Thank you to everyone who came to our Q&A with Karen Robb last week on the benefits of physical activity in cancer recovery. For those of you who couldn't make it, the transcript is below.

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Q: Have you found that many people that have had cancer treatment have been willing to take part in more physical activity as a way to help get better, or are some reluctant, or unconvinced about the benefits?

A: There is a real mixture. Those who are used to exercising are usually very keen to get back. Others who have not exercised before often take a bit of persuading with a round up of the benefits. As a physio I take advantage of what we call 'the teachable moment'.

Q: I am not even sure how much exercise is allowed after treatment? A: During treatment the recommendation is to stick to moderate intensity exercise i.e. not too hard and listen to your body. As long as you are medically ok and not experiencing significant side effects we try to encourage regular exercise, maybe on 4-5 days out of 7.

Q: As a bowel cancer patient, I'd like to know what 'significant' amounts of physical exercise means.

A: I can understand why you want more information on 'significant' - in this context it relates to following the recommended guidance on exercise which is participating in moderate intensity (brisk walking is a classic example) on at least 4-5 days out of 7. It’s important to include strengthening exercises and flexibility work too as needed.

Q: How about the port that I have in my arm does this limit my work outs?

A: I would always seek advice from your medical team with regards to what you can and cannot do; ask to see your clinical nurse specialist or physio for specific advice.

Q: I am often tired. I take walks with my wife most days and then I am exhausted but after a break I am fine again. Does this mean I am doing too much or does this sound ok?

A: This sounds fine, but you should double check with your Dr. We’ve got some information about how you can cope with some of the causes and effects of fatigue which might help here.

Q: Hi Karen I've seen some of this research before but what I'm struggling with is the meaning of "moderate intensity" exercise. Please can you advise? I completed my treatment for breast cancer a year ago. I'm mobile and getting some exercise but not sure if intense enough?

A: Intensity of exercise is very important. If people are unsure then heart rate monitors are a great tool to use. Ratings of perceived exertion scales work from 0 to 10. 0 being nothing and 10 being high intensity. Giving your exercise a level will help to see improvement. We have some more info and examples of exercise and their intensity here. When treatment is over it is perfectly acceptable to work towards higher intensity levels of exercise

Q: Will the doctors know when I should start doing exercise or does it depend on what cancer you have?

A: The doctors should know but if you are not getting the info you require then please ask to see a physio.

Q: Do you have any experience with yoga?

A: Yoga, I am a big fan of disciplines like yoga and pilates. I have not done any research on them and would be interested to see any papers if there are any. I can see benefits such as core strengthening, flexibility, relaxation etc.The relaxation and meditation side of yoga also help. I think there is a lot of support here and out there for yoga and I fully support it as an adjunct to cancer recovery

Q: What about zumba? Would that be too much at first?

A: I have no experience but my guess is that it’s quite intensive so probably not ideal as your very first intro to exercise.

Q: I've seen the Borg scale of perceived exertion - where on the scale does "moderate intensity" lie? is it "somewhat hard"? "Hard"? For example, does a brisk walk count as "moderate" or does it need to be a jog? Does swimming count as moderate?

A: moderate intensity is somewhat hard, so brisk walking is classified as moderate intensity in the literature.

Q: I am a personal trainer studying for the Cancer Trainer Exercise certification. Could you recommend informative up to date books that outline guidelines for exercise and cancer patients/survivors?

A: The ACSM has recently published a lengthy article on recommendations for exercise in cancer and I can get that info to Macmillan ; its an academic article so quite meaty but very interesting There is a good book I used for my specialist cancer exercise trainer course in Colorado a few years ago - its by Carole Schneider, 'Exercise and cancer recovery' http://www.bases.org.uk/write/Documents/SES_EXPERT_2.pdf

Q: It worries me about this "intensity" issue - I am recovering from lung surgery with the top of my left lung removed. I’m just coming to the end of my chemo and looking forward to starting exercising to get back a better level of fitness - however, I have a heart condition and emphysema so am already aware I cannot do anything beyond "gentle" exercising without gasping for breath, and yoga etc is a problem due to osteo-arthritis. What would you recommend - I intend to resume gentle gym sessions and swimming - as well as a slow gentle walk in the park with the dog.

A: Your history is quite complex and I really recommend you seek consultation with a physio to ensure you get a programme which is safe and individualised for you.

Q: I’m not sure if this has already been discussed but are the benefits of exercise stronger during treatment or following treatment

A: That’s very interesting and difficult to answer fully. The bulk of the literature looks at exercise post treatment so I think we really need more during treatment studies, but the key message is there are important benefits both during and after.

Q: What do you think the most important thing for a personal trainer to know when training a cancer patient?

A: I think a really good understanding of cancer and its effects on an individual; only when you have fully grasped this can you comprehensively plan a treatment programme so I recommend swotting up on cancer and its treatment - I know there are some courses soon to be starting to train up personal trainers in this.

Q: What are your top recommendations for people getting back into exercise following cancer treatment?

A: Keep it simple but vary as required to avoid boredom

Know what motivates you and use this to your benefit,

Get family/friends involved,

Don’t get frustrated with the bad days and stay positive,

ENJOY!!

Q:Finally, I'd also like to know what your tips for staying motivated are, and the best way to cope with fatigue?

A: I think using some of my tips can help; give yourself small, achievable goals and a big goal to work towards; family and friends can be a great support so use them and really try to find something you enjoy. Don’t forget to utilise your healthcare team; physios, specialist nurses can all help you plan a programme that suits you.