Strong and Stable: Exercises for Core, Strength and Balance

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Strong and Stable: Exercises for Core, Strength and Balance Exercise and physical activity before, during and after cancer treatment are important

Studies show that cancer survivors who exercise regularly feel better, have less fatigue and experience fewer treatment side effects than those who

1 Strong and Stable: Exercises for Core, Strength and Balance Exercise and physical activity before, during and after cancer treatment are important to recovery and general quality of life. Studies show that cancer survivors who exercise regularly feel better, have less fatigue and experience fewer treatment side effects than those who do not exercise regularly. This booklet offers a series of strength-building and balance exercises using a stability ball. Talk to your doctor before beginning any exercise program. Consult an exercise specialist kucancercenter.org/exercise

2 Getting Started There are some basic essentials to keep in mind when beginning an exercise program at any stage of diagnosis. Experts recommend for all cancer survivors to: Engage in regular physical exercise Avoid inactivity and return to normal daily activities as soon as possible after diagnosis Exercise 150 minutes per week (22 minutes per day) Include strength-training exercises 2-3 days per week Move at your own pace and pay attention to how you feel before, during and after exercising. Also, be sure to keep in contact with your doctor as you begin a new exercise regimen. There are three components of an exercise program that each contribute to improving your overall conditioning and general well-being and reducing fatigue. 1. Aerobic exercise is the most common type of exercise, as it requires little skill, equipment or cost. It is the best form of exercise to build general endurance and well-being and improve your heart and lung health. These include tasks such as walking, stationary biking and activities of daily living such as bathing, dressing and light housekeeping. Overall, aerobic exercise will help you feel better but does little to improve cancer-related fatigue. Tips: Walk a route indoors or outdoors at least once per day, resting as needed. Walk on a regular schedule and increase the time and distance as your energy improves. As you walk, be mindful of your posture and core basics. Slow your walks if necessary to keep your core engaged and posture tall. Walk near a wall if you need assistance with balance.

3 2. Core and balance training are simple, beneficial and can be performed any time and any place. Several muscle groups work together to make up your core and support your spine, pelvis, lower back and abdominal muscles. These muscles work in every single action your body performs: turning over in bed, standing, sitting down, putting on your shoes and sitting up to read a book. Strengthening the core and balance muscles helps your body sit upright and move with proper posture, which reduces fatigue. Sitting up straight allows your body to breathe deeply, completely filling the lungs, which allows oxygen to move more efficiently throughout your body. Try one of these core and posture exercises for 3-5 minutes daily: Sit up straight in a chair by pulling your shoulder blades back, chest up and tightening your abdominal muscles. Stand against a wall. Press your shoulder blades into the wall. When you feel comfortable, step away from the wall keeping the same body position. Complete posture walks for a short distance. Engage your core and walk as far as you can while keeping muscles tight. Work to increase this distance over time. Core Muscles ERECTOR SPINAE ABDOMINALS OBLIQUES HIP FLEXORS HIP ADDUCTORS LUMBAR REGION GLUTEUS MEDIUS GLUTEUS MAXIMUS 1

4 It s important to work on your balance in a controlled environment to help provide support when you most need it. Many small muscles of the feet, legs and core make up your balance muscles. These muscles will help you in basic body movements such as standing and walking, along with times when you need to turn your body or go up stairs or a curb. Having better balance is also key to reducing your risk of falls. Balance can also be affected by neuropathy, which may be a short- or long-term side effect from some chemotherapy medications. While balance training will not reduce neuropathy, it will improve your general function and ability to complete many tasks. Many of the exercises are shown on a chair or ball. Make sure you can complete the exercise on the chair first, then move to the ball. Begin with the ball in a corner where it is stable on two sides and eventually move it to an open area. Core and balance exercises can be completed daily, and you are encouraged to do them as often as possible. 3. Strengthening exercises help you build or retain muscle and are especially important to improve energy and reduce fatigue. Less activity contributes to a loss of muscle strength and may make you feel that you tire easily, making simple tasks more difficult. Examples include standing up from your chair and using resistance bands or light weights for upper and lower body muscles while climbing stairs and carrying objects. There are two kinds of strength exercise: functional and targeted strengthening. To gain muscle it is ideal to complete strength exercises every other day (with a day of rest to allow the muscles to recover and repair). If you would like to strength train every other day, complete all exercises in the booklet or provided to you from your cancer exercise specialist three times per week, such as Monday/Wednesday/Friday. If you would prefer a shorter daily workout, we suggest the following: Monday/Wednesday/Friday Upper body Tuesday/Thursday/Saturday Lower body and core exercises 2

Exercises Chair Sit Stand 4-6 inches in front of a chair. Stand up tall, shoulders back, and engage your core muscles.

Inhale and sit back into the chair, allowing all of your weight to rest at the edge. Exhale as you press up through your heels to stand.

If you don t sit back far enough, your knees will be over your toes, causing stress on your knees.

5 Exercises Chair Sit Stand 4-6 inches in front of a chair. Stand up tall, shoulders back, and engage your core muscles. Place your hands on the tops of your thighs. If that's too easy, fold them across your chest. Inhale and sit back into the chair, allowing all of your weight to rest at the edge. Exhale as you press up through your heels to stand. Keep your chest out and shoulders back by looking in front of you. If you don t sit back far enough, your knees will be over your toes, causing stress on your knees. Advanced: One Leg Option You should feel the work in your thighs and buttocks. If you feel pulling in the knees, don t sit down as far and push up through your heels. NUTRITION TIP Adequate protein intake is essential to build and preserve muscle mass. Choose fish, chicken and turkey more often than red meat, and try meatless meals using beans, lentils and quinoa in place of meat. 3

Straight Leg Raise Sit on the edge of your ball (or chair). Extend one leg fully in front of you.

Keep the leg almost straight, lift it as high as possible and keep your upper body still.

Keep your shoulders back focusing on good posture. Abdominals should remain engaged throughout the lift.

If you feel pulling in your knees don t sit down as far and push up through your heels.

6 Straight Leg Raise Sit on the edge of your ball (or chair). Extend one leg fully in front of you. Sit up tall, shoulders back, and engage your core muscles. Keep the leg almost straight, lift it as high as possible and keep your upper body still. Imagine you are lifting from the top of the thigh. Lower the leg and keep your foot off the floor. Keep your shoulders back focusing on good posture. Abdominals should remain engaged throughout the lift. You should feel the pull in your thighs and buttocks. If you feel pulling in your knees don t sit down as far and push up through your heels. Dipping Bird/Hamstring Stretch Stand on one leg by a chair holding a weight (optional). Stand up tall, shoulders back, and engage your core muscles. Slowly lean forward as far as you feel comfortable. Keep your shoulders back and look forward. Abdominal muscles should be tightened. You should feel the pull in the back of the thigh of the leg that s on the floor. 4

Over and Back Balance Face a chair or small stool. (Please note: The photos to the right use higher objects to clearly show action. Chose something lower to start with.

7 Over and Back Balance Face a chair or small stool. (Please note: The photos to the right use higher objects to clearly show action. Chose something lower to start with.) Stand up tall, shoulders back, and engage your core muscles. Balance on one leg, lift the opposite side up and over the chair or stool. Tap the top or move directly over. Use another chair or other stable surface for balance. You should feel the pull in both legs and possibly your abdominal muscles and back. NUTRITION TIP Fruits, vegetables and other plant foods provide good sources of phytochemicals, nutrients that help defend the body against cancer and other diseases. 5

Focus on tightening your abdominals, buttocks and thighs. Hold the position for as long as you can but do not hold your breath.

8 Plank Place your ball or chair against a wall, shoulders directly above elbows and feet shoulder-width apart. Lift your body off of your arms so it is in a straight position, like a board. Keep your hips in line with shoulders and feet. Focus on tightening your abdominals, buttocks and thighs. Hold the position for as long as you can but do not hold your breath. You can also do this on your knees for a less challenging exercise. You should feel the work in your abdominal muscles, shoulders, front of the thighs and buttocks. 6

Abdominal Crunch Roll down so that the ball is fitted into the lower back.

Slowly lift your shoulder blades off the ball as you stabilize your lower body.

Complete this exercise on the floor with your feet elevated (more back support) or lying on the floor.

9 Abdominal Crunch Roll down so that the ball is fitted into the lower back. Place your arms behind your head or across your chest (shown). Slowly lift your shoulder blades off the ball as you stabilize your lower body. The higher the ball is into your back (toward the shoulder blades) the easier the exercise. Complete this exercise on the floor with your feet elevated (more back support) or lying on the floor. You should feel the pull in your abdominal muscles and the top of the thighs. If you feel pulling in your lower back, roll down to a more comfortable position. NUTRITION TIP Achieving and maintaining a healthy body weight helps protect against chronic inflammation, insulin resistance, and keeps hormone levels in balance, which discourages cancer growth and progression. 7

Seated Crunch Start seated at the edge of your chair or on a stability ball.

Place one hand behind the base of your head taking care to not pull on your

Inhale and begin to crunch your torso by bringing your shoulder to the

To progress, lift the leg of the side you are crunching towards and then

10 Seated Crunch Start seated at the edge of your chair or on a stability ball. Sit up tall, shoulders back, and engage your core muscles. Place one hand behind the base of your head taking care to not pull on your neck at any time throughout the exercise. Inhale and begin to crunch your torso by bringing your shoulder to the opposite knee. Pause and return to starting position. To progress, lift the leg of the side you are crunching towards and then try this exercise on your stability ball. You should feel this in your abdominals and core muscles. It s also very common to feel this in your legs. 8

Standing Balance Hold Start by standing behind a chair or other stable object. Stand tall, shoulders back, and engage your core muscles. Shift your weight to one leg without moving your upper body.

11 Standing Balance Hold Start by standing behind a chair or other stable object. Stand tall, shoulders back, and engage your core muscles. Shift your weight to one leg without moving your upper body. Lift your knee as high as you can without losing the tightness in your core. Pause and slowly return to your starting position. You should feel the small muscles of your leg and feet engage and contract. You may also feel this in your core muscles as you are starting out. NUTRITION TIP The combination of a healthy diet and physical activity strengthens the body s immune system, lessens fatigue and helps prevent weight gain. 9

Back Extension Start by lying on the floor, bed or across your stability ball.

For beginners, lift each arm one at a time followed by each leg one at a time.

Pause at the top of each motion and lower in a controlled manner to your

As you get stronger you can lift your arms and legs at the same time like you

12 Back Extension Start by lying on the floor, bed or across your stability ball. Begin with neutral posture in your spine and your eyes focused down. For beginners, lift each arm one at a time followed by each leg one at a time. Then progress to lift one arm and the opposing leg together. Pause at the top of each motion and lower in a controlled manner to your starting position. As you get stronger you can lift your arms and legs at the same time like you are flying. You will feel this primarily in the lower back but it is normal to also feel this in the buttocks and back of shoulders as these muscles get stronger. 10

Face Down I-Y-T Start by lying on the floor, bed (easiest) or across your stability ball (for intermediate to

Start by lifting both arms up directly by your ears keeping them as straight as possible.

Lift arms in a Y position with your thumbs facing up and arms straight, pause and lower to starting position.

starting position. You will feel this in the backs of your shoulders and upper back.

13 Face Down I-Y-T Start by lying on the floor, bed (easiest) or across your stability ball (for intermediate to advanced). Begin with neutral posture in your spine and your eyes focused down. Start by lifting both arms up directly by your ears keeping them as straight as possible. Pause and return to starting position. Lift arms in a Y position with your thumbs facing up and arms straight, pause and lower to starting position. Then lift your arms straight out to the sides (this will be the most advanced position) and slowly return to starting position. You will feel this in the backs of your shoulders and upper back. It is normal to feel this in the lower back as those muscles are stabilizing throughout the exercise. NUTRITION TIP Evidence suggests eating a diet rich in a variety of vegetables, fruits, whole grains and beans, low in red meat and very little processed meat can fight cancer at several stages. 11

Lean your chest forward until you feel a moderate stretch. Hold for 10 counts.

14 Door Stretch Stand in a door frame with your arms at 90 degrees. Stand up tall, shoulders back, and engage your core muscles. Lean your chest forward until you feel a moderate stretch. Hold for 10 counts. Lift your arms higher if comfortable. If your door frame is wide, do one side at a time. You should feel the pull in the front of your arms. 12

15 About our program At The University of Kansas Cancer Center, we understand that cancer affects every aspect of your life. Our cancer exercise and wellness program is part of our comprehensive support services. Our support services team comprises a diverse group of specialists whose goal is to support the whole patient and their caregivers, not just the cancer. Support services are available upon request or may be recommended by your cancer treatment team to anyone currently or formerly being treated for cancer. TURNING POINT: The Center for Hope and Healing Turning Point is a program of The University of Kansas Hospital. Turning Point offers a variety of cancer-related wellness programs and classes throughout the community. Learn more at or

16 Learn more about the benefits of exercise for cancer patients. Visit kucancercenter.org/exercise BO

15 Minute Desk Workout

15 Minute Desk Workout Wall Squats Lean your back against a sturdy wall, with your feet planted 1-2 feet in front of you. Bend the knees to squat down and straighten them to push back up. Keep the abs