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The Exercise Guide: Table of Contents
Congratulations!Page 01
Ready to ExercisePage 02
Start SlowlyPage 03
Make It EnjoyablePage 04
Be CarefulPage 05
Stay ComfortablePage 06
Journal Your GoalsPage 07
Ready to BeginPage 08
Build Up MusclePage 09
When Have You Done Enough?Page 10
Sticking With Your RegimenPage 11
References & CreditsPage 12
Sample Exercise Goal Sheet
Blank Exercise Goal Sheet
Download Entire Exercise Guide

Copyright © 2009 HCA Cancer Care, All Rights Reserved.
All content, including the artwork, is the property of HCA Cancer Care, an affiliate of HCA. The Healthcare Company. Permission to copy any portions of this work should be obtained from HCA Cancer Care.

All references to “HCA,” “HCA Cancer Care” or the “Company” in this document refer to HCA The Healthcare Company, and/or its affiliates, as applicable.


You must be feeling better if you are thinking about exercise! If you are reading this booklet, you may see yourself in one of the following ways:

  • Your get up and go, just got up and went! You’re tired and you hope that by initiating an exercise program you might have more strength and stamina.
  • You used to be in fairly good shape, but since you became ill, you’ve lost a lot of your athletic prowess and fitness.
  • You’ve never been very athletic but recently your physician told you that you should begin an exercise program. You really don’t know where to begin.

Motivated from without or from within, it is to your credit that you want to improve your level of fitness! Regardless of your reason for beginning such a fitness program, exercise can have a number of benefits. These benefits begin almost immediately. Celebrate the fact that you are well enough to even think about getting in better shape!

Begin by personalizing your own definition of exercise. Everyone approaches exercise with different expectations and anticipations. It might be helpful to expand your definition of exercise to include the activities you enjoy. Depending on your level of fitness, exercise can be any form of movement. It is not hard to find an activity that qualifies! It could mean going for a walk, dancing in your living room, going to the gym, scattering crumbs for the birds, flying a kite, shooting baskets, riding a bike, skipping around the yard, taking a yoga class, or water walking at the beach or in a pool.

Most of us know the benefits of exercise. We just have problems getting motivated to start. It is difficult to decide how to exercise, the amount of activity that is just right, and the time of day that works best. These questions can only be answered by you. Your program must fit your lifestyle and personal expectations.

A brief word of caution: People who have been seriously ill should talk with their physician before beginning an exercise program. Sometimes a stress test will be recommended. A formal evaluation by a rehabilitation and exercise specialist might also be warranted.

Reasons to exercise abound!

An understanding of the benefits of exercise is helpful. Strong muscles protect bone by acting as shock absorbers, and reduce the risk of fracture. Achieving better balance can prevent falls. Exercise reduces blood pressure and improves the strength of the heart, leading to lower risk of heart disease. Good circulation reduces the risk of blood clots. A fit person has greater cardiovascular endurance and muscular strength.

Many people applaud exercise as a means of increasing their strength, making them feel happier, and instilling hope. People who are fit often have a more positive outlook on life, experience less fatigue, sleep better, and face problems in a more relaxed manner.

Exercise encourages the flow of lymphatic fluids and improves immune defenses. Exercise produces adrenaline, which acts as a natural decongestant that can help clear sinuses and bronchial airways. Exercise improves body composition - making it more muscular, and assists in weight management.

Scientists continue to research the connection between exercise, health, and disease risk. Exercise has been shown to reduce the risk of diabetes and certain types of cancer. Several studies have shown that those who exercise have other good health habits. They tend to drink less alcohol, eat healthier diets, smoke less if at all, take more vitamin supplements, and take better overall care of their health.

Start Slowly

If you have been very ill or have not been exercising on a regular basis, walking for five minutes, turning around and walking back might be a realistic goal. Then try to do it twice a day. Start exercising slowly and build up gradually. Don’t be surprised if you have some good days and some bad days. In fact, most athletes alternate “hard” days with “easy” days in their training plans.

If you are able to build up endurance without problems, increase the time you exercise by no more than 10% each week. In other words, if you walk for fifteen minutes three times a week – a total of 45 minutes – don’t walk more than a total of 50 minutes next week. Remember that there is a fine balance between too much and not enough exercise. As your level of confidence and fitness improves, doing an aerobic activity every day should become feasible.

Women who exercise beyond the American College of Sports Medicine (ACSM) guidelines do not rank higher on measures of cardiovascular fitness or fat loss than women who follow their guidelines. More is not necessarily better.

While it is important to exercise regularly, don’t feel you can’t take a day or two off. Your body needs time to adjust to the physiological changes occurring in your body. Muscle takes time to repair and rebuild. Rest also aids in the removal of metabolic waste products, such as lactic acid, the chemical responsible for muscle soreness and fatigue. You need rest to perform your best. For more information on fatigue or pain, click on the Fatigue or Pain icons at the beginning of this document.

If you work too hard and get your heart rate up too high, you will fatigue rapidly and be unable to keep up your activity. If you have access to a heart rate monitor, it can be a great tool to help you achieve your fitness goals. On days when you are tired or stressed, you may notice that your resting heart rate is higher than usual. This normal response is your body’s signal to proceed more slowly.

Make it an enjoyable routine!

Have fun!Finding a partner with whom to exercise can make the experience even better. This partner can even be the family pet. People who exercise together build friendships and develop an appreciation for the uniqueness of others. Support from your family and friends help make the experience more enjoyable.

Choose your activity. What form of exercise do you enjoy? What would personally interest you? Start with the expectation that you want to enjoy and complete the activity. Some like consistency in their routine; others like to vary the types of exercise they do and where they do it. After the activity, ask yourself how much fun you had. On a scale of one to ten, how would you rank the activity?

0 5 10

Miserable Okay Absolutely Fabulous

Beginning an exercise program involves taking a reasonable risk. It involves change. Change may be positive, but it can also cause anxiety. Give yourself enough time and practice to adapt. Your body will take note of the demands of a new activity, including energy expenditure, speed, timing, and direction of the movements. With proper instruction and practice, your body will eventually develop a blueprint of skills needed for the activity.

Be Careful

Don’t begin your exercise program alone or in isolated areas. If you exercise outside your home, never walk the same course each time. Vary your route. Always carry identification and money for a taxi. Ideally, carry a cell phone. Have a back-up plan for getting home if you become tired. Phone a friend for a ride home or take a taxi.

More information on home safety precautions.

Stay Comfortable and Cool

Carry a water bottle. Adequate hydration is very important. Do not wait until you are thirsty to drink. By the time you actually feel thirsty, you have waited too long, and may be on your way to becoming dehydrated. Always drink more than thirst demands. Symptoms of dehydration include feelings of listlessness, general fatigue, muscle fatigue, heat intolerance, light-headedness, headache, and low volumes of dark yellow urine.

Dress for success! Athletic footwear can make a huge difference in comfort and enjoyment. In cold weather, it is wise to layer your clothing. Wear fabrics that wick the sweat away from your skin and help keep you dry. If you are walking in the early morning or evening, wear clothing that makes you visible in traffic. Try to breathe through your nose to warm and moisturize incoming air. On cold days you might want to wear a scarf or surgical mask. Always wear a helmet when bicycling.

Eating well is especially important. It’s wise to time meals to provide optimal energy for exercise. Increase the amount of fruits, vegetables, and whole grains that you eat. Eat fresh or frozen foods rather than canned or packaged ones. Salt-cured, salt-pickled, and smoked foods should be eaten only in moderation. Increase fiber. Read labels carefully for fat, sugar, and sodium content. Eat less red meat and more fish and skinless poultry. Alcohol should be consumed only in moderation, if at all. Eat breakfast every day. Additional advice is available from a registered dietitian.

Years ago people were hesitant to tell their physicians if they were taking vitamins or supplements. Today, most doctors want to know which supplements their patients are taking. Consult your healthcare provider before taking a supplement, as there could be side effects with the medications you are taking.

Journal Your Goals and Set Daily Plans

What do you want to accomplish by starting an exercise program? Whatever your goal, it must be individualized to what you hope to accomplish, not what others wish for you or for themselves. Your exercise goals may be accomplished in a short period of time; others might require a longer commitment. Some long-term goals may be an extension of a shorter goal.

If you have never exercised or if you have low energy or endurance because you've been ill, your fitness goals may be different from someone who is more physically active. You also may share the common goals of improving your sense of well-being, changing your sleep patterns and appetite, decreasing discomfort from joint stiffness and muscle tension, and increasing your strength, endurance, and flexibility. A worksheet to help you identify your goals is provided. Just click on the icon below for Exercise Goals and Plans.

Daily plans are different from your goals, as they may change, based on how you feel at the moment. Write your daily plan in pencil with an eraser. Don't feel depressed if you can't complete a daily activity. If you feel ill the day you plan to exercise, modify your plan for the day. Still exercise, but on a lesser level. If your daily plans are obtainable, the possibility of reaching them is more realistic.

When you finish exercising, write down your accomplishments in the log provided. Click on the Goals and Logs button. Print or photocopy additional copies, as you continue to exercise. Other styles of logs are available at many bookstores. You might want to develop your own form, even using an excel spreadsheet. You could expand it to include all sorts of columns. What was the easiest part of the workout? How does today compare with previous days? If it is harder today, think about why. Was your diet a contributor? Did you recently have a medical procedure that threw you for a loop? Did something happen to make you sad? Log these comments. What did you enjoy most? Did you exercise with a friend, was the weather especially nice, or did you just generally feel well. You might also want to journal your thoughts and observations.

If your personal plan of exercise doesn't work, keep revising it until it does. You might need to change the type of activity, the time, or the intensity until you find a plan that works for you. And remember, there are resources and people to help keep you motivated as you achieve your goals.

You are now ready to begin your workout

Always start with a warm-up, which allows the heart rate to change incrementally and the muscles to adapt. This might be as simple as walking in place or moving your arms up and down. This simple activity prepares your body for exercise by increasing blood flow to the working muscles and connective tissue. The duration of the warm-up will depend on the intensity of your workout as well as your own fitness level.

After the aerobic warm-up activity, incorporate flexibility or stretching exercises. Stretching muscles after warming them up with low-intensity aerobic activity will produce a better stretch since the rise in muscle temperature and circulation increases muscle elasticity, making them more pliable. Stretching increases flexibility and may prevent muscle strain. Never bounce or force a stretch. Hold for about 15-20 seconds - to mild discomfort, not pain, to enhance flexibility. Stretching should be relaxing, not painful. Stretching, yoga, tai chi, Quigong, and Pilate's exercises can improve balance and flexibility.

One aim of exercise is to increase your body's capacity to utilize oxygen, and to increase the capability of your heart and circulatory system to supply blood and oxygen to all organs and tissues. Monitor your heart rate by checking your pulse or using a heart rate monitor. This is a good way to tell if you are staying at appropriate exercise intensity levels. Click for Heart Rate Training information.

Build Up Those Muscles!

Resistance training improves muscle strength. It is important to complement cardiovascular training with stretching and resistance training. Strength training uses either the body’s own weight or the resistance provided by weights or bands, to apply stress to the bones by way of the muscles. Muscle strengthening increases your muscle mass, which boosts your body’s resting metabolic rate and helps you burn calories more efficiently and keep your blood sugar in check. Weight training can increase strength and muscle and bone mass more rapidly than walking can.

Before initiating a weight program, become familiar with the equipment. Attend a training session or get help from an instructor or weight trainer. Warm-up your arms and legs before you lift weights. Only you can determine how much weight you can lift. Start with 2 or 3 sets of 8 slow repetitions, and gradually add more repetitions as your strength increases. Do not advance beyond four sets and/or 20 repetitions. Rest between sets, and try to breathe naturally during the exercise. Lift and lower slowly and smoothly. Exhale as you lift; inhale as you lower the weight. Stop if you feel any pain. Sore joints mean you have overdone it. Stretch after your workout to increase flexibility.

Water or pool exercises may restore mobility, build strength, and increase endurance. The buoyancy of water reduces the stress on weight bearing joints, bones, and muscles. For this reason, it is unlikely that a water workout will result in an injury or leave you with sore muscles. Water exercise can encompass all of the components of fitness: cardiovascular fitness, muscular strength and endurance, and flexibility. Many classes are suitable for non-swimmers and are offered at indoor and outdoor sites.

When Have You Done Enough?

You should feel energized, not exhausted, if you have exercised at the proper intensity. Some muscle soreness is natural with a new activity. If you experience soreness that persists longer than 72 hours, listen to your body.

Identify what hurts. Is there pain or swelling in your joints? Did you exercise too much? Does your form need to be corrected? Are you wearing the proper clothing and footwear? Perhaps the activity needs to be modified to suit your needs.

Warning Signals. Our body can warn us when we've exercised too much. Ask yourself the following questions to determine if you've exercised too little, too much, or just right.

  • Do you feel energized and a little hungry after your workout?
  • Are you sweating?
  • Was your heart rate and breathing noticeably faster than usual?
  • Can you feel your mood lift?
  • Did you want to keep on going because you are not bored or stressed?
    Just the right amount! - if you answered “yes” to any questions above.

  • Were you are unable to recover from your workout throughout the day, either because you are tired or sore?
  • Did you experience persistent aches and pains?
  • Did your pulse stay above 100 beats per minute five to ten minutes after you completed your exercise routine?
  • Did you lack interest in exercising on the following day because of pain from the previous day?
    Too Much Exercise! - if you answered “yes” to any questions above.

Be careful the next time you work out. Make sure your routine isn’t too rigorous. For More Information on Pain

Sticking With Your Regimen

If your exercise regimen is sporadic, don’t be down on yourself! Staying with an exercise routine is more difficult than initiating an exercise program. People discontinue exercising for numerous reasons. Some don’t notice significant benefits from the program. Others experience an injury. Activities other than exercising may take priority. The exercise program might not have been enjoyable. It might have been too challenging or too easy. Somehow it didn’t fit into the person’s lifestyle or provide sufficient rewards. Try to figure out what you need to do to make it work. Make the changes so that the program enhances your life.

If you are continuing with the program, congratulations! Applaud yourself and pat yourself on the back for a job well done!

The Exercise Guide - Credits

Connie J. Carson, Ph.D., Healthcare Consultant; avid skier and triathlete; Principal, Carson Consulting, Denver, Colorado

Fran Mason, M.D., medical oncologist; competitive distance runner and triathlete; Medical Director, Cancer Exercise Programs for Healthlinks Clinic at University of Colorado, Boulder, Colorado

Pat Stanfill Edens, RN, MS, MBA, FACHE, Assistant Vice President, HCA Hospital Corporation of America, Nashville, Tennessee

Susan Lasker-Hertz, RN, MSN, AOCN, Denver, Colorado

Fran Mason, et al.  A Physician’s Guide to Heart Rate Training

Jeff Berman, Fran Mason, M.D., and John Hanc,  The Force Program: The Proven Way to Fight Cancer Through Physical Activity and Exercise, Ballantine Books, New York, October 2001, paperback, 2003.
It is recommended by notable wellness practitioners such as Andrew Weil, MD and by the New York Times.

Exercise can be done in numerous locations, including one’s home. It is always wise to practice home safety. A fall or a twisted muscle can seriously jeopardize your exercise routine. Consider the following suggestions to reduce your risk of falling and to make your home safer.

  • Rugs are often called “throw rugs.” They should be thrown away, as they could easily contribute to a fall. Keep walking areas free from objects that could trip you.
  • Have adequate lighting, with light switches within easy reach.
  • Keep electrical cords out of the way of walking traffic.
  • Try to avoid walking in stocking feet, loose slippers, or bare feet. Keep your shoes tied securely so you don’t trip on your shoe laces. Consider using Velcro on your tennis shoes, instead of laces.
  • Use rubber strips and hand rails in your bathtub and shower.
  • Be cautious on walkways that are wet or have uneven ground.

A heart rate monitor can be a valuable tool for assisting you in your training. By performing an exercise session within an appropriate training “zone” you assure yourself that you are getting an effective workout.

Heart rate monitors come with a number of excellent features. Some are even built into the exercise machines at the gym. Usually there is a strap which is worn around the chest and which senses the heart rate. A receiver (worn like a watch) tells you the heart rate. Many monitors can be programmed with an alarm that sounds if you exceed or fall below the desirable heart rate zone. The monitors store information so that at the end of the workout you can see your average heart rate for each segment.

Many monitors also have a feature which tells you how many calories you expended during the workout. This feature can be an important tool for weight management, too.

To figure out what your heart rate should be while exercising, one needs to know his maximum heart rate. This is easy to figure out if you actually have a stress test and run to your maximal capacity. But a simpler way to get an accurate estimate of maximal heart rate is to subtract your age from 220. The maximal heart rate gets lower as we age.

A sixty year old person is expected to have a maximum heart rate of 160.

A thirty year old is expected to have a maximum heart rate of 190.

An effective aerobic workout is done when one’s heart rate is over 60% of the maximal rate. Ideally one should keep the heart rate 60-75% for long bouts of endurance work. When it is over this range, it is time to slow down.

Using the heart rate monitor allows you to keep your heart rate from getting too high; this will prevent excess fatigue, overtraining, and pain. It also keeps the exercise fun!

Many people who have been seriously ill are frightened. They choose not to talk about their pain for fear there might be something seriously wrong.

Increased mobility can sometimes reduce pain. Physical therapists and exercise physiologists can provide exercise programs to restore strength, increase range of motion, and improve endurance. Other physical exercises, such as walking programs and programs provided in fitness centers, have also been shown to be beneficial. Weights, upper and lower extremity fitness equipment, pool therapy, myofacial release, therapeutic touch, ultrasound, treadmills, exercise bikes and universal gyms – all could be appropriate, as long as the program is individualized for you. Talk to your doctor about the possibility of a physical therapy consult.

Log your level of pain according to a ten-point scale. Does exercise help relieve or worsen that pain? You may want to share these numbers with your healthcare provider.

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