I’m not usually one who says things like, “it takes a special person to do so and so,” but breast cancer survivors are special people. I’ve found that working with survivors challenges me and makes me want to go to work every day!
We all know that exercise is good for us. We all know the positive benefits of exercise. Now you just need to get out there and do it. The American Cancer Society states the possible benefits of regular exercise during and after cancer treatment as:
- keeping or improve your physical abilities
- better balance, lower risk of falls and broken bones
- keep muscles from wasting due to inactivity
- lower risk of heart disease
- less risk of osteoporosis (weak bones that are more likely to break)
- better blood flow to legs and lower risk of blood clots
- less dependence on others to do normal activities of daily living
- improved self-esteem
- lower risk of anxiety and depression
- less nausea
- better ability to keep social contacts
- fewer symptoms of fatigue
- better weight control
- improved quality of life
I have worked with over 250 breast cancer survivors and most of them agree that regular exercise can make a real difference. One of my clients, Kathy from New Jersey, did strength training and cardiovascular exercise throughout and following her treatment. She says, “I lifted weights before, during, and after my treatment and as a result, did not have the usual problem of loss of muscle strength.”
Kathy claims that working out helped her get through treatment better than she’d expected. “I worked out during chemo, after my mastectomy, and during radiation. The support I received [at the gym] was very uplifting. There were days when I was feeling down and didn’t feel like doing anything. But I always went to work out because I knew I would feel better afterwards. And I always did!”
As her trainer, the message I gave her was always the same — listen to your body and do what you can. She plans to continue her exercise program right up until her upcoming reconstructive surgery day.
Starting an exercise program at any time is difficult for a lot of people, but it can often be even harder after breast cancer treatment. You might be asking yourself, “What can I do? Who do I go to for help? What do I need to be wary of?”
Here are some guidelines that I hope you will find helpful:
- Talk to your doctor about her/his thoughts on exercise during and after your treatment.
- Express to your doctor that exercise is important to you and that you want to make it a part of your life.
- Keep in mind that the stronger you are before surgery, the more quickly and thoroughly you can recover from the effects of surgery.
- Find a qualified personal trainer in your area to assist you in beginning your program and show you any safety precautions you may need to take (I’ll be posting a future blog explaining ways to find a qualified professional in your area).
- Do some research on your own. There are some real risks out there, but I really believe, and my clients are the reason I believe it, that the benefits can outweigh the risks.
- Find out what lymphedema is and what to look for. The PAL Trial at the University of Pennsylvania has given us evidence-based research that exercise, specifically strength training, is good for women who have and who are at risk for lymphedema.
- Use common sense. You are the only person who really knows how you feel. Don’t overdo it. Your muscles will tell you when you need to slow down and rest.
- START!!
Walking is the easiest exercise program around. This is a great way to start getting your body moving and allow you some time to experience the good feelings associated with exercise.
If you have a little time before your surgery, feel free to do any exercises that you were doing before diagnosis while keeping an eye on how you’re feeling during and after exercise. For instance, if you like to strength train, then keep doing it.
If you have surgery planned for right away, then it is strongly suggested that you talk with a physical therapist and a qualified personal trainer about safely getting back into exercise after surgery. You should be able to do any exercises that you were doing before treatment, at a moderate level. Your goal is to avoid inactivity!
There are always so many precautions about everything and I certainly want you to pay homage to precautions regarding your exercise program after cancer treatment. But give it a try! And remember — it’s good for you and you may even like it.
I would love to hear where you are with your mission to fit exercise into your life. Exercise can play a very important role in staying healthy during and after breast cancer treatment. Feel free to comment and ask questions regarding this blog. There are more to come. Look for the upcoming topics, “What to look for in a qualified personal trainer” and “Experiences of exercising breast cancer survivors.”
I’m 2+ years out and taking Femara (my Stage 2 cancer was estrogen receptor positive). At age 42, I’m post-menopausal since having my ovaries removed too (I’m also Brac1+) and while pretty fit, feel older than my age due to fatigue, anxiety, poor sleep due to meds. The one thing that ALWAYS makes me feel better – is exercise. Even a little walk around the block in the evenings can clear my head and make me feel that I don’t have to adust to the ‘new normal’. Thanks for talking about this important issue and encouraging others. It can make a huge difference – it has for me!
Diane at http://www.pink-pockets.com
Great information Cathy!! Having worked with you I know how trustworthy you are! For those who don’t know you…they are in for a great surprise! I’d trust you with my life!! =)
Wowsers! I hope some of the women here who have experience with this will weigh in. Nice idea for a blog, but the points to keep right at the front of our minds are those that make it “swell safe”: low intensity, increase very gradually, no pain or fatigue. And if you opt to follow the recommendation for the added protection of compression, have the fit checked out by someone with experience.
http://www.stepup-speakout.org/proper_fitting_of_lymphedema_garments.htm
Hand protection along with the sleeve is recommended:
http://lymphedivas.com/lymphedema/gauntletandsleeve/
Even more to the point, I trust that bc.org will be promoting the recommendations of the National Lymphedema Network concerning screening and measurement for EVERY woman who is diagnosed with breast cancer. They include solid patient education as well as objective measurement before any treatment begins and at every doctor visit following.
http://www.lymphnet.org/pdfDocs/nlnBCLE.pdf
Pushing the importance of exercise without full acknowledgment of the risk of lymphedema and clear guidelines for lowering that risk is incomplete and leaves us at the mercy of these unwanted consequences. Because exercise is so crucial to our overall well-being, a balanced approach and emphasis on safe parameters for increasing our activity levels should be the primary concern.
Thanks, bc.org, for thinking of this important aspect of recovery. We’re depending on you to present the whole picture for our protection and on-going quality of life.
Binney
The PAL study did not definitively prove that weight lifting prevented or cured lymphedema: only that women without lymphedema didn’t develop it more frequently than the control, and that women with lymphedema had fewer flares.
Your photograph of women weight lifting without compression is concerning, as the PAL trial had custom compression garments.
The PAL protocol is not freely available, and is not the protocol used with Livestrong or other personal trainers.
And even with the careful PAL protocol, some women with lymphedema simply could not tolerate weight lifting.
While I support exercise for women after breast cancer, as a woman who has lymphedema, I’ve had to fight for accurate information and assistance, and your “find out what lymphedema is” comment is insufficient, and places women at risk of developing a chronic, incurable disease.
I suggest you post the NLN guidelines on exercise, and post links to reputable sites that define lymphedema.
http://www.lymphnet.org/pdfDocs/nlnexercise.pdf
http://www.stepup-speakout.org/
Your blog is listed on the lymphedema forum of breast cancer.org as a resource for women with lymphedema to find information on exercise, yet the one paragraph on your page is insufficient information.
Weight lifting did not harm women with lymphedema, but it didn’t cure it or prevent it either. Some women will tolerate slow, progressive weight lifting, and others will have to look to alternative forms of exercise.
Kira
Hi Cathy!
Thanks for starting this blog. I don’t look at “post cancer exercise” as being any different than what we should be doing anyway. So cardio and strength training.
I exercised all throughout active treatment including cycling with a drain. I made sure I got everyone’s sign off prior to doing it. I was out walking the day after my lumpectomy and was told to do the arm exercises immediately. So that is what I did.
I was extremely fit going in, so what I did was maintain my fitness level. I did take time off strength training until after my drains came out. Then I again asked my surgeon and she said “yes”. I went and got 5lb weights as my normal 10s were too heavy at that time. Three weeks later, the 5s felt like feathers, so back to 10s. By then I was well into chemo.
My attitude during chemo was that I might as well be “exercised and dragging” as opposed to simply “dragging”. So exercised throughout. I know I had a much easier trip than most.
I signed up for the Seattle LIVESTRONG which was 12 days after finishing up radiation. This forced me to train, and remember that I was being sponsored so I needed to deliver. I downsized from 70 to 45 miles as was an extremely wet, windy, and miserable day.
Four weeks later, I did the Seattle-to-Portland. I came up the post radiation energy curve just in time, so I was able to complete it (200+ miles over 2 days).
I did a number of other cycling events last summer, but at about 95% full energy so they were work. And I did my normal x-country skiing last winter.
My big learning is that I didn’t escape the long, slow healing curve, so took about 11 months from the end of radiation to get to 100%. One day, I realized “wow, it’s over”.
Now I would describe myself as “better than ever”. Much more focused, more discliplined, more confident, and stronger than at any time in my life. I think we do everyone a disservice by describing a “new normal”, which to me means “you will never be quite the same again, so you might as well suck it up and get used to it”.
Wrong message, and I think even affects overall mortality among breast cancer patients.
Which is why I think your work is just so very important.
BTW – just completed the Seattle-to-Portland this past weekend and was ever so much easier than a year ago. And certainly a lot easier than the first time I did it. This year makes 5 of 5. Now there’s something to celebrate!!
It’s great that BCO is doing a page encouraging women to exercise after b/c. But, I share the concerns about the lack of LE information and more so about the incorrect LE information, especially the overstatement of the results of the PAL study. Lymphedema precautions need to be made much clearer and stronger, and the picture showing women doing weight lifting with no compression garments must be changed.
Unfortunately, too many doctors and others in the medical community seem to believe LE is rare or non-existant, and they give their patients the “all clear” to work out when the patient has healed enough so exercise won’t damage surgical or radiated areas – not damaging the treated area is their only consideration. They don’t take the broader view that includes LE prevention. And most personal trainers are unfamiliar with LE, and as a result, are setting out training programs that put clients at risk – doing way too many reps with way too much weight, doing full pushups, or doing downward dog in yoga, etc. So the advice for b/c patients to discuss exercise with their doctors and a personal trainer is inadequate as there’s no guarantee the patient will be given proper advice on how to begin an exercise program that will minimize the risks of LE. Patients at risk (and that includes those with just one node removed, despite what too many surgeons believe) should be encouraged to seek out a certified LE therapist, get properly fitted compression garments, and be educated about LE precautions.
I am one of the many women who was eager to get back into shape after b/c. I got the all clear from my doctors, consulted with a personal trainer, and began weight lifting, doing yoga, and other exercises without proper education about LE precautions. I now have arm and truncal LE. Maybe I would have gotten it anyway, but I feel as if I was denied the opportunity to do everything I could have done to avoid it.
That said, even with LE I am very active – I routinely jog, elliptical, take yoga twice a week, and yes, I do weight and resistance training twice a week. I’m also an avid mountain hiker. But, I developed my workout program under the guidance of a certified LE therapist who has taught me all the proper management techniques. I am religious about doing the Lebed exercises, manual lymph drainage, and I always wear my compression sleeve and gauntlet when exercising or otherwise stressing the arm, such as gardening, painting, snow shoveling,etc. And I wrap or wear my night sleeve as appropriate when I flare. Having LE (or taking appropriate LE precautions for those at risk) doesn’t mean we have to give up an active lifestyle. We just need to be aware and take precautions.
Thank you so much for your thoughtful comments. I would like to respond and hopefully clear up any misunderstandings. I absolutely agree that precautions are important, as I mentioned above.
The National Lymphedema Network is a wonderful website, full of very important information and guidelines. Thank you for providing the link to their site in your comment. The National Lymphedema Network suggests that those who have lymphedema wear a compression garment while exercising and suggests that those who do not have lymphedema may choose to, but does not emphasize one choice over the other.
As lead trainer on the PAL Trial, I closely observed the experiences of the women in the study, and how exercise positively affected their lives. All survivors who opt to exercise in my PALS for Life program will wear a compression garment if they have ever been diagnosed with lymphedema. Those who have not been diagnosed with lymphedema are not required to wear a compression garment, but are certainly welcome to if they choose. The women in the first photo have not been diagnosed with lymphedema, and in accordance with NLN’s statement, opt not to wear sleeves. The woman in the second photo does have lymphedema, and therefore is using compression.
I’m very happy that you’ve read the PAL Trial papers! You are correct — the study did not prove that weight lifting prevented or cured lymphedema. I truly wish that could happen! However, I hope that helping survivors to be more confident and more functional in their activities of daily living and feeling healthier overall is a very good step in the right direction. I’ve spent a lot of time with women who’ve been diagnosed with lymphedema. One woman in particular told me that while lymphedema had had a big impact on her emotional state in the past, now that she’s regularly exercising and feeling stronger, lymphedema no longer controls her mood. These women’s experiences are why I continue this work.
I also suggest consulting with your physician prior to beginning any exercise program to consider your overall health status. This affects exercise too. As an experienced cancer and exercise personal trainer, I work very closely with my participants to monitor how their bodies are reacting to the exercise. I also pay very close attention to other issues that may be affecting them, including obesity, high blood pressure, and diabetes.
The PAL Trial protocol is available only to qualified professionals who have the appropriate training to work with people who are at risk for or who have lymphedema. This is a very specialized area of fitness training and I plan to continue educating qualified personal trainers and therapists through my effort with PALS for Life. I do suggest that you follow the link to the PAL Trial website, which is also provided on the National Lymphedema Network website, for more information about the PAL Trial. I’m also happy that you’ve read the NLN guidelines on exercise! This is again great information for women with and at risk for lymphedema. Happily, these were updated shortly after we completed the PAL Trial.
You’re correct in mentioning that LIVESTRONG at the YMCA and some other personal trainers are not currently following PAL protocol. If professionals with certain qualifications contact me requesting the protocol, I’m happy to send it to them. If they don’t have these qualifications, it means that they require training, which I’m also happy to offer! This is why I have begun PALS for Life — to provide all qualified professionals with the opportunity to learn how to work with breast cancer survivors who wish to safely put exercise back into their lives. The PAL protocol is the only research-based exercise protocol specifically for breast cancer survivors. I am certainly NOT saying that it is the only one that works, but I am saying that it is the one that I feel most secure in using and teaching after working so closely with over 250 breast cancer survivors who benefited from this research effort.
Weight lifting is not for everyone — that is for sure. If it were our general population, things would look very different. However, I believe that the benefits of exercise outweigh the risks in most cases. Thank you for chiming in with your questions and concerns. I think we all have the same goal – exercise that’s safe (first and foremost) as well as empowering!
I’m thrilled we are having this conversation. I also understand the medical world has a long way to go in understanding the full impact of lymphedema and how to handle it.
I’m curious about compression sleeves during exercise. My PT told me that there seems to be evidence for and against using it without LE. She even suggested it might precipitate it.
Overall, do you find women who do not have active LE and don’t wear compression garments fare well in the gym? What would be the reason not to wear it (unless one subscribes to the idea a sleeve might precipitate LE in those without a formal diagnosis)?
Thank you, all of you, for your rigorous questioning. It’s why we’ve made progress.
I also feel the benefits easily outweigh the risks. I started exercising daily as soon as I started chemo for metastatic disease in 2007 and haven’t stopped. After I had a mastectomy and an axillary node dissection I added arm exercises to my walking regimen and continued this through radiation. Several months later I started resistance training with Therabands 2-3 times a week. I also did daily massages, including some manual lymph drainage, as an LE preventive. I still do cardio and strength workouts everyday, now using weight machines I couldn’t handle before, and credit these with making the pain from hormonal therapy manageable. And like Claire, I am stronger today than before my diagnosis. So I would encourage everyone to get started, but slowly is best and if possible with supervision, particularly if bones may be brittle from cancer and from treatment.
I am so glad to see that this is on the blog. I trained with Cathy Bryan on the PAL study. After seeing the notice in the Princeton YWCA breast cancer publication that I could apply for the study, I jumped right on it. I had been going through many cellulitis infections as a breast cancer survivor. I was misdiagnosed initially in 1999 after a mammogram and ultrasound were negative. A few short months later, I found a lump in my armpit and went immediately to my doctor and the whole ordeal began, mastectomy, chemotherapy, radiation, failed reconstruction, etc. The PAL study was the most positive thing that I could do help myself with the pain and infections. I had been through hospitalizations and many visits to varying doctors. My Infectious Disease Dr. Golden was quite concerned that I was a “frequent flyer” as I referred to myself. I would have PIC lines inserted and go through a course of varying antibiotics to rid my arm of the infection. After starting the PAL study and following the proper warm-up and exercises prescribed, we noticed that during the study I was having fewer and shorter bouts of cellulitis infections which would make the fluid in my arm increase. When I did get an infection, the drugs used were administered only a short time. I do know that the rest of my life will require constant exercise to keep the infections to a minimum, recently I had the unfortunate instance where my cat scratched me while I slept and had an infection which required treatment. Without the lymph nodes to remove the fluid that accumulates in the arm it’s like a stagnant lake and a breeding ground for bacteria. I know that this will be a constant reminder that I am a breast cancer survivor and I need to “baby” myself for fighting the good fight to survive. Only when Science can create a replacement for the lymph nodes lost or damaged due to cancer could we hope for a cure of this disorder. I try to keep positive and pray that God will keep me safe.
LtotheK-
Thanks so much for your comment! I require all women who have been diagnosed with lymphedema to wear a compression sleeve to exercise. This is regardless of whether or not they are showing symptoms of lymphedema currently. We have found that strength training is one way that, for many women, may help manage the sometimes debilitating symptoms of lymphedema. Again, everyone’s situation is individual here.
I have not found that it is necessary to wear a compression sleeve for strength training if you have not been diagnosed with lymphedema. This being said, I would certainly support someone if they wanted to wear one during exercise. I will follow all National Lymphedema Network guidelines as they become available. I really believe that the key is the exercise protocol that is followed. An individualized program based on sound research and exercise science gives you the greatest chance to succeed.
As a breast cancer survivor of 6 years, I developed lymphedema almost straight after chemo and radio. I remember being so sick that I would have given anything to have the energy to be able to walk to the postbox to collect the mail.
After recovery I started walking bit by bit then my lymphetic drainage therapist suggested swimming. Not being a natural swimmer the thought seemed a little out of my reach however I started going to the pool in the mornings with my husband as he’d taken up swimming a few years earlier. I started in the baby pool just doing a little bit of breaststroke, I could do only about 10 strokes before I started to take in water . My Lymphatic therapist suggested that why don’t I have stroke correction, well a year after that comment I was outside in the 50 metre pool doing laps.
It’s without a doubt the most satisfying thing I’ve ever done, to think it took breast cancer for me to achieve this. I never ever thought of taking up swimming before let alone being able to breath properly .
At 61 to be out in the outside pool doing 30 laps 3 mornings a week is the best thing I do all day. I use to watch the people outside swimming and that was my aim to be outside with the real swimmers. Sometimes on a really cold morning I’m one of the very few people swimming outside, I feel so amazing. The days I swim my arm always feels at it’s best, there is no doubt that swimming is fantastic for lymphedema. I also do aqua aerobics, pilates and lots of walking a bit of running in the winter. I always wear my sleeve when walking and pilates but never when swimming or aqua. I’m most surprised that more women don’t swim to help their lymphedema.
At the moment I’m deciding weather to have the other breast removed as I’m over the prothesis and not being able to wear certain clothes, and being a small person I think it would be great not to wear a bra. A reconstruction has never been on my mind. My only concern is that I develop lymphedema in the other arm even though I wouldn’t be having lymph nodes removed etc. it would be purely prophylatic. I would love to hear from anyone that’s had the other breast removed weather they developed lymphedema and what the recovery time is (can’t imagine how I’m going to cope without swimming) before I can resume normal exercise.
I’ve so enjoyed reading the stories on this site, I’ve just discovered it, and great to hear of others doing lots of exercise as I thinks it’s definitely the way to a happy recovery.
Hello to All and thanks for this web-blog!
I am about 14 months post bilateral Diep Flap, and pretty much ok except for periodic fullness on the right side surrounding my “foob” and underarm. I don’t really notice any visual swelling but the discomfort is very real. I have an appointment with plastic surgeon in about 6 weeks, but thought I would ask if anyone else has this symptom.
Also, at times my foobs and abdomen have that taut, stretched feeling. I think it has to do with the scar tissue but I’m not sure, as it is periodic and not seemingly related to any particular physical activity or diet. Any thoughts about it and if there is some kind of stretching I might try?
Many thanks in advance for your advice!
I am glad that all of you found a way to exercise. I had a lot of difficulty. I suffered from significant nerve damage from lymph node biopsies hence serious strength deficits, then forzen shoulder and muscular imbalances througout my upper torso. Has anyone else experienced this? I found no information to guide me. It has taken me three years of trial and error to regain half of my strength . I failed PT three times.
I had a bilateral mastectomy, went through chemo followed by radiation. Just had my first 3 month checkup and my oncologist told me about a study that found that women who exercise can lower their risk of recurrence by half. This is obviously a great incentive to get started but I have persistent neuropathy in my hands and feet and have tried walking my dogs, all 3, and my feet are very painful during the walk and then feel worse for the next day. Can you suggest anything to start with for those of us who are struggling with neuropathy?
Hi Nancinurse, and thanks for your question. Neuropathy is a tough one! But you can still certainly exercise with it. You really have to pay attention to your symptoms and focus on what you CAN do! I will offer my thoughts, but as always, please remember that I am not familiar with your specific situation and without having met with you I am only offering just that… my thoughts.
I have worked with many survivors who have had neuropathy and we really had to listen to their bodies and build up their strength over a period of time. What has your Dr. said regarding any limitations? I have seen neuropathy symptoms decrease with exercise, but I understand that the pain that comes with it can be unbearable. With this said, I suggest trying something like a recumbent bicycle for 5-10 minute intervals to see if this helps lessen the pain at all.
Now, for the upper body. I always suggest that a survivor start with very low weights and gradually build up over time. Are you able to hold 1 lb. weights in your hands? I hesitate to suggest wrist weights and certainly do not suggest exercise bands in the beginning of your exercise program.
NCI (the National Cancer Institute) states on their website that some patients have found relief through acupuncture (obviously not in your affected arm), massage (obviously not in your affected arm), and some medications. I would try the exercise first. Swimming may be a good option for you if you have a warm pool in your area. The research on swimming for breast cancer survivors is showing some good results. You might look into the Arthritis Foundation, as they require their pools to be a certain temperature, and I can’t imagine that cold water would feel good on your hands and feet. Do you have a Cancer and Exercise Trainer in your area? Finding a qualified professional in your area who is willing and eager to research your specific symptoms and abilities would certainly be a big help to you. If you are anywhere near Delaware, I would love to work with you.
Good luck!
Hi Cathy, thanks so much for your input. I don’t have a Cancer and Exercise trainer in my area so your comments are most welcome. The only input I got from my oncologist is to push through the pain and try to exercise. My concern was not wanting to perpetuate the symptoms by pushing too much but he told me I will not make the neuropathy any worse by exercising. I had tried to walk with my dogs a few times but sneakers aren’t very comfortable as my toes and the balls of my feet or both hypersensitive and somewhat numb. The last time I walked 2 miles and they were sore for the next 2 days. I will listen to my body and try to go a bit slower. Thanks again for your thoughts.