can help to protect the heart but, as one woman who is not going to take it, I need to look for other ways to keep my heart as strong and healthy as I can.

Getting out of puff

The prescription for all adults is that we exercise to a point that we’re breathing more deeply than usual for 150 minutes a week. That’s half an hour, five times a week and that time can be notched up walking, commuting, climbing stairs.

For those who like their cardio served with extra intensity, the prescription is 75 minutes of vigorous-intensity physical activity per week, accumulated in bouts of 10 minutes or more [1]. That could equate to a couple of 5km runs, or short spinning classes.

If 150 minutes feels completely out of reach for you, for now, don’t worry. Work up to it. Add in little 5 minute breaks if you can – so-called exercise snacks – and see if you can accumulate minutes that way. Have a look at the ‘larking about’ film below. Measuring our steps is another way to measure how much weight bearing exercise we’re doing. As far as I know the optimal 10,000 steps a day applies to us as it does everyone else.

High Intensity

If part of your self-care plan is around reducing or minimising body fat then there’s an argument to try HIIT – high intensity interval training where you do your bouncy thing as hard as you can for short bursts of time with minimal rest breaks in between. The idea is that if you’re only doing it in short bursts you will find the energy and stamina to do it harder, higher, faster than if you were going to try to keep going continuously. It’s how I run – by ‘jeffing’.

Jeffing is the term given to a method of run/walking devised by Jeff Galloway, an athletics coach for the US Olympic team. He found that injury levels were much lower in those of his, ahem, veteran runners, who interspersed their running with regular, cyclical walk breaks. Unlike ‘couch to 5k’ and similar running programmes that aim to eliminate walk breaks and work towards running continuously, Jeffing retains the walk breaks and thus gives the body short, regular rest breaks. I swear by it as a way to make running more manageable, more enjoyable and – surprisingly – it’s often a way to make our running faster. I have ‘PB’s’ (personal best times) in 5k and marathon distance that were both achieved through jeffing. It’s very clever.

Jigsaw pieces

Being bouncier is one important part of exercise and self-care during the menopausal years. One of the changes you might have noticed however is that cardio exercise sometimes doesn’t feel as effective as it did before the whole hormonal hullaballoo. That’s a really common experience, and there are biological reasons for it. It isn’t that we are just not trying/training hard enough.

For those of us who are making lifestyle changes that involve trying to manage or reduce body fat, it, and it is definitely only one piece of the jigsaw. We also need to be working on our strength, hence the ‘lift’ part of my plan. We’re going to be lifting weights, ladies. Heavy weights.

A note of caution

I know that lots of people feel, for one reason or another, that they shouldn’t bounce about, and that’s reasonable. If you have bone mets then there is still plenty of scope, but we would take steps to minimise your personal risk of injury, especially of fracture. If you have bone metastases that have spread to your spine, it’s a good idea to talk to your oncology team about how best you could exercise – it’s often just a matter of mitigating against potential trips or blows and understanding how best to move without causing undue stress to your spine. It’s do-able though.

Likewise if you have neuropathy in your feet from chemo we can find ways to minimise your risk of falling – like using a rebounder mini-trampoline with a handlebar so you can steady yourself.

You may fear that if you bounce, your pelvic floor might not cope. Again, more than reasonable. Experiencing a weaker pelvic floor – leakage when you cough (or indeed jump) or having to go to the loo more frequently or with greater urgency – is really, really commonly experienced. Training the pelvic floor is an integral part of strength training for anyone who’s had a cancer diagnosis, and arguable doubly so for those of us enjoying the double whammy of menopause and cancer.

Some people have experienced injury, maybe to their knees, hips or other major joints, and are hesitant about doing high impact exercise in case they exacerbate the original injury. The trick here is to start light, start with lower impact activities, invest some time on that and on strength training that will support the joints and the connective tissue around the joints. It’s always worth checking in with your healthcare team if you’re worried.

Flexibility is important here too, and keeping our muscles, and the tissue around the joints as supple as possible. That’s part of the plan where we ‘chill’.

Things to try

·       Seated Cardio. This is a short routine, and a gentle way to get a little more bounce without jumping.

·       Skipping. I did a session with a couple of the marvellous Flat Friends as part of their Fit Flat Fortnight campaign during breast cancer awareness month. This is a session, shared with you with the kind permission of the two lovely women who joined me, and where we did some shadow boxing and planned how to start skipping. If you want to skip (ha!) forward to the bit about skipping, its from 13:30 onwards

·       Couch to 5k – this is a tried and tested way to get more bouncy by beginning, or returning, to run. This is a blog post I wrote a little while ago about running. It has a bit more about jeffing, and a couch to 5k plan.

·       Larking about at home. This is a little film I made at the start of lockdown, when we were looking for ways to move without going out. It’s bouncy.

This month’s sharing plate

·       ‘If this is you, you are not crazy’. Absolutely fascinating TED talk by Neuroscientist Dr Lisa Mosconi on how menopause affects the brain

·       You can find more detail on Jeffing here

·       Prunes for bones – who knew? Prunes have been shown to help preserve bone density during menopause and I now eat ‘em regularly. Here’s the study

·       Fasting. Time-limited eating is one part of the ‘fuel’ part of my plan. I found this episode of the mighty Menopause and Cancer podcast really interesting – episode 86 – what does science say about fasting after cancer

·       Two skipping role models. Check out Gail McNeill and Sue @sixtyandme - I’ve learned so much from these two. They’re both strong, fit women and they both skip like demons.

Next month I’ll write more about the wonderful benefits of strength training – the ‘lift’ part of the plan.

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[1] Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54(24):1451–62.