Please note: There are 19 references to the full academic papers discussed in this article; they are available by clicking on the numbers in the parenthesis.
Survivorship from breast cancer is on the increase…
Indeed, there are an estimated > 4 million breast cancer survivors in the US. Many continue to battle the post treatment side effects that can negatively impact their quality of life. (1) These effects may include:
a reduction in cardiopulmonary fitness and muscular strength
negative body composition changes
increased fatigue
depression and anxiety. (2)
It is possible to combat the deleterious physical and psychological effects of breast cancer treatment. You have an ace up your sleeve, EXERCISE. Dr. Kevin Smith, PT, DPT, OCS, COMT, CSCS, TPI
Although the benefits of aerobic and resistance exercise are now well known to our society, they bear repeating: Increased muscular strength and mass, increased cardiorespiratory fitness & increased bone mineral density are at the top of a long list of benefits. Less well-known benefits include the positive impact of exercise on lymphedema and your psychological well-being and a possible reduction in the rate of potential recurrence. (3)
Aerobic exercise interventions are aimed at improving the capacity of the cardiopulmonary fitness. Short term (as little as 3 weeks) and long term (6 months) interventions in which aerobic exercise was performed 2-3 x per week showed benefits in terms of both body composition (that is, decreased fat mass and increased lean mass) and Vo2 max. (4)
Resistance training benefits lean body mass, muscular strength, and aerobic capacity. In fact, patients with breast cancer who participated in resistance training showed a 33% decrease in all-cause mortality. (5) Muscle strength and lean mass gains begin in as little as 8 weeks while longer duration interventions even show improvements in Breast Cancer Survivorship (BCS). (6)
Combining both modalities may outweigh the beneficial effects of only performing one. Specifically, BCS participating in 5–6 months of combined exercise training have experienced multiple benefits including:
Greater decreases in central adiposity and waist-to-hip ratio,
Improved percent body fat
An improvement in the resting diastolic blood pressure and mean arterial pressure,
Increases in both fat-free mass and estimated Vo2 max, when compared to a sedentary control group. (7)
Exercise Impacts Your Bone Health!
Both aerobic and resistance exercise programs are shown to mitigate the effects of breast cancer treatment on bone health, as documented by dual-energy x-ray absorptiometry (DEXA). (13) This is critical as we know that estrogen deprivation treatments, such as the prescription of aromatase inhibitors, accelerate bone loss and increase the risk of osteoporosis/fractures.
An Answer to Lymphedema?
Lymphedema is reported to affect roughly 20% of women post breast cancer treatments and can develop 2 years following initial breast cancer treatment. (8) (9) Recent studies are beginning to show that progressive resistance exercise is associated with a stabilization of lymphedema symptoms in breast cancer patients. (10) Slowly progressed resistance training was also shown to be protective against lymphedema flare ups. (11) Contrary to traditional beliefs, a meta-analysis evaluating the safety and efficacy of progressive resistance exercise on breast cancer-related lymphedema showed that it did not worsen arm volume nor symptom severity. (12)
An Antidote to Fatigue and Anxiety
Emotional well-being is a major concern with respect to quality of life, fatigue and psychological/psychosocial changes following breast cancer treatment.
It is estimated that ~50% of women with breast cancer encounter depression, anxiety, or both upon a year following diagnosis. (14) Studies looking at the effect of aerobic, resistance or combined exercise interventions show a positive impact on ALL of these factors.
Furthermore, with regards to fatigue, A 3-month or 6-month combined exercise program was shown to have resulted in improvements in behavioral fatigue, sensory fatigue, affective fatigue, cognitive fatigue, and overall total fatigue in breast cancer survivors. (15)
One of the lifestyle factors most strongly and consistently associated with breast cancer recurrence or non-occurrence is exercise. (16) Numerous studies have associated moderate exercise with lower risk of breast cancer recurrence. (17) It is important to consider stage of life (pre or post-menopausal) when diagnosis is made when timing exercise participation.
A meta-analysis of studies examining the timing of exercise and risk of recurrence in pre- and postmenopausal women found that exercise participation after diagnosis was associated with 34% fewer deaths from breast cancer, 41% fewer deaths from all causes, and 24% reduction in recurrence. (18)
The argument for exercise participation following breast cancer treatment is undeniable. Through no fault of their own, it is estimated that women diagnosed with breast cancer experience an 11% reduction in physical activity with this number rising to 24% with radiation and to 50% with chemotherapy treatments. (19)
Post treatment it is absolutely vital to include exercise as a portion of the breast cancer rehabilitation process. A licensed physical therapist, strength and conditioning specialist or trainer can customize the program to make sure it is safe, intelligently progressed and helps you reach your goals. This is a game changer for breast cancer survivors, you CAN go out and reclaim your physical and emotional well-being post treatment. You aren’t confined to a dimmed version of your old self after treatment, start exercising and reclaim YOU.
CONTACT:
Dr. Kevin Smith, PT, DPT, OCS, COMT, CSCS, TPI
Founder of Smith Athletics
For private, physical therapist-designed strength and performance training, message me on Instagram @DrDadDPT
To work with a specialist breast oncology rehabilitation therapist,
email: therapy@prattpt.com
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