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Naomi Aaronson

Fitness for Breast Cancer Survivors

How personal trainers can help breast cancer survivors to maximize their function and bring enhanced wellness back into their lives.

By: Naomi Aaronson

Did you know that every 3 minutes another woman is diagnosed with breast cancer?

Breast cancer is the most common caner diagnosed in women. Due to improved detection and treatment, these women and men (men can get breast cancer to) are living longer and healthier lives. The treatment that they must undergo is grueling; physically and psychologically.

Personal Trainers Can Bring Enhanced Wellness to Breast Cancer Survivors

How can you as a personal trainer maximize their function and bring enhanced wellness back into their lives? This article will explore in brief the treatments these brave women face, treatment implications, exercise goals ,and exercise program design. However, it is advisable to do more research and obtain updated information as treatment continues to evolve.

When a woman is diagnosed with breast cancer, her cancer is staged from stage 1 to stage 4. Staging is a method of grouping patients to determine the type of treatment, predict prognosis, and compare different treatment protocols. Stage 1 has a better prognosis because the tumor is smaller and no lymph nodes are involved while stage 4 is cancer that has spread to the bones, liver, lungs or brain From this staging and other tests, treatment can be prescribed. Menopausal status and lifestyle requirements are other factors that determine treatment.

Two Types of Treatments

There are 2 types of treatment; local and systemic. Local treatment includes surgery and radiation and refers to the actual site of the tumor. Surgery is indicated for all women but depends on other factors.

When a woman is diagnosed with breast cancer, exercise programs can help.

The major types of surgery are as follows; lumpectomy (breast conservation surgery), mastectomy, and modified radical mastectomy. The least invasive procedure is the lumpectomy in which the tumor is removed with a partial axillary lymph node dissection (cancer spreads through the lymph nodes). Radiation usually follows this procedure.

Mastectomies involve removal of the entire breast tissue without lymph node removal. However, when a modified radical mastectomy is performed, the entire breast tissue is removed as well as some lymph nodes .Cosmetic deformity, chest wall tightness, loss of a body part and body image changes are all side effects after a mastectomy. Tightness in the pectoral and axillary (armpit) regions are some complications of this surgery with loss of range of motion and strength in the affected shoulder a concern.

Radiation is a local treatment that damages cancer cells so that they cannot grow and multiply. One undergoes radiation for 5 days a week for 5-6 weeks. It usually follows chemotherapy administration or 3-4 weeks after surgery if chemotherapy is not indicated. Scar fibrosis, skin irritation, burns, breast tenderness swelling and fatigue are side effects. Systemic treatments affect the entire body and include chemotherapy and hormonal treatments.

Chemotherapy is the use of cytotoxic (cell killing) drugs. Both cancerous and non-cancerous cells are affected. Hair loss, vomiting, and nausea are common as rapidly dividing cells in the hair and the intestine are most affected. Other side effects include diarrhea, fatigue, and risk of infection, premature menopause, weight gain, cardiotoxicity, anemia and peripheral neuropathy.

Exercise must be done shortly after surgery to prevent any complications.

Chemotherapy is administered once every 3-4 weeks for approximately 4-6 months. Hormonal treatment use cytostatic (cell blocking) drugs such as Tamoxifen. This drug is usually well tolerated but approximately 25% of all women suffer menopausal like symptoms including hot flashes, weight gain, vaginal dryness, nausea and vomiting. Increased risk of uterine cancer and deep vein thrombosis is noted with this drug. Fortunately, it appears to maintain bone density in post menopausal women.

Impact on The Quality Of Life And 'Sense Of Self'

A woman's quality of life and sense of self is affected by this disease. There are both physical and psychosocial implications which you must understand to formulate a viable program format.

These issues are as follows:

1. Impaired shoulder mobility -

After major surgery, discomfort and pain is to be expected. Surgery to the axillary and pectoral regions can preclude full range of motion at all planes in the shoulder. As a result, there may not be a willingness to move which leads to a loss of strength and function in the affected arm Exercise must be done shortly after surgery to prevent any complications. In addition, a good range of motion in the shoulder is necessary to receive radiation. Scar tissue continues to form for 1-2 years after surgery. Thus, the area needs to be continually stretched to prevent adhesions.

2. Fatigue-

Fatigue is common side effect associated with all treatments as most clients report experiencing fatigue .It sets up a vicious cycle of not doing activity thereby losing endurance and strength for daily tasks which leads to more fatigue. .Fatigue can be quite debilitating.

3.Lymphedema -

Any woman that has received lymph node dissection and/or radiation is at risk for lymphedema. This is a protein rich fluid which collects in the arm, chest or axillary region when the lymphatic system is unable to pump it normally it back to the heart. This is due to scar tissue or lymph node removal .It can develop right after surgery or many years later, and is an omnipresent issue. It is difficult to prevent as many factors may cause it to develop .However, precautions must be undertaken to decrease the risk... Clients may complain that their arm feels heavy, is aching feels numb or tires easily when experiencing this condition and should be referred to a medical professional immediately.

4. Osteoporosis-

>Since chemotherapy can cause premature menopause, these women are at risk for osteoporosis Age seems to be the best predictor of who will go through menopause. The older one is during chemotherapy, the more likely that one will go through menopause. Rapid bone loss occurs during the first 5 years and the risk of fractures to the spine, hip or wrist is a serious concern.

5. Weight gain-

Many women seem to gain 5-15 pound after undergoing treatment. This weight gain is influenced by the type of treatment, node status, menopausal status, and length of treatment....It is unknown whether it is due to a decreased level of activity, reduced metabolic rates after treatment or the chemotherapy drugs themselves .It is an additional stressor and influences ones self esteem.

6.Psychosocial issues-

After a diagnosis of cancer, psychosocial concerns are paramount... Fear of death, disfigurement and dependency are common .High stress levels are experienced along with feelings of anger , depression, fear or anxiety .Everyone reacts differently to this diagnosis therefore, humor, communication and empathy are extremely important when working with this population.

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