Webinar | Movement: A Tool to Optimize Your Bladder Cancer Journey

December 17, 2024

From enhanced physical function to improved sleep, the profound benefits of regular exercise and physical activity are undeniable. For bladder cancer patients, staying active during and after bladder cancer treatment can impact treatment outcomes and overall well-being. Kirstie Pomaranski, Certified Personal Trainer and Cancer Exercise Specialist, from the Inova Schar Cancer Institute, discusses practical strategies for integrating exercise/movement into daily life.

Year: 2024

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Movement: A Tool to Optimize Your Bladder Cancer Journey – Part 1

Transcript (PDF)

Movement: A Tool to Optimize Your Bladder Cancer Journey – Part 2

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Movement: A Tool to Optimize Your Bladder Cancer Journey – Part 3

Transcript (PDF)

Movement: A Tool to Optimize Your Bladder Cancer Journey – Part 4

Transcript (PDF)

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Full Transcript on Movement: A Tool to Optimize Your Bladder Cancer Journey

Patricia Rios, BCAN

I want to welcome you again to another Bladder Cancer Advocacy Network patient insight Webinar. Today’s webinar topic: Movement, a Tool to Optimize Your Bladder Cancer Journey is brought to you thanks to our generous sponsors, Merck and UroGen. As we go to the next slide, I want to share with you today’s topic. From enhanced physical function to improved sleep, the profound benefits of regular exercise and physical activity are undeniable. For bladder cancer patients staying active during and after bladder cancer treatment can impact treatment outcomes and overall, well-being.

Today, I am delighted to welcome Kirstie Pomaranski, certified personal trainer, cancer exercise specialist from the Inova Schar Cancer Institute for an insightful session on how physical activity can optimize our bladder cancer journey. For the next hour, Kirstie will share with us practical strategies for integrating exercise for movement into daily life.

Kirstie currently oversees the exercise program for cancer patients and survivors at Life with Cancer. She’s a member and certified by renowned organizations such as the American Council on Exercise, National Academy of Sports Medicine, and Cancer Exercise Training Institute among others. Kirstie is deeply passionate about supporting cancer patients on their journey to recovery and wellness. For more than a decade, she has trained clients individually in the small group settings from the ages of three to 93. She has also conducted live and virtual fitness classes from Inova Well and other organizations in the Northern Virginia area. Kirstie has made it her life’s work to help inspire, educate, and empower others to adopt healthy lifestyle changes to optimize their health and well-being.

Kirstie Pomaranski:

Welcome back everybody. I’m hoping you can see my title slide and we’re going to advance it to the next kind of learning objectives for tonight for our time together. I want to share with you one of the most profound and motivating videos that I’ve come across that really does a wonderful job demonstrating why exercise is so important, particularly with a bladder cancer diagnosis and really how it can help impact your physical and mental health and a lot of the other avenues that we’ll be diving into tonight.

We’re going to be talking about applying an evidence-based prescription of how we can start with getting more movement throughout our day. I’m going to be demonstrating some particular movement patterns that I think are very helpful in helping maintain muscle mass, bone density balance, improving cognitive functioning and coordination and more. We’re going to be talking about behaviors for success when you’re getting to started with trying to think about ways to get more movement throughout your daily life and exploring some resources that we have available that are free along with finishing tonight’s practice with diaphragmatic breathing, three-part breathing.

So let me get to the awesome video that just really inspires me and once you know this information, you really can’t unknow it, and we’ll get into the psychology of how we can work on our mental talk in terms of finding that motivation to get up on the days that we might feel pretty fatigued.

Video: “When you exercise, when you use your muscles, you are giving yourself medicine, and it is medicine you can’t access any other way. You can’t take a pill that has hope molecules in it. Until this current decade, scientists did not know that your muscles are endocrine organs. So endocrine organs are organs in your body that synthesize and release chemicals into your bloodstream that affect every system of your body. And biologists basically thought muscles were there to use energy to move your bones around in place, but your muscles are actually like a pharmacy in the same way that your adrenal glands or your pituitary gland, your pancreas. Your muscles are this amazing pharmacy that are manufacturing and storing chemicals that have profound effects on your physical and your mental health. And let me just give some examples.

So first of all, they’re called myokines. So “myo” means muscle and “kine” means set into motion by, so these chemicals called myokines, they’re set into motion by your muscles into your bloodstream where they can travel and affect your heart, your immune system, your brain. So some of them do really important things like help you regulate blood sugar to improve your metabolism and help you use energy. Some of them kill cancer cells when they’re in your bloodstream and help your immune system kill cancer cells. Some of them are really important for cardiovascular health and help protect the health of say your blood vessels in your heart. So researchers now think that these chemicals that your muscles produce, these molecules are one of the reasons why all forms of exercise are linked to better physical health and reduced risk of every disease you can imagine. It’s all forms of exercise because all forms of exercise engage muscles and your muscles are this pharmacy. So here’s the hope molecule thing.

So some of these myokines have their strongest effects on your brain, and they’re only released when you contract your muscles. So that’s one thing I forgot to mention. Your muscles are not giving up these myokines unless you use them. It’s like a rule, you use them and your muscles say, “Okay, I guess you are engaged with life. Let me help you out by giving you all these chemicals that will protect your heart and kill cancer cells and regulate your blood sugar.” So you have to move your body basically in order to get the full effect of this pharmacy you have.

So when you exercise your muscles release some chemicals that particularly target your brain. And when they reach your brain in the short term, some of these chemicals immediately act like an anti-anxiety. So to start to suppress fear and stress and worry and increase motivation and actually enhance learning as well. So a short-term effect. And in the long term, when your brain is regularly exposed to these chemicals, your brain starts to change in structure and function in ways that make you more resilient to stress. So it literally starts to change the connections between the systems of your brain that help you control your emotions, that help you have a challenge response rather than a fight or flight response to stress. That help you recover from things like depression or grief.

And a study that was published, I think it was maybe 2014, 2015, one of the first studies to look at this, the researchers called them hope molecules because these studies were showing that exercise was preventing trauma-induced depression, that there were literally molecules being released from your muscles that were like an intravenous dose of hope in really difficult circumstances.

So this is the thing I hope that people now, once you know it, you will never unknow, is that when you exercise, when you use your muscles, you are giving yourself medicine, and it is medicine you can’t access any other way. You can’t take a pill that has hope molecules in it. Not yet anyways. You need to lift something heavy or push something or dance or walk or play sports or garden. As long as you’re using your body, your muscles are going to be releasing these chemicals. And again, there are dozens of them and I just happen to love the hope molecules because I do like to think that I’m giving myself an intravenous dose of hope when I exercise.”

Kirstie Pomaranski:

So hearing that, it’s really quite profound that we’ve only learned this in the last 10 years. And so if you guys could just check in with yourself and on a scale of one to 10, ask yourself right now in this very moment, how important is exercise in your life and how confident are you that you can accomplish this on your own? So if you’d like to go ahead and just add that into our chat box, feel free to keep that to yourself or you can add that into our chat.

Kirstie Pomaranski:

All right, so let’s talk about how we can translate the awesomeness of what we just heard and learned about as far as the hope molecule into everyday life. And looking at this as movement-based medication, something that you can’t get in a pharmacy, something that is free for everyone to use and accessible and ready anytime, which is really amazing if you come to think about it.

We know that the way that exercise works is that everyone in the oncology field is starting to realize this is just as important as a lot of the other medications that are being prescribed and really very helpful as a tool to helping people cope with their diagnosis.

Kirstie Pomaranski:

So looking at the prescription, it looks very similar to individuals that have a non-cancer diagnosis. This is something that you can do to work up to if you’re not physically able to meet these requirements, if you can focus on small bite-sized, attainable movement patterns like getting up and walking, moving your arms, chair dancing, chair yoga. We want to try to get towards this two to three days of functional strength training on a weekly basis and performing activities that support your everyday life. I’ll be demonstrating what that looks like in just a few moments and making sure that we are working on consistency over perfection.

So focusing on something that helps you with stress regulation and reduction, balance and mobility that can look like yoga or tai chi or maybe just gentle stretching before you get out of bed in the morning. And we also want to work on our aerobic capacity to be able to walk up flights of stairs, go up hills without feeling winded, and that takes time and practice. And like any practice when you’re first getting started, it’s going to take a little bit of mental toughness, a little bit of being mindful of the things that we’re telling ourselves, establishing a practice of self-compassion because you’ve been through a lot and you might have a lot of things or barriers to work around. And so focusing on the things that you can do versus focusing on the things that you can’t can be a little bit of a mental shift, a mental game that you can play with yourself on helping you get started.

Kirstie Pomaranski:

So looking at this, this is a perfect example of how we can marry modern day technology with a practice of living in our own body and establishing what that feels like. Knowing how hard we can push ourselves but not hurting ourselves. This is about staying in the game and looking at this in terms of your lifespan. Helping you to live a high quality functioning life regardless of your diagnosis. Living independently, maintaining that cognitive functioning that we talked about that the myokines give you. Helping to maintain a healthy body mass composition. We really want to focus on maintaining our muscles because as we age decade by decade, we are losing muscle mass, not to mention bone density.

So thinking about this in terms of if you are looking at this beautiful colored scale that I have demonstrated on the left, if you think about breaking it down into numbers of one to 10, we want to be working in a zone of four to five. That’s moderate in intensity, meaning we should be able to have a conversation but not necessarily sing the words to a song. And we do want to actually get into some areas of vigor in our lives. So that means going up a flight of stairs, getting our bodies to a point where we’re having to catch our breath, but not feeling that we are all max effort being chased by a bear. So we want to ride that balance between having 30 minutes of aerobic based moderate activity mixed with two to three days a week of strength training, something mobility and stress reduction, and having that little bit of vigor, which helps us in numerous ways primarily reduce our risk of cardiovascular disease by up to 90%.

So you can learn through modern day tool to have a heart rate calculation. You can get instant feedback and learn to mirror this feeling in yourself monitoring, “All right, what is my breathing telling me? What is my respiration? What are my body physical cues telling me? And does this match what my smartwatch devices would be telling us?” So this is a beautiful practice in learning to live in our own body. Many of us have lived in our body for a long time, but we may not have been paying attention to the cues and the signal that it’s telling us. So this is a wonderful practice in just becoming more aware and mindful of what’s going on with you.

Kirstie Pomaranski:

So when we talk about strength training, this is one of my favorite topics because I love exercise, I love movement, and I really like to think about it in a more friendlier approach, like calling it a movement practice because movement is wonderful, movement is energizing, movement can be playful, and it really is about helping you live a higher quality of life and getting those hope molecules put into your bloodstream. All you need to do is get up and move, dance, perform some light housekeeping. But you can put some intention behind it and work on maintaining muscle mass and bone density.

So these are some examples of some movement patterns that I’ll be demonstrating today. As you can see, there are different images of people performing a squat, which is also called a sit to stand, a pushing movement, which I’ll demonstrate against a countertop, a pulling movement which strengthens the muscles of our back, something that stabilizes the core, that could be planks against the wall, planks against the countertop, and then advancing that down on the floor depending on what’s happening with you.

I also prescribe balance training activities, things that help us with eye gaze stabilization, which helps with being able to sense where you are in space and becoming more confident and grounded in your own physical body. And then things that will help get that heart rate up. And you can see this gentleman is doing some knee raises against the wall.

So some pro tips when you’re getting started with a resistance training program. You start slowly and listen to your body, making sure that you have a proper warm up, giving yourself about six to 10 minutes. It could be going for a little walk around the block, it could be knee bends, it could be shoulder circles, and I’ll be demonstrating kind of my tools and tricks. I like to start with about three to six of these movement-based patterns that help you climb stairs, go play with your grandchildren, put groceries away, play with your dog, whatever is meaningful to you. I want you to try to pick those activities and movements that will help you stay engaged and strong. So three to six exercises typically, perform about two to three sets and you’re going to be looking for a repetition range of about 12 to 15 repetitions.

A general rule of thumb is if you can lift more than 20 repetitions of a particular exercise, it’s a sign that you probably can handle more weight, and you can think about increasing your weight between two and 5%. And you can use various tools like dumbbells, resistance bands, water bottles, books, things that you have around your house just to get started until you are feeling a little bit more confident potentially going into a gym setting or a class setting.

I also recommend, if you’re dealing with lots of fatigue and in the midst of treatment, trying to break it into snacks or inserting it around your workday schedule. So if you have a meeting, scheduling time in your calendar, maybe five, 10 minutes, breathing, stretching, some marching in place. It doesn’t have to be so complicated, it just has to be that you’re establishing that pattern of repetition and attention to giving you the behaviors that will get you started.

When I select exercises, I want you to focus on alignment. So good posture is really important, making sure you’re standing with a nice tall spine, your shoulders are pulled back, thinking about you have a string attached to the crown of your head. And I would prefer you to do these exercises in a standing position if possible. If you need to move into a standing or sitting position. You are in charge here and you know your body best and your health history best. So I’m going to let people make that call for themselves.

Again, focusing on activities of daily living, like carrying groceries, rolling suitcases down airports, going up flights of stairs. These are all things that you want to think about in terms of how we would move and strengthen our body so that we can just transition seamlessly into our lives. And then always preventing lower back pain by strengthening your core, that really does help a lot of pain and dysfunction. And again, the goal of these types of movement practices are to stay in the game and prevent injury, not to leave you injured and feeling broken.

Kirstie Pomaranski:

So like any good exercise program, there are some signals that our body sends that we need to pay attention to. If you’re going to be starting an exercise program, you should probably check in with your doctor and just make sure that you’re communicating to them. They will know medications and your health history best, and will be able to give you some guidance on how you can best navigate some of the things that you might be dealing with in your health journey.

I always listen to chest pain and pressure that’s generally assigned that that’s not something good that you want to push past. Pulse, paying attention to heart rate monitors, developing a higher fast rate of a pulse more than a hundred beats a minute is usually an indication that you’re in trouble and you need to check in with the urgent care or ER. Monitoring your blood pressure is a good idea because as we age, these are metrics that help us gauge if we are in a good and healthy place.

And it’s about knowing what’s happening in your body and having those conversations with your care team. Reoccurring leg pains or cramps that can be problematic for many reasons, blood clots, things like that. And you just don’t want to push past these warning signs. You’re never going to want to exercise with a fever or if you’re experiencing any vomiting or diarrhea, that’s maybe a time where you just want to kind of ease back, be compassionate with yourself, making sure you’re getting rest and proper nutrition and then try it again tomorrow. You can always go for short walks and just play it by ear.

Kirstie Pomaranski:

All right, so I’m going to show you guys my rule of thumb for how I train myself and the people that I work with here at Life with Cancer, and we’re going to just try a little bit of a movement practice together. So I’m going to change my camera angle so you can see a full view and I’m going to adjust here really quickly.

So let’s just start really quickly with a nice breathing exercise, bringing those arms up overhead. If you have any shoulder injuries, you can try it in a forward flex motion and then raising and lowering. As you bring those arms overhead, you’re going to inhale and exhale, inhale and exhale. Okay, inhale and exhale. Grounding in the moment we’re taking the feet hip-width apart, hands on the hips. I want you to just kind of rock back and forth, feeling really solid and grounded in your body. We’re going to begin rolling those shoulders back, continuing to breathe, just gentle shoulder rolls.

Now we’re going to take it to the front. Just gently opening up, raising those shoulders, allowing the elbows to come out to the side and then opening up in the chest. We’re just going to open those arms. criss-crossing the midline, allowing the hands to come out to the side and feeling a nice stretch and pulling sensation in our chest. Continuing to breathe. Beautiful job. We’ll do three, two, one.

Hands on the hips. We’re going to begin to circle our hips. Just imagining we have a little cauldron and we are making a stirring motion with our hips and a hinging pattern. So that looks like this from the side. You’re hinging forward, spine is straight. Thinking about a string that’s pulling from the top of your head, the crown of your head to the ceiling. And then let’s change directions. So this looks like this from the side.

Kirstie Pomaranski:

All right, we’re going to begin to warm up our knee joints. You can do this in a seated or standing position. If you’re in a seated position, I want you to make sure that you’re balancing on your sitzvahs, that you have a nice tall spine and you’re sliding your heel towards the base of your chair legs. I’m just shifting my weight from side to side, bending the knee as much as I can, getting my heels to my glutes, continuing to breathe.

Let’s go back to some shoulders circles, and let’s work on some balance and ankle movement. I want you to reach out to the side. If you need to hold onto a countertop or chair or couch, go ahead, lift up your legs and we’re going to circle, circle, pointing and flexing the toe in a clockwise position and then taking that counterclockwise for me.

I’m going to go ahead and have you point and flex the toe point and flex the toe, and then shift that weight to the opposite leg. Opposite leg comes out, we’re going to draw our toe circles in a clockwise position and then counterclockwise from me. All right, and then point and flex point and flex the toe. Once again, you can do all of these movements in a seated position, if needed.

So we’re going to go into our eye gaze, stabilization. Eye gaze stabilization is helpful for balance. I want you to place your fingers on your chin and we’re going to extend that arm out in front. We are going to draw in a clockwise circle three to five times, and I want you to try to track your thumbnail with your eyes. When you have your three to five, we’re going to change directions. All right, go ahead and take it up and down for me as if we were making a noon and a six, three to five times at your own pace. We’re going to take it left to right or top to bottom, three to five times at your own pace. And then changing directions, left to right, top to bottom, three to five times. Great job.

I want you to bring that hand close, close up, close and then far away, up close, far away. One last time and we’re going to move into our standing functional movement pattern. So today I’m going to be showing you I have a countertop, which I think is a wonderful addition to helping get more movement into your day-to-day life. And I’m going to have you just march in place. You’re leaning your hands against the countertop for support. The farther away you take your feet, the more you engage your core and put pressure on your abdominal wall. If you want to reduce that pressure, you bring your feet closer together and closer to the base of the cabinet and you’re going to look to raise that knee as high as you can while maintaining control of your lower extremities.

We’re going to do this about three more times and then transition to our dynamic hugs, which is going to work our chest wall. I want you to turn to the side, see my spine, I’m hugging and releasing. I’m making a nice extension and flexion in my spine. This helps prevent lower back or upper back pain, improve mobility. I want you to imagine you’re hugging a tree and you’re using your best intention to contract those muscles and put your hope molecules into play. Wonderful job. We’re here just a little bit, stretch and open, extend in the spine as you come out. We’ll continue to breathe. Three, two, and one.

So if you have knee pain, I want you to think about hinging in the hips, holding here and doing a nice isometric chest press. And if you are able to, begin to rise, we’re going to do a little bit of a chest press with a quarter squat. So as you stand, you’re going to squeeze your backside as if you were going to pull a tissue out of a box, engaging the pelvic floor and working this into your lower body and upper body movement. So we’re doing a little isometric chest press, palms pressed together on the stand, and we’re just quarter knee bending it. Going at a pace that feels challenging and doable. Let’s go. Last three, two, and last one. Nice job.

Kirstie Pomaranski:

Our next movement pattern is going to be a hip hinge. So I’m taking my hands, laying them on the front side of the chest. I’m rolling those shoulder blades down and back. I’m hinging forward in the hip. I am keeping my spine straight. As I come up, I’m going to pull those shoulder blades down and back. Squeezing all the muscles on the backside of the body. This is going to help us strengthen all those muscles that are responsible for helping us have a nice tall spine. Really important as we age, let’s give ourselves three more squeeze of that.

All right, our next one. If you don’t want to put a lot of pressure on your abdominal wall, you can do some standing chest presses. Imagine with your mind that you’re pressing a wall away from you. Another option would be to come against your kitchen counter, you stagger your stance and perform a countertop pushup. Notice that my elbows are on the side of my torso. I’m slowly lowering it down. My leg is out in front to support me. If I want to advance this, I take my feet and take them side by side.

I want you to try to do your best, but listening to your own individual needs. Let’s go three, two, last one. All right, we’re going to come back up to a nice standing position. Let’s reset. Shoulder roll. We’re going to do a high level row, a mid-level row and a low to high row just using our body weight. So we are imagining we’re pulling resistance bands. We don’t actually have to have anything set up to do this. So it’s high, mid, squeezing those shoulder blades together. Low to high. You can say it out loud, high, mid, and then low to high. High, mid, low to high. One more round. We’ve got our mid level and then pulling low to high. Beautiful job. Just circle those arms for me. Taking the tension off the head and neck.

We’re going to take those arms 90 degrees and bring them in. You can add a flexion of the hip to make this more of a core balancing heart rate engagement here. Or you can stay right here and really imagining you’re bringing those elbows together, squeezing, and then somebody has their hands on the outside of your shoulders as you open them up, they’re pushing. So it’s a push-pull, continuing to breathe. You should be feeling warm, but notice I can still have a conversation. Okay, this feels nice. All right, one last time.

And we are going to perform a shoulder stabilizing exercise. I’m going to have you, you can start with your feet together to make it more challenging. You can stagger your stance or you can go to a one-legged approach, which makes it more challenging. So we’re going to do a Y, a T, and an A. This is an excellent exercise for stabilizing the shoulders. So you’re taking those arms up 45 degrees. Notice I’m just using body weight. I have a slight bend in my elbow. Hands finish behind the chest. Front to the side and back. Sometimes it helps to say what you’re doing to make that mind-body connection. Let’s do a few more here. Front, side and back. Really squeezing. Nice, tall spine. Continuing to breathe. We’ve got one more round. We’re going Y, T, A. Beautiful job.

Rolling those shoulders down and back, we’re going to do something for balance and core. This is a modification. We’re going to do this on a standing upright position. We’re going to raise that left arm and right knee, slowly lower it. This is working across the midline, which is good for brain health, for balance, core strength, we’re going to do as many as we can do while maintaining a nice upright position. If you need to hold onto something, it’s okay. We’re going to work on that. Practice makes perfect. We’ll do three, two, and one.

Now this is one of my favorite exercises for helping to improve lower circulation, especially if you’ve been used to sitting a lot. This is something that you can do to improve circulation. We’re going to do a heel raise and a toe raise. It is helpful when getting started to have something like a kitchen counter or a chair to hold onto. We’re going to raise up on the balls of the feet, slowly lower it down, and then rock back raising our toes up off the floor. So what we’re doing is improving ankle mobility, improving circulation of our lower extremities, and helping to support our knee.

Kirstie Pomaranski:

These are all very gentle exercises that help put those hope molecules into our bloodstream. Wonderful job. We’ve just finished 10 moves in about 10 minutes. See how easy and simple and straightforward this was. So I’m going to take you through my beautiful, cool down. I want you to use your kitchen counter for this. This is a modified downward facing dog. So you’re just going to bend in half, look through those arms, come out into a nice upright position here.

Each time you come down, I want you to think about looking through those arms a little bit more than you could before. Beautiful job. Now while we’re here, I want you to practice a little cat-cow in yoga. This is great for flexion of the thoracic spine. You’re going to pelvic tilt, strengthening our lower abdominals, going through a range of motion that feels right for your body. If there’s any pain or discomfort, you can shorten your range of motion or find something else that you can tolerate. You are the boss here. Last one. Beautiful job.

All right, one of my favorite qigong Tai chi moves. I’m going to have you stagger your stance. We’re going to hinge in the hip and just swing the arms. If this doesn’t sit right with you, because this makes you dizzy, I want you to just focus on this hip swing and arm swing action. Maybe you’re not going to hinge as far forward as I am. We’ll do three, two, and last one. Let’s change sides. Opposite he leg comes forward, hinging in that hip, using those arms, squeezing our backside. We’re feeling a stretch on the backside of the leg, rocking back, lifting those toes up off the floor. And we’ll do three, two, last one.

Let’s come back to a nice upright position. Rolling those shoulders back, taking some deep restorative breaths. We’re going to open up those palms. Taking a nice deep breath, I’m going to have you drop your ear to your shoulder, allowing all the tension, stress, worries of the day to roll off down the street, continuing to breathe, dropping the chin to the chest, head comes back to center. We’re going to repeat the same thing on the opposite side. Dropping that ear to the shoulder, allowing that tension, stress, worry to roll off the shoulder and down the street, visualize it. And then drop that chin to the chest. A few final breaths here as we reset and we come back to our power point.

So that is really a perfect example of movement practices that help you perform activities of daily living. We incorporated breath work, we incorporated body weight. We incorporated just a gentle easy movement practice that definitely got the heart rate up. You should be feeling warm, but it’s definitely something that you should feel like you could break it down into smaller chunks if you’re not there yet.

Kirstie Pomaranski:

Okay, so sharing some free resources. As you know, I work with Life with Cancer. We are a non-profit based out of the northern Virginia area, and we do offer free classes, fitness, mind-body classes that are streamed online and in person. We’re seeing more of a return to person and that really does help with building community, connections and helping with people feel less isolated, which we know can come along with experiencing a diagnosis like this. You can see that we offer over 23 classes that fit this evidence-based framework. So you don’t have to do a lot of the legwork and thinking about, “Okay, what do I have to do?” You have enough on your plate. You have some resources that are free that you could get started with today.

Additional resources that we have throughout our cancer community. We are a small knit group of people. We know each other, we work well together. We have a sister organization called 2Unstoppable and they also have strength training programs, free classes that are available, fitness connections and more. There’s a wonderful organization called Moving Through Cancer, which also provides a lot of basic user-friendly information to help guide and steer you on this process. And then there’s MindVictory.com, which is the Peloton of cancer exercise for survivors. They have over 2000 free on-demand classes available on this platform.

Kirstie Pomaranski:

All right, so we’re going to dive into taking what we know, our why, this is important because it’s giving us the hope molecules. We know that we need to be walking, we know that we need to be strength training. We know that we need to be doing for something for stress reduction and connection. So we’re going to dive deeper into the behaviors for success and that is really making the decision to own your health.

Kirstie Pomaranski:

You’re going to be in the driver’s seat, you’re the boss. And so exploring what resonates with you is really important. We know that you can do a lot of different movements and different varieties of movements, but the most important thing is that you are continually looking for things that are going to keep you in this practice.Identifying your barriers. Maybe you need more support, you’re not sure that you can confidently do this without supervision or guidance. Getting with your doctor. Finding out how you can either work with a physical therapist, an occupational therapist, maybe it’s a pelvic floor physical therapist, and then they’ll address any pain or dysfunction in the body, get you to a place where you can come back into a community setting with confidence and ease depending on what’s happening with you.

I encourage you to find your balance. Life can get really busy, especially when you have tons of doctor’s appointments and you’re just in the thick of things. So really having conversations with your loved ones, eliminating the things that aren’t adding value to your life and trying to reduce those stressors as much as possible is really important. And that takes practice. It takes sometimes getting with a therapist to help you navigate how to have these difficult conversations with people that you care about most or having those conversations with work.

And it comes back to setting up those boundaries, creating that personal space for you to help you prioritize your health and make this a part of your daily routine. I do think that yes, this is serious, but as long as you can keep it playful and joyful, that is an aspect that helps keep us young and curious and engaged. So finding out those things that spark that little, “Hey, I think I like this, I’d like to do it again,” is really critical to helping you stay consistent.

The mental toughness piece, this can be a really tough time for a lot of folks and we understand that more than you’d know. And so it is really important to kind of tune into your thoughts and establish your practice that helps create that awareness of the things that you’re telling yourself so that you can get out of that negative thinking. You can reframe it and try to make some positive connections in your brain that help you get out of maybe some unhealthy thinking patterns or naturally being worried that keeps you stuck in that stress response because it’s not doing your body any good.

I always think getting with a buddy, having a trusted friend, confidant is important in this process. Somebody that you can walk and talk with or just call and connect and hold you accountable can be really important as you start to create a movement practice for yourself. I do always want to remind people to limit alcohol intake because we know that there’s a lot of empty calories that come with these drinks and they’re not particularly going to help you stay clear and focused, have energy to try to take on some of these more challenging movement patterns and it’ll just disrupt your routine that you’re trying to set for yourself.

I think learning to hear your excuses comes back to having a practice of sitting quietly. It could be in prayer, it could just be in an area of quiet that you create for yourself and it could just be as little as coming back to your breath or noticing a color on a particular piece of art or getting outside and connecting in nature because it’s really grounding and helps us manage our stress levels.

So these are kind of some of the things that I work with my clients in the coaching capacity and just helping them pull out what’s meaningful and what they’d like to focus on first.

Kirstie Pomaranski:

So before we go into our three-part breath and calm ourselves for the evening, I’d like you to ask your self, how would you like things to be different in your life regarding a movement practice? Would you like to start with walking or maybe a dance class? What would you like to get focused on and what could you do to make it so small that you couldn’t say no to it? That’s a healthy way to get started is just making it micromanageable.

So how do you make it so easy that you can’t say no? And remember this is your movement medication. If you skip it’s going to cause problems further down the line so we wouldn’t skip our normal medication that’s prescribed to us by our physician. So if you can get into that thought process that when you’re learning to listen to your excuses, that you are becoming more aware of that and interrupting that thought and saying, is this going to help me get to where I want to be? And how do I make it so easy I can’t say no?

Kirstie Pomaranski:

All right, I’m going to finish tonight because we’re almost at time and I just appreciate everybody’s understanding as we’ve built with power outages and tech snafus to join me In this practice, it is taught by one of our yoga therapists at Life with Cancer. She teaches an intro to pelvic floor health and in this class she teaches you how to breathe properly so that you’re actually connecting with the base of your core, which is your pelvic floor. When you’re diaphragmatically breathing, it’s getting you out of that fight or fight response. It’s helping to change the pressure in your trunk, which helps with lymphatic drainage. It is one of the largest muscles in our body that helps connect our upper and lower extremity, and it’s a wonderful thing to do to be able to drop into your breath and calm and center yourself. So I’ll start this video right here.

Video:  “Thank you. Welcome to Soundness with Sadie. This diaphragmatic breath is built up in a wave. It’s three parts of our breath that when we’ve been under stress or after illness or injury can be damaged, particularly in times of fatigue. We don’t make space for our full breath capacity. The best way to do that is actually to be on your back and Kirstie demonstrated in the slide with a chair, or maybe on the couch, just kicking your legs up on a couch. You could also just roll up a blanket or beach towels and I’ll demonstrate how we can not only recreate our full breath capacity and the relaxation response that comes with it, retraining ourselves to know that we are in a place of calm and peace. And also to let our anatomy be supported.

So if you’re sitting, try and back yourself all the way up, whether you’re all the way back into a chair, whether you can actually sit back against the wall and maybe you put something under your bottom to get your hips into place. Natural curve of your low back supported. And if you’re seated in that chair as well, you can set that blanket in there to help not pop your ribs forward, but hold your low back. Same with our neck. We want to feel our skull supported either by the back of the chair or the wall. And in doing so, giving yourself permission to stop thinking, to stop concerning with this.

I’ll demonstrate on our back, and I do recommend this, I recommend this for something to do each day. Most helpful upon rising or right before sleep. Again, throwing your legs up on the chair or the couch or maybe just letting yourself use the roll of a blanket or bolster of some sort. But letting yourself soften all three corners of your tailbone onto the earth. Soften your skull into support. Whether it’s back against the wall or down onto the earth. Whether you add another cushion or not, we don’t really need our head higher, but we need our neck longer. So take a deep breath here. What is your deep breath? Can you relax just 10% more at shoulders or jaw at tailbone?

Because we aim to build the wave, the same wavelength that light travels on, sound reaches us upon, that same wave is built within us with breath, and it begins with our collarbone. As you inhale, can you expand that collarbone, not up and down through your shoulders, but wide across your heart. Hands there to help guide you. Exhale, release. This isn’t a very long area for breath. We breathe in, but can you breathe out of this area completely? We hold on to breath here just in case. Breathe in. You’ve got to tell yourself for the next two minutes, there are no emergencies. I don’t need to have somebody stop or go or ask for help. There’s no wait, wait, wait. Just let go of this breath.

Breathe in the width of your collarbone. Breathe out. Allow your collarbone to empty. Our first area of breath. The second area of breath is in our ribs. As you breathe in, can you expand all the way into your hands? Your thumbs come under you, adjust your wrists at your side, but you let your hands be there and as you exhale, you use those hands to help push the air out. Loosen your grip, loosen your elbows and shoulders, hands there guiding you as you breathe in. And now as you breathe out, can your hands help to push the air out? This area gets harder as we get older unless we run properly. Some of us don’t even run properly, or swim.

It’s hard to inhale between each set of ribs as we find that breath capacity to open. And then use those muscles as we exhale to actually let go of that which no longer supports us. Breathe from collarbone to ribs, and empty letting it wash over you out of ribs and out of collarbone. Before we come to a third area of breath, thumbs point up into that soft spot where the ribs aren’t connecting anymore. Index fingers towards your belly button. And as you inhale, they start to come apart. And as you exhale, we go with gravity, we just are done. What if we actually follow that naval to our spine? Inhale. That diaphragm’s work right now is to draw air into the bottom of the lungs by pushing our organs up into the air now or out if we’re seated.

And as we exhale, help that diaphragm recoil by drawing the tone to all of the muscles, squeezing and holding them gently. Inhale, build the wave from collarbone to ribs to belly and exhale out of your belly and all of your ribs and out of your collarbone completely. Inhale from collarbone to ribs to belly, maybe even down into your pelvis. And again, trying not to move so much through our bottom, our hips, our thighs, even our low back. Just inhale into that torso. Can your jaw and tailbone relax and your nose and neck relax? Can your torso fill as you inhale to build the wave from collarbone to ribs to belly, and out of your belly and out of your ribs and out of your collarbone completely.

This is your full breath capacity. This offers a full relaxation response and more importantly, a retraining to draw yourself out of the stresses that you have been experiencing. In doing so, you can strengthen this to wear your breath in is four, maybe even five count. And your exhale is double that, that you take the time to actually release with each exhale. I appreciate your time. Thanks for joining me. I’m Sadie and continue to practice your three-part breath, your [foreign language 01:00:34] with gratitude. I see you.”

Kirstie Pomaranski:

So that is a lovely example of just some simple breathing exercises, taking it from collar to rib to belly and learning to do this so that you’re incorporating this into your stress production. Maybe you don’t have time for a yoga class or even walking, but if you can get into a practice of controlling your breathing and your stress response, that’s the perfect place to start. So thank you so much for having me today. I really enjoyed sharing my experience, my practice, and how I work with my patients here at Life with Cancer. And I’d be happy to answer any questions that you might have.

Patricia Rios, BCAN:

Thank you Kirstie for that wonderful presentation. It was very thorough in providing practical tips in how we can incorporate movement in our daily life. Before I open the floor for Q&A, I just want to do a quick time check with you and see if we have a couple more minutes to-

Kirstie Pomaranski:

Okay.

Patricia Rios, BCAN:

Excellent. Perfect. We do have a couple questions in the chat. I also want to remind our participants that you can post your questions by using the Q&A box at the bottom of your screen. And so with that, I wanted to start with a question about the hope molecules. Well first thank you for introducing us to that concept. It’s a very unique and new term, at least for me, and I think some of the participants on today’s call. And I think the video did a great job explaining the benefits. So there’s a two part question. One I wanted to ask. In terms of just benefits overall for bladder cancer patients of exercise movement, can you give us a list of those benefits and why we should really be incorporating that into our daily life?

Kirstie Pomaranski:

Yeah, it’s really going to help you with just taking care of your emotional and physical state. And we know that going through a course of treatment can be really taxing. So trying to stay active, engaged, maintaining your muscle mass, your bone density, working on things that help you prevent falls, which can lead to other complications. This is about staying in the game and looking at it as a way of life and as a way of prescriptive medication that is going to help you manage the fatigue and some of the other aspects that come along with going through something.

Patricia Rios, BCAN:

Great. Thank you. And there was a question about if these are the hope molecules, if there’s hope that they’re eventually it can be turned into intravenous medicine.

Kirstie Pomaranski:

It would be wonderful if they could bottle this and make it into a pill. But I think the most important takeaway is it’s the beauty of our natural body’s mechanisms and using that to the best of our own ability. It’s free, it can be contacted at any point in time should we choose to. And I think that’s really empowering and to take that message away that you have more power than you realize over your situation and to always remain hopeful. And these are some ways that you can do that.

Patricia Rios, BCAN:

Thank you. And then there was also a question about this concept of nitric oxide dump exercise. Have you heard of that?

Kirstie Pomaranski:

I don’t believe that… that’s not really in my area of expertise. I mean I’d be happy to do some further research on it, but maybe they could elaborate on where they heard that or what their sourcing would be.

Patricia Rios, BCAN:

Yeah, I did a little bit of search in it. It says that nitric oxide dump workouts are a series of exercises that can help increase nitric oxide levels in the body. So like squats, arm raises, circular arm swings, shoulder presses, which really were a lot of the things that you showed us today.

Kirstie Pomaranski:

Yeah, so I mean, again, the power of exercise, and I think we have been conditioned think that exercise has to be this torturous practice that is very strenuous and vigorous. But there is a balance to that, especially when you’re going through a cancer diagnosis. It’s learning to balance that we’ve got to push ourselves, we’ve got to be the best. We’ve got to elicit this nitric oxide dump. We want to push ourselves, but we want to help strengthen ourselves at the same time. And sometimes that means becoming a little bit more self-compassionate and exploring gentler movements.

And this practice of embodiment, learning to understand what our body is signaling and cueing to us. And remember staying in the game. This is not about pushing ourselves to the brink of exhaustion or dysfunction. It’s about really empowering us, getting us stronger. And that can happen with consistency and flow, progression of strength training movements and doing a little bit more each day. And that would be my advice to anybody that’s in this situation.

Patricia Rios, BCAN:

And what I loved about the exercises you demonstrated is that you are able to modify the exercise depending on where you are. It doesn’t matter if you’re a beginner or advanced, the exercise can be modified to fit your level and need. I think we often, there’s so many terms out there and we use these interchangeably, exercise, physically active and now movement practice. Are there any differences in all of those as we are framing this concept of just living an active life and incorporating all these components of flexibility, strength training, aerobic exercise. How would you differentiate these terms? Are they one and the same? Should we think of it that way? Or is one preferred over the other?

Kirstie Pomaranski:

Well, I think the basic takeaway is not to over complicate it, especially if you’re just getting started. To try to remember how we can make this so easy, we can’t say no to it. And sometimes it’s going to what we know to be true. And that might be just simply getting outside for a walk. I would recommend that like any practice, when you’re learning something new, you get the support and resources that access those support and resources that are available. And in many cases, these are free. You don’t necessarily have to know all of this information or even be tasked with differentiating this right now. A lot of places like Life with Cancer have already kind of put that framework in place for you. And I think it’s really about what’s going to resonate with you in staying consistent and growing this natural interest in moving more, strengthening and not overcomplicating it.

Patricia Rios, BCAN:

Thank you, Kirstie. Well, we are out of time, so I want to thank you for joining us today and staying a couple minutes extra. I also want to thank our sponsors, Merck and UroGen for making this webinar possible. And of course our listeners for joining us today.