Exercise Can Provide Your Road To Recovery

by Rhonda M. Smith on February 7th, 2012
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Welcome guest blogger Carol Michaels, founder and creator of Recovery Fitness®, an exercise program designed to help cancer patients recover from surgery and treatments.  In her blog Carol discusses the importance of exercise in the breast cancer recovery process.  Take it away Carol!

When some people hear the word exercise, they immediately think about gym class exercise or boot camp.  The exercises that I will discuss are gentle, fun and effective.  They are not high intensity. Exercise might be the last thing on your mind after a cancer diagnosis. A good fitness program will help you build up your strength, improve your mood and will help your recovery.

Just to give you some background on myself-I am a cancer exercise specialist.  Cancer has been a part of my life for 30 years.  This disease has affected my family and friends.  And because of that, I was motivated to develop an exercise program to help them.    I have worked with hundreds of cancer survivors helping them improve their quality of life through their participation in my Recovery Fitness cancer exercise program which helps cancer survivors feel better physically and mentally.

When can you start a fitness program?  You should start stretching exercises as soon as you get clearance from your doctor.   It is important to talk to your doctor before starting to exercise.  This way you can determine what program is right for you.  Some exercises can be started soon after surgery while others can be done right after the drains and stitches are removed.

Many areas of the body can be affected by breast cancer surgery and treatments.  A lot of people complain about stiffness, pulling, tightness, and having less flexibility.  The muscles and skin are shortened because of the surgery and there is scar tissue.  Some of the nerves may be irritated.  You may feel burning, tingling, or numbness. We want to restore the patient to a level of fitness that they enjoyed prior to the surgery.  Initially, one of the goals of this program is to restore a person’s range of motion and break down scar tissue.

At the start of your exercise program the cancer exercise specialist will take range of motion measurements of the shoulder. I take flexion, extension and abduction measurements. For example the participant may begin with only 30 degrees of shoulder flexion and after several months improve to 170 degrees of flexion range of motion.  In an ideal situation it is helpful to take these measurements prior to the surgery.  This gives you a basis of comparison.

Once you have achieved an acceptable range of motion, it is usually necessary to continue your stretching program in order to maintain the ROM that has been achieved.  If you have radiation, stretching is very important to help keep your body flexible.  Radiation typically causes additional tightening. Radiation can impact the affected area for up to 9 months or longer after the treatment is finished.

Another reason to exercise is because posture is affected by the surgery.  After surgery to the chest it is common to want to protect the area by rounding the shoulders forward. Winged scapula and rounded shoulder are common.  Kyphosis or a head forward posture can be caused or exacerbated by tight chest muscles.  This can cause a chain reaction leading to neck and back pain.

A mastectomy without reconstruction can cause imbalances. Some of the reconstruction processes change the muscle placement, which can affect the body.   It is important to stretch the pectorals, which can tighten and strengthen the back and core muscles.  This is done to improve posture and decrease the chance of back and neck pain. Good posture is important for overall health.  Poor posture can create imbalances in the rest of the body.  This can be detrimental to the back, knees and other areas.

Your balance can also suffer after surgical procedures.  We find this to be especially acute with the TRAM flap procedure where the rectus abdominus is altered.  Poor core strength has a negative effect on balance. You will have to learn how to compensate for this change of muscle placement through a series of exercises designed to strengthen the remaining muscle such as the obliques. Balance can deteriorate as we age even without a cancer diagnosis.  Some of the chemotherapies can affect your balance.  Neuropathy can cause balance issues. The good news is that balance training can counter some of the effects of muscle imbalances and body asymmetry after surgery.   Balance training will help decrease the likeliness of falling.  Falls are dangerous for older women with weaker bones and for cancer survivors.  Cancer survivors are at higher risk for osteoporosis due to chemo and cancer medications. Being nervous about falling may cause you to withdraw from daily activities and decrease quality of life.  We need to exercise to maintain or improve balance.

After you have achieved an acceptable ROM, posture, and balance, strength training is added.  Why do we need strength training? After surgery the patient can lose strength in the chest, shoulders, abdomen or back.   We need to rebuild strength in the areas affected and keep all the muscles in the body strong and correct muscle imbalances. Strength training improves balance and posture by improving core strength and it improves quality of life by making activities easier and more enjoyable and it reduces the chance of injury. It can empower you physically and mentally.

Another reason to strength train is that chemotherapy can cause weight gain.  It can change the fat to muscle ratio. Strength training improves the muscle to fat ratio. We need to gain muscle mass, which can decrease during treatments and strengthen bones.  Having more muscle will increase metabolism. A pound of muscle burns twice as many calories as a pound of fat. So strength training is a great way to keep your weight at a healthy level.

Many of the treatments can increase the risk for osteoporosis.  Strength training helps build strong bones. Osteoporosis can be an issue and the exercises must take this into account.  You need to learn which exercises are contraindicated for osteoporosis.  For example, you would not do an abdominal crunch or extreme twisting movements.  Before you can start to strength train you must have upright posture, balance, good form and medical clearance.

Aerobic exercise is essential.  That would include any movement which elevates your heart rate.  As soon as you have medical clearance it is good to start walking.  Chemotherapy and radiation can cause fatigue. It may seem counterintuitive, but physical activity can help decrease fatigue and help you improve your ability to tolerate treatments. Walking can boost your energy.  You might be able to walk only 1 house distance at first.  Every day try to walk further until you are able to walk for a half hour to 45 minutes. Try to exercise when you feel the least tired.  You may feel exhausted at various times during treatment and recovery especially during chemo or radiation.  When you feel better, try to do more. Ultimately the workout will help energize you and ease the aches and pains.

Exercise is good for our emotional health.  It is one thing that you can control.  It is one thing that you can do for yourself.  The studies are leading us to believe that exercise can decrease the risk of recurrence.   It is empowering. Physical activity can decrease depression and anxiety.  Participants in my program reduce stress, increase confidence and build positive health habits. The participants will also gain endurance and energy level and decrease fatigue, which may be caused by treatments.

Carol Michaels caroljmichaels@gmail.com                                                                                                                                                                             www.recoveryfitness.net 973-379-4779

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