Welcome to blog #2 on exercising safely after breast cancer treatment. In this blog I will talk about what makes a qualified personal trainer and how to find one in your area.
We all know that the topic of exercise for breast cancer survivors is a hot, hot topic. And I first want to thank all of you who chimed in on my first blog and pointed out some very important factors regarding exercising safely after treatment and some important variables regarding lymphedema. This is truly why I love working with this community—you are so passionate and intelligent when it comes to what is right for you and your body. I commend you for that!
Among doctors, physical/lymphedema therapists, and personal trainers, there are those who are great, good, and not so great. I see it as part of my responsibilities to make sure that you know what to look for in order to find one of the good, if not one of the great, qualified personal trainers prepared to work with you. Now, the issue becomes finding one in your area. While the general population can go just about anywhere and get suitable exercise advice, breast cancer survivors do not have that luxury. Happily, this is changing. The research is becoming more and more available that tells us that exercise can be safe for most breast cancer survivors. Strength training exercises must be performed correctly and with the proper guidelines in order to be safe and beneficial for breast cancer survivors. Personally, I’m an advocate of the Physical Activity and Lymphedema (PAL) Trial protocol that was developed at the University of Pennsylvania. After working on this trial, I started a program called PALS for Life so that I can continue my work with breast cancer survivors to help them develop safe exercise routines. I also travel around the country training qualified personal trainers and lymphedema therapists how to safely and effectively plan exercise programs for survivors with and at risk for lymphedema. Having said this, qualified therapists and trainers are still few and far between. I have put together a list of some specific qualifications that you, as a breast cancer survivor, should look for in a personal trainer.
- The trainer MUST have a national personal trainers certification:
- Some very well-respected organizations are the American College of Sports Medicine (ACSM), the National Association of Sports Medicine (NASM), and the American Council on Exercise (ACE).
- A trainer with a Cancer and Exercise Training Certification (CET) from ACSM would be fantastic! (see explanation of this certification below)
- A degree in an exercise physiology-related field would be great.
- Experience working with a variety of clients (a good cross-section of clients would include older adults, people who are in shape, people who are deconditioned, and obviously breast cancer survivors).
- They must have the ability to listen to you as a client and take in what you’re communicating that you want out of your program.
- They must have the ability to take all of what you say and put it in the shape of a safe and effective exercise program for you.
- I prefer that they work with a reputable health club/organization, or have an accredited business license as an independent professional.
- If she/he is an in-home trainer, trainers’ insurance and adequate health history forms (for collecting your personal health history) are a must.
- Always ask for and check at least three references for any trainer!
National certifications for personal trainers have come a long way over the past 25 years. ACSM, NASM, and ACE are three of the top ones. This does not mean that personal trainers who have other national certifications are not as qualified to work with you. On the contrary, I have met many trainers who have lesser-known certifications but who are extremely well versed in the body and how it works before, during, and after cancer. I believe that the best way to find a trainer who is right for you is to set up a meeting, learn about their education, experience, and their reasons for wanting to work with you. I have been a nationally certified personal trainer since 1993 and I can tell you without hesitation that a great deal of my education came from working with students with disabilities. I learned how to adapt the environment, the program goals, and anything else that needed to be adapted in order to allow the students to succeed. I have carried this over into my career of personal training breast cancer survivors and into the PALS for Life workshops I teach. My education allows me to be a very good trainer, but my passion and desire to help people put health and wellness back into their lives is what drives me to continue to learn and grow as my career moves forward. Look for this quality in your trainer. No doctor, therapist, or trainer can know everything that there is to know about you, your cancer, or your treatment, but their passion to do right by you should ensure that they do everything they can to design the best exercise program for you.
How to find a qualified trainer in your area:
You can find a qualified certified cancer exercise trainer (CET) in your area on the American College of Sports Medicine website. As you click on “certification,” you’ll be able to choose which specific certification/registry level you’re looking for. The National Strength and Conditioning Association has a “Find a Personal Trainer” drop-down menu on the right hand side about halfway down the page. It’s very well hidden, so look carefully. You can find qualified trainers/therapists who have gone through the PALS for Life training with me at www.cancersurvivorfitness.com. Just click on “Find a Trainer.”
Specifically, professionals who hold the ACSM’s Cancer and Exercise Trainer certification have demonstrated knowledge on targeted competencies associated with a variety of cancers, including breast cancer. Recommended competencies listed on the ACSM CET webpage include: “Understanding of the potential impact of cancer therapy, especially surgery and chemotherapy, in putting cancer patients at increased risk of injury and other complications, such as lymphedema, from exercise.” The CET exam tests one’s knowledge on topics including, but not limited to, exercise physiology and related exercise science of the cancer patient/survivor, exercise prescription and programming for the cancer patient/survivor, along with clinical and medical considerations and physiology, diagnosis, and treatment of the cancer patient/survivor. This particular certification was built by a panel of experts in the cancer and exercise fields.
Other certified personal trainers can certainly gain knowledge on their own, and this is why I strongly suggest that you meet with the potential trainer—do not judge a book by its cover, or its certification.
This is a very important topic as we all understand how important exercise is to breast cancer survivors. I welcome your comments and questions! Please remember that we are all on the same side—we all want survivors with and at risk for lymphedema to be healthy, active, and empowered.
When I go to the ACSM site and do nothing more than submit a list for cancer certified trainers, only one person shows up. If I select my state, nothing shows up.
Thanks for the helpful and uplifting commentary. Those of us who frequent the “Lymphedema” forum of the Breastcancer.org discussion boards are familiar with the recommendation that women with lymphedema, or at (high?) risk of developing lymphedema, should engage in formal exercise programs only under the supervision of appropriately qualified therapists and/or trainers.
The lymphedema therapist who was treating my mild lymphedema noted that a conventionally-schooled “personal trainer” could cause considerable harm to someone with lymphedema. So, your advice about finding a trainer with ACSM “Cancer and Exercise” certification was welcome, as was the link you offered for the “find a trainer” search engine on the ACSM web page.
I went to that page, clicked on the “ACSM CEM” credential, and clicked on my home state (Alabama)…. zero. So, I tried 3 of the states adjacent to mine: Georgia, Florida, and Tennessee: … zero in each case. All right, I figured — must be a Deep South thing. So I tried a midwestern state — Minnesota, home of progressive medicine, Mayo Clinic, etc.: zero. I finally tried Pennsylvania, where Kathryn Schmitz has been working on upper-body exercise and lymphedema: … zero.
Are there any states in the U.S. that have ACSM CEM-certified personal trainers, or is this another case where the theory has advanced faster than the practice?
Otter,
Thanks so much for your comment. You are correct! The theory has advanced faster than the practice. Unfortunately, personal trainers are not always quick to jump on board and learn how to work with different types of clients. Personal trainers who are successful often stick to the mainstream where there is less risk of serious injury, less need for higher education and fewer requirements of their skills placed upon them. Don’t get me wrong — these trainers are very important to the success of our fitness industry. We are often under-motivated by nature, and conventionally schooled personal trainers keep us moving! However, your therapist is right when she said that the person who has lymphedema or is at risk for the condition requires a different knowledge base from their personal trainer. This is a large part of the reason I’ve started PALS for Life, Inc. My goal is to pass along my knowledge and experience of training breast cancer survivors with and at-risk for lymphedema to qualified personal trainers and lymphedema therapists around the country.
Until then, I suggest that survivors focus mainly on the flexibility exercises that you have been given by your lymphedema therapists, lower body exercises that don’t put any pressure on your upper body, and a comfortable level of cardio-respiratory exercises that don’t stress the arms (e.g. you’d want to avoid the arm motion that happens on the cross trainer, rowing machine, and arm ergometer until a fairly good base of strength has been established). Normal arm movement with cardio (walking, jogging, jumping jacks, etc.) is okay. And, of course as with any exercise, do not squeeze the machine to death. This becomes a blood pressure issue, as much as anything. You can also refer to the exercise section that will be up very soon on Breastcancer.org.
Good luck!
So, since it appears my chances of finding a qualified trainer in Michigan are slim, here is my challenge. I am already a weight lifter. I lift heavy for my size; I can bench 90 pounds, I routinely curl 20 pound barbells. I do planks, push-ups, seated rows, pulldowns, everything. I’m already quite strong (well, I was until I went through this cr*p and have been out of the weight room since early December. When people say “work your way up slowly”, or “avoid until a good base of strength has been established”, does that mean starting at square one? Or starting lighter than what I have been recently doing? I am already quite strong.
And what about swimming?
I should add I also am certified to teach TRX…what about training that involves using my own body weight? I am also a spinning instructor.
Thank you for your comment, Spinnerpom. First, I commend you on your dedication to exercise. I can speak generally to your comment/questions. I’m not sure exactly where you are in Michigan, but I did recently train a handful of trainers/ lymphedema therapists on the PALS for Life protocol in the West Michigan area, specifically near Allegan. You can find those professionals on my website: http://www.cancersurvivorfitness.com.
The research shows that most breast cancer survivors can strength train safely after (and even during) breast cancer treatment. The overwhelming results that I see as a cancer and exercise personal trainer tell me that you must start at a weight that is much lighter than you have been lifting, and that you should start at 0-1lb for exercises that use the upper body. This is probably where you say, “What?!” And this is where I say: That’s right. Let’s start at 0-1 lb., move up gradually, and do everything we can to avoid any negative side effects, including lymphedema.
Now, I don’t know your specifics regarding your treatment and I always suggest that you see your physician/ lymphedema therapist before beginning an exercise program, but we do know that surgery, radiation, and lymph node removal increase the risk of lymphedema. We do know that lifting heavy weight (heavy purse, child, gallon of milk, or dumbbell too soon) may bring about symptoms of lymphedema. And there’s no way to know exactly who will develop lymphedema. Exercising in a slow, progressive manner will always be my suggestion. You can start out at 1 lb., gradually build up to 15 lbs., and get to the point where you can do everything that you need to do throughout the course of a day. I believe that a great workout program can be built on this premise. And I believe that there is no limit to how much weight you can safely lift, just as I believe this for general population clients. We all have guidelines, we all have independent variables that we must work with whether it be cancer, a knee replacement, or a pacemaker.
Body weight and TRX exercises fall under the scope of “possibly too risky in the beginning.” By this I mean that I know exactly how much you are lifting when you are lifting 1 lb. or 5 lbs. However, I have no idea how much weight you’re lifting if you’re doing a push-up or a TRX plank rotation, or even using an exercise band. Do I believe it’s possible to work up to these exercises? Yes. Everyone is different, every body is different, and every lymphatic system is different.
I hope that I have given you some guidance. Start slow, progress slowly, and always work beneath the threshold of symptoms. Most importantly — stay active!
Spinnerpom,
My trainer was one of the group that Cathy trained recently here in west Michigan, and I’m the one who did the legwork to get her here. The trainers and LE therapists who attended were very pleased with the day. My own trainer will offer a free 12-week group session this spring, focusing specifically on a strength training program that follows the PAL Protocol guidelines. I see from your profile that we’re too far from your city for you to come for 24 sessions, but perhaps there are some personal trainers your way, who might make a day trip here–we have some local interest in having Cathy return to work with another group of trainers here.
I am on the road a lot for work, and in the past I used my TRX for in-room strength training. It is hanging in the closet for now, waiting for a good number of months as I work my way progressively up thorugh weights that before surgery (last July) I would have scoffed at. But to me, lymphedema is a serious issue (I have it; but fortunately it is mild), so I just keep telling myself to be patient, add upper-body weights one pound at a time, and eventually I’ll get to a place where I’m lifting heavy weights, with no LE repercussions. Then my trainer and I will talk about doing some limited TRX work, probably one exercise initially, monitoring for LE flare, and so on, before re-incorporating general TRX use into my travel fitness routine.
Lower body, core, and flexibility work have been either unaffected by my LE concerns, or easily adapted to accommodate them, so even as I sigh at the sight of the little baby dumbbells for upper work, every hefty push in the leg press machine reminds me that I am strong, will be stronger, and just need to allow time for upper body to catch up!
Carol
Does anyone know? Are there any programs like PALS in the North Texas or North Central Texas region?
Unfortunately, there are no PALs for Life programs in northern or north central Texas. You might want to find out whether there are any Livestrong exercise programs there. Another option is to organize bringing me to your area to train personal trainers/lymphedema therapists to run a program.