Written by Accredited Exercise Physiologist Kara Moore. Kara is specifically trained in exercise prescription for Breast Cancer

Will exercise harm me?    

The short answer: NO! Exercise is safe for almost anyone (excluding those with acute injuries or uncontrolled diseases). Exercise has shown to be a safe and effective intervention for women with breast cancer with a very low risk of harm, during any stage of cancer and treatment (ESSA 2019; Hayes & Spence 2017).

The long answer: Exercise does come with risks, however, these are very minimal and unlikely. When exercising there is a transient increased risk of cardiovascular events, but this risk is very small (1 in 400,000-800,000 hours of exercise for adults without existing heart disease or 1 in 62,000 hours of exercise for adults with existing heart disease) (Myers, J 2003). There are also risks of musculoskeletal injuries during exercise and muscle soreness after exercise. Additionally, from a breast cancer (BCa) point of view, risks may include exacerbation of symptoms or side effects – although, this is unlikely and exercise is more likely to positively influence these side effects (ESSA 2019).

Overall, the benefits of exercise far outweigh the risks, and seeking the help from an allied health professional trained to deliver and prescribe exercise, such as an Accredited Exercise Physiologist (AEP), will help to avoid these minimal risks by; delivering a tailored exercise program in a safe supervised environment, progressing slowly, and communicating with you and your cancer care team regularly.

What are the benefits directly related to BCa?

The short answer: fewer and less severe side effects, and improved mental health, physical ability and quality of life due to positive physiological adaptations within your body!

The long answer:

  • Prevent some cancers
  • Improve cancer survival rate
  • Counteract the negative side effects associated with cancer and its treatments – reduces the number and severity of side effects (fatigue, cardiotoxicity, pain, bone loss, depression and anxiety, lymphoedema, body composition changes, peripheral neuropathy, sleep disturbances, cognitive impairment, and more)
  • Improves cardiovascular fitness and muscular strength
  • Improves physical functioning (balance, strength, mobility) to help with daily activities
  • Improves mental health and reduces psychological distress
  • Improves immune function
  • Improves tolerance to and completion rates of chemotherapy
  • Reduced risk of cancer recurrence
  • Reduces risk of developing comorbidities (cardiovascular diseases, type 2 diabetes, dementia, mental health disorders, osteoporosis, joint diseases, and many more)
  • Improves upper limb range of motion after surgery
  • Reduces risk and severity of late appearing side effects (ESSA 2019; Hayes & Spence 2017)

Additionally, when going through BCa treatments women often feel like they have no control over what happens to them as they get told what treatments to have and how they will happen. However, exercise brings a sense of control and normalcy to women’s lives, so they feel like they can help their body while on their BCa journey. Lastly, women who are able to participate in a BCa-specific group class gain a fantastic social support group, where you can talk to and relate with other women who may be experiencing similar thoughts, feelings and side effects – which is very important for mental health.

What is the best exercise to do?

The short answer: anything you can and feel like doing is beneficial!! Whether that is a small walk, a few small bouts (10 mins) of some theraband resistance training throughout your day, or a training session with an AEP!

The long answer: the type of exercise best for you depends on multiple factors, including comorbidities, injuries, cancer treatments, symptoms you experience, mobility, functional capacity, exercise history, your bodies range of motion and most importantly, YOUR GOALS!

General guidelines for healthy adults (18-64 yrs) are:

  • At least 150 minutes of moderate intensity activity per week OR at least 75 minutes of vigorous intensity activity per week OR a combination of the two
  • 2-3 resistance training sessions per week at moderate intensity, consisting of sets, repetitions, rest and load determined by goals (i.e. improved strength or power or endurance)
  • Be active on all/most days of the week
  • Minimise prolonged sitting/sedentary behaviour, and break up long periods of sitting as often as possible (ESSA 2019; BCNA 2019)

Guidelines for older adults 65+ are:

  • At least 30 minutes of moderate intensity exercise on most or all days
  • Try to be active every day as much as you can
  • Incorporate a range of modalities (aerobic training, strength training, balance exercises and flexibility exercises) (BCNA 2019).

The American College of Sports Medicine and National Comprehensive Cancer Network guidelines both support that cancer patients can and should aim to reach the guidelines for healthy adults (mentioned above). Although, cancer patients should take a conservative approach, particularly if they are previously and currently inactive, and “start low and go slow”. Meaning that you should start lower than these recommendations and progress slowly to eventually reach these guidelines. However, there are particular contraindications and precautions that come with BCa, meaning exercise may need to be modified to avoid any adverse events or symptom exacerbation – which an AEP will do.

It is recommended that BCa patients receive guidance with an individualised exercise program tailored to them, their cancer diagnosis, treatments, comorbidities, physical capability, and goals (ESSA 2019). As seeking help will mean your prescription will be safe, monitored and progressed accordingly. You can generally expect your program to include a range of exercise modalities (aerobic, resistance training, balance training and stretching/mobility) when prescribed by an AEP. Each modality provides different benefits, so a mixture is often ideal to create a holistic approach and improve multiple aspects, however, there may be a particular modality best for you and your health and goals (which we can conclude in an initial assessment).

An example of what an individualised exercise prescription by an AEP may look like; A 50 y/o woman (Mrs X) who just underwent breast surgery will need time to recover, but seeking guidance from her medical professional and an exercise professional will help her stay active during recovery. Mrs X was found to have no comorbidities or physical limitations (other than her right shoulder due to surgery), so the following was recommended. Upper limb range of motion exercises if it feels comfortable to do so and returning to normal daily activities (e.g. household and hygiene activities) as soon as possible. Mrs X may also participate in lower body strength exercises and aerobic exercise (e.g. walking). After recovering for 4-6 weeks, Mrs X can slowly introduce and progress some upper body resistance exercises providing no complications arise. IMPORTANT NOTE: This would not apply for everyone, so seek guidance before commencing any exercise.

What if I feel really fatigued and do not want to exercise?

The short answer: we will not pressure you to exercise, it is ok to take a day off. But you will most likely feel a lot better after a short light intensity session over doing nothing at all.

The long answer: There has been a lot of research completed regarding exercise and women with BCa, showing that these women can tolerate exercise despite going through such harsh treatments. However, it is more than ok to have a rest day, but keep in mind that even just doing some light intensity exercise for a short amount of time (10 mins) can be beneficial for maintaining function and make you feel 10x better!! As AEP’s we can create a lower intensity exercise program for ‘bad days’ when you feel particularly fatigued or have intense symptoms. So, do not be too stressed if you can’t make a session with us, we don’t want to make you feel worse!! But try to think how great you might feel after some exercise – this can really help with motivation!

Why should I see an AEP over going to the gym myself or to a Personal Trainer (PT)?

The short answer: While PT’s are great at what they do, this is targeted for a ‘healthy’ population with no chronic conditions. Whereas an AEP is a clinically trained allied health professional who will take caution in delivering you exercise appropriate for you and your condition(s), and will always adopt a client centred approach (i.e. we will listen to you and your needs!). AEP’s are well educated and understand that BCa is such a dynamic condition with many factors to think about during delivery and prescription of exercise, which you may not consider when heading to the gym for your own unsupervised exercise session.

The long answer: An AEP is a tertiary educated allied health professional who completes, at minimum, a 4-year university degree containing in-depth knowledge regarding exercise delivery and prescription for those with chronic diseases. Additionally, AEP’s are accredited with a governing body, Exercise and Sports Science Australia (ESSA), to which professional standards must be upheld to. Furthermore, AEP’s may also undergo additional professional development training (must be completed yearly to maintain accreditation) in a specialised area such as BCa, meaning they have completed training above and beyond the basic knowledge taught in university regarding this condition/topic.

We will always put you (the client) first and what you may need, and we understand what you may be experiencing with a cancer diagnosis. We will conduct a thorough initial assessment to understand YOU and will monitor your health and symptoms across sessions to make sure you are responding well to exercise. We understand that you may have breast cancer-specific considerations and precautions permanently or temporarily (i.e. recent breast surgery needing time to recover, severe nausea, neutropenia, anaemia, PICC line or port, bone metastases or reduced bone mineral density, lymphoedema, etc.), and we will modify your exercise program accordingly. We will keep you motivated and accountable, and will track your progress with review assessments as needed so we can tweak our prescription to reach your goals. Plus, we love a good chat here at EP. EP. Exercise Physiology + Movement so your session will have a great social aspect (especially group classes – available once we are confident in your safety and ability to exercise)!!!

At what stage of cancer or treatment can I see an AEP and exercise?

The short answer: at any stage!

The long answer: An AEP can help you throughout any stage of your BCa journey, right from initial diagnosis, throughout treatment and to palliative care or survivor-ship (BCNA 2019). Exercise has been proven to be beneficial for women during any stage of BCa, but the general idea is that the earlier you start the better, but it is never too late to start! However, it is important for you to discuss starting an exercise program with your oncology team to get medical clearance first and then see an exercise professional to determine a safe and effective program.

What next?

Come see us at EP. EP. Exercise Physiology + Movement!

If you are interested in 1:1 care, a personalised home program or to participate in appropriate group exercise sessions we encourage you to make an appointment for an initial consultation. Your program and care is tailored specifically to you and your situation every step of the way.

If you do have more questions or would like more specific guidence on the right action step for you, please call or email us.

ph. 08 8239 0575 | e: hello@epexercisephysiology.com.au


Written by Kara Moore AEP ESSAM

Kara is an Accredited Exercise Physiologist & has specific training in Exercise Oncology Education: Breast Cancer


references

Myers, J 2003, Exercise and Cardiovascular Health, American Heart Association, https://www.ahajournals.org/doi/full/10.1161/01.CIR.0000048890.59383.8D

Hayes, S & Spence, R 2017, Breast Cancer and Exercise, Exercise is Medicine Australia, http://exerciseismedicine.com.au/wp-content/uploads/2020/04/EIM-FactSheet_Breast-Cancer_Public-2020.pdf

Breast Cancer Network Australia (BCNA) 2019, Exercise and Breast Cancer, BCNA, https://www.bcna.org.au/media/7659/bcna_exerciseandbreastcancer-booklet-web_oct2019.pdf

Exercise & Sports Science Australia (ESSA) 2019, Exercise & Cancer, Exercise Right, https://exerciseright.com.au/wp-content/uploads/2019/10/Cancer-eBook_2019_FINAL2510.pdf