History:
Kelly is a 40 year old female with newly diagnosed, Stage 3 self detected L) breast cancer.
She received a L) mastectomy and axilliary node clearance 3 weeks ago and is now starting Anthracycline chemotherapy.
Kelly lives with her husband and two primary school aged children. She works full time as a police officer and is currently on sick leave. She is usually fit and well but did not participate in formal exercise prior to her diagnosis and currently is walking the dog for exercise.
Her job requires her to pass a fitness test to return to full duties.
Her goals are to have the energy to care for her children and to return to her previous fitness level so she can return to work.
PMHx:
- Left shoulder reconstruction
Assessment:
- 6 Minute Walk Test: 571m, lowest SpO2 100%, BORG: 4
- 5 Times Sit to Stand: 6.65 sec
- Bicep curl 10 Repetition Max: 4kg both arms
- Timed up and Go Test: 9.5 secs
Questions:
- What side effects would you expect from the treatments Kelly is receiving and how would that affect your exercise prescription?
- What education would you provide?
- What type, level and duration of aerobic exercise would you prescribe at a baseline for Kelly?
- What resistance (strength) exercises would you prescribe for Kelly? Draft a 4 week progression of resistance training for Kelly with respect to her goals.
- What side effects would you expect from the treatments Kelly is receiving and how would that affect your exercise prescription?
- Common side effects of chemotherapy: fatigue, loss of appetite, peripheral neuropathy, mucositis, nausea, vomiting, diarrhoea
- Begin program with lower repetitions to encourage rests between sets to manage fatigue
- Be conscious of balance exercise programs as Kelly may be at a higher falls risk due to lower limb peripheral neuropathy
- With respect to recent mastectomy – lower starting prescription of UL weights/exercises until confident that pain and wound healing are not being disrupted by exercises
- What education would you provide?
- Importance of ongoing lymphoedema management and monitoring
- Benefits of exercise particularly in the breast cancer population
- Discuss the intensity and frequency of exercise required to achieve such benefits – give patient “Moving Through Cancer” info sheet
- What type, level and duration of aerobic exercise would you prescribe at a baseline for Kelly?
- Considering Kelly’s age, minimal co-morbidities and 6MWT score – our goal is to work Kelly at Moderate – Vigorous intensity of Aerobic exercise (Modified BORG 4-6)
- On a treadmill a starting level of 5.5-6 km/hr with 1-2 level of incline would be appropriate for 10 minutes
- What resistance (strength) exercises would you prescribe for Kelly? Draft a 4 week progression of resistance training for Kelly with respect to her goals.
- Consider the agility, speed and power components required for Kelly’s job alongside endurance for your prescription of resistance exercises
Kelly participated well throughout her exercise program and we were able to add in more challenging core based exercises and plyometric activities.
She is now back at work as a police officer and is regularly completing Pilates which is her preferred form of exercise.
Note: Case studies have been adjusted for educational purposes with the consent of the participants.