By Marissa Lee- Northsise Allied Health Accredited Exercise Physiologist
Exercise Recommendations and Guidelines for Breast Cancer Patients
It is great to hear that the current guidelines for cancer patients and survivors are now strongly recommending exercise for both during and post treatment. Historically, clinicians have advised cancer patients to rest and avoid activity; however, current science shows this guidance is outdated. In fact, studies have shown exercise helps to boost the immune system, improves energy levels, assists in the prevention and management of lymphoedema, improves a patients overall QOL as well as their mental and physical wellbeing. Recent studies have also demonstrated promising results suggesting that patients actively participating in moderate exercise can also help to reduce the risk of recurrence from breast cancer.
The Australian Physical Activity guidelines which are produced by the Department of Health are relevant for all Australian adults, including those who have been diagnosed with breast cancer. It is suggested that these recommendations are something for patients to work towards rather that the starting point. The amount, frequency and duration that a patient is able to achieve will vary depending on a number of factors including their stage and type of treatment (starting chemo? had surgery? during treatment- vomiting/ nausea, fatigue (treatment induced and de-conditioning) and current physical tolerances.
Exercise recommendations:
Adults 18-64yrs
- Aim for 150-300mins (2 1/2- 5hrs) of moderate intensity physical activity OR 75-150mins (1 1/2- 2 1/2hrs) of vigorous intensity physical activity back week.
- Try to do muscle strengthening exercises on at least two days each week.
Adults 65yrs and over
- Aim for at least 30mins of moderate intensity physical activity on most, preferably all days of the week.
- Try to be active every day in as many ways as possible, doing a range of physical activities that incorporate fitness, strength, balance and flexibility.
- Minimise the amount of time spent in prolonged sitting
- Break up long periods of sitting as often as possible
For patients currently undergoing treatment, just starting to exercise or who have not exercised for awhile, it is important that they start at a level that is easily manageable and gradually build up to the recommended amount, type and frequency of activity. This can be done by breaking down exercise into short periods throughout the day, e.g. 15mins in the morning and 15mins in the afternoon OR 3 lots of 10mins at different times over the day.
Five of the best exercises recommended for breast cancer patients during and/ or post treatment are:
- Walking (during and post)- It doesn’t cost anything and can be performed anywhere and at anytime and at an intensity and duration that a patient can tolerate. A study published in the Journal of the American Medical Association found breast cancer survivors who walked as little as 60 minutes a week improved their chances of the cancer recurring by up to 40 per cent.
- Yoga (during and post)- Helps to improve strength, mobility and reduce stress. In a US study, researchers found breast cancer patients who took part in a yoga class twice a week during their radiation treatment, reported having more energy, increased physical functioning, and better overall quality of life, than women who did not.
- Resistance Exercises or gentle weights (post)- Chemotherapy can cause a loss of bone density so some light weight training is recommended to help boost bone strength and reduce risk of bone fractures. Strength-building exercises can also help breast cancer survivors who have weakness around the rotator cuff (the muscles around the shoulder) which is relatively common after a mastectomy.
- Mediation (during and post)- helps calm the mind to reduce stress and anxiety. Improve a patients mental wellbeing and ability to cope.
- Canoeing or Dragon boat paddling (post)- has been found to be very helpful in preventing lymphedema (the swelling on the limbs common in cancer patients). For more information contact Dragons Abreast Australia on 1300 889 556.
Tips for maintaining regular exercise
- Start small and build up. Be gentle, particularly in the weeks just after treatment. Start with some slower forms of exercise like tai chi, gentle yoga, walking or aqua-aerobics.
- Do something you enjoy. It’s no good jogging if you hate it!
- Try something new. As your energy starts to return, try something you’ve always wanted to do but never got a chance – flamenco dancing or joining a bush walking club.
- Find an exercise partner. Find a friend or relative who wants to exercise too and make plans to do it together.
- Set yourself clear goals. And decide on a reward if you reach your goals (choose a reward that will be sure to motivate you).
- Join a class. It can be hard to stay motivated on your own – it really helps to join a class or a group.
Precautions
- All chemotherapies lower your white blood cell count (WBC), which increases the risk of getting colds and other infections. You should ask your oncologist whether you should exercise at home or in your neighbourhood or if you can return to the gym. If you go to the gym, wipe off the equipment before and after your workout. Also consider wearing flip flops in the dressing room and showers, as locker rooms can have a lot of germs.
- Chemotherapy can reduce red blood cell counts, causing anemia. RBCs help carry oxygen to your muscles, so if there are fewer RBCs in your body, you may not have the endurance or stamina for some exercises. You may get short of breath earlier in your exercise routine.
- Finally, some chemo regimens also drop your platelet count, which makes it easier to bruise or bleed. If your platelets are below 50,000, avoid weight/strength training. In terms of surgery, you want to make sure the incision is fully healed. Some people are concerned with lymphedema, or arm swelling, if they have had lymph nodes removed or received radiation as part of their treatment. If this is the case, present recommendations are to start with very low weights and add small amounts of weights very slowly. When starting a strength program, you should monitor for any signs of swelling in your arm, breast or trunk. Depending on the extent of the lymph node dissection, some suggest exercising with a compression sleeve.
Why Is Exercise So Important During & After Cancer?
- Exercise can help alleviate side effects of cancer treatment (i.e. fatigue, pain, bone & muscle loss, etc.)
- Exercise improves quality of life (i.e. stress, anxiety, depression, etc.)
- Exercise can reduce the risk of cancer recurrence (decreased inflammation, decreased free radical production, decreased cancer growth factor production, etc.)
- Exercise can improve self-image and confidence