Exercise After Breast Cancer: a Critical, but Challenging, Component of Recovery

Exercise After Breast Cancer: a Critical, but Challenging, Component of Recovery

Making working out a priority isn't easy for survivors, but research shows there are payoffs.

Exercises that enhance flexibility like yoga can be helpful for improving range of motion in breast cancer patients who've had surgery. (Getty Images)
For over a year, Mitria Di Giacomo couldn't look at herself in the mirror. Doing so would mean confronting the fact that a part of herself was literally gone forever. "It was just overwhelming," says Di Giacomo, now 59, who was diagnosed with breast cancer in 2007, and underwent a mastectomy, chemotherapy and breast reconstructive surgery soon after. "If I could avert my eyes from staring at my chest, I would."

Today, Di Giacomo has a more neutral feeling toward mirrors. "Now I look at myself like [my right breast] is part of my body and perfectly normal," she says. "It's been a real evolution."

The next phase of her evolution? Focusing on exercise – something that's always been a part of her life but naturally was put on the back burner during treatment and recovery. "Sometimes exercise while you're going through chemo could be as simple as managing to get out of bed, shower and walk," she says. Although Di Giacomo walks frequently now and tries to go to the gym twice a week, she's hoping to add back Pilates, kickboxing and weight-bearing activities to boost her strength, reduce her risk of cancer recurrence and feel more comfortable in her frame, which is 30 pounds heavier than before her diagnosis.

"I want to stay healthy," says Di Giacomo who owns a marketing and advertising consulting firm in New York City and is a board director for the AiRS Foundation, a nonprofit that raises awareness of and funding for reconstructive breast surgery. "It's risk reduction."

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While there are no published randomized clinical trials demonstrating that weight loss or physical activity is linked to a lower risk of breast cancer recurrence in humans (though a major one is underway), at least eight large, observational studies suggest that exercise in overweight cancer survivors can help ward off recurrence. Research on mice, too, has demonstrated that connection, says Kathryn Schmitz, a professor at the Penn State College of Medicine who studies cancer and exercise.

"There are a number of pathways through which we think exercise and weight control could have a strong effect on preventing recurrence," she says. For example, exercise and weight loss can reduce the amount of tissue on which cancer can grow, reduce inflammation (a known contributor to cancer growth) and support the immune system.

"A better immune system is going to do better surveilling and preventing cancer from growing in the first place," Schmitz says. "It's going to help us recover more quickly from the rigors of cancer treatment."

Outside of the suspected recurrence prevention, exercise is linked to improved quality of life and physical function in cancer patients and survivors, a review of 34 randomized controlled trials conducted by Schmitz and colleagues found. Exercises that enhance flexibility like yoga can also be particularly helpful for improving range of motion in breast cancer patients who've had surgery, says Dr. Janna Andrews, an assistant clinical professor of radiation medicine at the Zucker School of Medicine at Hofstra/Northwell in New York State. "Patients who don't focus on that, if you see them in follow-up, they're not able to lift their arms over their heads," she says.

At the very least, exercise can help breast cancer survivors feel more at home in their bodies. "You get so disconnected from your physicality when you go through trauma like this," Di Giacomo found. "You have to work on trying to find this person that’s looking back at you." Now, simply taking a walk along her waterfront home helps her center her body and mind.

But despite the benefits of exercise for breast cancer survivors, getting moving post-treatment is rarely easy, let alone a priority amid bills, family-rearing, career concerns and just catching up on the life survivors missed while in treatment, Schmitz says. "I need to leave enough money for my kids to be OK." "I need to put my mark on my profession." "I need to sleep and stop feeling so damn tired," are common thoughts breast cancer survivors have, she says.

Self-consciousness can also derail breast cancer survivors' best intentions to start a new program or to get back to their pre-cancer fitness routines. "All of those other people can do that many more pullups … and you can't even do the box jump. You feel like [you've aged] 10 years and you're only one year older," Schmitz says. Meanwhile, in that year, your gym mates seem to have only gotten fitter. "It's embarrassing," she says.

Then, there are survivors' very real concerns about how exercise may aggravate lingering treatment side effects like pain and fatigue, or cause a flare-up of lymphedema – the swelling often related to lymph node removal during cancer treatment. "The expectation is that once you finish treatment, you just bounce back," Andrews says. "It doesn't work like that."

Fortunately, there are programs and strategies that can help breast cancer survivors bust through many of those barriers. Schmitz's research, for example, supported the creation of Strength After Breast Cancer, a physical therapy program to improve symptoms of lymphedema, reduce body fat, improve strength and boost body image in breast cancer survivors. The program is just a half-hour two days a week and involves both upper and lower body strengthening exercises adjusted to the woman's needs and abilities.

"What is magical about this is nothing," Schmitz says. "It's not what exercises are being taught; it's how to do them with proper biomechanics and being taught how to [increase] the resistance very slowly." While doing too much too soon makes the average person sore, for a breast cancer survivor with lymphedema, "that's a flare-up," she says.

The American College of Sports Medicine and the American Council on Exercise also have certifications for fitness professionals who want to work with cancer survivors. Seeking one out can help ensure your exercise routine is safe, effective and considerate of the type of treatment you received, says Andrea Leonard, a thyroid cancer survivor and personal trainer who founded the Cancer Exercise Training Institute in 2004. The institute provides research-based continuing education on exercise therapy as a key component of cancer recovery.

"Breast cancer strips you of everything – your hair, your figure, your self-esteem and self-confidence," she says. "As a Cancer Exercise Specialist, we are able to help survivors take control of their minds and bodies at a time when they may feel they have no control."

For Di Giacomo, one key to motivate herself to exercise has been setting small, achievable goals. If she can walk a few extra blocks to get to work, she does. If she can get to the gym for just 15 minutes, she does. "If you set a goal and surpass that goal," she says, "you've won."