Gentle Recovery

What your doctor might not tell you

What your Doctor may not have had time to tell you… but what anyone affected by breast cancer NEEDS to know.

This is not a pitch for an alternative cancer treatment, miracle super-food or extreme diet promising to cure your cancer. The purpose of this article and my mission as a Physiotherapist and Cancer Yoga teacher is about spreading the word and promoting the powerful and multiple benefits of exercise and yoga, and to bring to your attention the science that backs this up for people affected by breast cancer. The research evidence is all there, but for some reason women with breast cancer are not routinely being advised to exercise and supported to do this.

Not so long ago, people with cancer were advised, “rest is best”, that they should limit any physical exertion. This may still be the advice if someone is struggling with symptoms such as pain, breathlessness or a rapid heart rate. And of course, there will be days when being tucked up in bed is exactly what you need.

So, what is the research telling us about the benefits of exercise?

Exercise can reduce the risk of your cancer coming back and can make you live longer

A study published online on April 2, 2020 in the Journal of the National Cancer Institute included 1,340 women diagnosed with stage I, stage II, or stage III breast cancer with a high risk of recurrence. All of the women had surgery to remove the breast tumour followed by a course of chemotherapy. The researchers found that women who met the minimum US federal exercise guidelines of 2.5 hours per week of moderate intensity exercise per week, before and after being diagnosed with breast cancer, had;

  • a 55% lower risk of recurrence compared to women who didn’t meet the minimum guidelines
  • a 68% lower risk of dying compared to women who didn’t meet the minimum guidelines.

Even women who began exercising post-cancer treatment got benefits from the physical activity; they had

  • a 46% lower risk of disease recurrence
  • and a 43% lower risk of dying compared to women who didn’t meet the minimum guidelines.

So, this research suggests that a program of exercise taken up at any point before diagnosis to after treatment can help women with high-risk breast cancer live healthier and longer lives.

Exercise can help you maintain a healthy weight.

Regular exercise can help you build muscle and burn fat. Being overweight can increase the risk of breast cancer coming back (recurrence). This higher risk is because fat cells make oestrogen; extra fat cells mean more circulating oestrogen in the body and oestrogen can make hormone-receptor-positive breast cancers develop and grow.

Exercise can help you build muscle and get stronger. Aging usually causes people to lose muscle and gain fat. Chemotherapy and hormonal therapy medicines can send you into sudden menopause which can also cause muscle mass to decrease. Strength training exercises can help make sure you have more muscle than fat – which means you’ll be able to carry out your normal activities of daily living such as picking up a bag of groceries, picking up a child etc. Again, strength training needs to start with very low weights and progressed gradually to reduce the risk of causing lymphoedema or worsening it if you have it already.

Exercise has been found to lessen the number and severity of side-effects from cancer treatments.

Current research suggests that exercise can:

  • ease chemotherapy-induced nausea
  • ease fatigue caused by radiation and/or chemotherapy
  • improve blood circulation to the legs, reducing the risk of blood clots (DVT’s).
  • stimulate digestion and elimination systems, easing discomfort of constipation
  • increase your sex drive

Exercise can boost your energy levels.

Fatigue is an troublesome side effect that many women experience during and after treatment for breast cancer. Regular exercise can increase your fitness levels, helping your heart and lungs work more efficiently, both of which give you more energy to achieve what you need to do each day, with energy left over.

Stretching and mobilising post-operatively can improve posture and shoulder mobility.

Scar tissue that forms after breast cancer surgery, reconstruction, or radiation can lead to your arm and shoulder muscles feeling tight. Tightness in the musculature at the front of the chest can pull the shoulders forward, round the upper back and cause your chin to poke forward, this posture can lead to further stiffness and pain in other parts of the body. Postural awareness and a careful and gradually progressed stretching and mobilisation program can improve any range of motion issues you may have in your arm, shoulder and chest.

Exercise reduces the risk of Osteoporosis (brittle bones).

The natural aging process causes lose bone mass. If you’ve been diagnosed with breast cancer, maintaining bone density is especially important. Research shows that some breast cancer treatments can lead to bone loss. Women are about twice as likely as men to develop osteoporosis (a disease that means your bones are weak and more likely to break) after age 50. Weight-bearing exercise, such as jogging or walking and strength training, can slow bone loss.

Exercise can boost your self-esteem and brighten your mood.

A diagnosis of breast cancer can be very frightening and women with breast cancer can understandably suffer from depression and anxiety. Exercise can help lift your spirits, keep depression at bay, and boost your self-esteem. Physical activity triggers the release of “happy” brain chemicals such as endorphins that can make you feel brighter and more at ease. You also might feel more confident about your appearance if you exercise regularly and see yourself looking more toned and leaner.

Exercise helps ease stress.

Any type of exercise can help melt away stress. Stress reduction is achieved by the brain ramping up endorphin production but also because exercise can be experienced as a kind of mediation. The body and mind love rhythm and in becoming mindful of how the body feels you may find that your mind feels clearer and more at peace. For me personally, this is a HUGE reason why I exercise daily, it helps me settle my mind, organise my thoughts and find mental clarity.

Exercise can help improve quality and quantity of sleep.

Regular exercise can help you fall asleep quicker and sleep more deeply.

Considering all of these amazing benefits, why do so few women with breast cancer know about the important role of exercise in cancer rehabilitation?

Despite the findings of so many research studies about the multiple benefits of exercise in breast cancer rehabilitation the message still isn’t getting out to the women that need it. The majority of women living with and beyond breast cancer are not physically active. A roundtable report published in October 2019‘Exercise is Medicine in oncology: Engaging clinicians to help patients move through cancer’ highlighted the many instances along a cancer patient’s pathway where the oncologist could have, but didn’t, prescribe exercise. The researchers found that this was either because of time pressures at appointments, a lack of awareness into the researched benefits of exercise or because they didn’t have rehabilitation and exercise specialists to refer their patients to.

I am not trying to undermine or say that oncologists or cancer teams are not doing their jobs well, not at all, I am very aware of the time pressures they are under and that at all appointments they have so much to cover, arranging for treatments, surgeries, chemotherapy, radiotherapy etc. Some women will be fortunate to have access to rehabilitation services such as physiotherapy or specialist cancer fitness trainers but many women will not get the support they deserve. This is why I feel passionately about reaching out and supporting as many women as possible to start an exercise program, empowering women to take an active role in their recovery.

So, what are the current exercise guidelines for women affected by breast cancer?

The NHS in the UK and the American Cancer Society both advise cancer survivors (those living with cancer and beyond) who are otherwise healthy to gradually build up to the levels of exercise recommended for the general population which is 150 -320 minutes of moderate intensity exercise per week. They also advise two sessions of strength training at least twice per week.

The NHS also advises that people with cancer complications or other health conditions (co-morbidities) that would stop them from being able to do moderate intensity exercise should still aim to be as active as their condition and abilities permit them to be (www.nhs.uk and cancer.org).

So, what is ‘moderate intensity’ exercise and how can I achieve these recommended levels of exercise?

Moderate intensity exercise equates to a brisk walk, walking at a speed where you can have a conversation with someone but you wouldn’t be able to sing a song.

It doesn’t matter where your starting point is, its ok to start with just a few minutes walking each day (perhaps walking from your front door to your back door) and gradually increasing the minutes you walk each day for example. Gradually working towards the target of 150-320 minutes per week.

A few words about Lymphoedema

Women who have had breast surgery and lymph nodes removed may worry about the risk of exercise causing lymphoedema. The current advice following a large study of breast cancer patients (The PAL Trial) and other studies have shown that a progressive program of aerobic and resistance exercise is safe and does not cause lymphoedema.

Check with your cancer team before you start exercising

Always check with you oncologist or cancer team before you start any exercise program. It’s really important to ask if any of the medications could affect your heart, lungs or bones. For example, some chemotherapy drugs can affect your lungs.

Getting started can be the hardest part

For the majority of people making the first steps in beginning a new exercise program can be tough, living with the breast cancer and the side-effects of its treatments can make this process infinitely harder. Sometimes even the thought of physical exertion can be exhausting. That’s why it’s important to start very gently and gradually increase the time you spend exercising each day, gradually increase the intensity of the exercise you do (i.e. how hard you work), and increase how many times per week you do it. It needs to be something you enjoy and you should leave each session feeling better than when you started.

Making exercise part of your healthy life-style, some secrets to success…

I would love to hear if you have had any insights from reading this free guide. What action are you going to take based on this learning? Do you have any further questions or topics you would like me to cover?

Please let me know on social media. You can always send me a message on Facebook.

Do you want to know another secret to success? Do you want to take your insight and action to the next level towards a more sustainable result? Research shows that people who share their goals and insights have a much higher chance of achieving their goals!

So, make it REAL and share your insights from this guide along with your next action step on your Facebook account and tag me @gentle_cancer_recovery so I can see it (and repost if you would like).

Would you like expert guidance and support on starting an exercise program specifically designed for women affected by breast cancer?

Exercise and yoga wellness programs for women affected by breast cancer

Exercise is one part of a healthy lifestyle; in my “Gentle Recovery” course. I will teach you to look at all aspects of your life and show you ways to achieve optimal health. The program is created in a way that helps you to fit health-promoting exercise and yogic practices into your probably already busy life.

Topics covered will include nutrition, relaxation techniques, stress-management, fatigue management, sleep, anxiety and depression to name but a few.

India Gooderham

India Gooderham’s background is as a Specialist Physiotherapist working in oncology and palliative care in the UK. She is now working as a Cancer Exercise Specialist and Cancer Yoga teacher and is founder of ‘Gentle Recovery’, an online rehabilitation and wellness platform for people affected by cancer. Her mission is to serve, educate and empower people at any stage of their cancer journey through exercise, yoga and wellness online programmes and 1-2-1 online coaching.

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