“Mrs. Doe, I’m sorry to inform you that your tests have revealed the presence of a malignancy…” These are probably among the most powerful and frightening words any woman can hear from her doctor.
A diagnosis of cancer conjures up all manner of horrific images: surgery, endless months of treatment, side effects, psychological and physical pain and, of course, possible disfigurement. First comes the shock, the utter disbelief…and then come the tears.
Every 3 minutes, another woman is diagnosed with breast cancer. According to the American Cancer Society, breast cancer is the most common malignancy, affecting 2.5 million American women. There is, however, some good news in the realm of survivability. Due to improved methods of early detection, as well as innovative approaches to treatment, today’s cancer patients are living longer and healthier lives than those diagnosed over a decade ago.
Along with the breakthroughs in medical technology, there are many other factors that can contribute to a woman’s ability to successfully navigate the arduous path toward recovery. In the past, individuals being treated for a chronic illness were often told by their doctors to rest and reduce their physical activity. While this may sometimes be good advice (especially if movement causes pain) newer research has shown that exercise is not only safe and possible during cancer treatment, but it can improve physical function and overall quality of life. Since too much rest can actually lead to a loss of muscle function and reduced range of motion in areas of the body affected by surgery, medical professionals now are urging their patients to be as physically active as possible during cancer treatment. To that end, properly skilled personal trainers can help breast cancer survivors to maximize their function and bring enhanced wellness back into their lives.
A research scientist from Alberta, Canada reviewed fifty-one studies on the effects of exercise on breast cancer patients, both during and after treatment. The individuals who participated in some manner of exercise intervention, (aerobic exercise, resistance training or a combination of the two) reported significantly improved quality of life, experiencing less fatigue and stress and greater levels of self-esteem. In other studies that examined various exercise interventions in patients undergoing breast cancer treatment, all showed significant physical and/or emotional benefit.
As more studies continue to reveal, the good news does not seem to be limited just to the musculoskeletal benefits of exercise. Researchers have also examined the effects of an exercise intervention after women have completed their course of treatment, and nearly all studies showed at least modest improvement in patients’ immune function, levels of depression, self-esteem, mood, anxiety and overall quality of life.
Armed with all of this positive feedback, what role should the personal trainer assume in facilitating a breast cancer patient’s ability to preserve or regain physical function after surgery? There are several key concepts to keep in mind when working with such clients. Breast surgeries tend to disrupt muscular balance in the shoulder, which in turn can affect posture, reduce functionality and cause pain. Likewise, surgery to the axillary and pectoral regions can preclude full range of motion at all planes in the shoulder. As a result, clients initially may be hesitant or fearful of movement, which ultimately could lead to a loss of strength and function in the affected arm. While it is true that physicians follow different time frames when it comes to recommending an appropriate time to begin range-of-motion exercises, it is generally felt that exercise should commence shortly after surgery to prevent any complications such as scar tissue and adhesions. To that end, gentle resistance training and stretching should be started as soon as the patient feels comfortable. Focusing on the triceps and pectoralis major will facilitate the stretching required to maintain full mobility. Yoga, too, can provide flexibility benefits as well as balance, controlled breathing instruction and overall stress reduction techniques.
Another point to keep in mind is the need for maintaining muscular balance in post-operative clients, especially if their surgery has affected only one side of the body, as opposed to a total mastectomy. The cross-education effect of resistance training comes into play here. When performing strength exercises unilaterally, we often observe muscular strength improvements in the same muscle group on the untrained side of the body. Thus, working to strengthen the healthy arm/shoulder/axillary region might help to minimize any potential muscular atrophy on the affected side, thereby facilitating recovery.
Depending on the chemotherapeutic agent with which a patient is being treated, side effects may lead to impaired cardiac function, pulmonary function or both. Some form of cardiorespiratory exercise can help in alleviating some of these detrimental symptoms. An exercise program that includes moderate intensity aerobic training should be encouraged, starting with one or two days per week that differ from resistance-training sessions. A study published in the Sept. 2007 issue of the European Journal of Cancer Supplements followed 203 women with early-stage breast cancer. The women who were assigned to a 12-week, supervised group exercise program reported multiple physical benefits including significant increases in distances walked in 12 minutes, greater shoulder mobility and better breast cancer-specific quality of life. They also experienced a reduction in fatigue and depression. At the six-month follow-up period, these women said they were able to draw peer support from exercising in a group dynamic, leading researchers to conclude that supervised group exercise may provide short and long-term physical and psychological benefits for early-stage breast cancer women undergoing therapy.
While much attention is, of necessity, devoted to the physical manifestations of breast cancer surgery and its aftermath, viewing the client as a whole woman is critical to a positive outcome. Deference should be given to the client’s sense of self-esteem, her view of herself as still being feminine and desirable. By incorporating an exercise program into her life, the personal trainer is affording her client the opportunity to regain a sense of mastery over her life, a return to some semblance of normalcy, all of which can contribute to a greater feeling of self-efficacy in every aspect of her life. A positive mindset such as this can translate to an improved immune system and the confidence that she truly can beat the medical odds and emerge healthy once again.
About the Author
Cathleen Kronemer is an AFAA-Certified Group Exercise Instructor, NSCA-Certified Personal Trainer, competitive bodybuilder and freelance writer. She is employed at the Jewish Community Center in St. Louis, MO. Cathleen has been involved in the fitness industry for 22 years. Look for her on www.WorldPhysique.com.
She welcomes your feedback and your comments!