Rehabilitation for Breast Cancer Survivors
Naomi Aaronson MA OTR/L CHT

It happens more than you think. You have received treatment for breast cancer including surgery, chemotherapy, and or radiation and your arm feels weak, tight, and is swollen and perhaps painful. No one told you that you should exercise, what exercises to do or how to do them, but you know that you need some guidance. Not only that, but you have gained weight and feel tired. You don't feel like yourself. What should you do? I am going to tell you about exercise and how important exercise is in recovery. Unfortunately, physical recovery after breast cancer treatment is not always addressed by medical professionals. That is why you must advocate for your needs and find a trained rehabilitation therapist who can assist in meeting your post treatment goals. This article is going to be written in a question and answer format. It is not intended to substitute for medical advice. At the end, there will be a list of references that I hope will be valuable. Please don't hesitate to contact me with more questions, as they may be useful to others.

I have just received an axillary dissection and lumpectomy to my right breast. When should I begin exercise to that arm?

Once the drains are removed, one can begin light exercises to the shoulder. However, be sure to wait until you have received doctors permission. In the interim, perform exercises to the elbow, wrist and hand such as bending the elbow and straightening it, moving the wrist in clockwise and counterclockwise circles and closing/opening your fist. Also, you can squeeze a sponge. Try to perform 12 repetitions or one set of these exercises once every hour or minimally a few times a day. This will help to reduce swelling. Keep your arm elevated above the heart with pillows at night. Exercises that promote range of motion to the shoulder should be performed daily. If movement is too painful, consult a physician who can refer you to a trained and licensed occupational or physical therapist. Deep breathing exercises (see mind and body link) are a good place to start along with neck rolls and shoulder circles for relaxation. Stretches to the axillary (armpit region where lymph nodes are removed) and pectoralis (chest region where tissue removed) are most important. This is where scar tissue is most likely to form . I recommend stretching to the pectoralis, axillary and latissmus musculature on a regular basis as scar tissue continues to form 1-2 years after surgery. Scar massage can help to break up adhesions which can limit range of motion.

What kind of flexibility exercises should I do?

If it is 2-4weeks after surgery, I recommend using active assisted exercises which use tools such as bars, balls, or towels to increase shoulder range of motion and muscular flexibility. By using these items, the stronger arm can help the weaker arm Try to perform 12 repetititons of each exercise several times during the day. If that is too much, start with a smaller number of repetitions and gradually build up. Remember to focus on the shoulder, chest and armpit regions. Be sure to start with good posture.

Can I do aerobic exercise if undergoing chemotherapy?

Many studies have found that women who participate in aerobic training sessions even while undergoing chemotherapy were able to sleep better, were less tired, and had a better quality of life. It is best to start slowly and at a low intensity. Bicycling, walking, or swimming are all good places to start. Aim to do this type of exercise at least 3 times per week. If you can only walk 5 minutes, start there. Gradually try to increase the time to 10 minutes, then 15 minutes, and finally 30 minutes. Be sure to drink plenty of liquids to keep hydrated. It is better to increase the duration and frequency of this type of exercise rather than the intensity, meaning that you should increase the number of times in a week that you do it rather than how hard you do it. Tip** Get a pedometer and increase the number of steps you walk in a day. Chemotherapy can affect blood counts so some activities may be off limits ie swimming due to risk of infection or your bloods oxygen transport ability. Be sure to check with your doctor regarding this type of exercise when blood counts are taken.

How can Pilates help breast cancer survivors?

Pilates is an exercise modality that emphasizes proper body alignment and breathing before movement, and fosters the mind body connection through its emphasis upon concentration and control. Recent research has indicated that it has improved quality of life, flexibility and strength. To learn more, please click on the link below and view this free hour long video.

Click here to read the article "Reconnecting Through Pilates"

Click here to read the article "Movement toward Healing"


References
Aaronson N (2006) Breast Cancer Recovery Exercise Program Desert Southwest Fitness Tucson, Arizona

Burt, J and White, G Lymphedema (1999) Hunter House Publishers Alameda, CA

Corneya,K Mackey, J and McKenzie, D Exercise for Breast Cancer Survivors The Physician and Sports Medicine Vol. 30 No. 8 August 2002

Corneya, K Mackey, J and Jones,L Coping with Cancer -Can Exercise Help? The Physician and Sports Medicine Vol 28 No. 5 May 2000

Stumm,D Recovering from Breast Surgery (1995) Hunter House Publishers Alameda, CA

Eyigor, S. Karaolat,H., Yesil,H. et al.
Effects of Pilates exercises on functional capacity, flexibility,fatigue, depression, and quality of life in female breast cancer patients : a randomized study. Eur J Phys Rehabi. Med Epub May 6, 2010

Keays, KS, Harris, SR, et al.
Effects of Pilates exercises on shoulder range of motion, pain, mood, and upper extremity function in women living with breast cancer: a pilot study Phys Ther 2008 :88(4)- 494-510




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