The many benefits of exercise AFTER breast cancer

Before she was diagnosed in August 1998, Melba Snively, now 58, wasn’t someone you were likely to see at the gym. But following that diagnosis and countless hours spent researching the disease, she decided major lifestyle changes were in order. Shortly after her lumpectomy, she found her way to Hinsdale, Illinois’ non-profit cancer support center, Wellness House, and the Director of their Exercise Therapy program, Howard Stidwill, Ph.D. “Howard said, ‘Give me 12 weeks and you’ll feel better.’ Six or seven weeks later, I was cross-country skiing with friends, and I was able to keep going after most of them stopped. Something just clicked. Suddenly, I was aware of what my body could do, and it gave me a new sense of confidence.” It also kept her coming back for more: She’s missed only one of Stidwill’s bi-weekly classes since signing up at Wellness House nearly a year ago.

Confidence is just one byproduct of regular exercise, however. Whether you walk, bike, jog, swim, take yoga or other classes, the positive results in your waistline and your outlook are just the beginning. Many of the benefits of regular activity are already well-established: weight control and improved metabolism; more energy; increased strength and flexibility; protection from heart disease and osteoporosis; a stronger immune system; better quality of sleep; lower levels of stress and anxiety; improved emotional well-being; and an overall better quality of life.

Over the last decade, numerous studies have pointed to the role of regular exercise in preventing breast cancer. Recently, it has even been suggested that exercise might possibly play a part in lowering the risk of recurrence and/or metastasis. With this in mind, doctors and researchers are finally starting to acknowledge the benefits of maintaining some level of activity following diagnosis and/or treatment, as well.

Dr. Alexandra Heerdt, of Memorial Sloan-Kettering Cancer Center in New York, is a breast surgeon who specializes in treating women at increased risk for breast cancer, and exercise is a big focus of her discussions with patients. Following surgery, she usually recommends patients begin getting back to their normal activity levels within one to three weeks, particularly for those who have been regular exercisers. “In fact, when we do lymph node surgery, we have people doing special exercises for that two days later because we don’t want them to baby that side and get frozen shoulders. It’s better to start moving sooner rather than later.” She’s equally encouraging of her less active patients but feels it’s important not to rush them. “I find that with most women who’ve been sedentary or who haven’t eaten well over their lifetime, questions about exercise and diet changes almost invariably come up within the first year after surgery, in one of their follow-up visits. And anytime someone says ‘I’m thinking of doing it&Mac226;’ I strongly encourage them.”

For women who are regular exercisers pre-diagnosis, much of this isn’t news. What is new is the idea they should get back to it as soon as they feel ready. For women like Snively, who’ve been relatively inactive, it provides an even stronger incentive to get started.

Stidwill, a former physical education professor at Northern Illinois University, is also the author of I-Can-Act, an exercise guide written specifically for recovering breast cancer patients. He says that because basic functions like lung capacity and balance aren’t affected as they might be with other cancers, exercise is a natural fit here. “Basically, these women need to get back to full function as quickly as possible—physically and psychologically.” While not everybody goes to the gym three or four days a week, he says, “many women are active at work and at home, gardening, cleaning, lifting groceries, etc. And whether it’s lifting a 10 lb. bag of groceries out of the trunk of your car or lifting a 10 lb. dumbbell at the gym, it’s pretty irrelevant. After a trauma like this, you’ve got to get back to the activities of your daily life.”

Getting started, it’s crucial that those who are relatively new to exercising consult with doctors and exercise professionals to avoid frustration, intimidation, strain or injury. Even previously active women may find the expertise and emotional support of a certified personal trainer or class instructor to be particularly helpful in setting (or re-setting) realistic short-term goals, monitoring progress, and correcting form—all of which can make the experience of exercise more comfortable and rewarding.

One of the biggest challenges many recovering breast cancer patients face is staying motivated, particularly when they’re exhausted and their body has been worn down by chemotherapy, radiation, or even drug therapies like Tamoxifen. But, paradoxically, exercising regularly can improve stamina and help overcome some of that fatigue. “A lot of women may dislike the moment of working out, but a trainer can help them understand it really isn’t about that moment,” says Christof Prus, an Elite Plus trainer at New York’s Equinox Fitness Club. “They’re exercising to achieve basic short-term goals like increasing energy, moving around comfortably, going up and down stairs, or even swimming five laps again. I’m not saying that quality of life is based on the number of laps you can swim, but being fit does affect how you feel each day. And it’s important to help this woman see that exercise does make a difference and can help.”

Logically, most women recovering from breast cancer surgery and/or treatment need to regain the full range of motion in their chest and arm areas, but it is essential that their exercise program focuses on the entire body. “The recovering body may be weaker, but all of this woman’s other functions are normal. She isn’t all that different from any other person,” says Prus, who has a B.S. in physical education, and is certified by the American Academy of Fitness Professionals as a Medical Exercise Specialist. “I would apply a little different strategy in training her, mostly as it applies to the area(s) affected by surgery and her level of fatigue, but everything else is the same; she needs her leg strength just the same as anyone else. If this woman was active before, she should be active now. She’s capable of doing anything as long as it’s done sensibly and in moderation.”

Post-surgery moderation is key, particularly for the woman who has never really exercised before. “It’s a trainer’s job to be concerned about the health and progress of their clients, but women also need to listen to their own bodies and to their doctors,” says Prus, who routinely consults with the doctors of his clients and researches their conditions on his own, as well. He recommends that the personal trainers best-suited to work with recovering breast cancer patients are those who have prior experience dealing with life-threatening diseases, are certified by the American College of Sports Medicine (ACSM), and, there should be a good fit, personality-wise.

Not everyone finds it necessary to work in a traditional gym/trainer setting, however. For Alina Sheffi, 43, a convenience store manager in Brooklyn, New York, it was simply a matter of being determined to get moving again. A long-time exerciser, Sheffi was diagnosed with breast cancer for the second time in early 1999, but following reconstructive surgery and chemotherapy, she was exhausted. “The week after I finished chemo, I was anxious to try my cross-country ski machine. I was on it for five minutes and was out of breath; I couldn’t do it.” So she took the time she needed, resting awhile longer. “It was really a month before I was able to get out and walk—fast walking—two miles again. And I started to feel good after the second week. Beyond looking better and losing weight, it really helps my mind. Every time I exercise it’s a natural high; it’s relaxing, like meditation. It’s a time when I really feel like I’m doing something for myself, and I feel good because I’m accomplishing something.”

For Sheffi, a single mother, it’s about more than simply feeling better, however. Her recurrence, nine years after her original diagnosis at 34, mirrored the ten years between her mother’s two bouts with the disease. Her mother also suffered from heart disease, but with the help of regular exercise and a low fat diet, Sheffi managed to avoid it. “I’ve already had one big illness and that’s enough. As it is, this will keep me busy for the rest of my life.”

Dr. Heerdt, for one, believes that making conscious lifestyle choices might give recovering patients an edge. “You can’t do anything about when you got your period, and you can’t do anything if you haven’t had a child by the age of 30. But more and more studies are coming out that say adjusting your lifestyle can make a difference, so I talk about diet and exercise a lot. Although nothing has ever been proven, a low-fat, high fiber diet is still the healthiest way to go. I always talk with my patients about being aware of what they eat, portion size, cutting alcohol and cigarettes, etc.,” she says. She also points to studies that suggest a lower fat intake and increased exercise, which lead to lower percentage of body fat or body weight, could mean less chance of recurrence or metastasis. “We talk about stress and cancer, too. Again, there aren’t any scientific studies that clearly say stress affects your rate of recurrence, but it makes sense,” she says, “so it certainly seems logical to be as stress-free as possible. One of the main reasons many people start exercising is the stress relief.”

Another important reason for the recovering breast cancer patient to consider exercising is Lymphedema, a swelling condition that is particularly common with radiation patients and occurs when lymph fluid is trapped in the arm by the scarring of the lymphatic system. “The prevailing misinformation about Lymphedema is ‘don’t lift any weights&Mac226;’ but that’s the last thing you’d want to do,” says Stidwill. “You just have to avoid heavy weights that can cause damage. The lymphatic system moves fluid around by muscular contraction, in a kind of milking action. So you need to be contracting those muscles to keep the fluid moving and prevent swelling.”

Michele Kelleher, M.S.P.T., a Delmar, New York-based physical therapist who specializes in treating the condition, agrees. “Exercise can definitely help suppress Lymphedema. In some people, exercise may bring it down completely.”

The most important thing, she stresses, is not overdoing it, monitoring yourself for any signs of new or abnormal swelling and not hesitating to seek immediate help in dealing with it. Still, she wholeheartedly endorses the idea of regular exercise during recovery. “If these women can maintain or even build their fitness, that gives them one more thing to hold onto.”

Sheffi, it seems, would agree. She insists it all boils down to faith and a little sweat. “Now all these things have come together for me: believing, exercising, and thinking positively. The more I exercise the more I see results, the more I see it coming back to me—everything is positive.” Her outlook is echoed by Snively. “For me, one of the biggest benefits of exercise is psychological. As a cancer survivor, I need to feel in control, because for so much of this process we’re not,” she says, admitting that her newfound strength and confidence are, in large part, a result of her commitment to regular exercise and to the camaraderie of her classmates. “We have a lot of fun, which is why we keep coming back—there’s a real spirit of support there. That class is my insurance policy.”

WHERE TO START

For many women, the process starts with basic therapy programs like Reach to Recovery, while they’re still in the hospital. From there, however, the quickest and healthiest way to begin feeling stronger and more like yourself is through regular exercise. This can mean anything from a daily 10- or 15-minute walk, to using exercise tapes, to taking classes at a gym or even working with a personal trainer. But what’s most important, all experts agree, is finding an activity that suits your interests, abilities and energy level, and is something you’ll want to keep doing. The dirty little secret about exercise is that in order to see results, it has to become a habit.

Laurie Sprague is the former managing editor of GLAMOUR Magazine. She has also worked at InSTYLE and BRIDE’S Magazines. A regular exerciser with a family history of breast cancer, she was inspired to learn more about exercise and cancer after seeing a cancer survivor at the gym several days each week while he was undergoing chemotherapy. Now, several months later, he’s still at the gym and looking stronger and healthier all the time.