According to the Centers for Disease Control, breast cancer continues to be the most common cancer among women. In 2012 (the most recent year numbers are available):
– 224,147 women in the United States were diagnosed with breast cancer1.
– 41,150 women in the United States died from breast cancer1.
– About 85% of breast cancers occurred in women with no family history of breast cancer. Rather, these occur due to genetic mutations that happen as a result of the aging process and life in general, rather than inherited mutations4.
Treatment has improved greatly over the past several decades and varies depending on the type and stage of breast cancer. Available options may include one of, or even a combination of, today’s treatment regimens. Radiation, surgery, hormone therapy and alternative measures are a few of the available treatments. The patient, their family and their healthcare team will create a plan that is best suited for that person. There will be months or even years of therapy needed to become a breast cancer survivor with side effects ranging from nausea and vomiting to hair loss, fatigue and depression, depending on the individual and their plan of treatment. (Not to mention the psychological impact of such a life changing condition, in which you are now fighting your own body to survive. )
With more survivors than ever before, let’s picture the strength needed to endure the diagnosis, treatment, and life changing effects of breast cancer. Now picture what it would be like to return to “normal” life. Where does one start?
Beginning Again
Laura Nadeau, M.D., F.A.C.P., Assistant Professor at William Beaumont Hospital-Oakland University School of Medicine has several key recommendations for breast cancer survivors and their loved ones. Dr. Nadeau starts by asking breast cancer survivors to:
• Acknowledge that you will never be mentally quite the same as before a cancer diagnosis. Many people liken it to PTSD, and you need to accept that you have had a life-changing event.
• Use your experience to break out of old unhealthy habits like stressing about the small stuff, and be free to try new fun experiences.
• Clean up your diet by eating more fruit and vegetables, and less meat and dairy. Most people find it hard to go vegetarian, so one suggestion I give my patients is to be sure half of what is on your plate is fresh fruit and veggies. Remember, the more color, the better!
From The Inside Out
It’s normal to start seeing the world through different eyes. Something that used to be small may seem more important, and something that seemed huge, may seem trivial now. Try meditation and centering to gather your thoughts and emotions. Taking a few moments every day to reconnect with your new body and outlook may even hold physical benefits too. One study found that psychosocial interventions providing stress reduction and emotional support resulted in trends toward better cell structure maintenance in distressed breast cancer survivors, compared with decreases in usual care.
Slowly But Surely
Breast cancer survivors may experience deterioration and limitations of their physical abilities during their time of treatment. Poor physical function can be associated with premature mortality, injurious falls, bone fracture and disability. A condition called lymphedema can persist after treatment depending on what interventions are preformed on the individual. Knowing that their body may still be recovering from treatment, it is wise to consult your health care provider first, and start at a very conservative pace. Still, studies have shown that slowly progressive weight lifting compared with standard care can reduce the incidence of physical function deterioration among survivors of breast cancer and improve the overall health and physical abilities of the individual3.
Doctor of Physical Therapy Meghan McElrath states that, “There has been overwhelming evidence that maintaining cardiovascular and musculoskeletal health during breast cancer treatments and after recovery helps to combat fatigue, maintain strength, maintain bone density, and has been shown to improve overall quality of life.”
While she also notes that, “Side effects such as lymphedema and decreased bone density, common with breast cancer, can be reduced with a gentle strengthening program. It is important to note that these exercises should be performed within the parameters of precautions set by physicians and monitored initially by a qualified health care professional.”
Her recommendations include:
Upper body
1. Triceps kickbacks with 1-2 lb dumbbells (modify weight to fitness level). 3 x 12 reps
2. Bicep curls with dumbbells (modify weight to fitness level). 3 x 12 reps
3. Resistance band rows: Roll your shoulders back and squeeze your shoulder blades together, hold for 5 seconds and then slowly release. 3 x 12 reps*
*Start at the lightest colored band (lowest resistance) and work your way to a darker colored band (higher resistance).
Core
1. Anterior/posterior pelvic tilt: Lay on your back with feet placed so that knees are bent, roll your hips upward and hold for 5-10 seconds. Release your hips back to starting position while maintaining abdominal control throughout. 3 x 12 reps
2. Bridging: Tighten your glutes and lift your hips off of the mat approximately 8-10 inches (or until there is no bend in your hips) hold for 5-10 seconds. 3 x 12 reps
3. Alternate arm/leg “Bird Dog”: Get on all 4’s with pelvis in neutral position, shoulders relaxed and eyes gazing down in between your hands. Carefully extend right arm out in front as you are reaching your left leg straight back trying not to tilt your body. 3 x 12 reps, each side (right arm/left leg & left arm/right leg equals one rep)*
*If it is difficult to perform this exercise moving the arms and legs simultaneously, isolate and alternate one limb at a time
Lower body
1. Bodyweight squats: 5-10 second hold at bottom or sit-to-stand from a chair or bench. Resistance bands or dumbbells can be used for additional challenge. 3 x 12 reps
2. Cable kickbacks: Using your resistance bands or a cable machine, kick a leg back to feel a good squeeze in your hamstrings and gluts. 3 x 12 reps, each leg
3. Side-stepping or lateral movement with resistance band: Loop band around ankles and alternate stepping right and left. Make sure to keep tension in the band. 3 x 12 reps, each direction
Both Dr. Nadeau and Dr. McElrath always suggest consulting with your personal healthcare provider before starting any exercise routine or any other significant lifestyle changes, as individuals will often require a case-by-case evaluation. Knowing this, DO feel empowered to learn more with your healthcare team on how to overcome and cope with any limitations you may have, while building on all of your many current abilities. Mind, Body, Spirit, you deserve to feel complete.
* Thank you to Dr. T. Nguyen for demonstrating the exercises. Thank you to Powerhouse Gym in Madison Heights/Troy, Michigan for letting us use your facilities.
REFERENCES
1. U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999–2012 Incidence and Mortality Web-based Report. Atlanta (GA): Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute; 2015.
2. Mindfulness-based cancer recovery and supportive-expressive therapy maintain telomere length relative to controls in distressed breast cancer survivors; Linda E Carlson PhD et al; Cancer (By American Cancer Society) Vol 121; Issue 3: 476-484; Feb. 1, 2015
3. Weight Lifting in Women with Breast-Cancer-Related Lymphedema; Kathryn H. Schmitz et al; New England Journal of Medicine; Vol 361: 664-673; Aug. 13, 2009
4. U.S. Breast Cancer Statistics; BreastCancer.Org: www.BreastCancer.org/symptoms/understand_bc/statistics ; Last Updated May 11, 2015. Retrieved September 19, 2015
