What do these studies mean for people who want to become more physically active?
The current guidelines recommend 150 minutes of moderate intensity exercise a week, like walking, combined with 2-3 strength training sessions, as a goal for cancer survivors. What I tell my patients, especially if they’re not doing anything at all, is that doing a little bit of exercise is better than none, and we really recommend that people start out slowly, that they set very realistic goals, and that they increase their exercise by a small amount each week to really build up their endurance so that you don’t put yourself at risk of injury. And we usually recommend that everybody talk to their doctor before they start exercising just to make sure that there’s not anything special that they should keep in mind.
What should women who have had surgery be aware of? For example, could women who have had a mastectomy/lymph node removal end up with lymphedema if they exercise too intensely?
It used to be that we told women who have had surgery not to exercise at all with that arm. But we’ve come to recognize that that really is not the right strategy, and that if you don’t ever use your arm ever your muscles really get weak, and your range of motion gets limited. Many studies show that weight training does not necessarily increase the risk of lymphedema; in fact, studies would get to the point where women lifted fairly heavy weights with that arm—there wasn’t like an upper limit of how much you should lift—but it was really important to progress very slowly and to not make big jumps and start too fast too soon. That was why the recommendation was that people should at least consider meeting with a trainer who has a certification in oncology or physical therapist or somebody that could provide more of a step-wise program so that you didn’t do too much so soon. So aerobic exercise is fine, even with more intensive exercise like running, there’s not concern regarding that. We’re more concerned when people want to do weight lifting with their upper body if they’ve had lymph node surgery—they should consider meeting with an exercise specialist just to make sure that they don’t progress too quickly.
Or sometimes if women have gotten chemotherapy that causes them to have neuropathy or diminished sensation in their feet, that could be another situation where they might want to have a little bit more consideration. If they’re doing things like walking, it could be a little bit more challenging, so they may want to explore cycling or swimming instead.
How much of a factor do lifestyle changes play in long-term health?
For many breast cancer patients with early stage breast cancer, their risks of breast cancer recurrence are actually a lot lower than their risk of developing heart disease or other medical problems. But sometimes with the therapies that women receive, some women will gain weight in chemotherapy or they’ll become less active, and those types of things may ultimately have a bigger impact on their risk of developing other medical problems that are more significant than their risk of breast cancer recurrence. So I think it varies for the individual patient and the stage of disease, but I do think that lifestyle is pretty important for most people after breast cancer diagnosis.
The graph below illustrates the stages of breast cancer and corresponding five-year relative survival rate, which compares the observed survival with what would be expected for people without cancer. Hover over graphic to read more about each stage of cancer.
People with stage 0 (non-invasive) cancer have about a 100 percent chance of survival over five years, compared to people with stage IV cancer, who have a relative five-year survival rate of 22 percent.
People who exercise typically experience less joint pain from aromatase inhibitors, they have better body image, they have less anxiety and depression, and they have better overall quality of life. There are definitely a lot of very real day-to-day benefits of exercise for survivors that have been now shown in many, many studies looking at all different kinds of exercise. From what we’ve seen so far, it doesn’t seem to really matter if somebody’s walking or riding a bike or doing an aerobic form of yoga—these things seem to all have benefits for people.
What are some good resources for people looking to change their diet/exercise routine after breast cancer?
The American Cancer Society has some very nice lifestyle recommendations for cancer survivors that I think are always a good guide. In addition to the recommendations for exercise, they also recommend that people try to keep their weight in a healthy range, and if they’re overweight or obese, that they try modest weight loss. And they recommend a healthy diet—fruits and vegetables, limitations of processed foods and sweets, encouraging whole grains over simple sugars and limiting alcohol.
And the LIVESTRONG at the YMCA is a community-based exercise program available in YMCAs across the country. It is a 12-week program group for cancer survivors to really get people moving again after cancer diagnosis. That’s one of the few national programs that exist that help people get moving. The ASCO (American Society of Clinical Oncology) just released some new materials for lifestyle change in cancer survivors—it’s available on cancer.net. It’s materials about weight management and obesity and provides a lot of resources both nationally and instructions about how to find local resources to help people make healthy lifestyle changes, improvements in diet and weight loss, and increase activity after cancer diagnosis.
What message do you want to leave people with?
At the end of the day, we really want to encourage people. Going through cancer is a very scary experience. It’s also a time when I think people really examine their lives and can make very powerful changes to improve their lifestyles and lead healthier lives. One of the things I’ve been involved in in the ASCO (American Society of Clinical Oncology) initiative is that we really want to help health care providers give their patients information to really help them use a cancer diagnosis to make their lives healthier overall. And that’s something that we really want to help support people in doing. Sometimes as a physician that takes care of cancer patients, we’re very focused on the medicines they need and the different medical therapies, and I think I’d also encourage people to think about how to help their patients make healthier lifestyle changes to help them strengthen their bodies and minds in the years after their cancer diagnosis and come away from it as a healthier person overall.