Fatigue & Depression

I have been going through quite a bit of fatigue and depression lately. I am still experiencing fatigue almost every day, so when I do have a burst of energy, I make sure to take advantage of it. On days when my entire body is hurting, I try to remind myself that I had my 4th surgery not that long ago, so I don’t need to be so hard on myself when I just want to rest. Resting has become another problem in the form of not being able to sleep properly. It is not out of the realm of possibility for me to be awake until 2 or 3 in the morning, sometimes even later, at least a few nights a week. I realize that fatigue is linked directly with depression, so I am beginning to understand how everything I have been dealing with within the last few months is all part of the same problem.

Not all of my depression is linked to breast cancer, but most of it is. I was talking to a breast cancer patient the other day, and she was asking me how long it has been since I had finished each portion of my treatment. I hadn’t thought about the timing of everything in a while, so as I was answering her questions, I was surprised that time has passed much quicker than I thought. It has been 11 months since my last chemo treatment, 7 months since my last radiation treatment, and 4 months since my previous reconstruction surgery; at times, it feels like a lifetime ago, but when I am having a bad day, it all seems like it happened yesterday. Even with all of that time passing so quickly, my body and mind are still healing. I have been experiencing what I thought were some of the side effects that I had at the end of chemo again, but chemo ended almost a year ago, so I am beginning to realize that some of them are symptoms of depression, as described below. Luckily, we are going on vacation soon, and the timing couldn’t be more perfect. I need a break; I need time away from everything that has been hurting my heart and soul lately, and I need to get my mind and body back on track, and I will!

Depression may be a side effect of breast cancer and fatigue is often a symptom of depression. Some people may have a tendency to depression, which treatment can make worse. At the same time, fatigue itself can lead to depression. Not knowing why you feel drained week after week, and not knowing that this abnormal feeling is normal for many people going through treatment, can make you depressed.

Treatment for breast cancer may leave you feeling sad, tired, or depressed. These feelings are complex conditions, resulting from and affected by many factors: your cancer diagnosis and treatment, aging, hormonal changes, your life experiences, and your genetics.

If you’re abruptly going through menopause 10 years earlier than you naturally would, with a quick lowering of hormone levels, you may experience feelings similar to postpartum depression.

Sadness is a natural part of your breast cancer experience, something you need to express and move through. If you don’t allow yourself to feel sad and grieve, the unresolved grief gets in the way of feeling better and getting better. You may be having hot flashes and trouble sleeping. You may be feeling overwhelmed or even debilitated. All of these factors can lead to fatigue and depression.

How can you tell the difference between fatigue, sadness, and clinical depression? The symptoms of clinical depression include:

  • an inability to cope
  • an overwhelming feeling of helplessness and hopelessness
  • inertia
  • an inability to concentrate
  • memory problems
  • panic attacks
  • loss of pleasure in what used to make you happy
  • lack of interest in sex or food
  • sleep problems

If you think you’re depressed, talk to your doctor. If your doctor doesn’t have experience treating depression, ask for the name of an accredited psychotherapist. Together you can sort out if what you’re feeling is depression or extreme fatigue. Therapy can help you feel supported and allow you to talk about what’s bothering you. Antidepressant medicines can help ease feelings of sadness and anxiety and help you feel better. An accredited psychotherapist with experience treating depression can help.

How Do You Tell People That You Have Cancer?

Telling people that are close to me that I was diagnosed with breast cancer was a very personal and difficult decision. I am sure you are thinking that I am crazy for saying that and I would have agreed with you when I was first diagnosed, but I don’t agree now. Why wouldn’t a patient want to tell their family and friends? Or, what would make a cancer patient regret telling them? It will probably surprise you to know that I have spoken with some cancer patients that didn’t tell anyone, or that after the fact, they had wished that they hadn’t.

Family members, friends, and co-workers are never comfortable hearing that someone they know and care about has received a breast cancer diagnosis. It is a hard subject to discuss and every cancer patient knows that to some degree once they start telling people that they have cancer, the flood gates open with questions and in some cases blame. It is sad but true that sometimes out of fear, people are ignorant enough to ask a cancer patient what they “did or didn’t do to get cancer”. I can tell you that I was blaming myself early on. I was sure that it was my fault, that I had done something wrong and that is why I ended up with breast cancer. I know now that it was ignorant of me to blame myself. I didn’t do anything to cause my cancer, cancer chose me.

Sometimes people stay away because it is easy for them to assume that since someone they know was terribly sick during chemo, that you will be too; or someone they know did not survive breast cancer, so you won’t either. Understandably, they are afraid to be close to you because they think that you will die and it will hurt more if they step into the reality of your cancer so if they don’t talk to you, it isn’t real. I have found myself reminding people that I am still me, that every breast cancer patient’s experiences and outcomes are different, even if they have the exact same diagnosis. So many factors go into how a patient will respond to chemo and radiation treatments as well as undergoing multiple surgeries like most of us do, so it is impossible to predict what will happen. I am happy to say that I am doing well now that I am well over a year out from my diagnosis…I am a survivor!

I didn’t tell anyone right away because my husband and I were in shock and we needed to process what was going on. I also had my first biopsy to go through and I wanted to have the specifics of my breast cancer before sharing the information with anyone. Just a few weeks later once all of the test results were back, I told my family and close friends first through phone calls and private messages. As the news spread of my diagnosis, some people reached out to me immediately and others often times the people I wanted to talk to the most, stayed away from me, not knowing what to say. I can’t blame people for distancing themselves because I understand how hard it is to hear about the pain, endless doctors’ appointments, and everything else that I had to endure both physically and mentally for months on end. I also understand that people think that they would be bothering me or burdening me if they wanted to talk about things that they are going through, but if that is what they are thinking, they couldn’t be more mistaken. Right now, especially while I am laid off from work, I need my friends and family, I need to connect with people.

Being diagnosed with breast cancer has taught me that we never know what tomorrow will bring. Putting off spending time with the people that we care about and love should not be left until tomorrow, or next week or when we think we will have time because time is not on our side. {Yes, I know that the virus we are all dealing with is not helping bring us together, face to face, but there are other ways to communicate.} Sometimes the choices we make will only bring us to feelings of regret in the future, and sometimes it is too late to go back to the cherished moments we should have had with those that we love and value.

Here’s Why Exercise Is Crucial in Preventing, Treating Cancer

I struggle with getting exercise into my daily routine not because I am too busy, but because I am still dealing with fatigue from over a year of fighting breast cancer. Everything about my journey has been exhausting both physically and mentally. Luckily I am on the other side of treatments and endless doctors appointments so my energy level is slowly improving. Most days I try to get some form of activity in, even if it is just cleaning part of the house or playing with my dog….it all counts and I make sure to remind myself of that.

Written by Matt Berger on October 20, 2019

Strength training two to three times a week along with aerobic exercise three times a week is recommended for cancer prevention.
  • A panel of experts has released guidelines stating that regular exercise can help prevent cancer as well as help people undergoing cancer treatment.
  • The experts recommend 30 minutes of aerobic exercise 3 times a week and strength training 2 to 3 times a week.
  • Experts say exercise can help prevent cancer by reducing inflammation, keeping weight under control, and boosting the immune system.

Kathryn Schmitz is seeking a paradigm shift.

Schmitz, a professor of public health specializing in cancer at Penn State University, thinks the perception of the ties between exercise and cancer is where the perception of the ties between exercise and heart health was decades ago.

Back then, she said, getting a patient out of bed and moving after a heart attack would be criticized. Today, the benefits of exercise to heart health and recovery are well known.

A similar consensus is emerging in the way the medical field thinks about cancer.

The latest sign in that shift came this week, with the publication of new guidelines that recommend physicians “prescribe” exercise in efforts to reduce the risk of certain cancers and improve the treatment outcomes and quality of life of those with the disease.

“Today if you asked someone with a dad with colon cancer if he should be exercising they’d probably either say no or they don’t know,” Schmitz told Healthline.

Schmitz co-chaired the roundtable — which included experts from the American College of Sports Medicine, the American Cancer Society, and 15 other groups — that put together the new guidance.

The gist of the guidance, published in three papers this week, is that exercise can contribute to the prevention of bladder, breast, colon, esophagus, kidney, stomach, and uterine cancer.

The guidelines also state exercise can help improve survival rates for people with breast, colon, and prostate cancer — as well as the quality of life of those people in terms of reducing side effects of cancer treatment.

How much exercise?

The researchers recommend that people with cancer do 30 minutes of moderate aerobic activity 3 times a week and strength training such as weights 2 to 3 times a week.

Schmitz said originally the researchers looking into that question sought to find out if there were specific “doses” of exercise that could be tailored to different people with cancer.

But the 30 minutes 3 times a week recommendation seemed to work pretty universally.

They still ended up with their goal of being able to “prescribe exercise like a drug,” Schmitz said. “Just turns out that it’s, say, 600 milligrams for everybody, if you will.”

In terms of cancer prevention, the recommended general physical activity guidelines are at least 150 minutes of moderate exercise or 75 minutes of vigorous exercise a week.

Schmitz says getting more tailored recommendations for cancer prevention is one of the remaining open questions that ongoing research hopes to help answer.

“We don’t know the exact, optimal dose of exercise needed for cancer prevention,” Alpa Patel, the American Cancer Society’s senior scientific director for epidemiology research, told Healthline. “But we know from the evidence to date that the more you do the better.”

Why exercise works

Patel, lead author of the paper that covered the prevention aspects of the new guidance, said how exactly exercise affects cancer prevention is severalfold.

That includes exercise’s effects on reducing inflammation, helping regulate blood sugar and sex hormones, and improving metabolism and immune function.

“Depending on the specific cancer, one or more of those mechanisms may be more important than the others,” he said. “So, for breast cancer, the benefits of exercise are really driven through the impact on sex hormones.”

“It can also affect cancer development or risk through reducing obesity, a risk factor for many cancers,” said Dr. Crystal Denlinger, an oncologist at the Fox Chase Cancer Center in Philadelphia and chair of the National Comprehensive Cancer Network’s panel on survivorship guidelines.

She told Healthline that the exact reasons why exercise affects certain cancers in different ways still needs additional research.

The current recommendations do vary a bit based on personal history, Denlinger noted. But, she said, “at this time, there is no one ‘best’ exercise — anything that gets you moving and active is good.”

She said further trials are under way to evaluate how and when exercise can affect cancer treatment.

The effort underway for Schmitz — through an initiative she started at the American College of Sports Medicine — is pushing to get oncologists to assess and advise cancer patients’ physical activity.

“This is an easy, cheap way to give patients less fatigue and a better quality of life,” she said.

Final Follow-up with My Surgeon

Mood: Accomplished 😊

I had my final follow-up appointment with my surgeon earlier this week. Both sides of my chest look good. During my surgery he stitched up my breasts from underneath a little bit so the implants would drop and settle without making my entire chest drop too much. During the first reconstruction surgery I had a breast lift so it was important that during the second reconstruction surgery, when he inserted my implants, that all the work he had done with my lift would not be ruined.

It has been 9 weeks since my surgery and my breasts are almost completely done dropping into a natural position. I am completely healed from surgery and cleared, no restrictions! It was important for me to get to the place where I am cleared with no restrictions because I have been having issues with a bulge on the side of my left breast, the side where the cancer was, that has been causing me some pain and discomfort since my first surgery over a year ago. The pain isn’t constant, but it is enough to bother me. I am feeling pain and pressure both when my arm is resting against the side of my breast and if I wear a bra for more than a few hours. With most of my clothes I don’t have to wear a bra anymore thanks to my reconstruction surgeries, but now I feel like I don’t have an option concerning wearing a bra or not due to the pain and discomfort.

During my last follow-up appointment with him we discussed this problem and it seemed like it might go away with time. He also stressed that it is difficult to operate due to pain, as he would be blind going in, not being able to actually see what is causing the problem. But since that appointment the pain and discomfort has only gotten worse so I mentioned it to him again this week during my appointment and we talked about it in more detail.

I asked him if he thought that the bulge was fat or tissue and he said that fat is tissue. So I asked if getting back to working out and maybe even lifting weights, now that I am cleared, would help give me some relief or even possibly get rid of the problem altogether. He said that it possibly could help and it was worth a try before falling back on having  another surgery that could fix the problem or not, no guarantees. So, we agreed to wait and see what happens once I am working out again and instead of making an appointment for three months out, the normal amount of time, we will see how I am doing in 7 weeks when I go back to see him after my mammogram in mid-August for my results.

In other news….here is a picture of what my hair looks like now! After 8 months of growth, I am a blonde again! 😁 I couldn’t deal with the dark/gray hair anymore…it was seriously depressing me!

15 Foods That Boost the Immune System

With everything going on these days, it doesn’t hurt to add as many of these foods into your diet as possible. For cancer patients, it is particularly important to keep your immune system protected and boosted with good healthy foods.

Medically reviewed by Amy Richter, RD — Written by James Schend — Updated on April 30, 2020

Immune system boosters

Feeding your body certain foods may help keep your immune system strong.

If you’re looking for ways to prevent colds, the flu, and other infections, your first step should be a visit to your local grocery store. Plan your meals to include these 15 powerful immune system boosters.

1. Citrus fruits

wedges of grapefruit, lime, orange, and lemon on top of a turquoise table

Most people turn straight to vitamin C after they’ve caught a cold. That’s because it helps build up your immune system.

Vitamin C is thought to increase the production of white blood cells, which are key to fighting infections.

Almost all citrus fruits are high in vitamin C. With such a variety to choose from, it’s easy to add a squeeze of this vitamin to any meal.

Popular citrus fruits include:

Because your body doesn’t produce or store it, you need daily vitamin C for continued health. The recommended daily amount for most adults is:

  • 75 mg for women
  • 90 mg for men

If you opt for supplements, avoid taking more than 2,000 milligrams (mg) a day.

Also keep in mind that while vitamin C might help you recover from a cold quicker, there’s no evidence yet that it’s effective against the new coronavirus, SARS-CoV-2.

2. Red bell peppers

14 red bell peppers on top of a dark wood table

If you think citrus fruits have the most vitamin C of any fruit or vegetable, think again. Ounce for ounce, red bell peppers contain almost 3 times as much vitamin C (127 mgTrusted Source) as a Florida orange (45 mgTrusted Source). They’re also a rich source of beta carotene.

Besides boosting your immune system, vitamin C may help you maintain healthy skin. Beta carotene, which your body converts into vitamin A, helps keep your eyes and skin healthy.

3. Broccoli

hands holding up a bowl full of broccoli

Broccoli is supercharged with vitamins and minerals. Packed with vitamins A, C, and E, as well as fiber and many other antioxidants, broccoli is one of the healthiest vegetables you can put on your plate.

The key to keeping its power intact is to cook it as little as possible — or better yet, not at all. ResearchTrusted Source has shown that steaming is the best way to keep more nutrients in the food.

4. Garlic

cloves of garlic on a wood table

Garlic is found in almost every cuisine in the world. It adds a little zing to food and it’s a must-have for your health.

Early civilizations recognized its value in fighting infections. Garlic may also slow down hardening of the arteries, and there’s weak evidence that it helps lower blood pressure.

Garlic’s immune-boosting properties seem to come from a heavy concentration of sulfur-containing compounds, such as allicin.

5. Ginger

slices of ginger on a dark wood table table

Ginger is another ingredient many turn to after getting sick. Ginger may help decrease inflammation, which can help reduce a sore throat and inflammatory illnesses. Ginger may help with nausea as well.

While it’s used in many sweet desserts, ginger packs some heat in the form of gingerol, a relative of capsaicin.

Ginger may also decrease chronic painTrusted Source and might even possess cholesterol-lowering propertiesTrusted Source.

6. Spinach

spinach leaves in a silver pot with a handle

Spinach made our list not just because it’s rich in vitamin C — it’s also packed with numerous antioxidants and beta carotene, which may both increase the infection-fighting ability of our immune systems.

Similar to broccoli, spinach is healthiest when it’s cooked as little as possible so that it retains its nutrients. However, light cooking makes it easier to absorb the vitamin A and allows other nutrients to be released from oxalic acid, an antinutrient. 

7. Yogurt

yogurt topped with seeds and granola and placed in a small white and blue floral bowl

Look for yogurts that have the phrase “live and active cultures” printed on the label, like Greek yogurt. These cultures may stimulate your immune system to help fight diseases.

Try to get plain yogurts rather than the kind that are flavored and loaded with sugar. You can sweeten plain yogurt yourself with healthy fruits and a drizzle of honey instead.

Yogurt can also be a great source of vitamin D, so try to select brands fortified with this vitamin. Vitamin D helps regulate the immune system and is thought to boost our body’s natural defenses against diseases.

Clinical trials are even in the works to study its possible effects on COVID-19.

8. Almonds

unroasted almonds in a dark-colored bowl on top of beige fabric

When it comes to preventing and fighting off colds, vitamin E tends to take a backseat to vitamin C. However, this powerful antioxidant is key to a healthy immune system.

It’s a fat-soluble vitamin, which means it requires the presence of fat to be absorbed properly. Nuts, such as almonds, are packed with the vitamin and also have healthy fats.

Adults only need about 15 mg of vitamin E each day. A half-cup serving of almonds, which is about 46 whole, shelled almonds, provides around 100 percentTrusted Source of the recommended daily amount.

9. Sunflower seeds

sunflower seeds in a clear jar on top of a turquoise table

Sunflower seeds are full of nutrients, including phosphorousmagnesium, and vitamins B-6 and E.

Vitamin E is important in regulating and maintaining immune system function. Other foods with high amounts of vitamin E include avocados and dark leafy greens.

Sunflower seeds are also incredibly high in selenium. Just 1 ounce contains nearly halfTrusted Source the selenium that the average adult needs daily. A variety of studies, mostly performed on animals, have looked at its potential to combat viral infections such as swine flu (H1N1).

10. Turmeric

turmeric powder, turmeric roots, and turmeric supplements on top of a turquoise and white plate

You may know turmeric as a key ingredient in many curries. This bright yellow, bitter spice has also been used for years as an anti-inflammatory in treating both osteoarthritis and rheumatoid arthritis.

ResearchTrusted Source shows that high concentrations of curcumin, which gives turmeric its distinctive color, can help decrease exercise-induced muscle damage. Curcumin has promise as an immune booster (based on findings from animal studies) and an antiviral. More research is needed.

11. Green tea

loose leaf green tea in a white mug on a wrought iron table

Both green and black teas are packed with flavonoids, a type of antioxidant. Where green tea really excels is in its levels of epigallocatechin gallate (EGCG), another powerful antioxidant.

In studies, EGCG has been shown to enhance immune function. The fermentation process black tea goes through destroys a lot of the EGCG. Green tea, on the other hand, is steamed and not fermented, so the EGCG is preserved.

Green tea is also a good source of the amino acid L-theanine. L-theanine may aid in the production of germ-fighting compounds in your T cells.

12. Papaya

two large papaya halves on a dark wood table

Papaya is another fruit loaded with vitamin C. You can find doubleTrusted Source the daily recommended amount of vitamin C in a single medium fruit. Papayas also have a digestive enzyme called papain that has anti-inflammatory effects.

Papayas have decent amounts of potassium, magnesium, and folate, all of which are beneficial to your overall health.

13. Kiwi

whole kiwi fruits and two kiwi halves in a metal basket with handles

Like papayas, kiwis are naturally full of a ton of essential nutrients, including folate, potassium, vitamin K, and vitamin C.

Vitamin C boosts the white blood cells to fight infection, while kiwi’s other nutrients keep the rest of your body functioning properly.

14. Poultry

uncooked whole chicken on a metal pan surrounded by salt flakes and a white and blue plaid rag

When you’re sick and you reach for chicken soup, it’s more than just the placebo effect that makes you feel better. The soup may help lower inflammation, which could improve symptoms of a cold.

Poultry, such as chicken and turkey, is high in vitamin B-6. About 3 ounces of light turkey or chicken meat contains nearly one-third of your daily recommended amount of B-6.

Vitamin B-6 is an important player in many of the chemical reactions that happen in the body. It’s also vital to the formation of new and healthy red blood cells.

Stock or broth made by boiling chicken bones contains gelatin, chondroitin, and other nutrients helpful for gut healing and immunity.

15. Shellfish

fresh crab and half of a lemon on a white plate placed on a table

Shellfish isn’t what jumps to mind for many who are trying to boost their immune system, but some types of shellfish are packed with zinc.

Zinc doesn’t get as much attention as many other vitamins and minerals, but our bodies need it so that our immune cells can function as intended.

Varieties of shellfish that are high in zinc include:

  • oysters
  • crab
  • lobster
  • mussels

Keep in mind that you don’t want to have more than the daily recommended amount of zinc in your diet:

  • 11 mg for adult men
  • 8 mg for most adult women

Too much zinc can actually inhibit immune system function.

More ways to prevent infections

Variety is the key to proper nutrition. Eating just one of these foods won’t be enough to help fight off the flu or other infections, even if you eat it constantly. Pay attention to serving sizes and recommended daily intake so that you don’t get too much of a single vitamin and too little of others.

Eating right is a great start, and there are other things you can do to protect you and your family from the flu, cold, and other illnesses.

Start with these flu prevention basics and then read these 7 tips for flu-proofing your home. Perhaps most importantly, get your annual flu vaccine to protect yourself and others.

8 Exercise Routines That Don’t Involve a Gym

A long time ago I had a gym membership with a friend of mine and eventually that friend stopped coming to the gym, even no showing our trainer. I kept my membership and continued to go to the gym but as soon as my membership was up I decided to find a way to workout at home. I have done a few of the suggestions below and I have found that a gym is not needed. Now with online classes both live and on demand and affordable home equipment, it is easy and convenient to workout at home. My workout schedule has been on and off over the past year due to extreme fatigue from treatments, generally not feeling well and having multiple surgeries. I intend on getting back to regular workouts soon and in the meantime I have been working on keeping my eating as healthy as possible so I am steadily losing weight. If I can do it, you can do it….there is always something you can do.

By Lorna Collier Last Updated: May 8, 2019

Skip the Gym and Get Fit at Home

You want to exercise, you really do, but it’s tough to fit a trip to the gym into your jam-packed daily schedule. Not to mention gym memberships can be expensive. Or it may be intimidating to think about working out next to pumped-up hard bodies if you’re just looking to stay fit. Whatever your reason, avoiding the gym doesn’t have to mean giving up exercise. Try these tips to reach your 30 minutes of daily activity outside of a fitness center. 

1. Video Workouts

Want to avoid spending money on fitness DVDs? Many local libraries have collections of workout videos you can check out for free. You can also buy used copies through online classifieds or garage sales. Streaming sites like YouTube or your cable’s on-demand service can also be budget-friendly sources of video workouts. Government agencies like the American Council on Exercise and the Centers for Disease Control also offer free online exercise videos. Seniors can get a free exercise DVD tailored to older participants from the National Institutes of Health. 

2. Exercise Videogames

Videogame platforms like the popular Wii Fit for Nintendo use technology to track your body’s movements, so you can play games like tennis or golf virtually, as well as ride bikes, box, and dance. One study showed that participants burned more calories playing Wii’s boxing module for 30 minutes than through brisk walking. Exer-games can be a fun way to stay fit at home, though you will need to use them regularly and with intensity. Along with the Nintendo Wii, you can find exer-games for PlayStation and Xbox, too. 

3. Home Gyms

These days, it’s possible to build your own home gym on any size budget. You can buy firsthand from sporting goods and fitness stores or score used equipment from garage sales, resale shops, or online resources like Craigslist. Friends or relatives also may want to find a new home for the treadmill that’s taking up dust in their basement, so let them know you’re looking. Many discount stores carry small exercise items, such as fitness balls, jump ropes, and resistance bands, making it convenient to complete your home gym on your weekly shopping runs.

4. DIY Equipment at Home

You don’t even necessarily have to buy equipment to exercise at home. Do you have stairs? Voila! You have a StairMaster. Want to do step training? You can swap out a pricey exercise step for a stepstool or sturdy chair. Large cans of food or 12 packs of soda make effective hand weights. Finally, use your own body as a weight, doing planks, push-ups, lunges, jumping jacks, and balancing poses to increase strength and tone muscle. 

5. Mall Walking

Walking is the easiest, least expensive activity to fit into your day. If you want to get out of the house but don’t have anywhere outside that you’d like to walk, or if the weather is bad, consider becoming a mall walker. Some malls even open early to allow mall walkers to make their way through the halls, which is especially good if you want to avoid slower-moving crowds of shoppers. Keep in mind that for a workout, mall walking is more than just an excuse to window shop. Walk fast enough that singing would be difficult, but not so fast that you can’t talk. 

6. Household Chores

It can be hard to get to chores when you think of them as, well, chores. But as fitness boosters, they’re a sure thing. Vacuuming, scrubbing floors and walls, and many other household tasks can rev up your cardio system or challenge your muscles enough to help you get fit. Outdoor chores like gardening or sweeping the garage count, too. Just keep your mind open to possibilities as you go about your daily tasks and remember to do them energetically enough to break a sweat and get your heart pumping. 

7. Outdoor Clubs

Community clubs and activity groups offer a fun and social alternative to the gym. The Sierra Club, for example, has lists of local hikes, bicycling trips, and other outdoor activities you can join. Search online social sites like Meetup.com for groups and people near you who are interested in outdoor activities like walking, hiking and other outside-the-gym fitness pursuits. For a more intense outdoor workout, try boot camp programs in local parks run by trainers who can provide a gym-level workout outside a traditional gym. 

8. At-Home Personal Trainers

Certified personal trainers don’t only work with clients at gyms. They also make home visits and can design personal workout routines for you in the environment you prefer. You can check with your local fitness club for referrals, or visit personal training professional associations like the American Council on Exercise to find qualified trainers in your area.