A Plan for Every Woman
10: A Plan for Every Woman
Excerpted from The Breast Cancer Survivor’s
By Carolyn M. Kaelin, M.D., M.P.H., Francesca
Coltrera, Josie Gardiner, and Joy Prouty
Reprinted by permission of the McGraw-Hill Companies; © Copyright
2007 by President and Fellows of Harvard College.
All Rights Reserved.
more information or to purchase this book,
follow this link.
The Right Mix
The right mix of exercises and the right timing
for getting started are outlined in this chapter.
Scales that will help you work out at a safe
level of intensity are described here, too. You
also will find sample exercise logs to copy and
fill in as you launch your workouts. Although
general principles remain the same for every
woman, the exercises and timing chosen for the
workout plans vary depending on the extent of
your surgery and the speed of your recovery.
Discuss this with your doctor.
Over the course of a week, a comprehensive exercise
plan combines cardiovascular training with
balance, stretching, and strength exercises.
If the thought of all this exhausts you, take
heart: you’ll start to build toward this
slowly and add on as you feel ready to progress.
Slow progress is best because it allows your
heart, lungs, muscles, skin, and other tissues
to gradually adapt to challenges presented by
the exercises. Even women starting this program
many years after their treatment will find a
gradual approach valuable, particularly if they
have not been active.
Often, women feel exhausted at various times
during treatment and recovery, especially in
the weeks after surgery or during the course
of chemotherapy or radiation therapy. If your
energy fluctuates, try to take a walk or do other
activities at times of day when you feel least
tired. A little exercise is always better than
none. Think of activity as a bank—add small
amounts several times a day by taking a short
walk or doing a group of balance exercises or
stretches so that the final tally rises gradually.
On days or at times when you feel better, try
to do more; on difficult days, accept that you
need to do less or sometimes even take the day
off. Ultimately, the workouts we’ve selected
will help energize you while easing aches and
After surgery, the very first thing you can
do for yourself is get out of bed and walk. Usually,
it’s fine to do so by the second day. Make
sure that someone walks alongside you to assist
you as necessary. The first steps you take may
simply be the short path from bed to bathroom.
Next, try to walk to the nurses’ station,
and then to the end of the hall. Rather than
concentrating on speed, focus on traveling a
little bit farther each time. It takes time,
but by walking as often as you can, you will
gradually attain goals that seem completely out
of reach right now—whether that is a short
walk without pain or a much longer walk at a
pace you enjoy.
If you follow health news, you know that goalposts
for cardiovascular exercise sometimes shift confusingly.
Our guidelines—and thus, your goals—stem
from careful analysis of numerous sources, including
recent breast cancer research, the 2005 Dietary
Guidelines for Americans, and recommendations
made for cancer patients by the American College
of Sports Medicine. Our simple walking program
delivers significant benefits that vary depending
on the time expended:
Breast cancer benefits. Walking
at an average pace for three to five hours a
week (about 30 minutes a day) cuts the risk for
breast cancer recurrence by 40 percent, according
to data from the Nurses’ Health Study published
Additional health benefits. Walking
for 30 minutes most days of the week offers health
benefits, such as lowering your risk for heart
disease, diabetes, osteoporosis, and many other
ailments, according to the 2005 Dietary Guidelines
Healthy weight benefits. Weight
matters to good health, too, and may play a role
in survival after breast cancer treatment, as
explained in Chapter 2. Combined with a healthy
diet, walking 30 to 60 minutes on most days of
the week can help keep you from gaining weight.
Raising the bar to 60 to 90 minutes most days
of the week may be necessary if you’re
struggling to lose weight or have lost a great
deal and wish to keep those pounds from creeping
back. Our bodies and our eating habits differ,
so you’ll need to see what works best for
you. See Chapters 1 and 2 for more information
if you are trying to lose weight.
Setting Goals. Here are tips
to help you set your goals for walking.
- Frequency. Start out walking
at least three times a week. Work up to most
days or daily if possible.
- Intensity. Start at 1 on
the effort scale (see sidebar, “Measuring
Intensity: Scales and Songs”). Move to
2 or 3 on the effort scale as you feel able
to do so. Initially, adding days and time or
steps is more important than boosting intensity.
- Progressing. First add days
until you are walking as many days of the week
as possible. Next, set new goals by adding
time or steps to your baseline assessment in
Chapter 9. Some days you won’t be able
to reach your goal—you may even slip
backward. Remember that any activity is better
than none. On other days you will exceed your
goal. Keep trying!
- Counting time? To progress,
add at least 10 percent to your baseline to
set a new goal. Thus, if your baseline is 10
minutes, add 1 minute so that your new goal
is 11 minutes. Depending on how fast you feel
able to move ahead, you could add 10 percent
to your current goal daily, twice a week, or
once a week. Each time you do this, you set
a new goal for yourself. Ultimately, aim for
30 to 60 minutes of walking during the day,
which can be divided into 10- or 15-minute
- Tracking steps with a pedometer? Clip
it onto your hip as soon as you get up in the
morning. Each day, try to add 10 percent more
steps than the previous day’s walk. Thus,
if your baseline is 500 steps, you’ll
add 50 steps (10 percent) to 500 steps for
a total of 550 steps. The following day, try
adding 55 steps plus 550 steps for a total
of 605 steps and so on. As your walking program
progresses, make your intermediate goals 3,000
steps, 6,000 steps, and 8,000 steps. Ultimately,
aim for 10,000 steps a day.
- Having trouble? Are these
goals too daunting? They may seem unattainable
if you recently have had surgery, are undergoing
chemotherapy or radiation, or simply haven’t
been physically active before. If so, make
walking 5 minutes every hour your first goal.
At the end of eight hours, you’ll have
walked 40 minutes. Gradually build up to longer
walks. If a goal you set proves too hard, listen
to your body and just do what you can on as
many days of the week as possible.
Benefits of Walking
Simply put, regular walks are better for
your all-around health than many medications.
What’s more, walking is far less
costly and has no significant side effects.
Engaging in a walking program on most days
of the week delivers a multitude of benefits,
- Cuts breast cancer recurrence and may
improve survival among women who have
been treated for breast cancer.
- Burns off calories, which helps in
weight loss and maintaining a healthy
weight, and pares down fat cells. Fat
cells produce estrogen, so having fewer
fat cells may be advantageous for women
whose breast cancers are fueled by estrogen.
- Lowers risks for heart disease, high
blood pressure, diabetes, and several
types of cancer.
- May make it possible to take less medication
for certain health problems, such as
high blood pressure, high cholesterol,
diabetes, and even pain.
- Helps maintain bone strength in the
lower body because walking is a weight-bearing
activity (unlike some other cardiovascular
activities, such as swimming and cycling).
- Boosts mood and eases anxiety and mild
- Improves sleep.
Starting Off. A few tips before you start:
- Get ready. Go to the bathroom.
For cool weather, dress for outdoor walks in
layers of clothes to peel off as needed. Put
on sunscreen and a broad-brimmed hat. Fill
up your water bottle and plan to sip from it
often to stay hydrated.
- Stay safe. Walk with a partner
if possible, especially at first. Have a destination
in mind, but listen to your body so that you
rest or stop when you need to do so. Carry
a cell phone, identification, and phone numbers.
If you’re walking on a road, traffic
should be coming toward you.
- Warm up. Walk slowly for
five minutes. The swing of your arms dictates
your pace. Once you’ve warmed up, move
more quickly, if possible (see sidebar, “Measuring
Intensity: Scales and Songs”).
- Practice good posture. Check
your posture and alignment occasionally as
- Keep your chin parallel to the ground.
- Lift your chest and roll your shoulders back
and down away from your ears, then relax them.
- Pull in your abdominal muscles.
- Swing your arms forward and backward in a
relaxed fashion. (Do not swing your arms from
side to side as if rocking a baby.)
- Stride comfortably and naturally, planting
the heel, ball, and then toe of your foot.
- Breathe normally.
- Cool down. Walk slowly for
Intensity: Scales and Songs
How intensely should you exercise? Since
this is a beginner’s program, we
recommend a gentle pace at first. As you
get stronger and build more endurance,
you can start to step it up. You can measure
intensity in a few ways.
Effort and Fatigue Scales
These simple scales measure your perception
of how intensely you are working out. The
scales take into account personal variations
in fitness and ups and downs in energy
that are typical during treatment and recovery.
For example, you might consider it a breeze
to walk six blocks, feeling that this requires
an easy effort on your part that is mildly
fatiguing. Only if you walked much
faster or up hills would your effort and
fatigue scales creep higher. A woman less
fit—or tuckered out by treatment—may
find six blocks at a slow pace requires
a hard effort and leaves her feeling very
0 5 No effort
1 5 Easy effort
2 5 Moderate effort
3 5 Hard effort
4 5 Working too hard
0 5 No fatigue
1 5 Mild fatigue
2 5 Moderate fatigue
3 5 Very fatigued
4 5 Exhausted
When you start walking or adding other
new activities, you should feel that you
are working around number 1 on the effort
scale. As you progress, it’s fine
to aim for number 2 or 3 on the effort
scale. If you’re heading toward number
4—working too hard—it is crucial
to listen to your body and take a rest.
Energy fluctuates during treatment and
recovery. If you feel you are at 3 or 4
on the fatigue scale (very fatigued or
exhausted), give yourself permission to
take a day off and rest.
Talking and Singing
As your heartbeat and breathing quicken,
talking becomes harder. If you can sing,
try to pick up your pace. If you’re
breathing comfortably and talking fairly
normally, you’re doing fine for a
beginner. As you progress past the beginner
stage, start to pick up the pace. Anytime
you’re too out of breath to manage
short sentences, slow down a bit.
Minute, Step by Step, Mile by Mile
How do minutes stack up to steps, and
where do miles fit in? When you’re
up to the challenge, these guidelines are
Minutes and Miles
Measure a mile of city blocks (roughly
20 blocks) or country lanes with the odometer
in a car. Then see how long it takes you
to walk that distance:
- 20 minutes = 3 miles per hour
- 17 minutes, 10 seconds = 3.5 miles
- 15 minutes = 4 miles per hour
- 13 minutes, 20 seconds = 4.5 miles
Steps and Miles
Step measurements are more approximate
because strides differ from person to person:
- 2,000 steps = 1 mile
- 4,000 steps = 2 miles
- 6,000 steps = 3 miles
- 8,000 steps = 4 miles
- 0,000 steps = 5 miles
If you’d like to be more exact,
use the odometer in a car to measure off
a mile, then count your steps with a pedometer
and make up your own mile chart.
Gentle stretching exercises go hand in hand
with the early weeks of your walking program.
All of our stretch and balance workouts are tailored
to the type of surgery you’ve undergone.
Why is stretching so essential? It counters
stiffness and changes in posture that follow
surgery and sometimes radiation. Otherwise, inactivity
can permit muscles and tendons to shorten and
tighten in less than ideal positions. After TRAM
surgery, for example, it’s natural to bend
forward at the waist and hip to avoid pain and
tension at the broad abdominal incision where
skin and muscle were taken from the belly and
moved up to the chest. Over time, this can shorten
the hip flexors that link legs to trunk, making
it hard to straighten the legs and causing lower
back pain. What’s more, such decreased
flexibility prompts lasting problems with posture
and balance and may interfere with daily tasks.
Along with benefits already mentioned,
- Helps you regain full range of motion
- Relaxes stiff muscles and tight skin
so that blood flows more easily, shuttling
nutrients into these tissues and flushing
- Gives you the ability to realign muscles
and joints to improve posture and balance.
- Makes muscles more elastic and less
prone to injury. If part of your treatment
plan includes radiation therapy, stretching
will enable you to more comfortably raise
your arm and hold it in position during
- Lubricates and protects joints by increasing
the amount of synovial fluid, a natural
lubricant that cushions joints. This
helps prevent joint injury and degeneration,
which can lead to arthritis.
- Enhances body awareness by helping
you focus on how each muscle or muscle
group moves and feels as you stretch.
- Improves coordination by reducing muscle
resistance and helping your body adapt
to moving in many directions.
- Enables you to more quickly counter
sudden shifts in balance and thus makes
falls less likely.
- Promotes relaxation and eases stress
by relieving nervous tension and calming
body and mind.
Stretching is the first step toward regaining
flexibility—that is, the ability to move
each joint through its range of motion with little
resistance from surrounding muscles and tissues.
Not only will our program make you more flexible—in
fact, probably more so than you were before surgery—it
improves posture and balance, enabling you to
undertake daily tasks and activities with minimal
effort and maximum effect.
Setting Goals. Here are tips to help you set
your goals for practicing stretching exercises.
- Frequency. Repeat each stretch
2–4 times, once or twice a day.
- Intensity. Only stretch
to the point of tightness.
- Time. Hold each stretch
5–20 seconds (or longer, if you like,
since after 20 seconds you may feel the muscle
- Progressing. The more often
you perform the stretches, the more quickly
your body will regain a comfortable range of
Our program is designed to enhance recovery
from surgery, so it differs slightly from guidelines
issued by the American College of Sports Medicine
(ACSM) in 2006. We recommend performing stretches
once or twice a day, while the ACSM recommends
doing stretches at least two to three times a
week (and ideally five to seven times). Because
your body is recovering from surgery, we recommend
holding stretches for 5–20 seconds, while
the ACSM recommends 15–30 seconds. Hold
each stretch at the point of tightness without
discomfort other than that which you might normally
feel after surgery.
Starting Off. A few tips before you start:
- Get the go-ahead. Find out
from your surgeon whether you need to limit
your range of motion or avoid certain stretches
at first. A doctor may recommend not raising
your arms above shoulder level for a number
of weeks after surgery, especially if you had
reconstructive surgery. Show your surgeon the
stretches in your workout so that she or he
can decide what is best for you.
- Warm up. Muscles are like
bubble gum—when warm, they stretch farther
and more easily and are less likely to tear
or be injured. Before performing a stretching
workout, warm your muscles for at least 5–10
minutes by walking, dancing to a few songs,
engaging in exercise, or taking a warm bath
- Proceed slowly. Start slowly
and build gradually, progressing at your own
pace. Over time, making the effort to stretch
correctly and consistently while focusing on
problem areas will loosen your muscles, improve
your flexibility, and make you feel better.
As a quick illustration of these benefits,
try this: Slowly turn your head to the point
of tightness. Hold the position for 5–20
seconds, breathing normally. Slowly turn back
to center. Repeat three times. Do you notice
a difference in how far you can comfortably
- Stay in control. Make smooth,
controlled movements, stretching just to the
point of tightness. When you feel comfortable,
see if you can take the stretch a little bit
farther. Don’t strain to hold any pose.
Think of bending a finger back toward your
wrist until you begin to feel a stretch. If
you push farther, you’ll start to feel
pain. Similarly, as you stretch other muscles
in your body, you want to feel the stretch
without feeling pain.
- Listen to your body. Muscle
fibers stretched too far spark pain. In response,
nerves tell your muscles to contract. This stretch
reflex helps prevents injury. Some discomfort
is realistic after surgery, but pushing a stretch
too far or bouncing does more harm than good.
Your muscles actually tighten to protect themselves
rather than relaxing. Overstretching temporarily
or permanently damages muscle fibers, prompting
increased soreness and the formation of scar
tissue that can further affect flexibility.
- Hold and relax. Usually,
we recommend holding stretches for 5–20
seconds. If you wish to hold a stretch a bit
longer, do so. After 20 seconds you may feel
the muscle relax further, so holding for up
to 30 seconds can pay more dividends.
- Breathe deeply. Breathe
smoothly in through your nose and out through
your mouth. Deep, fluid breathing relaxes you,
thereby improving the effectiveness of each
As we go about our lives, many of us give little
thought to balance—the ability to respond
to challenges to our equilibrium while standing
still (static balance) or moving (dynamic
balance). Your center of gravity hovers
over the center of your legs to maintain balance.
That sounds easy, but it is really quite complex.
Sensory systems—among them vision, hearing,
and special receptor cells in skin, muscle, joints,
tendons, and ligaments called proprioceptors—collect
information about your body as you move. Your
brain processes these signals and sends motor
commands to the appropriate parts of your body.
Staying balanced requires your body to constantly
adjust itself and quickly adapt to changes.
As we grow older, sensory receptors become less
sensitive, so that the brain receives less information
about the body’s position in space. Deteriorating
eyesight, depth perception, and muscle strength
coupled with slower reflexes further diminish equilibrium.
Whether balance is thrown off by surgery or
age, compensating by taking smaller steps or
standing with feet apart actually makes it harder
to negotiate obstacles safely. A fall, or merely
being anxious about falling, may encourage you
to withdraw from daily activities and thus prompts
a steady decline in your quality of life.
When done consistently, balance training:
- Counters some effects of skin tightness,
muscle imbalances, and body asymmetry
after breast surgery, which could otherwise
throw off balance in ways that make even
simple movements challenging or hazardous.
- Enhances stability, thus lessening
the likelihood of falls. Falls are especially
worrisome for older women, whose bones
tend to be more fragile, and for breast
cancer survivors, who are at higher than
normal risk for bone thinning and, possibly,
bone fractures due to chemotherapy
and anticancer medications that affect
- Eases the fear of falling, which can
be a potent barrier that gets in the
way of daily tasks and enjoyable activities.
- Wakes up reflexes and improves control,
coordination, gait, and posture while
enhancing body awareness.
Balance training, which strengthens legs and
improves flexibility in the feet, is often left
out of exercise programs. Yet everyone can benefit
from it, and women who have had breast cancer
surgery, which can easily affect posture and
balance, truly need it. Being off balance is
a serious problem. If the wheels of a finely
tuned car are badly balanced, unevenly worn tires,
a bumpy ride, extra fuel demands, and loss of
control that may lead to accidents typically
follow. It’s not all that different for
humans. Spending just 5 to 10 minutes each day
on balance training exercises can make a significant
Setting Goals. Here are tips to help you set
your goals for practicing balance training.
- Frequency. Repeat each balance
exercise three to five times, once or twice
- Intensity. Aim for 1 or
2 on the effort scale. These are gentle exercises.
- Progressing. The more often
you do balance training, the better the results,
so think about incorporating these easy exercises
into your day—while standing at the sink,
perhaps, talking on the phone, waiting at a
store, or watching TV.
Starting Off. A few tips about balance and balance
training before you start:
- Check medications. Some
medications, such as sedatives, muscle relaxants,
and blood pressure drugs, may cause weakness,
dizziness, lightheadedness, or loss of balance.
Certain chemotherapy drugs, such as paclitaxel
(Taxol), can affect sensation in your feet
and hands. Other medications taken during treatment
can cause fatigue, diminish alertness, and
impair judgment so that falls and other accidents
occur. Particularly if you take four or more
medications, some side effects, such as dizziness,
are more likely to occur. Talk to your doctor
about possible side effects from prescription
and over-the-counter medications. Your doctor
may be able to recommend substitute medications
or a lower dose if you are experiencing problems,
or can suggest other helpful precautions to
take while exercising.
- Stay hydrated. Dizziness
sometimes stems from dehydration, which may
be hastened by drinking too little, heat, exercise,
changes tied to aging, some medications like
diuretics, and certain chemotherapy drugs.
Make sure you take in enough fluids during
the day. By the time you actually feel thirsty
enough to crave a drink, you already may be
somewhat dehydrated. Checking your urine (it
should be straw-colored, not dark) usually
is more helpful.
- Check sight and glasses. Poor
vision may affect balance, so regular eye exams
are a good idea. Regular eye exams are especially
important for women taking tamoxifen (Nolvadex),
a drug that slightly raises the risk of cataracts,
which can blur vision. Be aware that bifocals
and reading glasses can impair depth perception.
Be careful if you wear them while exercising.
- Prevent falls. Throughout
the day and especially while exercising, wear
shoes that grip and provide proper support.
Wear outfits that won’t trip you by steering
clear of clothes that are too big or too long.
Clear away or avoid other household hazards,
such as loose rugs or carpets, clutter, insufficient
lighting, electrical cords, pets, spills, slippery
floor surfaces, and the like.
- Steady yourself. Make it
a habit to stabilize yourself before you move.
Often people lose balance when they get up,
change directions, or transfer their weight
too quickly. Rising swiftly after sitting or
lying down makes some people dizzy due to a
sudden drop in blood pressure (orthostatic
hypotension). If you’re lying down,
slowly sit up and wait a few moments before
standing; if you’re sitting, slowly get
- Gain support. When first
starting to do balance exercises, stand next
to a counter or a chair for support. Check
your posture in the mirror before and during
exercises. Square your shoulders and hips.
Notice any imbalances. Becoming aware of strengths
and weaknesses will help you to make improvements.
Strength training can benefit anyone, regardless
of age, but is especially helpful for breast
cancer survivors left with muscle imbalances
and weaknesses after surgery. The muscles of
your body can be likened to a rowing team. Pulling
on the oars all together speeds the boat ahead.
Uncoordinated actions by rowers slow the boat
or simply do nothing to help advance it. If one
rower is tired or drops off the team, the rest
of the rowers must pick up the slack to reap
the same results. Similarly, if you’ve
had reconstructive surgery in which a muscle
was relocated, you must recruit and strengthen
surrounding muscles to compensate for the loss.
If a muscle or muscle group has weakened due
to surgery or inactivity, you must rebuild its
strength gradually so that daily tasks and enjoyable
activities become possible again.
When done consistently, strength exercises
deliver many benefits, including these:
- Adds muscle, improving the muscle-to-fat
ratio, which helps reverse changes prompted
by chemotherapy, aging, or inactivity
- Burns off a handful of extra calories
every day if you add muscle through consistent,
progressive strength training. (A pound
of muscle burns twice as many calories
as a pound of fat.) This may not make
pounds melt away overnight, but every
little bit counts.
- Helps preserve or, in some cases, strengthen
bones throughout the body. That helps
slow accelerated loss of bone density
caused by chemotherapy, early menopause,
side effects of certain anticancer drugs,
or simply aging.
- Improves balance and posture, partly
by building core strength. Also counters
muscle imbalances tied to weakening of
certain muscles on the side of the body
affected by surgery or due to the relocation
of a muscle with reconstructive surgery.
These improvements make falls less likely.
- Adds to quality of life by making tasks
and activities easier and more enjoyable,
whether you’re lifting a child
or a bag of groceries or playing sports.
During treatment and even for some time
afterward, cancer can rob you of a sense
of control. Strength training can empower
you physically and mentally in ways that
return control to you.
One more among many reasons to begin strength
training is findings from a study published in
the journal Cancer in 2006. Eighty-six
women who had been treated for breast cancer
were randomly assigned to a group that performed
weight training twice a week or a control group
for six months. As upper body strength or muscle
mass improved in the strength training group,
so, too, did a variety of measures of psychosocial
well-being. Physical challenges that disrupted
daily activities eased, for example. Communication
grew better in personal relationships and with
medical team members.
- Walking, balance training, and stretching
all have a place in the early weeks after surgery.
Strength training does not. Before you begin
- Work on regaining upright posture and a comfortable
or full range of motion in your joints, especially
at the shoulder.
- Wait until surgical drains have been removed
and tissues have healed. You should have no
open wounds from surgery or radiation therapy.
- Ask your surgeon whether your surgery (and
reconstruction, if you had this) has healed
sufficiently for you to start our light-weight
- If you had a mastectomy, traditional lymph
node surgery, or reconstructive surgery, also
see the information in the “Save Your
Shoulder” sidebar in Chapter 9. It explains
how to tailor your exercise program to regain
shoulder mobility and protect and strengthen
shoulder rotator cuff muscles.
Pushing ahead too quickly before these conditions
are met may set you up for serious injuries.
It can hamper healing and affect the cosmetic
outcome of reconstructive surgery.
Setting Goals. Here are tips to help you set
your goals for strength training.
- Frequency. Start with one
set of strength exercises one or two times
a week. Ultimately, aim for three times a week.
Rest at least two days (48 hours) between sessions.
- Intensity. At first, aim
for 1 on the effort scale. As you progress,
work out at 2 or 3 on the scale. If lymphedema
is a concern, ask your doctor about this before
beginning our program.
- Choosing weight. Initially,
do the exercises without any weights so you
can focus on proper body alignment, a full
or comfortable range of motion, and slow, steady,
controlled movements. Next, choose a light
weight of one to three pounds that makes you
feel only mildly fatigued by the end of 10
repetitions. The amount of weight will vary
depending on the exercise. A repetition,
or rep, means going through the movement
one time. In our program, 10 reps equals one set.
You should be able to maintain good form, use
a full, comfortable range of motion, and stay
in control throughout all 10 reps. If not,
decrease the weight.
- Progressing. When 10 reps
become easy to do, you have some choices about
how to progress. Change only one at
- Increase weight by the smallest amount possible
(for example, go from one-pound to two-pound
- Or, increase sets (go from one set
to two sets, or from two sets to three sets)
by repeating the entire workout from start
- Or, increase days (go from one to
two days a week, or from two to three days
a week). Be sure to rest for two days between
American College of Sports Medicine (ACSM) guidelines
recommend two or three weekly strength training
sessions during which you perform one to three
sets of 8 to 10 exercises that overload—that
is, tire out—the major muscles of the body.
Because you are rebuilding strength after surgery,
the program we suggest is lighter. If you feel
especially tired, take a day off or cut back
on the amount of weight you lift or the number
of repetitions you perform.
Starting Off. A few tips before you start:
- Check precautions. If you
have had lymph nodes removed or radiation treatments
to the underarm or collarbone area, review
the lymphedema precautions for exercise in
- Choose a workout. Review
the “Save Your Shoulder” sidebar
in Chapter 9 to see if you would benefit from
a regimen designed to help you regain shoulder
mobility and protect and strengthen your rotator
cuff muscles. If so, start there first. If
not, choose either of the strength workouts
tailored to the type of surgery you had. A
choice of two workouts can help keep you motivated.
- Pick up weights correctly. To
prevent back problems, hinge from the hips
and slightly bend your knees when picking up
- Hold weights firmly. During
exercises, hold weights or resistance bands
firmly, but not too tightly.
- Check posture and positioning. Look
in a mirror every now and then (see “Posture
Check” in Chapter 9 and the following
positioning tips) so that good form will become
- Keep your wrists firm (straight as a pipe)
as you lift and lower weights.
- Keep knees and elbows soft rather than locking
- When you are performing a wall squat, your
knees should bend only 30 to 45 degrees. Don’t
allow your buttocks to go below knee height
to avoid putting too much pressure on your
- Breathe. Breathe normally
throughout each exercise, exhaling as you exert
yourself to lift, push, or pull against resistance.
If you tend to hold your breath, try counting
aloud to prevent this.
- Progress slowly. Muscles
strengthen more quickly than connective ligaments
and tendons, which need time to catch up to
minimize the chance of injury. Slow progression
is the key to success and injury prevention.
If you cannot manage all 10 reps, do what you
can and work on adding reps slowly.
Building Your Routine
The advice below comes from experts—women
being treated for breast cancer, breast cancer
survivors, and exercise professionals:
- Set small, achievable goals. Start
with short walks on as many days of the week
as you can manage and build up to longer walks.
Likewise, start with one strength training
session a week and add on when you can do so.
- Embrace wellness and commit to health. Just
try the program and see how you feel. Routine
helps, so try to exercise at the same time
of day. Walk in the morning, for example, if
this is when you have more energy. “I
can’t believe what a difference exercise
makes in your all-around attitude,” says
Laurie Durgan, a busy 47-year-old mother, who
credits Joy Prouty with teaching her a range
of exercises to prepare for surgery and recover
from it. “We are spiritual, emotional,
mental, and physical beings. When one is out
of whack, the rest get out of whack. Getting
my physical body going has helped me in my
mental and emotional states. It just makes
me feel happier.”
- Connect with friends. Four
mornings a week, Joan Lawhon, a board member
of Latinas for a Cure in San Antonio, Texas,
and a six-year survivor, walks three miles
around a local track with a very close friend
with whom she can discuss anything. “It’s
not just good for our bodies, it’s good
for our souls,” she says.
- Group up. Merry Murray Meade,
a preschool teacher with children of her own,
and Dara* had never met before they started
rowing on the Charles River in Boston. While
Dara had enjoyed small boats as a child, neither
had crewed on a team before joining forces
through WeCanRow, a program designed to enhance
wellness and rehabilitation for breast cancer
survivors, which Olympic rower Holly Metcalf
launched as part of Row as One Institute (see
Resources). Team members rarely skip sessions
unless they’re really sick, says Dara. “We
take it seriously because we love it and we
love being together. We have fun.” Adds
Meade, “Rowing has given me strength
and endurance. It pushed me to know I can take
on something new, which is kind of cool at
my age.” (*Not her actual name)
- Problem solve. Karen Jackson
is founder and CEO of Sisters Network,
Inc., a national organization dedicated to
promoting breast health education and supporting
African American survivors and community. At
62, Ms. Jackson is very active physically,
too—she rides a bike, walks, and swims. “All
of these activities can be enjoyed alone if
you are unable to find a partner,” she
notes. “If you wait for somebody to join
you, you may never, ever get around to exercising.
Make your exercise program a top priority.” If
you get derailed—whether because of exhaustion,
a move, or a time crunch—try again.
- Enjoy good days, accept bad days. Any
exercise is better than none, so it helps to
do whatever you can. Terri Gray, a vibrant
woman with metastatic breast cancer, slows
down at times when anticancer drugs prove especially
taxing. On days when her energy is in short
supply she gives herself permission to do little,
perhaps just joining her husband in taking
their three Boston terriers for a walk. “Sometimes,
my walk is barely a stroll,” she reports. “I’m
holding onto my husband’s elbow and saying, ‘Pretend
we’re 99—that’s what I feel
like today!’” Otherwise, she’s
a dynamo, walking full speed ahead and attending
Jazzercise classes several days a week.
- Celebrate every victory. As
Gloria Wade-Lessier recovered from the first
of three bouts with breast cancer, her legs
were so weak that a physical therapist had
her do all of her exercises in a swimming pool
at her Nevada home. “It took me a long
time to get stronger, but I did,” she
says. “I did exercises in the swimming
pool. Then I could walk a little farther, a
little longer.” Now she goes to the gym
three times a week.
- Expand your activities. Once
you’re feeling more like your old self,
branch out. Yoga, Pilates, and tai chi are
fine flexibility exercises; yoga and Pilates
strengthen muscles, as well. Dancing, swimming,
climbing stairs, running, and cycling offer
- Recapture joy. Sally Edwards,
a professional athlete and author of Heart
Zones Training, notes that the joy of
motion often gets lost as girls who reveled
in riding a bike, sinking a basketball, or
hitting a softball grow up. “People need
to do activities that they love,” she
says. Sometimes exercise is a vehicle to get
you to the point where you can do what you
love. Other times, it’s an enjoyable
end in itself. If you’re bored, try something
new! (See Resources.)
The Right Timing
Ideally, you would begin this comprehensive
program before you had surgery. That way, you’d
have a better sense of your usual range of motion
and strength before surgery, which would help
you work toward regaining these afterward. You’d
also be in better physical condition overall,
which could ease your journey through treatment
and speed your recovery.
Most likely, though, you are somewhere along
the path of treatment or recovery. If you had
surgery on one breast, try comparing the range
of motion and strength on that side of your body
to your other side. This will give you a sense
of the changes brought about by surgery that
your workouts will help you address. If you had
surgery on both breasts, your workouts will help
you aim for a full or comfortable range of motion
and improvements in strength on both sides of
Before starting our program, get advice and
permission from your doctor.
Mild muscle soreness within 12 to 48 hours
after strength training or another workout
may occur. Don’t worry that you’ve
harmed yourself. After a day or two of
rest from those activities, your muscles
will repair themselves, becoming a bit
stronger in the process, and the soreness
will subside. If your joints feel sore,
rather than your muscles, and this doesn’t
improve or go away within 72 hours, call
your doctor for advice. Also, be aware
that some anticancer medications may trigger
marked muscle or joint soreness. “If
I overdo it, I get chronic aches in the
muscle,” says Wendy Tompkins. She
found temporarily cutting back on
exercise and then moving ahead more slowly
A pulled muscle usually causes real pain,
not soreness. Check the sidebar “Remember RICE” in
Chapter 9 or call your doctor for advice.
When you are going through cancer treatments, the last thing you feel
like doing is exercising — but it can be the key to your well-being
and ultimate survival. In an encouraging, compassionate "I’ve
been there" tone, Dr. Carolyn Kaelin offers a wealth of practical
advice, proven techniques, and much-needed support. Read more »