Exercise seems to be the prescription for health for the 21st century. For women who’ve had breast cancer, staying active even seems to improve the chances of survival.
But not all exercise is created equal. According to City of Hope physical and occupational therapy experts, breast cancer survivors should take special care in the type of exercise they adopt and how aggressively do it.
 Lymphedema therapists can help guide exercise for breast cancer patients. (Photo by Paula Myers) |
Here’s why: lymphedema. That’s swelling in the arm caused by excess fluid that collects after lymph nodes were removed during surgery or damaged through radiation therapy. Anywhere from 10 to 60 percent of breast cancer patients experience this condition, said Jennifer Brown, M.A.,O.T.R., M.L.D./C.D.T., director of City of Hope’s Rehabilitation Services Department.
It can develop within a few months after surgery, or in the case of one of Brown’s patients, even more than 50 years after treatment.
“Although published studies are sparse, we have noticed that the degree of lymphedema patients experience is correlated with obesity,” Brown said. “We always recommend staying fit.” It’s important to keep moving to stay flexible after surgery, too.
Some exercise actually can increase the swelling involved in lymphedema, though, which makes exercise a tricky topic. It’s always a good idea to talk about exercise plans with a doctor and a lymphedema therapist before starting a program.
Lymphedema therapists recommend specific exercises patients can do while wearing compression sleeves or bandages that counteract swelling. “These exercises are gentle but allow the various muscle groups of the affected area to contract,” said Brown, a member of the Sheri & Les Biller Patient and Family Resource Center. “Muscle contraction is important in moving fluid.”
Diaphragmatic breathing, what some people call “belly breathing,” is important, too. That drives oxygen deep into the lungs and pumps the body’s lymphatic system in the process.
A physician can refer patients to a specially trained and certified lymphedema therapist who can provide an exercise program that reduces the chances of overstraining muscles or injuring ligaments and tendons. These injuries can increase swelling.
City of Hope’s Lymphedema Program, for example, provides customized exercises to patients after breast cancer treatment. Therapists first assess the extent of women’s lymphedema, their risk factors and how well they’re getting along from day to day. Patients learn about how lymphedema works and how to prevent infection.
The first, intensive program usually runs for two weeks, with a one-hour session held every weekday. Therapists teach patients how to perform manual lymph drainage (massage to stimulate the lymphatic system and redirect fluid) and how to perform compression bandaging, as well as providing a healthy exercise program.
Patients then go into a maintenance program, in which they get treatment two or three times a week for another two weeks. Lymphedema treatment is covered by insurance, though Medicare and Medi-Cal and some private insurance companies do not cover compression bandages and sleeves and other supplies.
Unfortunately, women with breast cancer tend to become less active after their diagnosis, according to studies, including research by City of Hope epidemiologist Leslie Bernstein, Ph.D. As increasing numbers of women go through breast cancer, researchers are looking at ways to encourage these women to safely stay active, so they can survive and thrive.
City of Hope’s Lymphedema Program is available to patients at City of Hope through a physician’s referral.
Keep movin’
Long after treatment ends, many breast cancer survivors continue to experience emotional and physical scars. To ease these lingering effects, WISE & Healthy Aging in Santa Monica, Calif., is conducting a pilot study with City of Hope called the “Mindful Movement Program for Breast Cancer Survivors.” The California Breast Cancer Research Program funded the Mindful Movement Program — which began Oct. 6 — to enhance self-awareness through simple body movement at participants’ own paces and abilities, said co-investigator Holly Kiger, M.N., R.N., vice president of clinical programs at WISE & Healthy Aging. “The study’s purpose is to assess whether this new, innovative program can improve the quality of life and emotional well-being of older breast cancer survivors,” said Kiger, who is working with City of Hope research partner Rebecca Crane-Okada, R.N., Ph.D., of the Division of Nursing Research and Education. Studies show that many breast cancer survivors experience lingering anxiety, depression and pain, as well as altered feelings about their body and fears that cancer will return. According to Kiger, research on the potential benefits of mindfulness and movement-dance therapy is limited, which sparked the project. Mindful Movement prescribes no formal meditation, specific body movements or postures. The leader encourages participants to move their bodies, often with music, in ways that are comfortable, fun, creative and natural to them. “In the process, participants become aware of their thoughts, feelings and sensations in the present moment, and express them, without judgment, in self-directed movement,” Kiger said. WISE & Healthy Aging’s first series of weekly, two-hour sessions enrolled 16 participants at its location on Fourth Street in Santa Monica. The series will be offered again in Inglewood in February and possibly at City of Hope in Duarte in June 2009. Enrollees must be breast cancer survivors age 50 or older without metastatic disease who completed treatment at least 12 months earlier. Participants must be able to read and write in English. More information is available through Holly Kiger at WISE & Healthy Aging, 310-394-9871, ext. 239, or Rebecca Crane-Okada at City of Hope, 626-256-4673, ext. 61255. |