Exercise in Breast Cancer
Exercise is beneficial for people with breast cancer, aiding the recovery before, during and after treatment including the potential reduction in risk of breast cancer recurrence.
People with breast cancer may undergo any combination or all of the following:
- Surgery e.g. lumpectomy (breast sparing) or masectomy (removal of breast) with or without breast reconstruction. Surgery may also include lymph node removal or axillary clearance. Women may also undergo ovarian ablation as the ovaries are the main source of oestrogen in premenopausal women.
- Chemotherapy. Common regimes include anthracycline and taxane based therapies
- Endocrine therapy e.g. Tamoxifen, Letrozole, Arimidex
- Targeted Therapy e.g. Herceptin
There may be post-operative limitations of upper limb movement and exercise protocols after initial cancer surgery and breast reconstructive surgery, it is therefore important to liaise with the surgeon and to be aware of the presence of drains, lines, or ports.
Lymphoedema can affect the upper limb, trunk and breast following treatment for breast cancer. Baseline assessment and regular monitoring for lymphoedema during exercise programs are recommended. A compression garment may also be considered.
Aim for 3x 30 minutes of exercise per week, building to 150 minutes per week
- Be aware that body image can be adversely affected in women who have undergone treatment for breast cancer. Ensure a comfortable exercise environment.
- A professionally fitted bra is important for comfort during exercise and lymphatic drainage. Further information on bra and prosthesis fitting is available at from the Cancer Council website. The Sports Bra app which was created by physiotherapists also provides guidance for bra fit for exercise
- Resistance training is recommended in patients with breast cancer
- Slow, gradual increase in frequency, then time and then intensity is recommended
- For individuals receiving hormone therapy, impact training (jumping, running) can be beneficial for maintaining bone density
- Increased body weight is a common issue after breast cancer treatment. You may consider high-intensity exercise and referral to a dietitian to aid weight loss if appropriate
- Upper limb pain and dysfunction is not uncommon following treatment for breast cancer.
- Potential causes:
- Scarring, axillary web syndrome or nerve injury, e.g., scapula winging following long thoracic nerve injury.
- Review upper limb symptoms and function prior to exercise prescription and if required refer to a physiotherapist.
- Potential causes:
- Radiotherapy treatment may result in fatigue and skin reactions that require exercise modification.
- Chemotherapy induced peripheral neuropathy can affect hands and feet, impact proprioception and increase falls risk. Balance assessment and retraining and structuring exercise programs to minimise falls risk is important. Good footwear and footcare is vital and a podiatrist review may be warranted.
- Chemotherapy and hormone therapy for breast cancer are associated with bone loss, which may cause osteoporosis. Weightbearing exercises may minimise this but it is also important to reduce falls risk.
- Chemotherapy and hormone therapy for breast cancer can cause arthralgia and myalgia, which may require modification of exercise programs.
- Chemotherapy, hormone therapies and targeted therapies for breast cancer are also associated with other side-effects that may impact exercise prescription, for example anaemia, neutropenia, and cardiotoxicity. It is important to liaise with the treating oncology team.