Endurance sports

Endurance sports include all physical activities that are carried out over a longer period of time and are aimed at improving endurance and the cardiovascular system. Endurance sports are aerobic, i.e. they use oxygen as the primary source of energy.Jogging, walking, cycling and swimming are among the most popular endurance sports. Cross-country skiing, inline skating, rowing and (mountain) hiking are also included.Endurance sports are generally associated with a range of health benefits. These include

• Improving cardiovascular health by strengthening the heart and improving blood circulation
• Increased stamina, allowing the body to remain active over a longer period of time without tiring
• Reducing stress, as endorphins are released during physical activity, which can increase well-being and reduce stress
• Improvement of general well-being, mental health and mood, reduction of anxiety
• Increase in general energy levels

Studies have shown that just two to three 30-minute bouts of endurance exercise per week can reduce fatigue in cancer patients [1,2]. Endurance exercise does not have to be extremely strenuous to have a positive effect. Training at a moderate intensity (approx. 65% of your maximum heart rate) is sufficient. Most people achieve this with a brisk walk, a lap on the bike or a few laps in the swimming pool.It is important not to exceed your own limits. It is generally recommended to start with light physical activities and slowly increase the intensity: walks where you increase the distance and walking speed over weeks and months, similar to other endurance sports. A training session should last 30-60 minutes, but intervals of at least 10 minutes are also fine. Easy activities are those where you can still have a good conversation. If it becomes more strenuous and you start to pant, activities are moderate training. However, this is just a rule of thumb.‍

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Strength and resistance training

Strength training is a form of physical training that aims to strengthen and enlarge the muscles through the application of resistance. In principle, this includes all exercises in which the muscles work against an opposing force, so that the muscles tense up more and work physiologically harder than in exercises without resistance. This resistance can be created by using weights, machines, elastic bands or your own body weight.

The general benefits of strength and resistance training include

• Maintaining and/or building muscle mass through stimulation
• Improving strength, muscle endurance and muscle function
• Improving posture and balance

Around 50% of cancer patients lose weight and muscle mass unintentionally during their illness. In a medical context, this is referred to as cachexia. Studies have shown that structured muscular training during chemotherapy or radiotherapy can have a positive effect on cachexia [5,6]. Regardless of the entity, strength training is recommended for all tumour patients in the (early) rehabilitation phase. Strength training can also have a positive effect on mood and quality of life and reduce fatigue [2].It is recommended that the large muscle groups are trained moderately two to three times a week for 45 to 60 minutes. However, it is important to carry out a strength test with an expert (e.g. sports physician, physiotherapist, in a good gym) before the first training session in order to determine the maximum load and create a training programme. Moderate strength and resistance training means that around 50-75% of muscle strength is used. Maximum strength training is not recommended during therapy. It is also recommended that you discuss with your doctor when training is possible.

Gentle forms of movement

Gentle movement types are activities that are gentle on the body and often aim to promote flexibility, balance, relaxation and mindfulness.

Gentle forms of movement focus on awareness of your own body, targeted controlled movement and breathing. They also take body awareness into account. A healthy body awareness describes a harmonious feeling that is in tune with oneself. You accept yourself and how your body feels. Gentle types of movement include

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• Yoga
  Yoga includes a variety of exercises, breathing techniques and meditations that can improve flexibility, strengthen muscles, calm the mind and reduce stress. There are different styles of yoga that focus differently on physical exertion, stretching and mediation.
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• Tai Chi
  Tai Chi is a Chinese martial art characterised by slow, flowing movements and deep breathing. Thai Chi promotes balance, improves posture and can help to reduce stress.
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• Pilates
  Pilates focuses on strengthening the core muscles, improving flexibility and promoting healthy posture. Through controlled movements and conscious breathing, Pilates can help to improve body awareness and reduce stress.
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• Qi Gong
  Qi Gong is a traditional Chinese practice that combines movement, breathing and meditation to promote the flow of vital energy (Qi) in the body. It can help to reduce stress, promote relaxation and improve health.
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• Water gymnastics
  Water aerobics or aqua fitness is performed in water and offers a joint-friendly way to improve endurance, strength and flexibility. The water reduces the pressure on the joints and enables a gentle workout. Water aerobics can also have a positive effect on stress levels and mood.
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• Meditative walks
  Meditative walk involves walking slowly in nature. During meditative walks, special attention is paid to sensory perception and breathing. They can help to reduce stress and calm the mind.

Drastic changes in life, such as a cancer diagnosis or an operation that may be accompanied by external changes to the body, can change the way you perceive your own body. These activities are particularly suitable for people who want to exercise after an injury, during recovery or with certain health restrictions.

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Gentle forms of exercise help to reduce stress through targeted and conscious movements and breathing. Clinical studies are increasingly showing that they can reduce fatigue and pain, counteract depression and anxiety disorders and improve quality of life. In addition, the repetitive movement stimuli lead to improved physical flexibility, stability and - depending on the method - strength. They can also reduce stiffness. Studies show that yoga and Qi Gong can reduce fatigue comparably or sometimes even better than strength and endurance training [7,8].

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