“Cancer survivors with physically demanding occupations are often unable to work because physical fitness is severely reduced through the disease, side effects of the anticancer therapies, and through physical inactivity. In colorectal cancer (CRC) survivors, for example, abdominal stability is reduced after laparotomy and endurance capacity, as well as strength, is affected by chemotherapy and radiation. Beyond that, 1 year after surgery, a temporary ostomy is quite frequent in CRC survivors with a rate of up to 35% or 50% (own unpublished data). A permanent ostomy is present in about 10% of CRC survivors. This is associated with permanently reduced abdominal stability and an increased risk of a hernia. Furthermore, it is related to various psychosocial problems (e.g., feeling depressed and tired, dissatisfaction with appearance, change in clothing, and worry about noises from the ostomy) and it negatively influences the quality of life (QoL). Therefore, still being able to work in physically demanding professions appears desirable for CRC survivors with an ostomy from both a psychosocial and an economic point of view. However, little is known about the trainability of this population.”1
There is a positive correlation between weight-bearing exercises and bone density. Particularly with age, bones weaken and muscle tissue fades away. Some weight training may help check this negative progression. However, avoid any lifting for at least 12 weeks after your ostomy surgery. You may do strength training with caution; use a mirror to follow proper technique.
Start working on the large muscles: legs and upper torso. Because of the ostomy, you will need to start very gently, doing just a few repetitions and immediately stopping if fatigued. As a general rule, something that cannot be lifted comfortably 20 times is too heavy. Build up slowly and rest plenty between sets. Drink during your workout and eat well afterward. If you are consistent, you will see the benefits. Lifting is a strenuous activity that creates considerable abdominal pressure. You should always wear an ostomy support belt to reduce the risks of injuries and parastomal hernias.
Core Muscle Conditioning
Strengthening core muscles makes it easier to perform most activities. They help maintain adequate back posture and take the stress away from the back, reducing the chances of back pain. Core muscles run through the abs, back, and pelvis. The main ones include the Rectus Abdominis (better known as the “six-pack”); External and Internal Obliques (sides and front of abdomen); Transversus Abdominis (key abdominal muscle beneath obliques, extends around the backbone providing shield and support); Hip Flexors (pelvic front and upper thighs); Hip Adductors (mid-thighs); and Gluteus Maximus, Medius, Minimus (sides and back of hip).
There are various exercises meant for core muscles. Many may be done at home on a mat or carpet and require no equipment. Breathe deeply while performing them and do not hold your breath. Muscle core exercises are useful but it is advisable to check your proneness to parastomal herniation with your health professional before engaging in a routine.
If you have been inactive, your abdominal muscles will be weak. It is highly recommended that you use a support belt (go for the ventilated kind). Doing sit-ups perhaps has the greatest risks of parastomal hernias as there might be excess pressure on the debilitated abdominal muscles.
Appropriate crunch technique requires that you lie on your back with knees bent and a foot apart. Bring your arms to your chest (do not place them behind the head), contract your abdominal muscles, raise your torso away from the floor, hold your body for three breaths and lie back on the floor. Be gentle and repeat as many times as you can while maintaining form. You may also try reverse crunches.
Other Recommended Core Exercises
Try low impact activities such as Yoga, Tai-Chi and Pilates. They are smooth but very demanding workouts, and they all target and bolster core muscles. Incorporate isometric exercises like the plank (abdominal bridge), side plank, reverse plank, and the back bridge. Also, you might try the hip lift, oblique twist, lunge with twist, push-ups and squats. When doing these exercises, contract your transversus abdominis muscle. Do sets of five. As you progress, increase repetitions to 5, 10, and 15. You may add a Swiss ball, medicine balls, balance boards, or wobble boards to the routine.
“Multi Joint exercises (eg, chest press, shoulder press, squats, lunges, pushups) are recommended over exercises focused on a single joint, and all major muscle groups (chest, shoulders, arms, back, abdomen, and legs) should be incorporated into a resistance training program. For survivors who do not currently engage in resistance training, clinicians should recommend that they start with 1 set of each exercise and progress up to 2 to 3 sets as tolerated. A weight that would allow the performance of 10 to 15 repetitions is recommended; however, individualizing recommendations for resistance and strength training is important.”2
We are designed to walk. Walking is a first good step to break into an exercise routine. Walking helps stabilize blood pressure and improves cardio conditioning. It is a low-impact and effective activity, but you must go slow. Be sure to get comfortable sneakers. Do not assume that since it’s “just walking” any shoe will do. Start with short walks and gradually increase distance and pace. Monitor your workout based on time, not distance. Shoot for at least 30 minutes and make an hour your ultimate goal. Do it at least 4 times per week. Aside from helping you get back in form, walking contributes to control your weight, improves digestion and discharge. It also relieves tension and improves blood circulation.
“You should begin walking in moderation after your surgery and do this regularly, every day after you get home. Walking stimulates the return of bowel function and will get you back on the road to regaining the muscle you lost while in hospital. Whatever sports you may have played in the past, you can enjoy them again with few exceptions. Common sense is required, of course and this mean no heavy lifting during the weeks immediately following surgery. Unless your surgery was done laparascopically, your abdominal muscles will have been weakened by incisions and must be given adequate time to heal. Improper lifting, or lifting too heavy a weight too soon could cause a hernia. Again, no lifting, not even a vacuum cleaner or laundry hamper for those first few weeks and then only introduce light loads gradually and carefully. If you want to return to the gym you can do this but you should avoid abdominal exercises for a while, and then only introduce these in gradual, gentle amounts. A personal trainer, if you can afford one, can work with you to develop a safe exercise regime.
Ostomates who regain previous fitness levels can and do return to a huge variety of sports and exercise — running, swimming, biking, snorkeling, golf, hiking, hunting, yoga, riding, team sports, triathlon — you name it. The list includes contact team sports as well – – professional footballers have played with an ostomy. Unless your chosen sport before was powerlifting or wrestling, you will probably be able to do it again.”3
Contact and Team Sports
An ostomy should not prevent you from practicing contact or team sports. As long as you re-build stamina and strength moderately, you can take up just about any sport: football, soccer, karate, wrestling, basketball, water polo, and the list goes on.
Damaging the stoma is rather difficult. So, dealing with a stoma in case of an accident is usually easier than repairing a broken arm or a pulled knee ligament. Aside from emptying and securing the bag before the activity for both comfort and to avoid any embarrassment (ripped bag), there is not much else to worry about. Once those who cannot live without contact sports learn that the are no medical barriers to practice them at will, little should come between them and their pastime.
Swimming is an excellent sport for ostomates. It is gentle on your abdominal muscles and exercises your full body. If you use a flange, make sure you change it a few hours prior to your session. Better yet, choose a product without a flange. If wearing a belt, go for the rubber kind as cloth belts stretch.
Learn to gauge your metabolism so that you can swim with a light pouch. If you are concerned about it being visible, there are ways to cover it up. Use mini-bags (non drainable and with no filters) and wear a patterned suit. Try a waterproof tape around your bag, and a belt under the suit. For men, select a size bigger. Trunk suits and a tight lycra underpants work well. For women, choose lycra. It makes you look slimmer and will keep the bag in place. Suits with skirts, shorts or sarons are good alternatives. Colostomists may substitute the bag for a stoma cap.
“Swimming, hot tubbing, and saunas may be resumed once your incision(s) heals completely. Prolonged exposure to water may cause the adhesive seal to loosen your pouching system. Applying surgical tape around the four sides of the adhesive seal of your pouch (e.g. like a picture frame) may help protect the seal. Smaller pouching systems are available and may be an option for wear during some activities. Some swimwear has patterns and various panels that may help to conceal the pouch. You may find a selection at retail outlets and at some medical/surgical (ostomy) supply stores.”4
“The health benefits of resistance training include improvement in muscle strength and endurance, improvements in functional status, and maintenance/improvement in bone density. Studies in survivors have shown improvements in lean body mass, muscular function, and upper body strength. A recent systematic review of 15 studies of resistance training interventions during and/or after cancer treatment concluded that meaningful improvements in physiologic and quality-of-life outcomes can be achieved. A similar review of 11 randomized controlled trials came to similar conclusions.”5
(1) Exercise and cancer: return to work as a firefighter with ostomy after rectal carcinoma – a case report. Wiskemann, J., Schommer, K., Jaeger, D., & Scharhag-Rosenberger, F. Medicine (Baltimore). 2016. https://pdfs.semanticscholar.org/91e7/4f625b47159f9b2c0710bb4d5d85aa730c93.pdf?_ga=2.41200546.1806053081.1560992394-1905186700.1560631858
(2, 5) Survivorship: Healthy Lifestyles, Version 2. 2014. Denlinger, C., Ligibel, J., Are, M., Baker, K., Demark-Wahnefried, W., Dizon, D., Friedman, D., Goldman, M., Jones, L., King, A., Ku, G., Kvale, E., Langbaum, T., Leonardi-Warren, K., McCabe, M., Melisko, M., Montoya, J., Mooney, K., Morgan, M., Moslehi, J., O’Connor, T., Overholser, L., Paskett, E., Peppercorn, J., Raza, M., Rodríguez, M., Syrjala, K., Urba, S., Wakabayashi, M., Zee, P., McMillian, N., & Freedman-Cass, D. National Comprehensive Cancer Network. 2015. https://jnccn.org/configurable/contentpage/journals$002fjnccn$002f12$002f9$002farticle-p1222.xml
(3) A Handbook for New Ostomy Patients 5th edition. Rooney, D. Vancouver Chapter of the United Ostomy Association of Canada. 2012. http://www.vcn.bc.ca/ostomyvr/NEW%20PATIENTS%20EDITION%205th%20printing%20web.pdf
(4) A Guide to Living With a Colostomy. The Canadian Association for Enterostomal Therapy. 2007. https://nswoc.ca/wp-content/uploads/2015/02/caet-guide-to-living-with-a-colostomy.pdf