May 13, 2019

Physical activity boosts health, including for people being treated for breast cancer. An expert answers questions about exercise and breast cancer.


Some risks for breast cancer — gender, age and genetics — can’t be changed. But several others are within your control. Exercise is a way to control weight, and keeping at a healthy weight in turn shrinks the risk of developing breast cancer.

About one in eight American women — and one in 833 men — will have breast cancer at some point in their lifetime.

People who are overweight or obese and inactive have a higher chance of breast cancer than those who are at a healthy weight and who exercise regularly. Exercise will also improve mobility, cholesterol levels, physical strength, confidence and the ability to do day-to-day activities.

If you have already been diagnosed with breast cancer, ask your doctor what kind of exercise to include in your treatment plan. Rachel Bateman, PT, DPT, is a physical therapist at the Vanderbilt Dayani Center. She works with people going through cancer treatment and answers some common questions about physical activity during treatment:


For your clients undergoing breast cancer treatment or who are breast cancer survivors, what does an exercise program typically involve?

Their exercise routine generally includes physical therapy and strength training. It also includes range-of-motion exercises, including stretches and movement of the body through the full available range of motion. For breast cancer patients, stretches focus on the neck, shoulder and trunk.

Clients are also encouraged to get moderate aerobic exercise, such as walking, for about 30 minutes at least three times per week.


What kind of exercise do you recommend that people undergoing treatment for breast cancer do on their own, outside of their physical therapy requirements?

People undergoing breast cancer treatment should walk or use a recumbent bike for cardiovascular health while in physical therapy, unless instructed differently by their physical therapist. If they were previously performing leg exercises, they should try to resume these, but may need to slowly build up to the previous level.


Are there certain types of exercise that help prevent or control swelling?

A patient who had any lymph nodes removed should wear a compression sleeve when performing any demanding activity such as weight lifting or strength training, to help control swelling (edema). She should inspect her affected sides (arm, breast and side of the body) before and after exercise to check for any change in size, shape, heaviness and tightness. If there are changes, she should wear a compression sleeve, elevate the arms and contact her doctor.


Are there types of exercise that help people recover from mastectomies?

Exercise following a mastectomy focuses on stretching the shoulders, neck, trunk and pectoral (chest) muscles. The strengthening exercises focus on the shoulders, chest, upper back and core. Pectoral muscle strengthening should begin with gentle exercises, such as doing push-ups against a wall.


During cancer treatment or just after, what are the typical exercises you have them do?

I have them work with light resistance bands or light weights for strengthening. I encourage them to walk or use a recumbent bike or the elliptical machine for cardiovascular exercise.

If they want to continue to work on flexibility beyond the stretches instructed in physical therapy, yoga is a good option but they may have to progress slowly back to positions where they are bearing weight through their arms.

I would not instruct them to jump right back into whatever exercise they were doing before cancer treatment. Many patients will have likely lost some strength, flexibility and endurance during treatment and will need to progress back slowly and take breaks as needed.


What level of intensity is reasonable considering typical cancer treatments?

Intensity level is dependent on the person. Everyone reacts differently to cancer treatments, so the intensity level may change based on symptoms. There may be some limitations to increasing exercise intensity if the person’s energy level is low — for example, while a patient is receiving chemotherapy or radiation therapy. The patient may be limited in progressing in stretching due to the side effects of radiation, as this can cause tissue tightness.

While going through treatment, walking is a good exercise to try to incorporate to the individual tolerance level to help build and/or maintain endurance. If the patient would like to get in the pool, a doctor’s clearance is likely needed, especially after surgery. An open incision could be a risk for infection. Expect any exercise to start at a low intensity level and build slowly and rest often to allow the arm on the side affected by surgery to recover.

While we encourage all of our patients to exercise regularly, they may have restrictions set by their doctor at first while in treatment, or pain might limit exercise.  When restrictions are lifted, the patient will need to return to exercise by slowly increasing time, repetitions and intensity. Many of our patients undergoing chemotherapy and/or radiation notice a decrease in their energy levels with normal daily activities and exercise.

With cancer treatment, it is expected that someone will feel fatigued. This fatigue may be related to surgical recovery, pain levels, chemotherapy and/or radiation. They will have good days and days when they are more tired.

Someone who was physically active before a diagnosis has an advantage of starting treatment strong, but can still experience fatigue from treatment. The type of treatment(s) and any other health conditions besides cancer can influence energy level.


After treatment, how quickly can someone expect to return to their normal level of activity?

Even after someone is considered cancer-free, she still may be recovering from surgical intervention or undergoing chemotherapy or radiation. After cancer treatment, it is expected that endurance and strength will be diminished. It’s important to work slowly to build strength.

With strengthening, improvement can be expected in about eight weeks with three times per week of strengthening exercises. But still, a patient may not be back to her normal level of activity. It is hard to give a set time for when that will happen, because everyone recovers at a different pace. Also, multiple factors can influence this, including health history, types of treatments, complications from surgery and compliance with exercise.

Some chemo drugs and radiation treatments can affect the cardiovascular system. Patients should discuss this with their doctor.

Despite initial challenges, getting into a habit of regular exercise helps cancer survivors’ quality of life.

The Vanderbilt Breast Center at One Hundred Oaks provides the most complete range of services for breast health in Middle Tennessee. The center offers screening, imaging, genetic testing and breast cancer care. To make an appointment, call 615-322-2064.

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