Taking Control
- The Breast Cancer
More than two million women living in the United States today
have been treated for breast cancer, according to the American
Cancer Society. Fortunately, we live at a time in medical history
when increasingly sophisticated, lifesaving treatments are changing
the course of this disease for hundreds of thousands of
women. Just a handful of years ago, some of the most remarkable
advances in surgery, radiation, and anticancer drugs were not yet
widely available. Now, for most women, a breast cancer diagnosis
may prove in hindsight to be a rough bump in the road, while the
length of that road ultimately remains unchanged. For those living
with metastatic breast cancer, an expanding list of treatments
may be life-extending, also.
Yet whether breast cancer treatments have been tested over
decades or emerge as new stars, they may take a heavy toll on a
woman’s body. “In barely a year, I’ve aged a decade,” one breast
cancer survivor succinctly reported, ticking off unwanted side
effects of treatments that pile on pounds and weaken muscles and
bones. Surgery to reconstruct the breast, which many women f ind
life-enhancing, often presents additional challenges.
Now a growing body of research strongly suggests engaging
in exercise reduces your risk for a recurrence and boosts the
likelihood of living a longer, healthier life. What’s more, a wellconceived,
comprehensive exercise program can help you minimize or avoid many other concerns that arise after breast cancer
treatments and reconstructive surgery.
No matter how uncomfortable or weak you might feel today,
the simple, safe, and powerful program described in this book can
help restore ease of movement and the strength and energy for
daily tasks and pleasurable activities. Our goal is to enable you to
rise to the joys and challenges each day brings. In essence, we
hope to help you turn back the hands of a clock that spun forward
far too quickly.
Laying the Foundation
Much of our program revolves around a series of progressive
workouts. Yet safely and slowly stepping up your activities is only
one part of your overall goal. Three other cornerstones of the
program are a healthy diet, rest, and stress relief. What does this
quartet have in common? Unlike so many aspects of breast cancer
treatment, all four lie largely within your control. Together,
they can signif icantly improve your health and the quality of your
daily life. What’s more, they can help you regain a sense of control
over your own life that a cancer diagnosis so often
undermines.
In the following sections, key facts and strategies are outlined.
More in-depth information on paring off pounds, rebuilding
muscle, and shoring up bones appears in Chapter 2.
Why Exercise?
In a nutshell, exercising regularly can help you:
• Optimize longevity. Being active cuts down the likelihood
of breast cancer recurrence and boosts the odds of living
longer. The long-term Nurses’ Health Study surveys more
than 120,000 female registered nurses about lifestyle factors
and chronic diseases every two years. In 2005, researchers
reporting on data drawn from nearly 3,000 study participants
diagnosed with breast cancer found that those who engaged
in even modest physical activity (such as walking for three to f ive hours over the course of a week) lessened the likelihood
of recurrence and improved survival when compared with
those who were sedentary or less active.
Gain energy. One common concern stemming from breast
cancer treatments is fatigue. Often, women report that their
energy fluctuates day to day during treatment. Afterward,
some women f ind energy returns fairly quickly, while others
remain at low ebb for many months or longer. Slowly
rebuilding endurance through easy cardiovascular exercise
can help. According to the National Cancer Institute, some
small, preliminary studies suggest that light to moderate
walking or other activities may boost energy.
Improve mobility. Discomforts that stem from mastectomy,
lumpectomy, or lymph node surgery, radiation, and reconstructive
surgery sometimes may be quite long-lasting, as
Clara Walton can attest. Ever since her mastectomy and
reconstructive surgery, her limited range of motion—that is,
how far and in what directions someone can comfortably
extend her arms, let’s say, or turn her body easily—has bothered
her. Nine years into survivorship, she says, she still
hasn’t recovered entirely. On a scale of 1 to 10, with 10
being the movement she had before her treatment began, she
rated her ability to move easily and comfortably the f irst year
after her surgeries at 3 or 4. Now, she says, it’s closer to a 6
or 7. “Range of motion is still a problem,” she notes.
What causes this? Tightness created by scar tissue after
surgery, radiation, moving muscle and tissue during reconstructive
surgery, or simply disuse can limit your range of
motion. Tightness also can lead to poor posture, which may
contribute to other problems like an aching back. Over time,
careful stretching expands a limited range of motion and
helps release tightness.
• Rebuild muscle and regain strength. Sarcopenia is a simultaneous
loss of muscle and gain in fat tissue. Aging, inactivity,
chemotherapy, menopause, and possibly other hormonal
changes brought on by breast cancer treatments all may cause
muscle to dwindle while fat tissue builds up. Typically, excess
weight accumulates as well. Exercise helps pare off unwanted
pounds and rebuild muscle. Tipping the fat-muscle ratio of
your body more favorably in the direction of muscle helps
reverse losses in muscle and gains in fat that frequently occur
during chemotherapy. Fat cells release estrogen, which fuels
some breast cancers, and excess weight is associated with
higher mortality in women who have had breast cancer.
Moving muscles during reconstructive surgery—a latissimus
dorsi flap, for example, uses a large back muscle to
re-create the breast—affects strength. Your body is quite
practical, however, and often can use other muscles to help
compensate for those no longer in their original place.
Strengthening the appropriate compensating muscles helps
ensure that you will be able to perform simple tasks like closing
the hatchback or trunk of a car or lifting heavy groceries
and comfortably engage in enjoyable activities such as crosscountry
skiing or tennis. Strength training also addresses
muscle imbalances, which affect posture in ways that can
spell future pain.
Keep bones healthy. Research suggests that chemotherapy
may speed bone loss in premenopausal women. In a Harvard
study detailed in Chapter 2, researchers have found that
within one year after beginning chemotherapy, particularly if
chemotherapy induces premature menopause, a woman can
lose 7 percent of the bone mass from her spine and 4 percent
from her hips. For a woman going through natural menopause,
this amount of bone loss usually takes f ive years to
occur. Weight-bearing exercise, such as walking and strength
training, coupled with calcium and vitamin D supplements as
well as boneQuell treatment-related nausea. Some research shows that
exercise may lessen nausea during chemotherapy, which will
certainly improve your quality of life.
• Enhance appearance. Often, changes stemming from treatment
undermine appearance and self-esteem. A 40-year-old
woman undergoing chemotherapy commonly experiences a
Special Situations: When Exercise Is Especially Difficult
If you have compounding health conditions or
disabilities, some of the exercises described in
this book may be difficult or impossible for
you to do. Sometimes even medications that
improve your health may interfere with exercise
to a lesser or greater degree. Kaelyn
McGregor, a lively 42-year-old who has always
been active, found that true this past year
when she began taking a drug designed to
combat metastases. “I’ve been dealing with a number of new physical challenges. I can
assure you that trying to stay fit while also
using a cane on certain days is quite the
predicament,” she says wryly. An experienced
physical therapist or personal trainer may be
able to suggest modifications of our exercises
or an entirely different exercise plan tailored to
your needs. Information on locating these
professionals appears later in this chapter.
2.5 percent increase in body fat in one year. That’s the
equivalent of what typically occurs over 10 years to a 40-
year-old without breast cancer. Exercise—which tones muscles
and trims fat—helps turn back that clock.
Net additional health benefits. Performed regularly, exercise
tunes up the heart and lungs, eases insomnia and mild
depression, boosts self-esteem, reduces high blood pressure
and high cholesterol, and helps ward off many health conditions
that shorten lives, including diabetes, colon cancer,
heart disease, and stroke. On the other hand, being inactive
is a risk factor for nearly all of these health concerns. When
you realize that the majority of women who have had breast
cancer will outlive their diagnosis and die one day of another
cause entirely, it’s easy to see how important staying active is
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