Exercising during Breast Cancer Treatment

PJ Hamel Health Guide
  • Cancer feels like walking down a long, dark path, doesn’t it? You can’t see where you’re going. You don’t know where the path leads. Like any dark place, it’s scary.

    And you just want to sit down, pull a blanket over your head, and make it all stop.

    Uh-uh; not an option.

    The worst thing you can do during cancer treatment is to “just stop,” emotionally or physically. Cancer is like a journey through grief, or any kind of hardship. You can’t go around it; you can’t fly above it. You have to walk right through it. And stopping only prolongs the misery.

    One of the hard lessons I learned during my 10 months of active treatment was to keep moving, no matter what. There were times when I wanted to give up. With surgical drains dangling from my chest, and the queasy, foggy after-effects of 8 hours under anesthesia, I simply wanted to curl into a ball in that hard hospital bed.

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    In fact, I tried that approach. But I didn’t feel better, physically. And it gave me too much time to think – about the chemo coming next, my Frankenstein chest, and whether I’d be able to hold onto my job.

    So I heaved a sigh, got up, and started to walk. Connected to an IV, I grabbed the rattling wheeled rack with its saline drip, and started making circuits around the nurses’ station. I saw their wide-eyed looks of surprise.

    “So, is it OK for me to do this?”

    “Sure, go for it. Just be careful of that IV and your drains.”

    That was my first experience with exercise during breast cancer treatment. But it certainly wasn’t my last. Through chemo, pneumonia, radiation, lymphedema, and hormone therapy, I figured out a way to exercise.

    Even now, years later, I’m dealing with cancer through exercise, having shaped my current fitness program to address the bone loss brought on by Arimidex.

    You may think rest is going to make you feel better. And in some cases, you’ll be right. But over and over again, I’ve found that moving – not sitting – is the ticket to healing: not just your body, but your mind and heart, too.

    The following information will help you figure out how to stay active all the way through breast cancer treatment – from diagnosis, through hormone therapy.
    my post on exercise:

    Let’s begin. FIRST – and I emphasize this, because this is always your first step – check with your doctor. After surgery, ask your surgeon. During chemo or other treatments, ask your oncologist. But always – ALWAYS – connect with your doctor prior to starting an exercise program. Even if you’re a veteran gym rat, your doctor has to OK any exercise program you undertake while under active treatment.

    Surgery
    For most women, surgery is the initial step on the path. First comes the biopsy, then lumpectom(ies), or mastectomy, perhaps reconstruction. How should you exercise after surgery?

    The very best, safest way is under the guidance of a professional, at least initially. Prior to your operation, ask your surgeon for a referral to a physical therapist. Your goal is to get back the strength and range of motion in the arm on your affected side, in order to avoid shoulder problems and possible lymphedema down the road.


  • In general, you can start exercising within a couple of days after a lumpectomy. If you’ve had a mastectomy, or mastectomy and reconstruction, that couple of days may stretch into a couple of weeks, or until your drains are removed, and your surgeon says the incisions are sufficiently healed.

    You’ll do upper-body stretching and general posture exercises, to make sure you’re holding your shoulders, neck, and upper body in the correct position. It’s natural to kind of “huddle” and slump around the surgical area; your therapist will make sure this doesn’t happen.

    If you’re unable to have physical therapy, ask your surgeon or surgical nurse for a printout of recommended stretches and exercises; they should be able to provide you with that kind of guidance, as well as give you the OK to begin.

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    Chemotherapy
    Chemo can make you feel wretched, there’s no doubt about it. But even tiny bits of exercise – e.g., getting up and walking around – can make you feel better. Studies show that women who exercise through chemo are A) more likely to complete the entire treatment, B) sleep better, with fewer side effects, and C) actually experience less severe fatigue, than those who don’t exercise.

    And what kind of exercise is best during chemo? Anything you can handle without exhausting yourself. Remember, your immune system is being severely challenged; you don’t want to add fatigue on top of that.

    If you’re a member of a gym, you may want to consider taking a break; germs are your mortal enemy during chemo. Whirlpool, showers, sweat… not the most sanitary of environments, eh? So assume any exercising you do will be done in your home, outdoors, or perhaps as part of a hospital program with other chemo patients.

    Which segues perfectly into the best, easiest, safest exercise to combat chemo side effects: walking. Walk slowly around your bedroom on your worst days; take a brisk, long walk outdoors on good days. Walking helps both muscle tone and your heart; there’s also something about breathing fresh air, and feeling the sun on your back, that makes everything seem a little brighter.

    Walking is easy; it can be done alone, in a relatively germ-free atmosphere; and it’s free. If you feel up to it, add some light weightlifting; but walking your way through chemo is key to taking the edge off those nasty side effects.

    Radiation
    Many women report extreme fatigue during radiation. It may be an after-effect of chemo, for those who’ve had that therapy prior to radiation. Or radiation itself may induce fatigue. The good news is, you can help control this extreme tiredness with a two-pronged exercise program: walking, combined with light resistance training, e.g., lifting light weights, or working with stretchy resistance bands. 

    A National Cancer Institute study showed that women with breast cancer undergoing radiation, who walked and did weight training daily, actually finished radiation with greater aerobic capacity, while those who didn’t exercise saw their fitness decline. After 4 weeks, women who exercised were able to walk farther and faster, and felt less fatigued, than the control group that didn’t exercise.


  • Another study showed that simply walking 3 to 5 days a week, during radiation, helped prevent a decline in red blood cells. It’s this loss of red blood cells that helps promote fatigue; thus women who walked had more energy.

    Lymphedema
    For years, women with lymphedema were advised to not physically tax their affected arm: to avoid carrying or lifting anything heavier than 15 pounds.

    Now it appears that those strict guidelines may be changing. All women are different, and while some can only lift light weights without risking lymphedema, others can pursue a carefully supervised weightlifting program, and eventually progress to the point where they can lift heavy weights.

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    A program of regular light weightlifting, as well as aerobic exercise, is actually helpful in controlling lymphedema. Studies show that resistance training using the upper body increases lymph flow, which in turn reduces swelling.

     

    Women are cautioned not to start lifting weights without first consulting their doctor. They should also be instructed in proper technique by a physical therapist, or fitness instructor trained in lymphedema management.

     

    Bottom line: light weightlifting with a gradual progression to slightly heavier weights is the safest way to go.

     

    Swimming is also a great lymphedema exercise. The pressure of water on your body helps control swelling, and the effort you expend gets your heart pumping, which in turn increases blood flow and helps your lymphatic system do its job.

    Finally, yoga and similar gentle stretching exercises help keep skin flexible, increase range of motion, and relieve that uncomfortable feeling of “fullness” that lymphedema often brings.

    Doctors caution that if you have lymphedema, you should wear your compression sleeve and glove while exercising (except while swimming). You should also avoid swimming if you have any open wounds on your affected arm, to avoid possible infection.

    Hormone Therapy Drugs
    Long-term hormone therapy drugs, such as tamoxifen, or an aromatase inhibitor (Arimidex, et. al.) can create side effects such as weight gain, hot flashes, depression, and joint pain. Obviously, exercise is a great way to combat weight gain. And it’s also been shown to alleviate both hot flashes, and depression.

    But what about that stiffness (I’ve heard it described most often as “creakiness”) and joint pain that so often descends on women taking an AI?

    While there are no long-term studies showing an exercise benefit during AI therapy, I’ve found that a brisk walk or a gym workout, first thing in the morning, seems to reduce my pain level all day long. Likewise, taking a break from your desk to walk around and stretch at regular intervals is helpful.

    So, there you have it: how to exercise your way through cancer treatment. Use common sense; don’t think you can go out and compete in a triathlon during chemo, or become a champion power lifter in the midst of a lymphedema flareup.

    But don’t hibernate in bed or on the couch, either. Get your body moving at regular intervals, via walking, weight-lifting, swimming, cycling, dancing… and you’ll feel better. Simply remember to check in with your doctor first; not to overdo anything; and to prevent infections by avoiding “germy” situations, when necessary.


  • Exercise – as the folks at Nike would say – just do it.

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Published On: April 12, 2010