Exercise Programming for Breast Cancer Patients

Here is an excerpt from an article that I wrote which appeared in the IDEA Fitness Journal in June 2011, on programming for breast cancer patients.  To read the full article, click to read the article "Exercise Programming for Breast Cancer Patients". Most people know that exercise can help prevent breast cancer as well as increase the likelihood of a full recovery after treatment. However, it is not as widely recognized that regular exercise can mitigate many of the symptoms of cancer treatment (including symptoms of pharmacologically induced early menopause). Here are a few of the most notable benefits:

  •     increased functional capacity
  •     increased postmastectomy mobility and ROM
  •     decreased body fat
  •     increased lean muscle mass
  •     reduced loss of bone mineral density
  •     decreased nausea and fatigue
  •     improved mood, self-esteem and sense of control

In short, exercise can be beneficial before, during and after a diagnosis of breast cancer.

Programming Considerations When you are serving a client who is dealing with a cancer diagnosis, you will want to consider the following critical points when creating an exercise program:

  • Care About the Client. As a personal trainer, you will be more effective if you develop basic counseling skills, within scope of practice. Active listening, attentive body language, genuine compassion and empathy will go a long way to enhancing client compliance and satisfaction. Learn about resources available to breast cancer patients in your area, including counseling and peer support, and do not hesitate to make a referral.
  • Obtain Physician Clearance. Before embarking on an exercise program, your client must obtain clearance from her oncologist. The clearance must be in writing, in accordance with the American College of Sports Medicine (ACSM) guidelines for clients with medical problems.
  • Assess Cardiovascular Fitness. Chemotherapy medications usually cause a decline in maximal oxygen consumption (VO2max), so make it clear to your client that one of the goals of cardiovascular exercise is to minimize this loss. Use a low-risk, submaximal assessment protocol that will generate necessary information about the client’s current fitness level without putting her at risk of musculoskeletal injury. Simple cardiovascular tests such as the Rockport Walk Test and the Ross Submaximal Treadmill Protocol are easy to administer and can be stopped immediately if the client feels unwell.
  • Test for Strength and Range of Motion. For this client, 1- or even 10-RM protocols are usually inappropriate. For strength, it is probably better to use an informal, ongoing assessment model by commencing with a 15- to 20-RM protocol and keeping meticulous records of reps, sets and loads. Every few weeks, motivate the client by drawing attention to achievements and gains. Of course, a woman who was highly trained before diagnosis can continue with her previous program if she is able. Assess range of motion (ROM) as you would for a healthy client—with the exception of the muscles that act at the shoulder girdle, as they may have been involved in breast cancer surgery.
  • Modify the HIIT. Implement cardiovascular training with modified high-intensity interval training (HIIT) to offset the decrease in VO2max that occurs with cancer treatment. HIIT segments can be between 65% and 90% of VO2max for 30 seconds to 3 minutes, depending on the client’s pre-existing cardiovascular fitness level. It is imperative to use a heart rate monitor in order to safely observe and adjust the workload.
  • Include Strength Training. Strength training offsets the loss of lean tissue associated with chemotherapy regimens. In general, most women, unless they strength train, will have below-average upper-body strength even before they commence treatment. In addition, mastectomy and lymphadenectomy (removal of lymph nodes) surgeries involve cutting through muscle. On days when your client feels unwell, manipulate variables that will not interfere with strength development—for example, rest periods between sets, exercise position (i.e., sitting instead of standing) and, if necessary, reps. Do not reduce exercise load unless absolutely necessary.
  • Plan Your Sessions, But Be Prepared to Rework the Plan. Women undergoing treatment will have good days and bad days, and exercise intensity and duration need to be adjusted accordingly. With this in mind, have your client do more cardiovascular and strength work on good days. On bad days, spend time focusing on flexibility training and ROM improvements in the shoulder, neck and scapular musculature—areas of the body most impacted by breast cancer surgery.
  • Take Time to Rest. Communicate the importance of rest as part of the fitness program. Explain that exercise adaptations occur during the recovery period following workouts, not during the actual exercise sessions.