Getting Strong with Exercise After Breast Cancer

by: Naomi Aaronson MA OTR/L CHT

Add html Getting Strong With Exercise After Breast Cancer By Naomi Aaronson MA, OTR/L, CHT We are bombarded daily with conflicting messages regarding exercise and diet. If you have had breast cancer, it is even more confusing. Should you exercise after surgery? When should exercise begin? What kind of exercises should you do? Should you use weights if you are at risk for developing lymphedema? What if you feel pain when you exercise? The information that follows can help you to begin an exercise program to increase flexibility and strength in the affected arm and develop better posture after undergoing breast cancer surgery. This information can help to facilitate your recovery and reduce lymphedema risk. It is not intended to be a substitute for medical advice, and a physician’s clearance should be obtained before you begin this or any exercise program. Exercise After Surgery Most women are able to begin light exercise to the shoulder, arm, back, and hand after the surgical drains are removed. Before you begin, you should talk with your doctor about the exercises that you intend to do. It is important to strengthen your arm after surgery. This will help you to perform daily activities, such as lifting children or groceries, more easily. Strengthening the arm also will help to prevent musculoskeletal problems due to muscle imbalances and weakness. Young women who are put into premature menopause early due to chemotherapy and women who use an aromatase inhibitor as their hormonal therapy are at increased risk of osteoporosis. For these women, exercises that strengthen the back, hips, and wrists are a necessity to reduce the risk of fractures. Lymphedema Lymphedema is a chronic condition characterized by the swelling of a body part. It occurs when lymphatic fluid builds up because it cannot drain properly due to malfunctioning of the lymphatic system. Lymphedema is estimated to effect up to 40 percent of women whose breast cancer treatment included lymph node dissection and/ or radiation. If you are at risk of developing lymphedema, you must proceed slowly with an exercise program. Before you begin any of these exercises, you should consult an occupational therapist or physical therapist who can teach you what exercises to do and can help you learn the right way to do them. Your physical therapist or occupational therapist will probably suggest that you perform exercises that will strengthen the muscles around the shoulder and shoulder girdle, as this can facilitate alternative lymphatic pathways and help reduce the risk of developing lymphedema. Exercises that can strengthen this area work on the anterior deltoid, middle deltoid, triceps, and rotator cuff. Exercises that strengthen the lower back and abdominals are important as well. It is necessary that you learn how to do these strengthening exercises properly. Doing the exercises the wrong way may lead to injury and won’t build the muscles that you are trying to focus on. Your physical therapist or occupational therapist may recommend that you wear a sleeve on the affected arm. A sleeve is a type of compression garment. Sleeves provide gentle pressure that helps to return lymphatic fluid back to the heart, they also support the muscle as it contracts. You may need to wear the sleeve while you go about your daily activities as well as when you exercise. Check Your Posture It is important to have good posture while you are exercising. It is quite common to find postural changes after surgery. As you are exercising check and see: Is your head forward? Are your shoulders slumped forward? Is your back hunched? Look into a mirror and try to correct yourself by planting your feet under you shoulders and keeping your knees unlocked. The chest should be lifted with the shoulder blades back. Line up your ears over your shoulders. There should be a gentle curve in your neck and lower back. Warm Up: Neck and Shoulder Rolls Neck rolls and shoulder rolls are a good warm-up that can be done right before you start a formal exercise program or begin your daily activities. Use a deep breathing technique that can assist with pain management and the return of lymphatic fluid to the heart. As you inhale, feel your abdominals and chest expand; as you exhale feel them flatten. Take 5 counts to inhale and 5 counts to exhale. It is natural to feel some pain, as you just went through major surgery. But you should not feel a lot of pain. Keep going if you have some discomfort. If you have a lot of pain, stop. Slowly and gradually, while using the deep breathing technique, try to do more rolls each time you exercise. If you find that you need assistance performing the exercises described below ( such as the shoulder lift) or that you are experiencing a lot of pain, ask your physician for a referral to an occupational therapist or physical therapist who is skilled in this area. Increase Range of Motion: Stretching One of your goals should be to improve your range of motion. Performing stretching exercises that focus on the armpit and the chest area can do this. These should be done daily for up to two years after surgery to promote flexibility. These exercises can help stretch scar tissue, which can severely limit range of motion, and which continues to form for up to two years after surgery. It is better to do several repetitions of a few exercises over the course of the day rather than perform all of your stretching exercises at once. When you begin, you should do each stretch five times. Your goal is to hold each stretch at the furthest point you can achieve for ten seconds. Gradually increase the time allotted to 15-20 seconds. Then gradually increase the number of repetitions until you are doing each stretch 10 times. If you are at risk for developing lymphedema, you will want to speak with your physical therapist or occupational therapist about how to monitor your arm. This is typically done by using a tape measure to measure the circumference of your arm in five different places. You should measure before you begin any exercise program. These measurements will be your baseline. Future measurements will be compared against these initial measurements, to allow you to see if any changes have occurred. Balls, towels, and ropes are tools you can use while stretching to help you regain your range of motion. All these tools allow you to use your strong arm to support the arm affected by the surgery. You may want to begin with the shoulder lift. To perform this exercise, you position yourself on your back with both knees bent. Hold the ball with both hands and slowly raise it to your face and as far overhead as you can. Keep both elbows straight. Work on gradually stretching the affected arm as high as the other. Exhale as you slowly lift the ball overhead. Gravity will assist you in getting it higher each time. Work for slow gradual changes. Variations include lifting the ball to both the right and left sides (once you are able to get it further overhead) or kneeling and stretching the ball from side to side. Another good stretch as you get stronger is the triceps stretch which stretches the axillary (armpit) region where lymph nodes were removed. Although it is tempting to avoid using the arm, try to do your daily activities, such as making the bed, folding laundry, or drying the dishes. This will increase your range of motion and strength. Keeping your arm elevated, with the elbow above the heart with pillows, especially at night, can also help to reduce swelling and promote lymphatic flow back to the heart. Strength Training Strength training to the affected arm should only begin after full mobility has been achieved in the arm. While waiting for this to occur, you can still do strength-training exercises for the back, legs, hips, and unaffected arm, unless you have received reconstructive surgery. In that case, you must wait until you have your doctor’s approval to begin an exercise program. You should warm-up, check your posture, and stretch, before you begin your strength-training exercises. When you begin, you should start with light weights that are no more than 1 lb. for the affected arm. (Even if you used to work out a lot and lift heavy weights, you still need to start with 1 lb. Going back to lifting heavy weights right away may increase your risk of developing lymphedema.) For strength training to be beneficial, it should be performed two to three times per week to each muscle group. You can gradually increase the weight once you see how your arm and body responds. Perform one set (12 repetitions is one set) for each muscle group. Rest after each set or change arms. Stay at the same weight for three weeks and then gradually increase the number of sets. You will slowly increase both weight and sets, but you should not increase both at the same time. Be sure to breathe deeply and to exhale as you lift the weight and inhale as you lower it. 1 set=12 repetitions Example: Deltoid Raises Week 1 Week 2 Week 3 Week 4 1 lb., 1 sets 1 lb., 2 sets 1lbs., 3sets increase weight to 2 lbs., 2 sets Monitor your arm for swelling. If swelling increases, the weight or number of sets was too much and you need to go back to what you were doing previously. Be alert to the signs and symptoms of lymphedema. This includes a feeling of heaviness or fullness in the arm, aching in the limb, rings that don’t fit, or a pins and needle sensation in the limb. If any of these problems develop consult your physician immediately. If your breast cancer treatment did not include lymph node dissection and/ or radiation, you are not at risk for lymphedema and can proceed more quickly. In this instance, you can increase the weight once you see how your arm and body responds. Below is a guide for how to increase weights and repetitions. This is just a guide. Different muscles get stronger faster so, for example, it is often possible to increase weight for leg exercises sooner than you can for shoulder exercises. 1 set=12 repetitions Example: Deltoid Raises Week 1 Week 2 Week 3 Week 4 1 lb., 2 sets 1 lb., 3 sets 2lbs., 3sets 2 lbs., 3 sets Aerobic Conditioning Aerobic conditioning can help improve cardiovascular endurance. This is your ability to sustain heart-pumping activity for increasing periods of time. Aerobic activities are those that use the large muscles in the legs, along with the arms, to bring the heart rate up for a continuous period of time. Dancing, swimming, running, and walking are all examples of aerobic activities. While you are undergoing treatment, you will want to do an activity that is easy and safe, such as walking or riding a stationary bicycle. Start with five minutes of walking and then gradually increase the duration of time you walk or bike to 20-30 minutes. Try to do an aerobic exercise three to five times per week. Once treatment is over and you are less fatigued and less prone to infections or treatment-related side effects, you can increase the intensity of the exercise (how hard you work) as well as the duration (the amount of time you exercise). You can also add more variety to your workout regimen by taking part in other types of aerobic activities. By following a slow, gradual approach to exercise you will have the best chance of optimizing your participation in the leisure and daily activities that you enjoy. You may even find that, before long, you are even stronger than you were before. Naomi Aaronson is an occupational therapist and fitness professional who specializes in breast cancer recovery. Naomi believes that exercise after surgery is instrumental in healing mind and body. She is the author of the Breast Cancer Recovery Exercise Manual, which is used to educate fitness instructors on breast cancer rehabilitation. You can visit Naomi’s web site at http://www.recovercisesforwellness.com/ The pictures in this article are from Naomi’s CD Recovercises: Exercise For Breast Cancer Survivors, which can be purchased through her web site. You can contact Naomi at recovercises@aol.com. References: Burt, J White, B Lymphedema (1999) Hunter House Publications Courneya ,K Mackey, J and Mckenzie, D Exercise for Breast Cancer Survivors Research Evidence and Clinical Guidelines The Physician and Sports Medicine Vol. 30 # 8 August 2002 Harris, S Hugi,M Olivotto, I and Levine,M Clinical Practice Guidelines for the care and treatment of breast cancer : 11. Lymphedema Canadian Medical Association Journal January 23,2001; 164 Lasinski, Bonnie B. Exercise, Lymphedema, and The Limb at Risk www.lymphedema-therapy.com/Exercise.htm Miller, L Exercise in Breast Cancer Related Lymphedema” Innovations in Cancer Care 3 (4) 101-106 September 1998 Stumm, D Recovery from Breast Surgery (1995) Hunter House Publications back to top <<