A Prescription for Fitness

After surgery, breast cancer patients are encouraged to exercise.

After a diagnosis of breast cancer at age 40, Linda Fisher faced a double mastectomy and possible surgical complications including pain, chronic swelling, and tightness in the chest and shoulders. With little direction from her doctor on post-surgical exercise, it was a comment from a friend that prompted her to look into the benefits of exercise in her recovery. She questioned her surgeon, who provided her with some exercises, but it took Fisher additional research on her part to develop a fitness regimen.

Fortunately, many breast cancer patients are given information on post-surgical exercise soon after the decision is made for surgery. Lois Lattimore, RN, NP, a nurse practitioner with the breast surgical oncology team at the Arizona Cancer Center in Tucson, says to head off complications her team goes over specific exercises before and after surgery to better prepare the women. “In an ideal situation, these women would be given the information because the complications are very common," Lattimore says. “It can be as high as 50 to 70 percent depending on the type of surgery.”

A 2008 study presented at the American Society of Clinical Oncology annual meeting this past year found that complications, including numbness, pain, stiffness, swelling, and weakness in the arms and shoulders, occurred more often in women who had mastectomies over lumpectomies, but it also depended on if and how many lymph nodes were removed during surgery. The study, which tested upper body strength, endurance, hand grip, flexibility, and range of motion, found that many women reported problems even a year and a half after surgery.

If patients don’t do some very basic arm movements every day to loosen up the scar tissue and make it a little more flexible, it gets tight and painful.

CURE

Lymphedema, swelling caused by the build-up of lymphatic fluid resulting from lymph node removal or damage, can sometimes exacerbate these problems, but it doesn’t always go hand in hand, authors noted. The study showed that six months after surgery, more than 65 percent of women with lymphedema reported other arm and shoulder problems; however, 44 percent women who did not develop lymphedema had similar problems. (For more information on lymphedema, read “Downsizing Swollen Limbs” from the Winter 2008 issue of ).

Experts recommend simple exercises beginning shortly after surgery may prevent or reduce many of these problems. Donna J. Wilson, RN, a nurse and fitness coordinator at the Integrative Medicine Center at Memorial Sloan-Kettering Cancer Center in New York City, says once a patient’s drains are removed or after the first post-surgical visit, they can begin slow and gentle arm movements. In order to prevent problems with decreased flexibility and immobility in the arm, she recommends focusing on the range of motion in the shoulders, such as moving shoulders up and down, front and back, and doing a figure-eight movement with the hand to rotate the shoulder. In addition, “patients can also do abs [abdominal exercises] as much as they want, or lower body squats and lunges,” Wilson says. “I don’t recommend doing any sort of running or jumping.”

Over time, tightness can occur in the upper body from scar tissue forming during the healing process, which is why stretching is so important during this stage. “If patients don’t do some very basic arm movements every day to loosen up the scar tissue and make it a little more flexible, it gets tight and painful,” Wilson says.

Patients undergoing reconstruction surgery with breast tissue expanders should be careful to avoid certain exercises that may build up chest muscles. “If you have an expander put in, they are put behind the pectoral muscle, so you don’t want to do any exercises that change the shape of that muscle,” she says. “If you do an exercise like a push-up or a chest press, you enlarge your pectoral muscle and it will change the position of the implant.”

The New England Journal of Medicine

NEJM

Studies also suggest that certain exercises and stretching may help lower the risk of lymphedema. A small study published in suggested that weight-lifting may not increase lymphedema as once thought, but may actually be beneficial (read more on the study in “Weight lifting and lymphedema”). Researchers concluded in the article, "… slowly progressive weight lifting had no significant effect on limb swelling and resulted in a decreased incidence of exacerbations of lymphedema, reduced symptoms, and increased strength."

Movements that can stimulate lymphatic flow, such as arm circles, bicep curls, and figure-eight movements with the arm, are also recommended, says Wilson.

For Fisher, the pain was too intense to start exercising right after surgery, so she waited until she began feeling well enough to start slowly exercising and then built up her fitness regimen.

“After about two or three weeks I started taking short walks,” she says. “I had to hold my hands behind me so it wouldn’t irritate my incisions. After three weeks, I started using my arms. After four weeks, I started doing yoga.”

About 10 weeks after surgery, Wilson says it’s OK for patients to include light aerobics in their fitness regimen, depending on the patient’s health and recovery. “Some can do a light jog with a very strong supportive bra on,” she says. “They can start doing some cardio on the treadmill, elliptical, bike, or a good walking program. They can also do light weight-training, starting with one- to three-pound weights.”

As always, patients should discuss with their physician what the best fitness regimen and exercises are for their particular situation, as it may depend on the type of surgery, overall health of the patient before and after surgery, and any side effects the patient may be experiencing. Involving a physical therapist or trainer who is familiar with post-surgical recovery can also be helpful at least in the initial stages, and much of the instruction can then be carried out by the patient independently. Examples of post-surgical exercises for breast cancer patients can be found at the resources below:

AboutBreastHealth.com

American Cancer Society

Canadian Cancer Society

Staying Abreast