Breast Cancer Exercise

Research in regards to the benefits of exercise for patients with breast cancer is rapidly expanding.  Overwhelming research is indicating that exercise confers an array of benefits; ^{[1, 3, 4, 5, 6]}

• Reduced risk of Cancer recurrence, secondary Cancers.

• Improved fatigue management and management of side effects of treatment.
• Improved upper limb strength and function.
• Avoid adhesive capsulitis (frozen shoulder) and permanent loss of range of motion of the upper quadrant.
• Decreased risk of Lymphedema.
• Improve quality of life.

• May improve joint pain and reduce risk for sarcopenia, osteopenia and osteoporosis.
• Enhances adherence to adjuvant therapy and return to usual activities including employment.

Research has also illustrated that when exercise is appropriately tailored to the individuals needs and requirements it is safe, feasible, and effective. It is also debunking the historical recommendation of rest being the most important aspect of rehabilitation. Current evidence-based exercise guidelines recommended cancer survivors avoid inactivity and strive to achieve 150 minutes of moderate to vigorous-intensity exercise weekly.^[5]

Exercise Prescription¹

Regardless of the type of surgery planned, the aim is to complete six weeks of prehabilitation to improve upper limb and trunk stability and flexibility prior to surgery. Prehab is beneficial for improving post-surgery recovery.

Five key components (Figure 1) of pre-rehabilitation for Breast Cancer has shown to have both short and long-term benefits. ^[4]

Figure 1 Breast Cancer Prehabilitation Interventions

Rehabilitation is most commonly introduced after either locoregional therapy (surgery or radiation) and/or systemic therapy. Postoperative focus is on restoring upper quadrant function through mobility and flexibility exercise to mitigate shoulder-related impairments. It is important to follow rehabilitation guidelines to assist with return to regular physical activity. Commencement of postoperative rehabilitation is dictated by the type of surgery performed, Lumpectomy (3-4 weeks), Mastectomy (4-6 weeks) and Reconstruction Surgery (6 weeks). It is also important to consider and address other muscle weakness associated the type of reconstructive surgery performed.^[4]

Rehabilitation Guidelines

• 0 to 2 weeks: range of motion exercises below shoulder height in combination with light to moderate walking.
• 2 to 4 weeks: Starting to increase shoulder range of motion over shoulder height.
• 4 to 6 weeks: Incorporating light resistance-based exercises and trunk stability exercises.
• 6 to 12 weeks: Gradual progression of upper body and lower body strength programming.
• 12+ weeks: return to normal activities and sport.

At Advanced Physiotherapy our Women’s Health Exercise Physiologist will complete a thorough initial assessment to identify the stage of treatment and current level of fitness. This in turn will assist in developing an individualised treatment plan, comprising of pre- and/or rehabilitation program, and progressing into long-term management of persistent side effects and associated health conditions.

 

Reference

1. Möller, U. O., Beck, I., Ryden, L., & Malmström, M. (2019). A comprehensive approach to rehabilitation interventions following breast cancer treatment-a systematic review of systematic reviews. BMC cancer, 19(1), 472.
2. Understanding Breast Cancer, Cancer Council Australia  © 2020. Last medical review of source booklet: July 2020. 
3. Neil-Sztramko, S. E., Winters-Stone, K. M., Bland, K. A., & Campbell, K. L. (2019). Updated systematic review of exercise studies in breast cancer survivors: attention to the principles of exercise training. British journal of sports medicine, 53(8), 504-512.
4. Santa Mina, D., Brahmbhatt, P., Lopez, C., Baima, J., Gillis, C., Trachtenberg, L., & Silver, J. K. (2017). The case for prehabilitation prior to breast cancer treatment. PM&R, 9(9), S305-S316.
5. Santa Mina, D., Au, D., Brunet, J., Jones, J., Tomlinson, G., Taback, N., ... & Howell, D. (2017). Effects of the community-based Wellspring Cancer Exercise Program on functional and psychosocial outcomes in cancer survivors. Current Oncology, 24(5), 284.
6. Zhu, G., Zhang, X., Wang, Y., Xiong, H., Zhao, Y., & Sun, F. (2016). Effects of exercise intervention in breast cancer survivors: a meta-analysis of 33 randomized controlled trails. OncoTargets and therapy, 9, 2153.