Your Guide to Exercising With (and After) Bladder Cancer

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If you (or a loved one) have gone through bladder cancer treatment recently, hitting the gym might not be top of your priority list. But it probably should be: According to the American Urological Association, patients who complete exercise programs after surgery for bladder cancer have better outcomes than those who don’t. In fact, it even pays to get in shape before treatment. British researchers reported positive outcomes for patients who engaged in intense aerobic interval training before surgery, according to a study in Supportive Care in Cancer.

But how can you exercise safely after cancer and a major surgery? We talked to an oncologist, urologist, and physical therapist to find out.


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Exercise Really is a Magic Bullet

Overall vitality is one of the four most important factors linked with good recovery and a low complication rate after bladder removal, says David Finley, M.D., a urologist at Kaiser Permanente Los Angeles Medical Center. (The others are good nutrition, a healthy immune system, and adequately controlled diabetes). And guess what’s essential to “overall vitality”? That's right: Exercise.

Small studies show that physically active patients heal faster, enjoy better physical function, and an improved quality of life after surgery. “There really are studies showing that any type of activity has a positive impact for the patient,” says Rashmi Menon, M.D., chief of oncology at Kaiser Permanente Medical Center in Woodland Hills, CA. “In patient surveys, any level of activity provided some benefit over none.” And even more data shows that exercise in survivorship reduces the risk of the cancer coming back.


You Can Exercise Throughout Treatment for Bladder Cancer

That's right, from pre-op to post-op, you can work out in some way the entire time, Dr. Menon says. Of course, a number of different challenges will define what that exercise looks like at different stages. “When I’m seeing patients in pre-op, they’re usually on chemo,” Dr. Menon says. “So I want them to do whatever they can to maintain muscle mass without pushing too much, like walking.”

Different types of surgeries will trigger different types of recoveries, she adds. But somewhere between four and six weeks post-surgery, you’ll likely be getting into daily activities. This is prime time for getting into an active routine. It’s also a great time for most patients to see a physical therapist (PT) and work on specific, bladder-related exercises. (And if your urologist doesn’t refer you to a PT, ask!)


Try (If You Can) to Increase Your Fitness Before Surgery

Bladder surgery is a six- to eight-hour operation requiring a four- to seven-day stay in the hospital. “This is like running a marathon,” says Dr. Finley. And just like training for a race, optimum conditioning is essential to maximize endurance and healing, he says.

“If you can climb the Santa Monica stairs without difficulty, you will be in good shape for surgery.” (For non-Californians, that’s 170 steep steps.) If you're nowhere near that level, then speak with your doctor setting a realistic goal. Any improvement in your fitness will help you later.

For active smokers, it also means quitting. “All active smokers are advised to quit immediately and offered counseling, classes, and medication to help,” Dr. Finley says.


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Follow the Recommended Program

On your first visit to the physical therapist, you’ll likely have an evaluation. That’s because every patient reacts to surgery differently, and without an evaluation—with a real PT, not Dr. Google—you could easily end up doing the wrong exercises, says Tia Pederson, a physical therapist at Fairview Health Services in Wyoming, MN, who's a specialist in pelvic-floor dysfunction.

For example, after bladder surgery, most people need to strengthen their bladders to improve retention. But some need to do the exact opposite: They need to learn how to relax their bladders to improve voiding.

It’s also important to remember that more isn’t necessarily better, Pederson says. “Some patients will run with a program on their own and go overboard,” she says. “And that can cause pelvic pain. And then, if they hadn’t had retention issues before, they could develop them.”


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Wait Until Your Body is Ready to Exercise

In the post-surgery period up until about six months out, most patients shouldn’t do exercise with much impact or anything that increases abdominal pressure, Pederson says.

“I wouldn’t want [you] to hold [your] breath to put the effort in,” she says. “And I don’t want [people] running. After six months, you could think about running.”

If you’re an athlete, be patient: Expect a full assessment plus pelvic-floor exercises and core strengthening before resuming your pre-surgery routine.

After your evaluation, you’ll likely be assigned one or more of the following exercises—but before doing these on your own, make sure to clear it with your doctor or PT!


Start With the Bum Squeeze

Got the OK to start exercising? “Pretend you’re at church or the library and you have to pass gas, but you don’t want to,” says Pederson. Next, mimic the action that allows you to hold it in. “Squeeze like you're trying to close your rectal opening—not your ‘cheeks’!” she says. “It should feel like a very small and subtle movement. No one should be able to see you do it.”

Most patients start with 10 of those quick squeezes, timed to their heart beat, about three or four times a day.

You can progress to holding that squeeze for a count of 3. Keep up the 10 reps, three or four times a day routine. If it’s easier, you can lie down to start and then progress to sitting, she says. Just don’t do the squeezes on the toilet, she advises.

“Don’t stop and start your urine until a doctor directs you to,” she says.


Practice Deep Breathing (Yup, It's Exercise Too)

This one might feel counterintuitive, Pederson warns. But it’s important, so be sure to ask your doctor or PT for clearance before trying diaphragm breathing.

“A lot of times bladder cancer patients think they can’t take deep breaths after surgery—but they can,” she says. If you don’t practice, though, stomach tissues may fuse together and you may not be able to breathe deeply.

Here’s how Pederson teaches diaphragm breathing: As you breathe in, make your belly as big as you can. As you breathe out, let your belly return to normal.

This technique increases diaphragm use and prevents the fusing of stomach tissues, she says. And by doing this type of breathing, you’re increasing mobility through your stomach and abdomen area.


Move On to Core Work Later

When you’re about three months out from surgery and you’ve worked up to successful “bum squeezes” of 10 seconds each, 10 times, (and, most importantly, once you have permission from your doctor or PT), Pederson would start you on transverse abdominis training. In other words, you’ll be toning your deep abs. Start on your hands and knees, moving into the “cat” and “cow” postures popular in yoga classes.

You’d also do some side-lying hip-strengthening exercises. To do “clams,” keep the top hip more forward than the bottom hip, raise the top knee toward the ceiling while keeping your feet together, and then lower.

Finally, you’d do balance exercises, starting on a solid surface and then working to wobbly surfaces. Start by simply balancing on one leg (near a counter or something to grab onto, please!) for 30 seconds at a time.


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View Exercise as a Long-term Investment in Your Health

After you’ve graduated from PT (congratulations!), your provider can help you ease into a regular exercise routine.

“I have [patients] set a goal number of days they can be active, starting slowly and increasing intensity gradually,” Dr. Menon says.

Think in terms of an exercise routine that fits into your life and that you can maintain for a long time, she advises. “Lifestyle changes work when they can be sustainable. In cancers across the spectrum, research shows you have to be consistent and regular after the completion of therapy.”

If your doctor doesn’t broach the subject of exercise following treatment, it’s worth starting the dialogue yourself, she says. “Patients who can be advocates and look into what resources they have will do better overall,” Dr. Menon notes.