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Provider Chat with Janette Poppenberg

• Brad Buchanan and G [Josie] van Londen

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In this episode of Cancer Survivor MD, Dr. Josie van Londen is joined by Brad Buchanan, Colleen Dwyer Diehl, and special guest Janette Poppenberg, a cancer-certified personal trainer in the Pittsburgh area, for a practical and compassionate conversation about physical activity after cancer treatment. Focusing on survivors who are no longer in active therapy, the group discusses how to safely begin moving again, why “start where you are” matters, and how small, consistent steps can help rebuild strength, stamina, confidence, and trust in the body.

Janette explains what a cancer-certified personal trainer does, how assessments can be individualized, and why range of motion, aerobic capacity, and muscular strength all matter in survivorship. The conversation also explores cancer-related fatigue, the role of medical clearance and primary care involvement, the potential value of oncology massage, and realistic motivation strategies—such as starting with five minutes a day, pairing movement with something enjoyable, and finding supportive groups or classes.

The episode emphasizes that exercise is not about perfection or pressure, but about finding safe, meaningful ways to move that fit each survivor’s body, energy, goals, and life.

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SPEAKER_02

Hello everybody, welcome to another episode of Cancer Survivor MD. This time I'm with our usual guests who you know from previous episodes, Brent Buchanan and Colleen Dwyer Deal. But today we have a fourth person joining us, a special guest. Her name is Jeanette Poppenberg. She is a cancer certified personal trainer who works in the Pittsburgh area. Her links and contact information will be in the show notes. We have the pleasure of talking with her today for about an hour about everything she knows about exercise for cancer survivors, although we will add some disclaimers and we will delineate who this episode is for specifically because there's different types of cancer survivors, and today we're focusing on a very specific group of cancer survivors who are in the non-active therapy phase with the hope that a second episode will follow where Jeanette can continue her sharing of her wisdom for those who are in active therapy. One of the things I would like to say to the listeners is please go back to a previous episode that Brett and Colleen did on lifestyle and health behaviors. Some general disclaimers and pearls of wisdom that I uh addressed in that particular episode, I would like to start off with in this particular episode. And that is that yes, exercise can help survival quantity of life, quality of life of everybody, including cancer survivors. We're learning more and more about how it helps us to live longer and live better for many, many survivors of many tumor types. And survivors often see that as a way to take control after they were diagnosed with cancer and went through cancer therapies where they often feel that they are without control. However, I want to say that there is at the current time not enough evidence to say that there is a perfect exercise regimen for a cancer survivor, let alone a cancer survivor of a specific tumor type. And secondly, at the end of the day, your lifestyle is not the only factor that determines your outcomes. And having said that, I'm going to give it to Jeanette, who, as I mentioned, is a cancer certified personal trainer. She has many more certifications, but I'm letting her explain the alphabet soup to you. So without further ado, here is Jeanette's.

Meet Janette

SPEAKER_03

Thank you, Josie. I'm glad to be with you here today. I've been a cancer exercise trainer for 20 some plus years, working with all different types of cancer survivors and actually cancer patients at different parts of their life. As Josie has said, we're going to talk about today specifically those who are survivors, who are done with treatment, who are possibly maybe just on a maintenance treatment plan at this point, and who have the energy and the bandwidth to think that they might

Start Where You Are

SPEAKER_03

want to do a little bit more. Two of the things that come across all the time when we're working with survivors is wondering how to trust your body again and learning to do that. And I think that's really important and something that physical activity can do for you. And it's also very important to meet yourself where you are, what works best for you. And at the point you are, where's your energy level? How do you feel what still hurts? How could we make that better first before we go on to more or different types of physical activity? I'm more and more liking replacing the word exercise with physical activity because our bodies are meant to move, and motion is lotion. The more that we move ourselves, the better we can feel. And so I think it's important that it doesn't have to be a dedicated exercise plan that you're going to carry out, but maybe it's activities of daily living, or maybe it's a certain type of exercise that you want to do. But whatever it is that works for you, that's what we want to work towards. Early on in my education, one of my professors said, and I think this holds a lot of truth. If if you're just getting back, if you're just starting to move again, maybe the best thing for you to do is start with massage, if that's something that you're open to and that is available to you. Because you can learn to stretch those muscles and work those muscles and wake them up again in a more benign manner than maybe some more extenuating physical activity that you're thinking about. But it's a good way to get started again and see what you need to work on and how you can do that. So, Brad, Colleen, Dr. Dennis, tell me what's on your mind. Like, what are you thinking about for survivors? What do you want them to know about physical activity?

SPEAKER_01

Well, I'll just jump in here because I have a question, even just going back to what you were saying about starting where the person is and what feels good for them. Like maybe you could talk about in a session, what happens with somebody.

Assessments and Priorities

SPEAKER_03

So when we do meet with somebody initially, um, we want to know about the treatment plan, what has occurred, what what's happened to them. We want to know their story. That's really important. And then once we know that story, what was their physical activity like before? And what are they doing now, or what might they want to do? Um, I think one of the hardest things is particularly if somebody was very physical, physically active before, is to then be patient and consistent in getting back to the activities that you want to do. Sometimes it's just a discussion and starting out with some very simple things that they can do to gain some strength or endurance. Sometimes it might be assessing their physical fitness. And so we might do some fitness tests to make sure that all the components are there and what might need to take priority. So one of the things that's really important, I feel like in my practice when I'm working with somebody is I want to make sure all the ranges of motion are present first. Because if we have all the range of motion that we need, we're less likely to have an injury. And of course, nobody wants or needs that. And then we work on aerobic capacity. What are they doing for aerobic capacity? If anything. And when I say that, it could be going out for a walk, but it could be maybe you want to be able to wash your kitchen floor on your hands and knees without being breathless, or wash your car. It it could be any of those things. But if we want to be able to get back to doing those things, how do we do that safely? And then lastly, but not any more least important, is muscular stress. So often during treatment, we don't have time to be physically active or we don't feel like being physically active. And so we're losing muscle mass every week that that occurs. And so muscular strength is very important. There's kind of a new tagline out there that muscle is the currency of health. And starting at the age of 30, no matter what, we begin to lose our muscle unless we're doing something about it. And then if you have a diagnosis and you have treatment, you could possibly be even losing more than you would have. And it's really important to build up that muscular strength in any way you can, any type of physical activity that works for you, so that you can be as healthy as you can be and age well, still doing the things that you enjoy doing. Um, did that answer it, Colleen?

SPEAKER_01

Thank you. That gives us an idea where how you meet with them and what happens

Consistency

SPEAKER_01

during your sessions and where they are. I guess the second part of my question was then when you do start where they are, do you see that they become more consistent or like because I think I hear a lot, people don't know where to start, they don't know how to start. It's overwhelming to think about because they know they should be doing something, but they're not really sure what that is, and they're scared. Yeah.

SPEAKER_03

Yeah. Very good point. It is really important to meet somebody where they are. So that's why sometimes I don't start off with physical fitness testing, because that's not where somebody is, and that's too overwhelming in itself. Some guidelines we use, and these are going to be some of our takeaways from today's discussion, is you brought up a very good point, consistency. That is the key to all of this, being consistent with our physical activity. But we do have to start off with small doses and build that. And it might be building that up again, or it might be building it for the first time. But it is how you're going to get your energy back, and it is how you're going to be able to combat any fatigue that you might be feeling. So, one of kind of the rules of thumb we use is that just do five minutes of something every day. And that five minutes can be out for a walk. It can be just walking around your home, it can be washing the car or gardening or sweeping your floor, whatever that five minutes of activity is. But the key to this is then we have to do another five minutes the next day. And the next day we have to continue doing that five minutes. That's where the energy is going to come from. And that's where we're going to be able to then get better and proceed and do more. Because once you do that five minutes for a period of time, you'll realize that I can have that six minutes, and it's not that hard to do. It it becomes part of you, it becomes easier to do, and you get the energy that you get to do the things that you want to do.

SPEAKER_00

See,

Massage and Recovery Story

SPEAKER_00

that's that makes a lot of sense. And um I I wanted to sort of echo what you previously said about massage. And I never thought I'd be a person to go get a massage. I thought that was for you know ladies at the spa or something. But, you know, just going back to where I was post-treatment, I was essentially bedridden for a few months in a hospital, and then they sent me home when I was blind still, and I had lost a ton of muscle mass. So I could barely get off the couch. And you know, I eventually started to go for walks around my neighborhood, first of all, on someone's arm because I was blind, and then I got more confident using the white cane, so I started walking around here with my white cane. But I I did need a lot of occupational therapists to help me with my balance because I was falling all the time. You know, when you lose your vision, you lose a lot of your balance too. And I really had to relearn how to walk to some extent. But that was a very peculiar side effect of my treatment that you know I was blind for a year and a half. But when I got to the point where I was like, okay, I can do something more than just walk around, I started getting massages. And the first actually was from someone who built herself as an oncology massage therapist, which basically meant super gentle massages. Uh, because I still had like a portline in my chest because I was being treated for my chronic illness that I got after my transplant. Graf versus host disease. So my medical team said, Brad, no deep tissue massages. Even though I was done with my treatments for cancer, I was not done with other treatments for my chronic illness. So anyway, I did the oncology massage for a couple of years, and it was nice. But I still had problems with that range of motion that you were talking about. Because I I had slept on my side in in the hospital for months and months, and my shoulders were completely hunched forward. Like I was in terrible posture all the time. And I still get massages to try to get my shoulders back where they started. They're better now, but without massage, I would never have gotten that range of motion even partly back. And I still have challenges in that regard. Like I still can't like throw a baseball the way I used to, or reach the top shelf in the pantry without some difficulty. But yeah, massage has been instrumental and kind of just fitting my body back together again. I don't know if I cancer patients feel this way, but certainly people who've had a stem cell transplant feel this way, that our bodies often feel like they have been disassembled and put together improperly so that they don't feel like they're connected from head to toe. But and massage was like the number one way that I felt like my body got reconnected. And so anyway, I if people can get over their inhibitions, especially guys, I think, have trouble with this. Getting massages, you know, I I like to say that that's the last uh optional expense I'm gonna eliminate from my budget. I I don't have insurance that covers massages, but I I'm gonna keep doing it as long as I possibly can. But yeah, and I, you know, I I still have challenges, like I can't really run any longer because the something about the chemo regimen just made running extremely painful for my knees. So I've had to shift to lower impact stuff like riding my bike, which I do every day. If it's nice outside, if it's not, I ride my stationary bike inside. And and that's been a wonderful way of like even walking long distances is too high impact for me. So anyway, I I I really do appreciate your impulse to meet patients where they're at and not be unrealistic and getting them onto some fitness regimen that just may not be at all what they need, you know. As I say, because I was starting from ground zero, like, can I get off the couch today? That would be fabulous. Anyway, so that's just sort of my my two cents on on what you've already helped us to understand so far.

SPEAKER_03

And kudos to you for listening to your body and doing what it needed. And I I appreciate the point too. I did have a deep tissue one time, and honestly, it took me about two weeks to get over that passage. But it was it was almost worse than some of the harder workouts that I had. So it's a good caution, but to the point is that it does stretch and wake up those muscles, hopefully in a lighter touch and in a more gentle way, but it is a great way to get started. And also to give yourself the grace to say, okay, this the running's not working, it's hurting my knees, but there are options. There's always something that you can do, and you found it for you, and you made it work, and that's so important.

SPEAKER_00

Well, and I still have fantasies, of course, that I will somehow recover my enough like muscle mass, or somehow I'm taking glucosamine and chondroitin supplements because I have heard on you know, whatever, this is just commercial advertising that somehow that will rebuild, or who knows what it'll do. But I'm I'm hoping that someday my knees will stop hurting. But I'm not gonna wait around for that to magically happen. I I still need to exercise every day.

SPEAKER_02

Gotta do something right.

SPEAKER_00

Yeah.

SPEAKER_02

I wanted

Working with PCP

SPEAKER_02

to ask Jeanette, how do you involve the PCP in this creation of an exercise regimen that you make for a cancer survivor for safety?

SPEAKER_03

Good question. So, yeah, my certification is from the American College of Sports Medicine. And one of its arms is called exercises medicine, which is another one of my certifications. And exercise is medicine talks about different diseases, diagnosis, and how exercise impacts those. And it also has that arm of how do we keep your PCP or other professionals in the loop to help you. And so it's actually becoming more and more popular to do that. So I do get that request sometimes. So the biggest thing is if I'm working with somebody and they just generally, if they want reports sent to their PCP and happy to do that, probably though, the easiest way to do that is if somebody does the physical fitness test. Um and when we say that, I just I don't want anybody to be scared away by that. If you're working with a professional and they say they want to do some physical fitness tests, they're usually just five or six physical activities that take no more than two minutes. They're usually 30 seconds or they might even just be a stretch, but we're just quantifying where you are in range of motion, in strength, in aerobic activity, in agility. And so if you want a update to go to your PCP to work with them, that's probably the best thing to do because we can quantify it. We can give them numbers as to where you are when we start, and then we can give them progress reports and we can have that conversation back and forth. I am seeing more and more PCPs adding a physical activity component to their prescriptions for their patients. And so I am actually getting more and more requests for that kind of information because they want to know that their patients are doing something and progressing. And so I think that exercise is medicine arm of the American College of Sports Medicine is going to become very beneficial for not only the patient or the survivor, but for the medical professionals as well.

SPEAKER_02

Thank you. Thank you, Janet. Do you need a patient's provider to give a clearance that they're safe to participate in physical activity? Is that something you usually do? Is it something that the patient should proactively pursue?

SPEAKER_03

100%. We want the um know if the PCP has any concerns or the oncologist. Do they have any concerns for this particular patient first? And we need to address those. And those might be addressed through other professionals like a physical therapist or an occupational therapist. We want to make sure things are in order first before we go ahead and work with them. Absolutely.

Cancer Trainer Explained

SPEAKER_02

And I I realize, Jeanette, that I went about this a little bit the wrong way. But can you tell our listeners what a cancer certified personal trader actually is? What makes that certification what makes you so special? Thank you, yes.

SPEAKER_03

So the certification has been around since about 2007. And you specifically study the different types of cancer, the different treatments of those cancers, and how physical activity affects that. So and the one thing I will say about my certification is there is a lot of practical hours, which I think is very important that you're being mentored and working with survivors or maybe people in treatment, because actually that's how it's all moved. It's moved to a physical activity being done during treatment as well as outside of treatment now. Um, but um understanding how all of this works together and what can be beneficial and helping them feel as strong as they can, helping them maybe not to lose their strength or mobility during treatment, how to get it back after treatment. So, and you do want somebody that understands that. You don't want to go to a basic trainer, physical fitness trainer, because they might not have that knowledge, that understanding. And there are some special circumstances that have to be addressed before you can proceed.

How to Find a Cancer Certified Personal Trainer

SPEAKER_02

How can people find whatever they are? Because listeners are all across the globe. Where can our listeners find a kids a certified personal trainer? And do they all meet to meet in person, or would there be the opportunity for video visits too?

SPEAKER_03

So I do work in person as well as virtual. Like a lot of certifications, right now, at least, we're not confined to a state or several states. So that is one nice thing. If you find somebody that you think you're interested in working with, we can cross state lines to do that. Um the American College of Sports Medicine used to have a When I say used to, we'll qualify that for a second. Um a site called Profinder, where you could go in and list where you are and list the certification you're looking for, and it would come up. The last time I tried to do that, it wasn't working exactly how it used to. Um they've updated it and it's different. Um, so I apologize that I can't give you more information on that right now, but I do know that it does exist so that you can't find that.

SPEAKER_02

We will put the link in the show notes. Thank you, Judette. I know Colleen had a question, and Brad's face looks like he has questions too. So I'll be silent for a

Exercise Dosing to Help Post Treatment Symptoms

SPEAKER_02

bit.

SPEAKER_01

I was just gonna throw out fatigue. I feel like when we talk to people that are in this stage of their cancer experience, fatigue is something that comes up often, and just trying to deal with it, and it's it's just unlike anything you can explain unless you've experienced it. So could you talk a little bit about trying to exercise when you feel that level of fatigue?

SPEAKER_03

No, fatigue is the number one concern that we get, that we hear, that people are experiencing. And it does go back to that something is better than nothing. And it uh Dr. Josie, you could jump in here on this one too. My understanding, my training is that if everything else is in line, the person is no longer anemic or there's no other medical conditions that are precluding them from being active, that the number one way for them to get their energy back is through physical movement. But that has to be done slowly and consistently. I'm gonna let you jump in there for a second.

SPEAKER_02

Yeah, correct. You need to make sure that you rule out any medical contributors, or if there are medical contributors, that you optimize that as much as they can, that a person is safe to exercise, or if they are not safe, that there's precautions and limitations prescribed to the patient. And that yes, exercise is one of the highest impact factors to help fatigue. Similarly, with other symptoms that cancer survivors can have, such as brain fog, exercise has one of the highest therapeutic impacts after having corrected for any medical contributors to make sure that we're not missing anything and we're being safe. And in terms of physical activity, start low, go slow.

SPEAKER_03

Absolutely. Yes. So that leads me to kind of my third takeaway for today's session is that there is actually a chart that's put out by the American College of Sports Medicine called the effects of exercise on health-related outcomes in those with cancer. And why I feel like it's so important for every cancer patient survivor to know that this exists, and Dr. Josie will put it in the notes for this session, is that we actually have research that strong evidence for certain side effects that you might be experiencing and how much physical activity you need to combat that to help yourself feel better. And so fatigue is number one on the list. We do know that a combination, a dosage of exercise between aerobic activity as well as resistance or strength training, if we can build up to doing a certain dosage of those two things every week, we can actually combat the fatigue that you're experiencing. And please rest assured, the fatigue you're experiencing is very different than somebody just saying, I'm tired. We understand that. We know that it's very different. It's a fatigue that you can't just sleep away and it's better. That's not going to happen. But the awful thing in some ways is that the thing that actually helps it is the thing that you least want to do, is move, right? So that's why it has to be that small dosage that we do consistently and we build up slowly in doing and have to be patient. Give yourself the grace to be patient.

SPEAKER_00

Yeah, thank you, Jeanette. I and all of that is it makes perfect sense, and our rational minds know that we should be exercising.

Motivation Tricks that Work

SPEAKER_00

But my question, and I'll preface it with a little comment of my own here. I watch a lot of sports. Why do I do that? Because that is my motivation. Like, I don't feel like exercising every day, but I know I should. So, how do I motivate myself? Well, I find a video or a live game of some kind where they're running around or skating around. There's lots of sports out there, and so I watch the sports on my phone while I'm on my exercise bike. If it's not a nice day and I don't have anywhere to bike, you know, that's my trick anyway, to like remind myself like, okay, I know I'm not going to play soccer or hockey again. Very unlikely. However, by watching the game, I can remind myself, oh yeah, this is a this is a wonderful thing that all these people are able to run around and play the sport. And so that's my little you know, trick in some ways to motivate myself to get off the couch. Because I spend a lot of time on the couch or on this leather chair that you see me in. But I know I need to get off and and do something every single day, or else my body will hate me. But uh, Jeanette, I'm wondering if you have any motivational tricks that you know you might have used successfully.

SPEAKER_03

I love that's the impression that it's kind of a joke here at Cancer Bridges with me because I was never I didn't start jogging till I was 40. I never liked to run. I was always a speed person, short, quick distances. I never liked long distance. And I I wanted to become a jogger. I wanted to figure out how to do that. And so a couple things that have become kind of legendary around here that I did to make that happen is often I slept in my exercise clothes with my shoes by the door and my alarm set so that when that alarm went off, I got up, I put my shoes on, and I was out the door. But the other thing that I had to do was I drank one cup of coffee every morning and I love that cup of coffee. I just love the smell, the warmth, but I had to go for my dog before I could have that cup of coffee.

SPEAKER_00

Oh, oh, that's that's almost masochistic.

SPEAKER_03

That is how I became a jail. I like your way much more, Brad. I think I'm gonna let you a dog.

SPEAKER_00

Well, but you know, I I really like what you um what you shared. And um, you know, I that's the going to bed in your jogging clothes, like that I realized at one point that was the biggest obstacle for me was just getting into the clothes to get out and run, right? Like when I was when I was jogging, and I I I started jogging in again in my middle age because I wanted to have more endurance to play soccer. And I realized like the biggest barrier to my exercising was just taking off the clothes I was wearing and putting on the jogging clothes. So, first thing in the morning, you know, get up and you don't don't put on your regular clothes, don't have a shower, put on your jogging stuff, and eventually you'll get around to doing it. Right. So, yeah, I really like that. Whatever works, you do you anyway. Thank you for sharing that.

SPEAKER_03

But you're but you're right. We we all have barriers to entry, right? Barriers to how we're gonna do this, and we have to figure out what those are for ourselves and how we can get past them because that's the only way we're gonna end up building any consistency up if we make it easier for ourselves, less decisions.

SPEAKER_00

And I like the reward of the wonderful cup of coffee.

SPEAKER_01

Yeah, I like the idea of the of the sports. That was that was a great one, Brad.

SPEAKER_00

I figured I might as well share it because yeah. And you can watch sports any time of day now with YouTube, and you know, there's a sports 24-7 in this in this world. So it's not hard to find.

SPEAKER_02

So

Wrap Up and Take Aways

SPEAKER_02

uh we are approaching the end of this first episode that is focused on those long-term survivors, those are who are starting the long-term part of their journey, not on active therapy. Jeanette hopefully she's willing to come back and do the second episode, which is a little bit more challenging, talking about physical activity for those who are on active therapy either in the beginning of their journey or those living with uh with cancer. One of the things that I would like to end with is that you're not alone. Please talk with your providers if it's safe for you to resume or initiate uh physical activity, if there's any limitations. And there are people like Jeanette available to you, maybe hopefully in person, but if not, uh through video visits so that you can regain the courage and uh the inspiration and the motivation and education, I guess, to slowly but surely uh increase your physical activity level. And then I give it to all of you to share any take-home message if you have any.

SPEAKER_01

I'll just add one of the many roles that Jeanette plays, because she has many different hats, is that she is the cancer exercise trainer at Cancer Bridges. So she is involved in many programs here. And Jeanette, I was just gonna throw out the let's get moving program where you do one-on-one sessions for up to three of them with those that have had or are in treatment or post-treatment from cancer. And then they can join a group class that happens. So if that's something that you're interested in, Dr. Josie will have a link in this podcast for you to be able to join that. And I just appreciate the conversation today. I feel like it's just so real, you know, just to share these experiences. So thank you all.

SPEAKER_00

Yeah, and um, you know, this just occurs to me, and I don't have a specific organization in mind, but um, there are a lot of groups of people who are cancer survivors who get together to do a team sport like rowing. Cancer survivors are now sort of a critical mass where we can get together, find each other in large enough numbers to support each other in participating in this incredibly powerful exercise. Because I I think if you can find other people, you know, eventually what I did, and this is before the pandemic, and unfortunately, this option no longer exists because the gym closed as a result of the lockdown. But I I joined a gym where it was basically retirees, and I myself was retired, but people much older than me who were either recovering from illness or or you know working on an ongoing disability, that we all went to this gym together to sort of do you know fitness activities that were pitched for people with our slightly, you know, I would say moderate capabilities. In other words, not the gym where you're watching the incredibly buff guy watching his biceps flexing in the mirror and feeling judged and less than. Uh so there are ways to get connected with other people who are in a similar space to yourself after cancer has done a number on you. So I think that that is that would be an added motivation is to get involved with a group or a team.

SPEAKER_03

Yeah, that's a wonderful idea, Brad. And yes, we do locally here in Pittsburgh, there's at least two rowing teams for cancer survivors and that camaraderie and that scheduling. I'm gonna be there Thursday at six o'clock with my team, and having people who understand makes a huge difference. That's really important. I think we could share some of those links as well. I enjoyed being with all of you today. This was fun. And I would say my three takeaways from today for all of you is start where you start where you are. Something is better than nothing. We can find something that we can do. Health transformations are build on the foundation of tiny, consistent steps. So, whatever that is for you, reward yourself, pat yourself on the back for taking those small steps and being as consistent as you possibly can. And if you're really struggling with a side effect of treatment, know that, and and we'll post this in the information, that we do have strong evidence, particularly for about six of the side effects that we commonly hear about, and the dosage of physical activity that's needed to help with that side effect. And so there is help out there for you.

SPEAKER_02

Thank you, Jeanette. Thank you, Brit. Thank you, Khalid. We hope you will return to us, Janette, for part two.

SPEAKER_03

I would love that.

SPEAKER_02

Thank you.

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Josie

Host
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Brad Buchanan, PhD, MA

Co-host
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Cancer Bridges

Guest
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Janette Poppenberg

Guest