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Exercise in all forms is beneficial to breast cancer survivors, helping to improve quality of life as well as increasing survival rates.
"Exercise promotes better blood flow through the body and the brain," says Cheryl Rock, professor of family and preventive medicine at UC San Diego. "It can be empowering, and they're reminded they can do things to make themselves feel better." Exercise also can improve mood, she adds, which can help battle the depression, stress and anxiety that often accompany diagnosis and treatment.
Rock lists some precautions: Going through chemotherapy and radiation treatments can result in anemia and tremendous fatigue, so exercise may have to take a back seat until energy returns. Also, chemotherapy may compromise the body's immune system, so women should avoid going to public gyms and pools until their white blood count returns to normal.
Aerobic exercise and strength training help improve blood flow and muscle strength, and yoga and Pilates can increase core strength and flexibility. Most women will probably want to start slowly, though: "After going through treatment they become quite sedentary," says Dr. Anne McTiernan, director of the Prevention Center at the Fred Hutchinson Cancer Research Center in Seattle. "So most are starting at a lower baseline than the general population."
Beginning with easy walking and progressing to a moderate to brisk level three times a week for 30 to 45 minutes is a good place to start, she says. As women feel better they can add more days and exercise at a higher intensity. Strength training can be incorporated two to three times a week.
Several studies suggest that exercise can improve quality of life for breast cancer survivors; in one pilot study, 60 women were randomly assigned to either a six-month lifestyle intervention incorporating short bouts of daily moderate activity or a group that received standard care. At the end, the intervention group reported more positive effects on pain and general health than the control group and were more ready and motivated to exercise. The study was published in 2006 in the journal Patient Education and Counseling.
Another study found a possible link between exercise and survival after diagnosis. Researchers tracked 1,264 women ages 20 to 54 who were asked to recall their average frequency of moderate to vigorous activity: at ages 13 and 20 and a year before their diagnosis. The women were followed for eight to 10 years. The study, which was published in the journal Cancer in 2006, found that those who were overweight or obese at the time of their diagnosis and were also very active the year before, had a 30% higher survival rate than those who were sedentary. (The quarter of the group with the most activity in the year before diagnosis showed a moderate reduction in risk. And those who were an ideal weight or underweight showed no reduced risk.) The effect of exercise on survival could be linked to the body's suppression of hormone production, McTiernan says. "Some hormones, such as estrogen, testosterone and insulin may promote breast tumors." Exercise might help reduce those levels. She adds that exercise also may decrease inflammation and boost the body's immune function. Physical activity can also help with weight control, an important issue in prevention, because obesity appears to be a risk factor for breast cancer.
Those who aren't sure how to create an exercise program for themselves might want to check into community- or hospital-based programs specifically for cancer survivors. Hiring a personal trainer is another option, but not all trainers are created equal. When interviewing candidates, make sure he or she has reputable, current certification, and ask about previous experience dealing with cancer survivors.
Finding a qualified trainer may soon become easier. The American College of Sports Medicine received a grant from the American Cancer Society to develop a specialty certification for health and fitness instructors working with cancer survivors. The certification is being beta-tested now and should be available this summer.
Some athletic clubs have developed their own specialty programs. Julie Main developed the Well-fit Program at the Santa Barbara Athletic Club in 1994 because of her own experience with breast cancer. She's convinced that she dealt with the rigors of chemotherapy, a mastectomy and reconstructive surgery better than the average person because of her devotion to exercise.
The 10-week program, which is geared toward cancer patients, emphasizes strength training, because muscle mass is often lost during treatment. "Many people have loss of leg strength," says Main, owner of the athletic club, "and those are the largest muscles in the body. If you don't have leg strength, it's hard to do cardio."
She says that those who have gone through the program report less fatigue and more ability to do daily tasks such as grocery shop.
"Cancer patients' treatment is dictated by other people," Main says. "The program gives them empowerment over their own bodies."
-- Jeannine Stein