The Importance of physical activity after active treatment of breast cancer
Moderate physical activity after finishing active treatment is extremely important for your overall health and quality of life. It can help you:
- Improve your overall physical fitness
- Maintain a healthy weight
- Reduce the risk of developing other serious chronic diseases such as diabetes and cardiovascular diseases, as well as prevent the recurrence of cancer
- Restore and maintain your mental balance. When you are physically active, your body releases hormones that make you feel good. Physical activity helps reduce tension, stress, and mental fatigue, and improves sleep, concentration, memory, mood, and confidence.
- Lower the risk of developing lymphedema or improve your condition if you already have it
Before starting any exercise program or physical activity, consult your oncologist, as they know your current condition and how you are recovering from treatment. Ask for advice on the exercise regimen that is suitable for you at this moment.
Some people can safely start or maintain their own exercise program, but others will have better results with the help of a sports instructor or physiotherapist. Specially trained professionals can help you find the types of exercises that are appropriate and safe for you and recommend how often and how long you should train.
If you choose to work with a specialist, inform them about your diagnosis, the therapies you have undergone, whether you have lymphedema, and any restrictions recommended by your oncologist regarding your current condition.
Being physically active does not necessarily mean intense and heavy workouts. Walking in the mountains, pilates, yoga, pool exercises, and exercises with resistance bands and light weights are good options for you.
Keep in mind that if you have had lymph node dissection, mastectomy, or radiation therapy, you should protect the affected arm during physical activity by avoiding lifting weights over 3 kg, placing body weight on the arm, letting the arm hang down freely, and repetitive rotational movements with the arm.
Physical activity with Lymphedema
Lymphedema is a condition characterized by the accumulation of lymph fluid in the skin and subcutaneous tissue due to removed or damaged lymph nodes and impaired drainage (lymph stasis). It usually affects the upper or lower limbs, depending on the location of the surgery. It is often observed in people who have undergone treatment for breast cancer. Lymphedema can appear at any time after treatment, even many years later. It most commonly occurs (in about 75% of patients) by the end of the first year after surgery involving extensive lymph node dissection in the armpit.
The lymphatic system can be damaged during breast surgery, lymph node removal, or radiation therapy.
In some cases, the body finds ways to stimulate the activity of existing nearby lymph nodes, increase their efficiency, and create new connecting branches (anastomoses) to other lymph vessels and veins to redirect lymph fluid drainage. When this mechanism does not fully work and lymph fluid accumulates in the affected limb, we talk about lymphedema.
Studies show that between 2% and 38% of women treated for breast cancer develop the condition, depending on the treatment they received. In cases of extensive lymph node dissection, the incidence reaches up to 62.5%. Science has not yet explained why some people develop lymphedema while others do not.
Lymphedema is a progressive disease, and early diagnosis and treatment are crucial. Lymphedema is clinically diagnosed. Accurate diagnosis plays a key role in determining further treatment methods. At the first signs of the disease, a mandatory consultation with a lymphologist is necessary - in Bulgaria, this function is performed by a vascular surgeon, angiologist, or phlebologist.
Lymphedema is a chronic disease that does not directly threaten human life, but if not treated properly and timely, it can lead to permanent swelling, irreversible skin changes, frequent infections, reduced mobility of the affected limb, significantly worsened quality of life, and even disability. Although there is no cure for lymphedema, it can be controlled through appropriate and comprehensive measures such as good hygiene practices, massages, compression bandages, physiotherapy exercises, medications, and surgery. The focus is on reducing swelling and pain to maintain a stable condition.
Daily physical activity is an important part of both intensive anti-edema therapy, when the main goal is to reduce swelling, and the phase of maintaining achieved results. During active and repetitive movements with the affected limb, muscle contractions act as a natural muscle pump, helping lymph fluid drainage and reducing swelling. Light exercises are performed to facilitate lymph drainage - aerobic, elasticity, and flexibility exercises. The exercise program is developed by a specialist and tailored to the degree of swelling, therapy phase, and physical condition of the patient. Exercises are performed with a compression garment, which may be a compression bandage during intensive therapy or a compression sleeve during maintenance therapy.
Physical activity starts at a lower intensity level and gradually increases, allowing the lymphatic system to adapt to the new activity level.
Physical activity with osteoporosis
For women who have undergone breast cancer treatment and are dealing with osteoporosis as a result of hormone therapy, it’s important to choose exercises that are both effective and safe. It is essential to focus on exercises that promote bone health without putting them at risk for fractures. Consultation with a healthcare provider or physical therapist is recommended to tailor the exercise program to individual needs and conditions.
Here’s how each recommended sport or exercise aligns with those needs:
- Jogging. Jogging is beneficial for improving bone density and overall cardiovascular health. It is a weight-bearing exercise, which is crucial for strengthening bones. You should avoid high-impact jogging on hard surfaces to reduce the risk of fractures. Opting for softer surfaces like grass or using proper footwear can mitigate these risks
- Bodyweight Exercises, Free Weights, and Elastic Bands. Strength training is highly effective in combating osteoporosis by improving bone density and muscle mass. Using bodyweight, free weights, and elastic bands can target various muscle groups, enhancing stability and bone strength. It’s important to start with light weights or low resistance to prevent strain on bones and joints. Ensure proper form and technique to avoid injury, especially for those with weakened bones
- Pilates. Pilates is excellent for improving balance, flexibility, and core strength, which can help prevent falls and fractures in women with osteoporosis. Modifications might be needed to avoid excessive spinal flexion or twisting, which could increase the risk of vertebral fractures. Exercises should focus on stability and controlled movement
General Guidelines for physical activity for breast cancer survivors
- Warm-Up and Cool-Down. Always start with a 5-10 minute warm-up to prepare your muscles and cardiovascular system for exercise. Finish with a cool-down to help your body recover and reduce muscle soreness
- Intensity. Keep the intensity at a moderate level, especially in the beginning. As you build strength and endurance, you can increase the intensity, but it's important to listen to your body to avoid overtraining
- Progression. Gradually increase the duration, intensity, and complexity of exercises. This progression is essential for continuous improvement without risking injury or overtraining
- Listen to Your Body. Pay close attention to how your body responds to different exercises and modify or stop any exercise that causes discomfort or pain
- Regular Assessments. Regularly assess your strength, flexibility, and overall well-being to adjust your exercise regimen accordingly
- Consultation: Regular check-ins with a healthcare provider or a fitness professional specializing in oncology are recommended to ensure that your exercise program is safe and effective.
For breast cancer survivors, a well-rounded exercise regimen incorporating cardiovascular exercise (like jogging), strength training (using body weight, free weights, and elastic bands), and flexibility/balance training (such as Pilates) can significantly improve physical and mental health. These activities should be adjusted to individual capabilities and recovery stages, with a focus on gradual progression and balanced muscle engagement.
