When I was first diagnosed I mourned my ability to exercise, something I love very much and which has been part of my daily life for a long time. I was thrilled when my oncology team encouraged me to continue and said that it would help a lot with my treatment and side effects but I wasn’t sure how much I’d be able to handle.
I started out using my model for recovery from my 2023 bike crash, which resulted in a hip replacement and a broken elbow. With that I exercised with a focus on recovery, using exercise as a stimulus, followed by rest and nutrition, to help heal my injuries and encourage muscle growth and nerve repair.
Before the hip replacement, I’d been training for a century ride and was getting into running. I was in great shape and then suddenly I was learning how to walk again. That was a slow and steady process, and as with training for anything, I ended up enjoying it immensely. So when I was diagnosed with cancer, I decided to adopt the same model.
The 10 Minute Rule
When I first had returned home from the hospital with my new hip I was supposed to walk as much as I could. That was easier said than done, since I had to use a walker and it was tough to use with the broken elbow. So I started small. I began walking indoors, around the living room. After the first couple of days at home I was able to navigate the stairs and driveway to walk around the neighborhood. My biggest obstacle was that it felt so overwhelming, so I gave myself a 10 minute rule: if it still felt overwhelming 10 minutes after leaving home I could go back. The only goal I really had to meet was getting out the door and giving it a try.
I started with 3 walks a day, 1/3 mile each. That was more than enough since navigating stairs and some rough sidewalks with a walker was exhausting. As it got easier I moved to 2 half mile walks, then finally a continuous mile. By the time I could walk a full mile I had graduated from the walker to trekking poles (in lieu of a cane) and added another mile week over week until I was walking 5 miles a day.
When I was diagnosed with cancer I was a lot more mobile and already walking 5 miles a day, plus a lot of snow shoveling, and cycling as the weather allowed. Still, the 10 minute rule became really important as I started treatment and nervous about how my body would tolerate exercise, especially in cold weather.
Supporting my Body
Just as important as the exercise, however, were two other facets of my recovery: rest and nutrition. In training for anything these are important because exercise stimulates muscle (and other) repair in the body immediately after exercise, and eating lean protein after an effort provides the body the resources to enable that. As an endurance cyclist I learned that the gains in strength come from these recovery periods, and I hypothesized that I could leverage this natural tendency of the body to recover from my surgery as well.
I made sure that I was getting daily exercise, directly followed by sufficient protein to help my body repair itself, and that I was getting enough rest (and ice in the case of my hip). Achieving those three things every day became the foundation of my recovery. It all went extremely well and I went from struggling to move my feet in the right way while walking to a 25 mile self-supported backpacking trip three months later. I’d have never thought it was possible when I was just released from the hospital, but I made it happen step by step, through consistency and active recovery.
Applying the Plan to Chemo
I was still walking my intentional 5 miles a day when I was diagnosed with cancer almost 2 years later. Once I learned that I could continue exercising with no problem I decided to do what I could every day. Leading up to my first chemo treatment I started getting very short of breath and coughing a lot so some days I would go for a shorter walk, but I still got out for some activity every day.
On my first day of chemo I went for a short walk after my infusion. I was scared about what would happen, so I packed a lot of things like a vomit bag and a pill case with all of my anti-nausea medications just in case. I didn’t need any of them, but I did get a slight taste of the cold sensitivity associated with oxaliplatin since it was snowing a little. Mostly it felt good to be out in the fresh air and to move my legs after a long day sitting in a chair.
I quickly began to realize that exercise not only helped improve my energy levels, it helped me a lot with digestion. When I felt uncomfortable after eating nothing helped so much as getting out for a short walk. I gradually got more confident that I could do even long walks on chemo days and felt better when I did so I started incorporating in more cycling and strength training as the chemo started working and making it easier for me to breathe. My goal was to increase my aerobic activity (and joy) with cycling and to retain muscle tone through strength training, since muscle loss is common with pancreatic cancer.
Focusing on Active Recovery
The idea of rest days is important in endurance training, and that can involve taking a day off completely from activity, or engaging in light activity while eating and resting well. Normally while training athletes take a day or two a week for recovery, and the rest of the days are focused on more strenuous training. Since I have cancer, not an athletic training goal, I flipped that schedule around for myself so that most days I do light activity, usually walking 3-5 miles, and do more strenuous activity a couple of times a week, some mix of cycling (to get my heart rate up) and strength training (to preserve muscle tone).
Essential to being able to do this is being able to eat, which is a huge challenge with pancreatic cancer. I wanted to exercise to keep my body and mind healthy (apart from the cancer) but to do that I needed to eat not only enough calories to maintain my body weight but also enough to cover the activity, between several hundred to a thousand more than my regular needs. When I was first diagnosed I couldn’t eat more than 1/2-1 cup of food comfortably, so I had to eat small meals constantly throughout the day, and I added in a lot of high calorie foods wherever possible. I found that eating snacks while walking made eating slightly less uncomfortable, so I did a lot of my snacking while I was out moving. During the course of chemo my ability to eat large meals improved dramatically, so now I tend to take my daily walk either just before or just after a regular meal.