If you're diagnosed with cancer, the gym likely isn't your first stop.
But updated recommendations from a group of international experts, led by the University of British Columbia, are calling on doctors to prescribe exercise as part of cancer treatment plans.
The guidelines, published in Medicine & Science in Sports & Exercise last month, suggest specific "exercise prescriptions" would address common side effects, such as anxiety and fatigue, associated with cancer diagnoses and treatment.
The University of Waterloo's Well-Fit program has a track record of treating cancer patients and survivors at the gym, as part of a wider treatment plan.
Since 2002, oncologists at the Grand River Regional Cancer Centre have referred people to the 12-week program, run through the Centre for Community, Clinical and Applied Research Excellence. The exercise is prescribed during other cancer treatments, such as radiation or chemotherapy.
Patients come in two times a week, for one hour per session.
An exercise physiologist works with them at each session — everything from cardio and weights to resistance training and core work.
After the three months are up, patients have the option to continue coming to the program.
'I couldn't wait to get out of the hospital bed to get back at the gym'
At the start of 2018, Joanne Ross-Zuj entered one of the most difficult periods of her life.
She went through six rounds of chemotherapy after being diagnosed with non-Hodgkin's Lymphoma.
"You have no strength. You have no muscle. You basically are relegated to a chair," said Ross-Zuj.
She had her first session at the Well-Fit program six months after her diagnosis.
Ross-Zuj remembers feeling terrified. "Is it possible to flunk out?" she wondered.
But after a few sessions, she noticed a change in the amount of activity and weights she was able to handle.
Then it got to the point where she was actually looking forward to going to the gym.
"I couldn't wait to get out of the hospital bed to get back at the gym because it just gives you that energy that you need to … connect back to life," said Ross-Zuj.
Ross-Zuj says it's the little things that have meant the most. She has her independence back. She can tie her own shoes. She has the energy to entertain in her home.
"You get stronger and stronger and life starts changing for you because the chair no longer is your day," said Ross-Zuj.
"This program just brings you back to life."
'The cancer centre keeps me alive, but the Well-Fit program keeps me living'
For more than 14 years, Anita O'Brien has been lunging, squatting and planking every week.
It's a drastic change from her life before breast cancer.
She didn't work out regularly. The thought of big exercise classes made her cringe.
"You know if somebody yells at me and says, 'Do this,' or 'Try more,' or whatever, that would be it," said O'Brien.
She was receptive, though, when her oncologist at the Grand River Regional Cancer Centre told her about the benefits of exercise as part of a treatment plan.
Now, she feels fit, both mentally and physically. The individualized exercise program and instruction has kept her alert and active.
But the other big driver in sticking with the work-out prescription is all about community.
"It helps me with people who understand what I might be going through. Sometimes if you have a new medication, you can say, 'Does anybody have this or has anybody had this side effect?' so that keeps you going," said O'Brien.
"The cancer centre keeps me alive. But the Well-Fit program keeps me living."
'I wanted to actually keep up with my young kids'
When Scott Leatherdale was diagnosed with stage three colorectal cancer earlier this year, he immediately told his oncologist he wanted to be part of the University of Waterloo's program.
He's a professor at the university in public health, so he was familiar with how it worked. As an academic in the field and an active person, his doctors didn't have to sell him on the benefits of exercise.
His goal was clear from the onset — to stay active through treatment.
"I wanted to keep playing hockey because it was in the winter, and I play hockey four times a week," said Leatherdale.
"I have two young kids at home, so I wanted to actually keep up with my young kids, so they built the program around allowing me to be able to cope with the radiation and chemo daily."
Leatherdale says a prescription for exercise worked. Even on the days when he felt miserable, he felt obliged to show up to his workout session.
"It was a good motivation to get me over those humps sometimes when you didn't necessarily have the energy. If you just did the program they prescribed, you actually felt quite better at the end," he said.
'We want them to feel empowered'
More than 2,000 patients have been prescribed exercise through the University of Waterloo's program over the last 17 years.
Lori Kramer, an exercise physiologist and kinesiologist with the program, has worked one-on-one with hundreds of patients in the gym.
"People come in are having a really tough time just getting through their day-to-day function because they feel so tired and so rundown from treatment and within a few weeks they are better able to get through their routines at home and feel much better after after exercising," said Kramer.
She's seen dramatic physical strides, especially with patients who have kept coming since the program started.
But Kramer recognizes there's another imperative goal for patients beyond increased energy and ability.
"We want them to feel empowered, that this is something that they can do at a time where there is, you know, a lot of loss of control in their life," she said.