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Writer's pictureDr. Jasia Correa, DPT

Breast Cancer Wellness

Breast Cancer Survivorship is a term we use from the moment of diagnosis. No matter what stage of your journey, health and wellness are crucial components to this long-term goal.

 

I started my career in oncology, proudly working for the #1 ranked cancer hospital in the nation. Rehabilitation as a core part of the cancer journey is understood at a highly specialized facility such as that. You have a diagnosis, you get rehab. Unfortunately, this may not always be the case for those who have treatment in areas that, for reasons of size alone, may not offer this specialty as part of the standard practice. So, what can you do if you're one of the many who don't have physical therapy as a local resource for your Survivorship Path? Education. Being informed is the best tool you have, and although this article is focused on the Breast population, it applies to everyone no matter what the cancer diagnosis.


CHEMO AND RADIATION FATIGUE:

The kind of exhaustion you might experience from your treatments is very different from how you feel after a long day, an hour at the gym, or even when feeling very ill. Chemo and radiation-related fatigue can be all encompassing, effecting not only the body but the mind as well. It can make it difficult to focus or stay on task. Many people will want to spend the majority of their recovery time resting and sleeping because this is what have learned to do when we are sick. However, the research has proven that inactivity will not only increase your fatigue, but could also lead to loss of function and strength. The best solution for treatment-related fatigue is exercise. Even short bursts of 5-10 minutes throughout the day can be beneficial, giving you that much needed second wind of energy. Of course, napping is allowed, but try to limit naps to no longer than 1 hour, and take no more than 3 naps per day. Staying active will not only help to keep your mind clear, but can improve quality of life and prevent loss in function in the long run.


Recommendations for when you start to feel fatigued:

  • Go on a walk, long or short - It can even be around the couch in your living room.

  • Do sit-to-stands from a chair (10 repetitions, 3-4 sets) - Chemo and steroids, which are commonly used as an adjunct treatment, weaken the quadriceps. If it's hard to get out of a chair, you probably won't want to do it very often. Keep those leggies strong!

  • Take 5-10 deep belly breaths - improve oxygen to the brain can help clear the fog.

  • Stand and march in place for 5 minutes - commercial breaks. Just sayin'.

  • Do some upper body resistance exercises (i.e. seated rows or bicep curls) - a can of beans in each hand can be all the resistance you need. Just. Get. Moving!


MAINTAINING RANGE OF MOTION:

During radiation, some women notice that their skin becomes very red and might even blister or peel like a bad sunburn; and some women have little to no changes at all. But in either case, all women who receive radiation will experience some level of change within the soft tissues of the chest, shoulder, shoulder blade, and neck that could cause movement problems later on. Radiation is known to continue causing gradual soft tissue changes for 3-5 years after treatments have ended, and newer research is even suggesting up to 10 years, so it is important to commit to a regular stretching program throughout and beyond treatment. For women who have had lumpectomy followed by radiation to the breast tissue, tenderness in the breast is common and can be alleviated by regular, gentle self-massage.


Recommendations for addressing radiated tissues:

  • Perform the assigned stretches daily - get the arms up and overhead, reach high, put your hands behind your head and push your elbows back, do snow angels, anything!

  • If you have had a lumpectomy, massage the breast gently for 5 min per day with oil or lotion. For mastectomy, do the same thing to the skin and scar tissue, but also work on moving the skin around daily without lotion or oil.

  • Be conscious about your posture - keep the chest open and the spine tall. Working on short bursts of 30 seconds in "perfect posture" multiple times throughout the day is not only a good reminder, but will help strengthen the postural muscles over time.


BONE HEALTH

Bone loss is a common part of aging in women, especially after menopause. However, breast cancer treatments, especially with anti-hormone therapies such as Anastrazole (Arimidex) and Tamoxifen (Nolvadex), can accelerate this process. Bone strength is important to prevent fractures and other complications, particularly pain. Fortunately, the best way to stimulate bone growth is as easy as exercising the muscles. Regular weight training can not only improve strength of the muscles and prevent bone loss, but can also help decrease joint pain which is commonly associated with anti-hormone treatments.


GENERAL WEIGHT TRAINING GUIDELINES:

Breast cancer wellness should focus on progressive resistance training which slowly increases to the guidelines set by the American College of Sports Medicine:

  • 2-3 non-consecutive days per week

  • 1-3 sets of 8-12 reps for healthy adults

  • 1-2 sets of 10-15 reps for older and frail adults

  • 8-10 exercises should be performed that target the major muscle groups

*Older information warned against weight training in women who have or are at risk for lymphedema, a common swelling in breast cancer, but newer research suggests that regular weight training can prevent and even assist in decreasing this swelling over time.


GETTING STARTED:

  • Equipment: Exercise Bands, hand weights, machine equipment, water weights, body weight, can o'beans, etc.

  • Start light: lower weight, higher repetitions

  • Slowly work your way up to moderate resistance based on the guideline above. If you're a woman like me who loves to lift heavy, don't let fear stop you! I would still highly recommend working up to a heavier weight very slowly, allowing you body to adjust and looking for signs of swelling. In future posts, I'll talk about the signs, precautions, and self-treatment for lymphedema. Just know that it is a condition that is preventable, manageable, and treatable.

Basic Example:

  • 3lb bicep curls, 2 sets, 20 reps

  • Next week, progress to 4lbs

  • As weight continues to increase, decrease # of reps and increase # of sets

  • Rest longer between sets

  • Stop when you lose good form

  • Good form means: no compensating (turning on other muscles and straining), able to go through same range you started with, no throwing or dropping weights – feeling “the burn” is okay! If you're not sure or have never worked with weights before, reach out to a local personal trainer. Let them know your history, and they will guide you through a safe program that is specific to you.

  • Keeping a journal or exercise app is the best way to keep track of progress, and seeing the change over time is very encouraging!


CARDIOVASCULAR AND PULMONARY HEALTH

During your treatment journey and thereafter it is important to maintain the health of your heart and lungs through regular, moderate intensity aerobic exercise. We have already discussed how exercise can help you through the fog of chemo and radiation fatigue, but making exercise a part of your active lifestyle can have many other beneficial effects on your health and quality of life.


Recommendations from The American College of Sports Medicine and American Heart Association:

  • Moderate-intensity aerobic (endurance) physical activity for a minimum of 30 min on five days each week OR vigorous-intensity aerobic physical activity for a minimum of 20 min on three days each week.

  • My recommendation is do find something you love. Cardio doesn't have to mean walking, running, biking, or elliptical training. In fact, I hate all those things! Yoga and Qigong work heavily with the breathe and have been shown to be fantastic for your heart and mind.


ONCOLOGY NUTRITION


There is nothing more packed with anti-oxidant health benefits than fruits and vegetables. Don't feel like eating a plate of fruit and veg or just can't stand the taste of kale? Smoothie-it, girl! Tastes like dessert and you'll never know those healthy greens are in there!

This article will not address nutrition in depth, but I want to encourage you to be very mindful of the foods you are fueling you body with while you are recovering. It can be very easy to fall into the fast-food trap when you feel like crap (that sounds like a bad country song), but helping your body fight means giving it what it needs to do so. Focus on fresh fruit and veg in a variety of colors. The colors in food correspond to specific phyto-nutrients, each one packing with it a plethora of healing and protective benefits. Dark, leafy greens in particular are of high importance. Try to get those in every day, even if that means hiding them in a smoothie or cooking them down to a sautéed dish. Shoot for getting your proteins from plant-based sources, too. They're anti-inflammatory and won't weight heavy on a nauseous stomach. These can come from beans, legumes, nuts, and seeds.


So, my main message here is to empower you by showing that you have more control over how you feel and recover than you realize. I have worked in oncology for a long time, and in that time I have been through many journeys with many brave souls. Some of them triumphant, some of them I miss dearly, but all of them courageous. Don't be a passive passenger on this road. Take control of your health and wellness any way you can! And reach out to others who know what you're going through. As supportive and loving and wonderful as your friends and family members might be, if they've never been diagnosed with cancer, they just have no way of really knowing what its like from the inside; including me, and I've worked on the front lines! Search for local groups or online resources that can connect you to the world of other brave women who are out there every day, kickin' cancer in the ass...

and drinking a smoothie while they do it.


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