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Breast cancer is the leading cancer for women but one with an increasing survival rate and one that lends itself most directly to therapeutic exercise. Depending upon the diagnosis, treatments may include surgery, radiation therapy, chemotherapy and hormone therapy such as tamoxifen or aromatase inhibitors such as Arimidex. Surgeries may involve a lumpectomy, a simple mastectomy or modified radical mastectomy, or very rarely, a radical mastectomy. Increasingly, for many women a lumpectomy has become a common surgical option. A lumpectomy is often performed on an outpatient basis and presents few limitations to exercise. Those with severe range of motion limitations or breast reconstruction may get assistance from a physical therapist.
Physical benefits of exercise include the maintenance or the improvement of cardiorespiratory or aerobic function that may in turn reduce the fatigue common to the cancer experience. Recently, aerobic exercise has also been thought to reduce the effects of “chemobrain” or the forgetfulness associated with chemotherapy. Exercises that increase range of motion (ROM) around affected areas such as the shoulder, as well as strength exercises to enable one to lift everyday objects should be prescribed. Relatively high repetition resistance exercises will assist in the management of lymphedema. Many weight bearing exercises will assist in maintaining bone density that may be lost following hormone therapy such as Arimidex. The maintenance of a proper weight will also reduce the likelihood of reoccurrence as well as the
possibility of lymphedema.
Psychological Benefits of Exercise
The ability to perform daily tasks without undo fatigue and restriction will lead to an increased sense of control which is often lost during the cancer experience. A variety of psychological mechanisms will often reduce the depression and anxiety which is common to cancer patients. Recreational exercise will provide a “time-out” from the cancer experience.
Generally any exercise prescription should begin with 20 to 30 minutes of moderate aerobic exercise such as walking, biking and running. In addition to reducing fatigue and possibly addressing the effects of chemobrain, aerobic exercise also provides a warmup effect prior to flexibility and resistance exercise.This should be followed flexibility exercises specific to the affected areas. In breast cancer patients this is often the site of surgery in the underarm for staging purposes or follow-up radiation. More extensive breast reconstruction will also create many restrictions.
Strength or resistance training will assist one to maintain or regain strength that is often lost due to inactivity. Many patients fearing lymphedema mistakenly limit the use of the affected arm resulting in a disuse phenomenon whereby they effectively lose the use of one arm. Lifting light weights 8-12 times per muscle group, 2 to 3 times per week will limit this problem. Simply lifting everyday objects in a domestic environment will be effective in overcoming the disuse phenomena.When possible do not let your husband, children or caregiver do all of the lifting for you, such as lifting objects milk jugs from the trunk of the car.
While therapeutic exercise is an important component in one’s treatment, it is also important to recognize that adequate rest is equally necessary. When tired, rest, particularly in the post- surgical and adjuvant treatment (radiation and chemotherapy) phases.The combination of appropriate exercise and adequate rest will greatly assist the rate of your recovery.
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Howard Stidwill, Ph.D. is an author, speaker and President of InnerStrength Rehabilitation Services for Cancer Patients, Inc. InnerStrength's products and services are based upon the belief that therapeutic exercise should be seen as an integral part of one's treatment strategy.
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