What if running could help you heal? In this episode, Dr. Denise Millstine sits down with author Josie Lloyd and cancer rehabilitation expert Dr. Nandita Keole to explore the powerful intersection of breast cancer recovery and exercise through Josie’s uplifting novel The Bright Side Running Club. Inspired by her own diagnosis, Josie shares how journaling and joining a running group transformed fear into resilience and community, while Dr. Keole explains why movement—even during treatment—boosts strength, mood, and hope. Together, they remind us that thriving after cancer isn’t just possible—it starts with one step forward.
What if running could help you heal? In this episode, Dr. Denise Millstine sits down with author Josie Lloyd and cancer rehabilitation expert Dr. Nandita Keole to explore the powerful intersection of breast cancer recovery and exercise through Josie’s uplifting novel The Bright Side Running Club. Inspired by her own diagnosis, Josie shares how journaling and joining a running group transformed fear into resilience and community, while Dr. Keole explains why movement—even during treatment—boosts strength, mood, and hope. Together, they remind us that thriving after cancer isn’t just possible—it starts with one step forward.
This episode was made possible by the generous support of Ken Stevens.
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Dr. Denise Millstine
Welcome to the “Read. Talk. Grow.” podcast, where we explore women’s health topics through books. Today we'll talk about breast cancer and exercise. Our book is “The Bright Side Running Club” by Josie Lloyd. I'm your host, Dr. Denise Millstine. I'm an assistant professor of medicine at Mayo Clinic, where I practice women's health, internal medicine, and integrative medicine.
My guests today are Josie Lloyd, who's been writing novels for 25 years. She's the mother of three daughters and a beloved dog, Ziggy. She lives in Brighton in the UK with her husband, Emlyn Rees. Together, they've written seven internationally bestselling novels and their latest joint venture, “You & Me & You & Me & You & Me” will be out in the United States in February 2026.
Josie was diagnosed with breast cancer in 2017 after a routine scan. She wanted to read something positive, hopeful and uplifting about what she was going through, and so she wrote “The Cancer Ladies Running Club,” published in the States as “The Bright Side Running Club.” She's also written the screen adaptation of her novel, which is in development as a feature film. When she's not writing, Josie loves traveling, cooking and is a keen sea swimmer and swims all year round no matter the weather. That has got to be cold. She's also a patron of the charity Lobular Breast Cancer UK and regularly runs journaling and wellbeing workshops to help women going through a cancer diagnosis. Josie, welcome to the show.
Josie Lloyd
Thank you so much for having me. It's lovely to be here.
Dr. Denise Millstine
Our physician expert guest is Dr. Nandita Keole, who's an assistant professor of physical medicine and rehab at Mayo Clinic in Arizona, where she focuses on cancer rehabilitation. She teaches at the Mayo Clinic Medical School and is the current chair of the Arizona Society of Physical Medicine and Rehab. Her work focuses on helping patients recover, function, and improve quality of life during and after cancer treatment, including focusing on exercise as medicine. Nandita, welcome to the show.
Dr. Nandita Keole
Thank you. I am so excited to be on this.
Dr. Denise Millstine
All right, let's talk about the book. One of my reading besties, Chelle actually preview “The Bright Side Running Club,” which was such a gift for me and emphatically, immediately upon finishing it, urged us to consider having your book and you, Josie, on the show.
For our listeners, “The Bright Side Running Club” is a women's fiction novel about Keira, who is busy in mid-life with her three children, running her business, and is happily married to her husband Tom. She feels she's doing really well in life, but perhaps healthy living isn't her top priority. She's sideswiped at a mammogram when she's told she has breast cancer. What follows is a story that encompasses two basic themes. One is Keira's diagnosis, treatment, her family's reaction, and how she's becoming involved in a running club that changes everything for her.
Okay, you both know how “Read. Talk. Grow.” works; we discuss books that portray health topics in an effort to better understand health experiences through story. In this case, we'll discuss breast cancer again, but focus on the importance of exercise. Josie, will you talk more about your inspiration for writing this book?
Josie Lloyd
Absolutely. One of the reason that I wrote this book was because I always tend to fiction in times of crisis. And in 2017, I had been called up for a routine mammogram test. It was actually a pilot scheme to test women under 50, and I noticed a tiny dimple appear in the bottom of my left breast, and I could only really see it when I took my shirt off my, you know, my running bra or whatever.
And I've been to the doctor twice, been to my GP twice, and the GP had said, oh no, it's nothing to worry about. I can't feel a lump, right? So I was sent away. So when this appointment came up, I thought, well, the gods are smiling. And off I went to go and have this routine mammogram. And of course I said to the woman in the clinic, I said, well, I'd been to the GP and she said, well, you should have been seen no matter what, because nine times out of ten it's nothing, but if there's any change in your breast tissue, you should have been seen. And I'd only really got the message that we were looking for lumps and there wasn't a lump anyway. The biopsy was done, but I knew straight away at that appointment that it was really terrible and that I was going to have a breast cancer diagnosis.
And so firstly, I started writing things down. I'm a great believer that writing is a great comfort and it gets all your thoughts out and I started writing down my experience. And one of the things that I found really the most upsetting about the whole thing is that suddenly my life as I knew it, felt like it had been ripped away from me, and that instead of being Josie and also a mother I wrote all these kind of things, I was suddenly like, everybody's looking at me going, oh no, she's got cancer.
Oh, she's got cancer. In a kind of really pitying me, my life is over kind of way. And I found that kind of labeling awful. Also, you're not allowed to have a sense of humor when you get a cancer diagnosis because people expect you to be very, very serious. And I'm not a very, very serious person. And I always take the humorous look, can I say, cope with things through humor?
So I found my only real outlet for this was to write things down. And I went to the school gates and I met this woman called Roz, she's a mum, and she also had breast cancer. And she said, well, you must stay fit during your diagnosis. And I said, no, Roz, I am going under the blankets and the duvet with the chocolate biscuits forthwith. Goodbye. She said no, no no no no no, you need to really stay fit. You need to keep healthy. And so she said, I run a group of women who are running through cancer treatment, come and meet them on the seafront in Brighton, where I live.
So off I went with quite a lot of trepidation to meet this group of women, and it was a little bit like being very heavily pregnant and then meeting brand new mothers, because they gave me all the horror stories, all the details of everything that happened to them. And I was slightly a rabbit caught in the headlights, but I really liked their gallows humor and the fact that we got on and they were like, no, you're going to get through this. It's going to be fine. And some of them were the other side. And we started running and I had been a runner. You know, I've done a marathon before, but it didn't really sort of occurred to me that when I was poorly, I should put my trainers on and, and go and run, but actually a little bit of a run in the fresh air did my soul a lot of good, you know, and my headspace a lot of good.
So I came back and I carried on writing this journal of mine as I kind of get swept into the treatment, you know, juggernaut that you find yourself on. And a couple of weeks later, I went down and there was a journalist from the local newspaper, and they were there with the (unknown), and they said, oh, it's so good that you're running the Brighton Marathon 10K. And I said, what? What? Didn't I tell you this was the training group for the marathon 10K? No Roz, no, actually you didn't at all. And so I kind of didn't know what it was going to do it.
I had two rounds of chemotherapy. So it's just before my third round of chemotherapy. So I'd run out of hair and you know, I was beach body ready for the first time ever in my life, smooth as a seal I was. But anyway, so I started running and in this race and very soon I was exhausted. I was really tired and I started running and I got really breathless. And then I took off my cap, and I got rid of my cap and I was running boot and then this amazing thing happened. A woman came up to me, she tapped me on the shoulder. She said, I'm Clare, five years, keep going. And then somebody else tapped me on the show and said, I've been through what you've been through. You keep going. You're doing really well.
And then there's one woman ran with me and she said, I had to, you know, stage three cancer. They thought I was a goner. But look at me now. And she had this long, gorgeous brown hair and she was really healthy. And she just keep going. And on the last turn of the race, she'd waited for me. And she said, I just want to tell you something. And I said, what is it? And she said, well, when I was going through my cancer treatment, I was in the hospital and I was in a cafe, and I was at my lowest ebb really feeling terrible. And this woman across the cafe came over to me and said, I want you to know that you've got to keep hope and that actually your life the other side of cancer treatment can be better than ever. Mine is. And you've got to keep up hope. And this woman in the cafe taken off this little butterfly necklace and given it to this runner and said, this is a little butterfly of hope, and I'm giving it to you. And I want you to know that your life will be better the other side of cancer. And in this race, this runner said, I've been wearing this necklace for three years, and I've been wanting to pass it on, and I've just realized that it's you. And she gave me this necklace. She's gifted me this necklace of this little butterfly, and she put it around my neck and we had a cuddle and I don't know her name. And she gave me a hug. And then I found my gang, and we went over the line together. And it was such an empowering, incredible experience, this experience of friendship, not just from these new runners that I've met, but just from these all these women in the race. And I kind of thought, I really need to write this.
So when I finished all my diagnosis and my treatment and I've gone through it all, and I had quite a lot of copy left from this diary, I gave it to my agent and she said, what do you want to write a memoir? And I said, no, actually, what I want to write is a story that that gives some hope. Because actually in fiction and on television and in films quite often, you know, novelists will all the screenwriters will bring out cancer is the big gun emotional scene. And we all know we've all seen the films, we all read the books with the mums dying with tubes up their nose. And I'm like, well, hang on a minute, 1 in 7 women in this country get breast cancer. There's many, many of them that thanks to our great detection, early detection systems and fabulous treatments, survive, but only survive, they thrive the other side. And where are the stories of those women? Because I've been I've written 22 novels. You know, by that point, where's my story with a happy ending? So that was very much my motivation for writing “The Bright Side Running Club,” to show people how you could get through something like that.
Dr. Denise Millstine
I love this so much. And for listeners who have not yet read “The Bright Side Running Club,” you'll see some of these details that ring through into the fiction and the one that I want to highlight before I ask Nandita about her reaction to the book is about the dimpling on the breast, because when I read that about Keira, it made me cringe and I realize health systems are different and approach to women can be different. And also this is your experience is now eight years ago, which hopefully is a little bit different.
But for women who are listening to this episode, if you see a dimpling or a change, especially when you're moving your arms in front of the mirror and it's a pulling in, that means something is tugging at that tissue and it's probably not supposed to be there. Now, it doesn't mean it's a cancer, but it 100% needs to be, not only examined, but also imaged, whether that's an ultrasound, a mammogram, or both, or something else. So if you're being dismissed after you've noticed a change in your breast tissue, please advocate for yourself that that extra step is taken. And I'm glad you're still fine, Josie, even though there was a delay in your care.
Nandita, will you tell us your reaction to the book and also what it's like to work in cancer rehabilitation?
Dr. Nandita Keole
Yeah. So when I see. When I read the at “The Bright Side Running Club,” what stood out to me is that it captures part of that cancer experience that we don't always necessarily see or hear about in our clinic visits. You knowyou touched upon a lot of things in that book, you know, like changes in finding in like family dynamics, you know, the way that financial strain, you know, you have to keep working different aspects of this experience that a lot of times our patients may not be comfortable with telling us.
And also it reinforced kind of how important this multidisciplinary care model is. I mean, we practice a lot of it at my institution and in the United States, you know, things like social work, integrative medicine, PTOT rehab medicine that I do. And this book, really your story really captures why that's important, why it really matters. And then, of course, it was the running. That's something I enjoy. And it was not just about the exercise like you pointed out. Of course there's benefits of exercise. It reduces fatigue, improves mood, improves treatment tolerance. But then it was like you highlighted the community, the connection, the feeling like yourself again, you know I really liked that, how you covered all those things.
Josie Lloyd
I think that's so important that you find your tribe. I think one of the things that it's very difficult when you are going through something like a diagnosis for cancer treatment, it can be very isolating because especially for women, you know, they're holding it together for their families, for their colleagues, for their partners or husbands. It's really difficult because you have nowhere to turn. And I think it's really important if you can get to somewhere where you're going to have a community, it's vital to find people get in the same boat.
Dr. Nandita Keole
And all of your friends and I mean, the four close ones that you highlighted had different social situations, which was very good because it sort of added the diversity element to that in terms of how different people could be experiencing it. And then what it means to practice cancer rehabilitation. It's really meaningful because I get to meet patients when they're focused, not just on surviving that cancer, but also figuring how to live through and beyond it.
Cancer, of course understandably, a lot of the treatment focuses on survival, the treatments to help patients get better. But a lot of times these treatments come with physical and functional side effects like neuropathy. You know, I think you had some temporary ones that you mentioned. At least your character did fatigue, pain, weakness, difficulty with day-to-day functions and roles.
And so my job really is to step in that space and help the patients regain control of their lives. It's very collaborative. Its very team based. So I'm always talking with my dieticians, exercise physiologists, surgeons, the medical oncologists, therapists, sort of help people hold on to what is meaningful to them their identity themselves, their quality of life as they navigate their cancer journey.
Dr. Denise Millstine
What I really love about what you do, Nandita, is that sometimes we think of physical medicine and rehab. You go in something is wrong, right? You are having an issue with your shoulder and you go because something's wrong that you want to improve. But what you're doing is saying, how do we get you into the body state you want to be in navigating all of these changes that have happened, whether there's been surgery or weakness that's developed because of a time you haven't been able to exercise. And so you're this health promoter and so creative in figuring out how do we get you back running or whatever the activity is that the person loves to do to be as healthy as they can be after they've had this experience.
Josie Lloyd
And I do think that exercise can be a key part of that. And I really it's really admirable what you're doing and what you're saying about the multidisciplinary side of it, because actually, I think what happens to a person when they're diagnosed is that life as they know it finishes because you're going through such a massive major health challenge.
You change and you have no idea how you've changed. But the old you of how you did your life is actually no longer there. And for quite a while, we're kind of unmoored before you get to the new land of the new you. And so having healthcare professionals like you who will hold your hand during that process is so vital. And I think part of it is just giving people reassurances and the tools that they will get there, because you don't know what it's going to look like or how you're going to be, or how your life is going to change.
And actually, one of the things that I've really learned through my cancer diagnosis, and what I really want to write about in the book, was that Keira’s so busy, you know, she's a mom. She's doing things at 100 miles an hour. And really what she's done is she's put her own well-being at the bottom of her list.
One of the things that happens when you get a diagnosis for cancer is you go, why me? What did I do? Go through this massive questioning process. Was it because I drank too much? Was it because I smoked when I was a teenager? Was it because I did this, that and the other? And what you learn, you know, especially when you go into the health sphere in hospital is that they you know, my oncologist said, well, why, why not you, it’s 1 in 7?
And that's there's so many factors that might have caused this cancer. You don't know exactly which one it is. And so yes, of course you can try and change your diet and change your lifestyle. But actually one of the things that I kind of realized that one of the things that I could take control of was my own well-being. And so I just changed is putting everybody else first. I've learned, and it's taken me quite a long time.
It's I've let myself first, and it's not necessarily in ways that anybody else would notice, or even my family would notice. But for example, I get up every morning and I go straight outside and I go outside onto my balcony or into my garden, and I do a 15 minute Qigong practice, to deep breathe, to take in the world, to see some green, to do some deep breathing and to check in with myself. And it's very, very simple. But I think that that kind of thing where you put something very small in, has profound effects for your wellbeing.
Dr. Denise Millstine
Let me just highlight what you just said, because Keira does practice this in the book as well. So Qigong is a gentle movement practice that comes from traditional Chinese medicine, where you use the breath and movements of the body to shift energy. It's very powerful. And for listeners who haven't had an experience with this, I urge you to even look up a video, a guided practice. You can go to a studio and do it in a group setting, but this is a very simple and straightforward practice that we would consider part of integrative medicine to incorporate.
I want to jump into some of the details about Keira's experience, so listeners will have heard that Josie's personal experience inspired the novel, but really focusing on the character who is Keira. So, Josie, when we first meet her, when we first meet her at a party, but when we really first meet her, she is getting her breast imaging done. She's in a hurry, basically she's just checking a box. She's like, I just need to get this done so that I can get to work. I'm late for a meeting. I was curious if, again, you're trying to kind of create this everywoman scenario because when women go for routine breast screening, they probably think, I'm just going to it's going to be fine. Like how it always is. Is that what you are after that common experience?
Josie Lloyd
Yes, it really was. And also just that it's not really been on her radar. When you're kind of juggling everything, and if you've got all the balls going all in the air, you kind of feel invincible. And I really wanted this to show what it feels like when suddenly you're confronted with your health and actually you realize that everything that you're carrying is actually not as important as this thing, and you haven't paid it much attention.
And I think it's. But I also wanted to get across the kind of frustration, quite often of being in a hospital when your time is with the best one in the world. Every time we walk through the door of a hospital, no matter how wonderful it is, one of the things that you leave at the door is your control over your own time.
Because you're in hospital and people are doing things at their pace and they're doing their best, but you don't have any control. And I think one of the things that I really wanted to show in the book was this sense of her losing control. So that was a real kind of thing. Certainly, you know, the time management and she's late and she's not really taking any care of it. And I think that's something that we can all relate to. And again, it's about standing back and going, oh no, actually this is a little bit more important than I thought.
Dr. Denise Millstine
Yeah, yeah, I really thought that was powerful.
Dr. Denise Millstine
Hey listeners, we hope you're enjoying this episode of “Read. Talk. Grow.” If you find our discussions helpful and insightful, please take a moment to subscribe to and rate “Read. Talk. Grow.” on your preferred podcast platform and don't forget to tell your friends to listen. Your support will help us reach more readers and those eager to learn about health through books. As always, feel free to drop us a line at readtalkgrow@mayo.edu with suggestions for books, topics or any comments. Thanks for listening.
Dr. Denise Millstine
Nandita, while Keira's there, they need to do one more study. But there's going to be a break so she has to wait. I love that she gets terrible hospital coffee because it always is terrible coffee, isn't it? Well, not always, I guess. And she goes across the street and sits in a park, and she sees this woman who's running, who Keira describes as a terrible jogger who might as well be walking.
The woman stops to rest nearby and tells Keira that she is a distance runner, or at least she used to be. Which we later learn is because this is a very important character in the book, Tamsin, who's on her own cancer journey. What was your reaction to this depiction of Tamsin running and then talking to herself and telling herself, just keep at it. Just keep at it.
Dr. Nandita Keole
I just want to say there's a lot more judgment that goes on, other than the fact that she was a terrible jogger and might as well be walking. And I think that was that's really good because she's kind of shown this gray area, right. It’s a very relatable character. I really like that.
But with regards to Tamsin, I think as you correctly point, Josie, you know, so many patients have to give up so much control any time they get sick that anything that they can hold on to that gives them a sense of normal life or control, you know, it's very valuable. And so this Tamsin was a runner before. So for her to be able to continue to do that may have been a little grounding. You know, at least I can still do this. This is a little bit of the old me. And even though when she was a distance runner and she can't do that, she's just showing up, right. She's decided every day this is important to me. She's still motivated and she clearly is finding some benefits from that.
And, you know, from a clinical perspective, I always tell my patients I was like, you know, this, as you mentioned, this is like 2.0 and you may not have reached 2.0 yet. Right? You're in a different iteration of yourself. You're going through a different journey. And patients, especially who've like, been very fit before, are able to do a lot before, not just for their day to day lives and juggling everything, but also in like their recreational activity or hobby, or working out for them to just say, you know, I can't do that anymore, but I still want to engage in that activity. That takes a lot to say. I'm not doing it at the level that I was, but I'm like to recognize that I'm still getting something out of it is really, I think, remarkable in this character. And we see you know, a lot of other attributes that she has.
Josie Lloyd
I loved Tamsin so much. I've described her as an elder goth because she's covered in tattoos. You know, she's got this kind of elder goth energy and she's very much based on my friend Jane, who was somebody that I met through running. What I liked about Tamsin is that she becomes this sort of magnet because just because she's doing it, as she say she's showing up, she's putting her trainers on. And in that sense, she becomes very inspiring for Keira and for some of the other characters who then kind of gather around and before she knows it, she's sort of got this little running group going and it becomes a lifeline because they understand what she's going through and she can be herself. And they see her and they understand the sort of journey that she's going.
She doesn't have to be holding it all together like she is for her kids. And her husband. She can be herself with them. And I think that's really important. And it's just they get to just be out in the sunshine and no matter how slowly they jog and it's not running, it's seriously almost walking, doesn't matter because they're out there and they're doing it. And I think that's really important. And I think because as you say, it's a very important step to go on the journey to get to 2.0.
Dr. Nandita Keole
Yeah. And I mean, it's a very generous spirit that she has. Right. Like I'm going to share this. Not only do I realize this for myself, she even, you know, mentions to Keira like, you know, just focus on your well-being. I think she says something like that in the journey too. Just like the cancer, like when you get your diagnosis and you know that you have maybe six cycles of chemo, then you have radiation and then surgery or whichever order it is, and patients will be like, oh my God, I just see this whole mountain in front of me and I can't climb it. And it's just like, well, break it up, right? Like saying, let's look at the next step and take it is just kind of like running. Like I think you've mentioned like put one foot in front of the other and just.
Josie Lloyd
And that becomes their mantra. And Keira’s really panicking about what's going what she's going through, she remembers that it's just one foot in front of the other and you don't think too much about the past. You don't think too much about the future. You just keep on going and you deal with the here and now. And I think one of the things that is so difficult is dealing with the fear, the terror that you kind of the what ifs, you know, you lie there at night. What if, what if all these things go wrong? What if I lose my life? What if I lose my breast? What if I lose my livelihood? You know, all these things become. You know the what ifs. And they can be broken down into one step at a time.
So I think that's a really important thing that she learns during the book to kind of focus in and become a lot more in the here and now, and it gives you an enormous amount of power, and it becomes sort of her superpower in the end. And she'd never expected that to happen. And I think that's one of the things that is really surprising about any journey that you go on when it's bad, good things happen to when you are in these really difficult moments in life, no matter whether it's getting cancer or not. But quite often in face of adversity, it's not all terrible.
Some nice things happen then, and you will always find some great examples of the generosity of the human spirit. And I think that's incredibly comforting in those kind of environments and in those kind of scenarios. And how women particularly really help each other, and they can really be a real massive support to each other if you ask for the right support, if you just say, this is what I need, they will turn up, you know.
Dr. Denise Millstine
I think you mentioned something important about where the mind goes and some of the catastrophizing that is part of the process. If you're not thinking these heavy thoughts, then you're maybe in denial, which is not a good thing either. Doesn't mean you have to sit with them all the time, but they will rise.
But another difficult moment for Keira is when she's waiting for her diagnosis. So she gets the biopsy and she sort of goes back and forth on this. She's pretty certain it's cancer, but maybe it's not. She's talking herself out of it. And then she eventually does get her diagnosis. And Josie, maybe this is a good point to talk about the type of cancer that Keira has.
Josie Lloyd
Yes. And I was very important to me to write about this because I didn't know what my diagnosis meant. And actually, I'd never really been in a hospital, never been ill. I've never read anything about cancer. I didn't know anything about cancer. And suddenly you're bombarded with all of these big words, and it's kind of estrogen positive, and it's this and it's that, and you just don't even and you're in such shock because you actually don't really know what is going on.
And I was told that I had lobular breast cancer. Now I've never heard of lobular breast cancer. I didn't even know that there was different types of breast cancer. And then I subsequently learned that there's quite a few different types of breast cancer. But mainly there's ductal and lobular and lobular breast cancer grows in a different way. It grows in a kind of spidery way. And so it's actually by the time it's diagnosed, it's quite often a lot bigger than people think. And then I was kind of looked into lobular breast cancer. And I only realized that actually it behaves in quite a different way to quite a lot of other cancers. And so it's quite slow growing. It doesn't show up for a lot of women who have dense breast tissue and it doesn't quite often it gets missed in mammograms.
Dr. Denise Millstine
And I think it's important to recognize that there are several different types of breast cancer. And to your point, they don't all behave the same way and they aren't all detected in the same way, nor do they recur if they recur on the same timeline.
So it's very important for you to know the type of breast cancer that you've had and make sure that you're working with a team that's familiar with that type of cancer, and how it should be followed through time, and how you should be monitored for any recurrence or new cancers. Because once women have had one breast cancer, they're at risk, at higher risk for a second breast cancer.
We talked about types of cancer fairly extensively in episode number 68 with the book “Maggie; or A Man and Woman Walk Into a Bar.” So listeners who are interested in this topic should go back and check out that episode as well. But thanks for highlighting lobular breast cancer, because it indeed I think is a trickier breast cancer. Particularly since it's not the most common, which is the pathway and the recurrence risk that we often think of, but not all breast cancer behaves the same.
Nandita, I want to talk about the running that Tamsin, Keira, and the ladies do throughout their treatment. Can you just make some comments about how incredible it is that they continue to run, even while going through chemo, even while recovering from surgery while they're on their medications. I just loved that it wasn't just I'll get to that when I'm done with my active treatment, that it was literally all the way through.
Dr. Nandita Keole
Yes. And in your book, at least some of them were not runners before. But it's important because I think the best way the community can encourage novice people to run. And I mentioned that there's some benefit to exercise. I do want to say that clinically, I will tell my patients that you have to pace yourself. You do need to do some energy conservation because the goal here, of course, is consistency, right? Maintaining and supporting recovery, maintaining your strength. You want to move, but not push so hard that you wipe yourself out for the next few days.
But we've found that exercising during cancer has a lot of benefits. And for a long time, even in the States, it's been found. You know, initially a lot of physicians used to say, you know, rest during cancer. You want to, you know, save this energy. But through a different studies and over the years, I found that actually sarcopenia, which is loss of muscle mass and function, is actually detrimental. It can worsen treatment tolerance, can worsen recovery, cancer related fatigue, which, you know, I think you mentioned just being tired, not just physically but also cognitively, like not being able to think, not being able to do so many tasks.
Sometimes patients actually will quit their treatment because of this. And exercise has been found to be one of the most powerful tools. It's honestly one of the most powerful supportive tools we have in our toolbox that is really safe for patients and that patients can continue to engage in. And so I think it's very important that in your book, you highlight that.
And also outdoor activities like the sunlight, like there's lots of indirect benefits from that, like being out, talking to people, getting that psychological support, community support. So I think all of these things, you know, help you with sleeping better, help your mood. Not to say, you know, your resilience, emotional resilience, reducing stress. Like a lot of not just with treatment of this breast cancer, but in reducing recurrence, improving survival, not just breast cancer, a lot of other cancers. So I think that was a very important message in this book, that you can do it, but listen to your body, which I think yeah.
Josie Lloyd
I think they do. I mean, I think Keira does push herself a bit too far at one point, but I think what's so important is that message, as you say, about getting outside, getting some sunshine and that kind of thing. I don't know where, you know, your weather is different in the States, but certainly where I am bright and seasonally it can be quite dark and gloomy here in the winter and actually think if you're going through cancer treatment in winter, you got to get outside and get some sunshine. You've got to see that vitamin D on your skin because it's so important for your recovery.
And I think it's humbling when you can't run like you want to run. But again, there is an enormous sense of achievement saying, I'm going to go and I'm just going to run to that bin and I'm going to say congratulations to myself. And if I want to stop, I'm going to stop. But if I've got some juice in the tank, I'm going to go a little bit further. And I think that's how she learns to break it up that, you know, she does it little bit by little bit. And I think that's how she learns as well, how to get through her cancer treatment. You know, one step at a time.
Dr. Nandita Keole
Yeah. I think that is absolutely important that you listen to yourself, but you do push a little. And then depending on where you are, because a lot of times, you know, in the beginning of your first like treatment cycle, the first couple of days are bad and then the next few days are a little bit better. And so, you know, I think you can adjust some of what you can do that way too.
And also what's whether you have energy more in the morning, more in the evening. So a lot of people can adjust their tasks that way. So but I think it's important that you can do it during recovery too, when you don't have to push it to the end.
Josie Lloyd
I also think as well, that is really helps a lot with her body image as well, because one of the things that she's so nervous about when she gets diagnosed is that she's going to lose her breast and how is that going to be for her and her husband? And how is that going to affect herself as a woman? How is that going to make her feel? And I think a lot of women go through this kind of total identity crisis when they are faced with kind of losing a part of their body. But actually, as Tamsin says, if you can lose anything, a breast is fine because nobody is going to notice and you're still going to be able to run.
So it does reading alter her sense of body image. And also she kind of realizes that it doesn't matter that she's got wrinkles on her face or anything like that, because old age is the prize. You know that, you know, when you go to a really big house like this, you really learn that old age is the prize and that she then that really lets you off the hook about aging and all the silliness that goes on around that. It's like, yes, yes, please bring all my wrinkles.
Dr. Nandita Keole
Yes. It makes you reevaluate your priorities in life for sure. And I will say that a lot of times I also have patients that are like, oh, I don't want to see psychology. I have, you know, my husband or my partner and I want to talk to them about it. Now, you know, I sort of remind them caregiver support is important. And I mean, it's good that you have this dynamic, but sometimes you need others. Even if you're in the community, it may be your running friends. It could be your friends in a different social club, whatever it is you enjoy. But it's important to have that. Or it could be one of these support groups, I'm sure that you have in the UK too. Some.
Josie Lloyd
Yes, and I do. I do run a lot of wellbeing and support clubs with my, with my cancer charity and one of the things that I really do, and I really encourage people to do is journaling, because if I hadn't have journaling, if I hadn't got into the journaling, this book would never have happened. And I always keep a diary.
But this is really what I found writing this book was that I found writing the best way of absolutely getting all of those nasty thoughts out of my head, that I couldn't tell anyone else. I couldn't tell my husband the self-pity. You know, the terror, all of that went down on the page. And actually, once it's out of your head, you can function because you've done that.
But also, I think what's really important in these groups that I run is actually getting people to write a visualization of how they're going to be. So whether or not they're cancer free or not is immaterial. I get what they get them to do is visualization of them in the future, and I get them to write as much detail as they possibly can. And it's such a powerful exercise to do. Where you are, who you are with what you're wearing, what the weather like, and what are you doing in that moment? And quite often I get letters from people saying, you know, I wrote that saying it happened and, you know, it will be somebody at their son's wedding, or it will be somebody walking along the beach with their grandchild.
And I really believe that you can make these things happen and come alive. But also it's very powerful when you're kind of unmoored as we discussed, you know, to write a visualization in the future and how it's going to be. And I think that's really powerful as well, that you can you can create your own future, even when you're feeling absolutely at your most dreadful.
And one of the things that I sort of get people to do is to just really, really do that and to lean into that and to make it as detailed as possible and write it several times, you know, what is it like? You know, I really want to, you know, I say to them, I want to know what it feels like. And so make it as detailed as you possibly can. And I found that to be really quite effective. So I would say that one of the things about this book, apart from the running, is that it's the book itself. And actually writing is so powerful. Of all the things I know, I kind of think that writing is really, really powerful.
Dr. Denise Millstine
I think that's really so incredible. We talked about writing to Heal and episode 32, and I wholeheartedly agree with you. Whether it's processing honestly and without fear of judgment, because the journals not going to judge you, what your thoughts are, letting recognizing that they're coming up and then projecting to the future and what that can hold. There is so much in this novel.
I can't believe we've gone through our time. And I was hoping that each of you would just give some advice to any listeners who are out there. Maybe they've been diagnosed with breast cancer and are wondering how to incorporate activity. Can you just leave them with some last advice? Nandita, do you want to go first?
Dr. Nandita Keole
Sure. So I think some advice I would give you is find something that you enjoy. Now it doesn't have to be running. It could be walking or it could be something as small as, like a little hand cycle, something that's going to get your heart rate up and you can do for ten minutes. You don't have to think of something for 30 minutes. One hour. Nothing. Just, I always say time. You know, you can always find ten minutes in your day and do that and then figure out you're not going to go from 0 to 100, you know, in a week or two. We do it slowly, consistently, and then maybe try to add some kind of strength. I mean, it could be tai chi, you know, for balance. But if you can do a little bit of resistance to help those muscles and eat, I know it's hard with cancer, but while you're doing that, make sure you don't not have enough calories, enough protein. So those are a couple of my pearls.
Josie Lloyd
And I would say just do it. Just don't overthink it. Just put your trainers on and go, now what you got to lose. You just don't just don't overthink. Just do it right now. And then you kind of analyze it later and kind of think, but you're going to feel so much better once you get outside and into the sunshine, and it will just change your perspective, because where you are sitting in your world, your thoughts have become very dominant, possibly. And actually, as soon as you're outside and you kind of realize where you are in the world completely changes everything. So I think my advice would be to do it immediately. If it's crossed your mind, just do it.
Dr. Denise Millstine
Well, my advice would be to go and read “The Bright Side Running Club” because there's so much to reflect on here in the book. It's really been my pleasure to talk with you, Josie and also you, Nandita. Thank you for being on “Read. Talk. Grow.”
Dr. Nandita Keole
Thank you.
Dr. Denise Millstine
“Read. Talk. Grow.” is a product of the Women's Health Center at Mayo Clinic. This episode was made possible by the generous support of Ken Stevens. Our producer is Lisa Speckhard Pasque and our recording engineer is Rick Andresen.
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