So now what? 

“So now what?” is a question shared by many patients who survive a cancer diagnosis. Although today cancer survivors live longer due to advances in preventative screening and intensive treatments, we don’t often talk about the repercussions of survival itself. Anxiety, depression, post-traumatic stress, and the constant fear that the cancer may return can significantly impact their quality of life. Physical and mental challenges do not simply disappear after treatment.

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Enter nature. In 2020 I led a study with cancer survivors in the Fraser Valley of British Columbia who headed out on group walks in the forest for two months, twice per week, with a hiking guide. At the end of our trail-walking program, our participants reported feeling significantly less stressed, consistent with the lower stress levels they described at the end of each walk. We believe their immediate improvement in anxiety was due to reduced rumination, thought spiraling, and distraction.

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One walker who had survived bladder cancer said, “There were no distractions. I could stay in the moment, then I’m not worrying”.

Another participant who had beaten colon cancer reflected on the changing seasons, saying,

“It’s just so full of life, so even at this time of year it’s just amazing part, most of the leaves were down so you are walking on the leaves so you are witnessing this sort of cycle of nature but at the same time there is life and birds and moths and…it’s just…it’s good.”

For another brain cancer survivor, her gratitude for the outdoors and her new lease on life was expressed in the words, “I am just so thankful. I do love trees. I feel like they are here to celebrate so I do touch them and hug them because I guess I’m just so thankful that I am still here.”

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More of my research in cancer survivors, published this year, showed that more minutes of outdoor physical activity were linked to increased happiness and higher quality of life, with simple outdoor walking the most common form of exercise. Not only that, but how connected patients felt to nature also boosted their happiness. Finally, our group believed that peer support was key to keeping them motivated to stick to their outdoor program.

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Tips for getting outside and getting active on your local trails after cancer

• Speak with your physician before engaging in a new physical activity program
• Start slow. Gradually increase your time until you can comfortably walk for 30 minutes. If you feel up for the challenge, add intensity by walking faster or up hills
• Find as green and biodiverse an environment as possible
• Find a support person to walk with you
• When walking in more remote areas carry a backpack with a basic first aid kit, bear spray, a whistle, water, headlamps, extra layers, and let someone know where you are going
• Wear hiking shoes with good grips
• For those with neuropathy, other balance impairments or obesity, use trekking poles
• For those with incontinence look for trails with washrooms. These can often be found near the parking lot and periodically along the trails

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‘Walk it Out’ with Knight’s Cabin

I do much of my research with Knight's Cabin, a national charity founded by Dr. Lisa Bélanger in 2014 to help cancer survivors live the rest of their lives in the best way possible. As we know from the research, two key elements to improve quality of life and wellbeing are physical activity and social connection. Therefore, our Walk It Out program was created to leverage the physical and mental benefits of movement and community.

In this time of physical distance, we hope to safely bring cancer survivors and caregivers together to ‘walk and talk’ in nature. Our goal is to establish small walking groups in communities across Canada that help people get active, get outside, and find companionship with others walking in the same shoes. These ‘green walking groups’ will allow people to experience connectedness with each other, themselves, and to nature.

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Walk it Out is actively seeking ambassadors to help spread the word and coordinate weekly walks for cancer survivors within their local areas. We also welcome survivors and caregivers to join us in experiencing the benefits of a green walking program.

For more details, please contact Katie Sevalrud at katie@knightscabin.com.

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With contributions from Joleen Prystupa.

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Dr. Iris Lesser is an Assistant Professor in the Faculty of Health Sciences at the University of the Fraser Valley whose research focuses on exercise in nature, mental health and chronic disease.

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