An REI member explores her shifting relationship to the outdoors after being diagnosed with cancer last summer.

The cancer diagnosis felt like the ultimate betrayal. I was a healthy, active, middle-age woman who seldom got sick. In the summer of 2020, I learned I had cancer in my lungs though I’d never smoked a day in my life. Nothing had prepared me for this.

I instinctively began thinking through all the things I felt I would no longer be able to do on this new path suddenly laid out before me: taking long, leisurely vacations, eating the foods that I crave and love. And at the top of the list: hiking.

In the 16 years that I’ve lived in Seattle, I have discovered an unquenchable passion for the outdoors and feel lucky to live in a place surrounded by such natural beauty. Mount Rainier, with its year-round snowcap, sits majestically in view from almost any route I take to drive home.

My partner and I used to spend nearly every Sunday hiking some of the gnarliest peaks in the Olympic and Cascade ranges, like Bandera, Granite, Thorp mountains. We biked trails that weaved through dense forests or meandered through open fields, paddled the mountain lakes in our canoe, and camped in places like the Hoh Rainforest on the Olympic Peninsula. Exploring nature always felt like magic medicine.

Now, all that suddenly seemed lost.

Hidden Lake, North Cascades

Before her cancer diagnosis, the author spent most Sundays hiking gnarly peaks, including ones in the North Cascades, Washington. Photo Credit: Stephen Haile

In the months following my diagnosis, I’d scroll through stunning mountain views from local hiking groups in my Facebook feed with a sense of longing. But I also began to notice posts of hikes with less elevation—some with views just as striking. In my old life, I would bypass these flat trails at the base of mountains or paths that snaked alongside rivers, thinking they were best left to families with young children or people out for a stroll.

Now with a body weakened by chemotherapy, I’ve come to learn that while my diagnosis limits the intensity of my outdoor activity, it doesn’t prevent me from engaging in it. As a way to stay close to home, my partner and I, amid the pandemic, had started to discover and add 1- to 2-mile trails with low-to-no elevation gain trails to our weekend hiking mix—many of them nestled in residential neighborhoods, like the one a block from our house where we take evening walks with our dog. Turns out we’d been doing what we loved all along, just not at the same scale.

I still get nostalgic for the big peaks, especially when I see the jaw-dropping pictures people post on social media. But I now recognize that hiking exists along a continuum…

These low-to-no elevation hikes remind me of how much I missed as I was grinding away to reach the summit of some big mountain, like the different ecosystems that exist at lower elevations or the numerous stories that you can learn about a region from interpretative trails. Many can be found nearby and they’re often far less crowded, in our experience.

Chemotherapy is like a blanket of fatigue. I have metastatic cancer of unknown origin in my lungs and liver. It behaves like and is being treated like colon cancer. The fatigue I feel from that treatment is unrelated to any level of physical activity and does not really improve—even with rest. Chemo treatment leaves you with less energy to spend because your body is working to generate energy to metabolize the chemotherapy.

I have to constantly fight the urge to want to lie down. That means that with any activity—from simply doing the dishes to going for a hike—I’m in an endless battle with my body to get up, to move, to go.

But I know what I’m doing is important. A growing body of research supports the theory that physical activity, including hiking, can help reduce fatigue for cancer patients and that regular exercise that increases the heart rate can also help prevent cancer or lower the risk of it returning.

“It’s expected and normal to lose both strength and aerobic fitness with cancer and its treatment,” said Dr. David S. Zucker, a cancer rehabilitation physiatrist at Swedish Cancer Institute in Seattle, who treats me. Rest is just as important as physical activity, he says. Too much of either can amplify fatigue. So, he recommends finding a balance to avoid too much rest but also overtraining.

With chemotherapy, he says, a person’s emotional, behavioral and physical capacities change, though we may not always be attuned to that. “There’s an association between what the mind remembers and would like to think it should do and what the body can actually do,” Dr. Zucker said.

Chemotherapy leaves you with a different body, “a new body, really, that has a different way of functioning,” Dr. Zucker adds.

For inspiration, Dr. Zucker shares the story of his patient Phil, an outdoorsman who longed to hike the Camino de Santiago, a 500-mile ancient pilgrimage route across Spain, until a Stage 4 cancer diagnosis appeared to end those dreams.

So, Phil recreated his own Camino on 10 acres in his backyard on Washington’s Vashon Island. With each lap, he would plot his progress on the Santiago map, while Zucker trained and guided him. He eventually got a break from his chemotherapy treatment long enough to make the trip to Spain. His story is told in the documentary Phil’s Camino.

Woman standing at a scenic mountain lookout

The author at a lookout in the North Cascades in fall 2019. Photo Credit: Stephen Haile

You certainly don’t have to replicate Phil’s effort to engage in the outdoors, as I’ve learned. Here in Washington state, for example, the Washington Trails Association, a member-driven group that fosters the stewardship of trails and public lands, lists over 1,700 low-to-no elevation gain trails across the state, ranging from paved to rugged. Many are wheelchair accessible.

Kindra Ramos, a spokeswoman for the group, says often just taking time to focus on the small wonders of nature can make a hike worthwhile. “When I need to get out but am not feeling like I have much energy, I like to pick short loops that I can do a second time if I am still feeling good after the first go around,” she said.

Other times, just walking around the streets of your neighborhood can be enough.

I still get nostalgic for the big peaks, especially when I see the jaw-dropping pictures people post on social media. But I now recognize that hiking exists along a continuum, from scaling peaks thousands of feet high to the gentle walks through neighborhood parks. And in this post-diagnosis reality, I’ve come to appreciate this different way of exploring and enjoying nature that doesn’t involve a big scramble to the top.

Lornet’s Hiking Tips

In addition to finding lower elevation hikes, here are some of the other things I’ve learned from my own experience of hiking through fatigue.

Prioritize stability. Hiking with trekking poles can give you an added level of security on uneven terrain. Although my partner always used them, I never did, even on our big hikes, because I always felt like they’d slow me down. Now, I consider them if our hike includes any form of elevation gain at all.

Make sure you have proper gear—shoes, socks and jacket. (These hiking and camping checklists from Expert Advice can be helpful resources.) Some chemotherapy treatments, like mine, can lead to patients feeling cold all the time. Last fall, we rented a recreational vehicle for a camping trip to Cape Disappointment, the point on Washington’s coast where the Columbia River meets the Pacific Ocean. Tent camping in November was out of the question, given my chemo treatment and the cold and wet conditions.

It was my first time camping in an RV and I loved the idea of coming back at the end of a day of hiking to a warm, dry space with heat, running water and a working kitchen. Hiking around Cape Disappointment, as with other hikes we do in the cold, I wore heated gloves. I’d been using the e-gloves even before I began chemo because of Raynaud’s Syndrome. Now they’ve become an essential part of my kit.

Remember that hiking is a journey. Take breaks before reaching the point where you’ve become desperate for one and be honest with your hiking partner about what your limitations are. Let your body guide you on how far and fast you go and know when it’s best to turn around.

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