Recovery Fitness

Senior Woman Exercising In ParkWhen, why, and how to start an exercise program after breast cancer treatment

By Carol Michaels and Maria Drozda

Breast cancer surgery and treatments affect many areas of the body. Complaints of stiffness, pulling, tightness, and a lack of flexibility are common. Often this occurs when the muscles and the skin are shortened because of the surgery, which can also leave scar tissue. Surgery can irritate the nerves. As a result, you may feel burning, tingling, or numbness.

When to Start

You should start stretching exercises as soon as you get clearance from your doctor. It is important to talk to your doctor before starting to exercise. This way you can determine what program is right for you. Some exercises can be started soon after surgery, while others can be done right after the drains and stitches are removed.

For those who have access to post-surgery specialists, a physical therapist or cancer exercise specialist will take range-of-motion measurements of the shoulder at the start of your breast cancer exercise program. These include shoulder flexion, extension, abduction, and rotation measurements.

For example, you may start with only 30 degrees of shoulder flexion and after several months see significant improvement. Some patients have improved shoulder flexion by more than 140 degrees over periods ranging from two weeks to three months. Everyone heals at a different rate. In an ideal situation, it is helpful to take these measurements prior to the surgery to give you a basis of comparison.

It is also a good idea to meet with a lymphedema therapist if you are at risk for lymphedema. This way the lymphedema therapist can take limb girth measurements, which can be used as a basis of comparison if there is a suspicion of lymphedema.

Why and How to Start

Emotional Health

Exercise is good for our emotional health. It is one thing that you can control and do for yourself. It is empowering. Physical activity can decrease depression and anxiety. Participants in exercise programs reduce stress, increase confidence, and build positive health habits. The participants also gain endurance, increase their energy level, and decrease the fatigue that may be caused by treatments.

Exercise Progression

Many variables determine the exercises that are safe and effective for your particular situation. Every day brings new challenges and new accomplishments for the cancer patient. It is important to be able to modify your exercises to fit your needs at a given time.

Pain and fatigue levels can change from day to day and even from hour to hour. You may wake up feeling fine but may have increased fatigue as the day progresses. Track your energy levels throughout the day to determine the best time to schedule your exercise sessions. For example, if you have more energy in the afternoons, you should exercise in the afternoons.

Exercise when your energy levels are high. Common sense and listening to your body are of utmost importance. You should not feel like you have to follow a set protocol or a strict schedule. Your routine must be customized due to the numerous physical and psychological side effects you may be experiencing.

Both healing times and pain tolerance can differ greatly from one person to the next. Speed of recovery depends on your presurgery fitness level and the type of surgery and treatments. The progression and the timing of a cancer exercise program can be determined only after a thorough discussion between the patient and her healthcare provider.

Relaxation Breathing

There is an emotional toll that cancer survivors face in addition to the physical one. A cancer diagnosis can cause depression, anger, anxiety, fear, and stress. Proper breathing techniques and stretching can improve the psychological recovery.

For example, research has shown that breathing can help reduce stress and anxiety. When feeling stressed, we usually take shallow breaths. During breathing exercises, we use our full lung capacity and breathe slowly and deeply. You should be aware of your breathing, as it has a calming effect.

Inhale for five seconds and fill the torso with air, then exhale from the lower abdomen for five seconds, pulling the navel in toward the spine. Imagine all of your tension and stress leaving your body with each exhalation.

You should begin relaxation breathing immediately after surgery, as it allows you to focus all of your energy on healing. Stretching will restore mobility in the chest and back, which allows for freer movement of the lungs and the diaphragm.

Aerobic Exercise

Aerobic exercise is essential for good health. This includes any movement  that elevates your heart rate. As soon as you have medical clearance, you should start walking. Chemotherapy and radiation can cause fatigue. It may seem counterintuitive, but physical activity can help decrease fatigue and help you improve your ability to tolerate treatments. Walking can boost your energy.

Even if you are able to walk only one house distance at first, every day try to walk a little farther until you are able to walk for 30 to 45 minutes. If this is not possible because of health issues, aim for 15 minutes one to three times a day. Try to exercise when you feel the least tired. You may feel exhausted at various times during treatment and recovery, especially during chemotherapy and radiation. When you feel better, try to do more. Ultimately, the workout will help energize you and ease your aches and pains.

Stretching

Stretching exercises developed with your physical therapist or an exercise professional trained in cancer recovery exercise should be performed every day for a year or longer, depending on your particular situation. The older you are, the more important daily stretching is to maintain flexibility.  Commit to stretching regularly so that you gradually improve your posture, range of motion, and flexibility.

First, warm up for five to 10 minutes by marching in place, or use a stationary bicycle while swinging your arms. Then perform the stretching exercises two to five times per day in the beginning of your recovery. Use only smooth, controlled, nonbouncy movements.

All movements should be done slowly and with great concentration. Try to reach the maximum pain-free range of motion possible for you. Stretch slowly and allow the tissue to lengthen. Hold the stretch until you feel a little tension—but not to the point of pain. The goals are to restore joint mobility and break down residual scar tissue. Always feel free to modify any stretch to your ability by going only a fraction of the distance.

At first you might suffer from fatigue and low endurance and might be able to exercise for only a short period of time. Every day you can lengthen the session. Patience and practice will pay off. As you get stronger, you can increase the length of the sessions.

Once you have achieved an acceptable range of motion, it is usually necessary to continue the stretching program so that you can maintain that range of motion. If you have had radiation, stretching is very important to help keep your body flexible. Radiation typically causes additional tightening. The impact of radiation on the affected area can last for a year or longer after treatment has ended.

Important: If you notice swelling or tenderness, contact your healthcare provider. 

Strength Training

Next up is strength training, which improves balance and posture by increasing core strength. It can improve your quality of life by making activities easier and more enjoyable. It can also reduce the chance of injury and can empower you physically and mentally.

Another reason to strengthtrain is because chemotherapy can cause weight gain and can change the muscle-to-fat ratio. Strength training improves the muscle-to-fat ratio. We need to gain muscle mass, which can decrease during treatment, and we need to strengthen bones. Having more muscle increases metabolism. A pound of muscle burns twice as many calories as does a pound of fat, so strength training is a great way to help get your weight to a healthy level and keep it there. While diet is often the most critical factor for weight loss (and is beyond the scope of this article), strength training is a major factor as well.

Many cancer treatments can increase the risk of osteoporosis. Strength training helps build strong bones. You need to learn which exercises are contraindicated for osteoporosis. For example, if you have or are at risk for osteoporosis, you should not do forward bends, abdominal crunches, or extreme twisting movements. Surgery can lead to weakness in the muscles of the chest, shoulders, abdomen, and back. Surgical patients need to rebuild strength in the affected areas and keep all the muscles in the body strong, as well as correct muscle imbalances.

After you have achieved an acceptable range of motion and posture and have medical clearance, it is time to add strength training. Exercise gently, focusing on slow and progressive improvement. Control and good form are essential.

Adapted from Exercises for Cancer Survivors (Friesen Press, 2013)

For more information or to purchase a copy of Exercises for Cancer Survivors, visit carolmichaelsfitness.com.