Chemotherapy and Exercise

I got a very detailed comment on my blog about a fitness professional that went through breast cancer.

I did not want the comment to get lost in the blog so I posted it as an article because I know this will help so many people.

She shares her story and what she went through.

Thank you, Linda.

I am a certified yoga teacher and a breast cancer survivor.

My Story

In November, 2010, I underwent modified bi-lateral mastectomies and had 30 lymph nodes removed from beneath my right arm.

All women with invasive breast cancer have lymph node surgery done as part of their breast cancer treatment. Most of the axillary lymph nodes are clustered in the armpit and their primary function is to drain waste fluid and micro-molecules from the system. The lymph nodes are about the size of a pin head and are hard to see and thus a section of tissue is removed from the armpit and the nodes are then harvested from the tissue and tested to see if any cancer cells are present.

As a result of this surgery, some women develop arm motion restriction and axillary web syndrome after a sentinel node biopsy and axillary clearance. Prior to any surgery, the woman is given a choice as to the type of reconstructive surgery she prefers.

Those types of breast cancer reconstruction are:

Prosthetic (implant) reconstruction

Autologous reconstruction including: Latissimus dorsi flap (black flap; TRAM flap (abdominal flap); Free tissue transfer (free TRAM) and Perforator flaps (DIEP flap).

I chose a prosthetic (implant) as my reconstruction option, so during my mastectomy surgery, expanders with a dermal graft were placed between the edge of the pectoralis major and the chest wall. The purpose of the expanders is to stretch the pectoralis major and remaining skin creating a pocket so that implants may be inserted during a second (reconstructive) surgery.

Usually two weeks after the mastectomy, the plastic surgeon will begin filling the expanders on a biweekly basis to start the stretching process. At first this is not too painful, but after several fillings the pectoralis can become painful. As you can imagine, immediately after surgery, there is a lot of trauma and pain in the chest and armpits. Movement is limited but within a couple weeks you begin feeling better.

As soon as I started feeling better, I began slowly moving and stretching my arms.

Breathing exercises before and after surgery and during recovery are very important.

Lifting the arms overhead was painful at first but you learn to breathe through and witness the process.

Exercise and Chemotherapy

Just when you start to feel better (usually a month after surgery) you then begin chemotherapy. Chemotherapy sessions generally last from 3 to 6 months. After chemotherapy, then radiation.

Doctors recommend that patients should NOT exercise on the day that they receive chemotherapy.

Radiation therapy has it own array of implications with regard to exercising and range of motion. In many cases radiation thickens and scars the surrounding skin and tissue. As a result, range of motion is affected.

Today, most doctors want you to start exercising as soon as possible after surgery. While under chemotherapy and radiation, it is important that the patient and the exercise instructor know the blood count.

If its low, there is a risk of infection and while the patient should maintain some level of activity, strenuous exercise is not advisable.

There is another issue that affects about 49% of all breast cancer survivors and that is lymphedema. Due to the structural or functional impairment of the lymph system during surgery, the lymphatic flow is disturbed resulting in lymph accumulating and swelling the affected arm. Bacteria thrives on this protein-rich fluid, so lymphedema affected tissues are prone to infections. There is a lot of conflicting information on types of exercises for patients suffering from lymphedema.

I have been diagnosed with Stage I lymphedema and I wear a compression sleeve and glove during waking hours. It is important to note that if you have a breast cancer survivor as a client and you notice that one of the arms is swollen, you should immediately refer them to their doctor for treatment.

A person with lymphedema should not exercise without their compression garments.

I certainly appreciate this discussion and hope that my input is helpful. I have been teaching yoga to cancer patients at local hospitals and medical facilities and find it so rewarding. Hospitals and many cancer centers around the country are conducting classes and programs for certified yoga instructors and physical therapist to work with cancer patients. If not, I bet you could talk your local hospital in putting together one for your area. Sorry for the long length of this message but it’s my passion! Peace!

– Linda

Thank you so much Linda, there was some great information in there.

Thank you for sharing and great idea on starting up a yoga program at the hospital.

Rick Kaselj, MS

P.S. – If you are looking for an exercise program to do after cancer, you can check out: