Exercise: Special Considerations for Breast Cancer Patients
By SUSAN GILCHRIST, M.D., M.S.
What can I do regarding exercise? Can I exercise with lymphedema or with metastatic disease to the bone? I want to start a new program but not sure if it is safe? These are important questions that I am asked as an expert in exercise related to the care of cancer patients.
In modern day oncology practice, we now ask our patients to be more active and engage in guideline-based physical activity (150 minutes a week) and in some cases, resistance exercises 2 times a week. Missing in those general recommendations are the special issues related to surgery, lymphedema, and overall fatigue that impact a breast cancer patient. Moreover, patients start at different places. For some, it is hard to just get up and move...for others they want to run a marathon tomorrow!
Given this, below are a few tips to get you guys on your way:
If you have pain or swelling or physical limitation/balance issues-- seek out guidance from your doctor before starting exercise. Document the starting date of the complaint, severity, what makes it better/worse, and any new medications or medical history that might be playing a role.
If you have a surgical drain in place, exercise is likely going to be limited and activity will be 100% dependent on the recommendations of the surgeon who placed it.
Lymphedema. A classic research paper in the New England Journal of Medicine (N Engl J Med 2009; 361:664-673) demonstrated that resistance exercises actually reduce symptoms, reduce recurrent lymphedema, and increased strength. The trick is to start low (low weight) and go slow with progressing on increasing weight. The second trick is the resistance exercises need to be done with the correct form or you can be injured. That is why seeing a lymphedema specialist is a great idea to get started toward a proper resistance training routine. Compression sleeves and/or massage may also be recommended in this setting to help.
Bony metastases: Resistance training has been done in this setting. In most cases, the resistance program still focuses on working large muscle groups, but a particular muscle group is avoided for the affected bone. For spine or hip metastases, there are positions to unload the joint for exercise. However, these particular recommendations and exercises need to created in concert with a specialist, such as a physical therapist, prior to initiating.
Stay hydrated and listen to your body.
One thing that is important to note. You will get through this - yes, having to see a specialist for concerns such as pain, lymphedema or affect limbs is not what you want to hear. I know you want to just forget this entire cancer thing and be on your way. I GET IT! However, the preparation and care you give to your body to get back on track is half the battle. I have taken care of scores of patients that have taken the time and effort to address these issues, and are now building positively toward their exercise goals and achieving them!
Lastly, I would say, not every breast cancer patient has limitations as above (or they have overcome them) but a new exercise routine is requested. In breast cancer patients following treatment, I usually figure out the patient’s current aerobic exercise time and volume and then build up by 10% every few weeks and adjust accordingly. I avoid recommending high-intensity workouts or heavy weight lifting right out of the gate to avoid subsequent injuries and or severe fatigue that lower motivation to continue. With this mind-set and a diligent patient, goals have been achieved in my practice (i.e. running half-marathon, participating in a triathlon, playing with grandchildren, going back to a place to walk and hike).
Hope this helps and stay tuned for more specifics and guidance on exercise routines!!
In the next post we’ll take a deep dive into some of the questions we’ve received.