Exercise therapy is critical for breast cancer survivors both during treatment and after. During treatment, exercise can help lessen side effects and improve peace of mind. Once treatment is finished, exercise can aid a woman in regaining strength, endurance, and control over her body and life.

During and immediately after treatment, women should seek physician approval before beginning an exercise program. It is the physician who is acutely aware of the cancer's status such as low blood counts, weight loss, or other considerations.

Physical Benefits of Exercise

The side effects of breast cancer treatment lend themselves to therapeutic exercise. In this sense, exercise "treats the treatment." More specifically, an appropriate exercise prescription can directly ameliorate the loss of flexibility in the shoulder area, loss of arm strength, and loss of libido, as well as weight management due to surgery, radiation, chemotherapy, and/or hormone therapy.

Aerobic exercises, such as walking, jogging, and swimming, assist in weight management and improvement of cardio-respiratory function that can, in turn, reduce what is often called "cancer-related fatigue" or CRF. Aerobic exercise has also been shown to decrease the nausea associated with chemotherapy. It can also help a woman maintain a proper body weight, which can reduce the likelihood of reoccurrence, as well as diminish the possibility of lymphedema.

Other sorts of exercise are helpful as well. Upper body stretching increases the range of motion around affected areas such as the shoulder girdle. Resistance training with light weights maintains strength so women can lift everyday objects such as golf clubs or groceries. Exercise-related fatigue - as distinct from cancer-related fatigue - may also reduce the "sleeplessness" of the cancer experience.

In addition, relatively high repetition resistance exercises helps manage existing lymphedema. Many people believe that light to moderate weight lifting can cause lymphedema, but this is not the case. Rather, movement improves drainage of lymphatic fluid, which makes the condition less likely and less debilitating.
Weight-bearing exercise is important too. In fact, many weight bearing exercises assist in maintaining bone density that may be lost following hormone therapy such as Arimidex.

Psychological Benefits of Exercise

As well as its many physical benefits, exercise does wonders for a woman's state of mind. The ability to perform daily tasks without undo fatigue and restriction leads to an increased sense of control, which is often lost during the cancer experience. Exercise has also been shown to reduce the depression and anxiety common to cancer patients. Recently, aerobic exercise has been thought to reduce the effects of "chemo brain" or the forgetfulness that is often associated with chemotherapy.
In addition, recreational exercise provides a "time-out" from the cancer experience. In addition, exercise done in a group setting other cancer survivors provide support for those who may not be attracted to traditional support groups (see sidebar).

Exercise Prescription

Generally any exercise prescription begins with a warmup of 20 to 30 minutes of moderate aerobic activities. Machines that incorporate upper body movement such as rowing machines or elliptical trainers, will warm up the specific muscle groups and connective tissue for the flexibility exercises to follow. These machines are particularly helpful for breast cancer patients because they incorporate the muscle groups and connective tissue that are often the site of underarm surgery for staging purposes or follow-up radiation.

Strength or resistance training assists women in maintaining or regaining strength they may have lost due to inactivity during recuperation. Many patients fearing lymphedema mistakenly limit use of the affected arm resulting in a disuse phenomenon whereby they effectively lose the use of one arm. Lifting light weights 8 to 12 times per muscle group, two to three times a week limits the problem. Simply lifting everyday objects can often overcome disuse. While being careful not to overdo it, breast cancer patients and survivors can benefit from everyday actions such as lifting objects and carrying milk jugs from the trunk of the car.

When exercising, patients should remember to include recreational exercise such as gardening or whatever they like to do. It provides for an escape and because it is enjoyable, they are more likely to do it on a regular basis. "The best exercise is the one you'll do."

While therapeutic exercise is an important component in treatment, it is also important to recognize that adequate rest is equally necessary. When tired, women should rest, particularly during the initial treatment phase. At the beginning, it may be wise to exercise only two to three times a week, gradually increasing to five or six times a week. Women should remember to listen to their bodies. If an activity hurts, don't do it.

It is important not to think of prescriptive exercise as something else you want to avoid. Rather, consider it part of the treatment strategy with attendant lifestyle changes for years to come.