Features

Cancer care: how online exercise plans can boost patient recovery and quality of life

Nurses should promote online exercise plans to continue supporting people with cancer

Big potential is seen for online exercise plans and nurses need to promote their use in supporting people with cancer before, during and after their treatment

  • COVID-19 saw many health support services move exercise plans online and also personalise them to help rebuild lost confidence
  • Exercise before, during and after cancer treatment can help slow progression of the disease and improve chances of survival
  • Exercise also helps improve quality of life by reducing cancer-related fatigue, increasing mobility and boosting mental well-being

Online exercise programmes for people with cancer are here to stay and more nurses should consider referring to them, say cancer rehabilitation experts.

The COVID-19 pandemic has seen

...

Big potential is seen for online exercise plans and nurses need to promote their use in supporting people with cancer before, during and after their treatment

  • COVID-19 saw many health support services move exercise plans online and also personalise them to help rebuild lost confidence
  • Exercise before, during and after cancer treatment can help slow progression of the disease and improve chances of survival
  • Exercise also helps improve quality of life by reducing cancer-related fatigue, increasing mobility and boosting mental well-being
Big potential is seen for online exercise plans and nurses need to promote their use in supporting people with cancer before, during and after their treatment
Picture: iStock

Online exercise programmes for people with cancer are here to stay and more nurses should consider referring to them, say cancer rehabilitation experts.

The COVID-19 pandemic has seen many health support services move online and, while there will always be a need for face-to-face activity, it’s clear that virtual programmes have much to offer going forward. Research shows that exercise before, during and after cancer treatment can help slow progression of the disease, improve chances of survival and reduce the risks of cancer returning.

Exercise also helps improve all-round quality of life by reducing cancer-related fatigue, improving mobility and body function, and boosting mental well-being.

Online sessions enable people to join an exercise programme wherever they live

The importance of staying active is stressed by the charity MOVE, which offers an eight-week virtual exercise programme to those aged 13-30 with cancer or in recovery.

Providing sessions online enables the organisation to work with people wherever they live, explains MOVE cancer rehabilitation specialist Helen Murray. She believes online programmes can work well for any age but are a particularly attractive option for young people.

‘The fact you don’t have to go to a gym and everything can be done at home has huge appeal,’ she says.

Personalised online schemes can help rebuild lost confidence, adds Ms Murray, who says she has seen the incredible difference such support can make.

Watch our video of MOVE charity founder Gemma Hillier-Moses

Those receiving treatment must be referred to the MOVE programme by a healthcare professional, while those who have completed treatment can refer themselves.

Participants have an initial consultation with a cancer rehabilitation specialist who will then put together a tailored programme. This usually entails a mix of strength and cardio exercise – which may just be going for a short walk – and can include one-to-one workouts using Zoom.

At the end of the eight weeks participants are given information and resources to help them keep active and may receive follow-up calls if needed. MOVE will also provide feedback to the referring healthcare professional.

‘Being online makes it more appealing, because many struggle with anxiety, have body image issues and feel embarrassed’

Laura Cutler, Macmillan clinical nurse specialist

How to encourage patients to join in with online exercise

Ms Murray has seen demand for the programme shoot up during the pandemic, with an increase in referrals from professionals such as physiotherapists who are unable to see patients. She believes there is huge potential for online schemes to continue supporting people with cancer and survivors once the crisis is over.

Macmillan clinical nurse specialist Laura Cutler
Laura Cutler

Macmillan clinical nurse specialist Laura Cutler, based at Nottingham City Hospital, helps long-term survivors of teenage and young adult cancer and regularly refers patients to MOVE’s virtual exercise programme.

Ms Cutler says: ‘Being online makes it more appealing, because many struggle with anxiety, have body image issues and feel embarrassed.’ Lack of transport and the cost of travel are also a concern, so online sessions are much easier to sell to people, she says.

MOVE is also behind the 5K Your Way initiative which – in normal times – sees people affected by cancer attend parkrun events held across the country on the last Saturday of every month.

5K Your Way has found ways of keeping the initiative going online

People run, jog or walk all or part of the distance, volunteer or cheer from the sidelines. During COVID-19 organisers have looked for ways to keep it going online, says consultant oncologist and 5K Your Way co-founder Lucy Gossage.

5K Your Way founder Lucy Gossage with MOVE founder Gemma Hillier-Moses
Lucy Gossage (left) with MOVE founder Gemma Hillier-Moses

This has included providing monthly Move Your Way workouts on Facebook Live in which people can join in at the time or watch later on the 5K Your Way YouTube channel or website.

It has also run online workshops on Zoom on topics such as cancer-related fatigue and exercising after abdominal surgery, and sets virtual challenges such as encouraging people to complete five 5Ks to gain a medal.

‘Online is never a substitute for real life,’ says Dr Gossage, who says it is impossible to replicate the camaraderie and peer support experienced by those who meet at 5K Your Way events. However, she says online elements – such as the workshops – will be an important part of the scheme’s development.

SafeFit offers exercise, nutrition information and emotional support

The SafeFit programme was developed by Macmillan, University Hospital Southampton and others in response to the pandemic and is now being studied in a clinical trial. It offers exercise, nutrition information and emotional support from cancer exercise specialists and is open to people aged 18 and over with any type of cancer at any stage.

5K Your Way runners

People can refer themselves, then go through a screening and assessment process before being matched with an instructor who will devise a bespoke programme over six months that may include online one-to-one and group exercise sessions.

Macmillan SafeFit lead June Davis says nurses may be concerned that patients undergoing treatment can self-refer, possibly without the knowledge of their clinical team. But she says the emphasis is on ensuring participants are safe, and clinicians will be consulted if the trial team has any concerns. Ms Davis says online schemes are proving an efficient and flexible way of reaching people and increasing patient choice.

‘You tend to get fewer people not attending, fewer cancellations, and if people don’t feel particularly well, sessions can be rescheduled and interventions paused. My view is this will become business as usual for many organisations.’

How MOVE’s online exercise programme helped one patient

Mother-of-two Nicola Oliver, 31, was diagnosed with soft tissue cancer rhabdomyosarcoma in March 2019
Nicola Oliver

Mother-of-two Nicola Oliver, 31, was diagnosed with soft tissue cancer rhabdomyosarcoma in March 2019. She had nine rounds of intensive chemotherapy, surgery to remove lymph nodes around her neck, 28 sessions of radiotherapy and a year’s worth of maintenance chemotherapy.

Before her diagnosis she was active and played netball every week. She wanted to get her fitness back but didn’t know where to start.

During maintenance chemotherapy her consultant suggested she try MOVE’s online exercise programme and introduced her to MOVE cancer rehabilitation specialist Helen Murray.

‘I was apprehensive about starting the programme because of how tired chemo made me feel – the last thing you feel like doing is exercise. But if I’d known how good it would make me feel I’d have done it earlier.’

The fact that the programme was recommended by a trusted healthcare professional spurred her on. She embarked on the MOVE programme in February 2020, working with Ms Murray one-to-one.

‘Helen would send me weekly programmes and we would catch up once a week,’ she says. ‘Some weeks she would do a workout with me over Zoom. It was nice to do it with someone.’

The programme was tailored to her needs. ‘I had a PICC (peripherally inserted central catheter) line in my arm and didn’t want to do press-ups or put too much weight on that arm so we worked around that.’

Nicola Oliver now does weekly 5K runs
Ms Oliver now does weekly 5K runs

Ms Oliver says online sessions were easier to fit around family life, and living in rural Lincolnshire she would have struggled to access a face-to-face group.

‘I wouldn’t have felt confident walking into a gym and joining a class as my fitness level wasn’t there. I wasn’t physically confident in my appearance because I didn’t have any hair.’

Ms Oliver continued exercising once the programme ended and built up to running a 5K inspired by MOVE’s 5K Your Way initiative and Facebook group. Recent scans show no signs of cancer, her fitness has improved dramatically and she now does weekly 5K runs.

Teenage Cancer Trust runs dance, yoga and aerobics classes

The Teenage Cancer Trust has provided a range of online exercise opportunities for young people throughout the pandemic, including dance, yoga and aerobics classes as well as signposting to virtual schemes run by others.

The charity’s head of youth support coordinator Helen Veitch says: ‘Online exercise schemes, such as those provided by our youth support coordinators and other organisations, can play a key role in supporting a patient’s well-being during treatment and aiding their recovery afterwards.’

Following a regular online exercise programme can have benefits for people living with cancer
Picture: iStock

One of the schemes promoted by the trust is the RENEW programme run by the charity trekstock. Before the pandemic hit, this eight-week group exercise programme for people aged 20-39 in treatment or recovery was offered in two YMCA centres in London, with plans to roll it out across the country. Now it is being delivered online to up to six people at a time, grouped according to activity levels, stage of treatment and location.

Trekstock health programmes and engagement lead Jemima Reynolds explains that applicants are triaged by cancer exercise specialists who decide whether it is safe for them to exercise online in a group.

‘Once people complete a programme they often feel on top of the world, but it can be hard to keep that momentum’

Jemima Reynolds, Trekstock health programmes and engagement lead

Anyone in treatment or who has just finished treatment must have a referral from their healthcare team. Those with more complex needs may be offered one-to-one sessions, although the aim is to provide group sessions to all to help reduce isolation.

Jemima Reynolds, Trekstock health programmes and engagement lead
Jemima Reynolds

Drop-in sessions help people keep their fitness up and the momentum going

Numbers and completion rates have increased during lockdown, with 67 people completing the programme since June. The charity has started running fortnightly top-up exercise sessions for groups of up to 12 former participants, which have proved extremely popular.

Ms Reynolds says: ‘Once people complete a programme they often feel on top of the world, but it can be hard to keep that momentum so we set up drop-in sessions to help people keep their fitness up.’

Trekstock also offers fortnightly online pilates sessions and is currently developing a low-level exercise programme specifically for people who have just been diagnosed. The plan is to continue with some online delivery when things get back to normal, Ms Reynolds says.

‘We’re definitely going to continue to offer an online option because we believe exercise is so important for all young people with cancer and want to ensure everyone has that opportunity.’


Find out more

Want to read more?

Subscribe for unlimited access

Enjoy 1 month's access for £1 and get:

  • Full access to cancernursingpractice.com
  • Bi-monthly digital edition
  • RCNi Portfolio and interactive CPD quizzes
  • RCNi Learning with 200+ evidence-based modules
  • 10 articles a month from any other RCNi journal

This article is not available as part of an institutional subscription. Why is this?

Jobs