Thriving after Breast Cancer: Essential Healing Exercises for Body and Mind

By choosing this program you are honoring the needs of your body and making a commitment to the quality of your life. You have chosen to thrive. I salute you and I support you. I want you to have the safest and most pleasurable experience possible when you participate in the Focus on Healing exercise program.

As breast cancer survivors, we have unique needs and concerns. Some of these are physical and some are emotional. But none are a reason to avoid exercise. In fact, regular exercise can help with everything you feel and do. It can make you stronger and more flexible. It can relieve tension, elevate your mood, and give you a chance to celebrate and express your femininity. However, you must take your individual needs into consideration and exercise with care.

Your physiology has been changed by the type and extent of the surgery you have undergone. Lumpectomy, mastectomy, node dissection, and reconstruction all leave permanent imprints. Furthermore, your body may also be processing the radiation or chemotherapy that you received to treat your cancer. Perhaps it has been years since your surgery and you've been relatively inactive, or you are at risk for lymphedema--swelling that results from blockage in the lymphatic vessels--or have other health concerns. For these reasons it may be important to have a conversation with your doctor before you begin this or any other exercise program.

If you are a recent survivor, you may begin doing the Focus on Healing exercises as soon as your surgical drain is removed with the approval of your doctor. The surgical drain is a tube the size of a drinking straw that's inserted into your side a few inches below the armpit to siphon off excess lymphatic fluid. It has a bulb on the bottom. Sometimes you get two of them, the second being placed in the chest wall. A drain is kept in the body anywhere from three days to a week on average, until your body makes an adjustment.

Many surgeons have their patients begin doing simple arm movements during early recovery. These are extremely gentle and safe, as are the Focus on Healing exercises. Still, I recommend waiting until the drain is removed so that no unexpected complications occur at the site of your drain incision. It is a sensitive time and it is critical that you give your body the time to heal properly.

ABOUT THE PROGRAM Focus on Healing was designed under the supervision of two gynecological surgeons, Marc Lebed, M.D., and Joel Lebed, D.O. Dr. Marc Lebed is currently the medical director of the program and ensures that it incorporates new advancements in medicine. The exercises are based on kinesiology (the science of movement), anatomy, and gentle ballet and jazz dance movements. Focus on Healing uses progressive patterns of passive and active arm movements to facilitate and improve your postoperative range of motion. It has been shown that these activities can also diminish your risk and incidence of lymphedema. In addition, lower-body exercises target muscles that enhance your posture and balance. The experience of doing the program is enjoyable and even sensual since it combines movement therapy with dance.

Focus on Healing works many important areas in your neck, shoulders, back, chest, torso, arms, hands, and fingers. The illustrations opposite identify the names of the muscles that are being used and receive benefits.

What kind of exercise should I do and what kind should I avoid? And when is the appropriate time for me to start exercising? Factors from your medical history that your physician will take into consideration include whether you are a recent or long-term survivor; whether you are currently undergoing chemo- or radiation therapy, your age, general health, and fitness; and whether you are a regular exerciser.

How high can I lift my arm? And when? Your range of motion dictates the nature of the activities in which you can participate. Full range of motion means that you can lift your arm all the way up and slightly behind your ear while holding it close to your head. You can restore your flexibility through regular stretching, even when you have the extreme condition known as frozen shoulder. As I will repeat throughout the book, you should never do a movement that causes you pain. In a few pages I will help you assess what this means.

What is my weight restriction? How much weight can I lift with my surgical arm? And when? During recovery from surgery you lose strength and muscle tone and gain scar tissue. Radiation also tends to shorten the strands of the muscles. To exercise safely, you must know your limitations. You do not want to tear scar tissue while you are in the process of rebuilding your strength and flexibility.

What is my risk of lymphedema? Anyone who has had a lumpectomy, a simple mastectomy, a modified radical mastectomy, or axillary node dissection (the surgical removal of lymph nodes from the armpit), often combined with radiation, may be at risk for lymphedema. These treatments can reduce the functioning of your lymph nodes. Lymphedema can involve swelling of your breast/chest, arm, hand, and fingers and is caused by lymphatic fluid from your immune system pooling in these places. The swelling can result in discomfort. You can develop lymphedema at any time after surgery, from immediately to a couple of months afterward, or even twenty years or more down the road.

If you feel indications such as tingling and a tightness or fullness in your fingers, hands, arms, or chest, you should seek your doctor's attention and ask for a referral to see a lymphedema specialist. Lymphedema is incurable, painful, and sometimes leads to complications. It is a sign that your immune system has been compromised. Skin redness and the rapid onset of swelling, discomfort, and/or fever are signs of a possible infection, which must be evaluated as soon as possible. A certified lymphedema therapist can be a physical therapist, an occupational therapist, or a massage therapist who has trained in complete decongestive therapy. The National Lymphedema Network provides suggestions to the public on choosing a lymphedema therapist. You can call, write, or e-mail them to receive the information (see Resources).

The National Lymphedema Network has developed a comprehensive list of eighteen steps to prevent and control lymphedema. You should ask your doctor or a lymphedema therapist to review and discuss the list with you. Regular gentle exercise stimulates circulation and reroutes fluid to healthy pathways. It is therefore a key component of successful management.

A CONVERSATION WITH YOUR PHYSICAL THERAPIST OR OCCUPATIONAL THERAPIST Particularly when you're starting a new form of exercise, it is often advisable to seek the guidance of a physical or occupational therapist to help you overcome your challenges and monitor your progress. As you work through the Focus on Healing program, these trained professionals will know how to address your unique clinical needs. Your physician can give you a referral to a specialist.

An appropriate therapist must have experience working with other breast cancer survivors and understand your risk for lymphedema. Do not go to anyone without experience in the field. Before choosing a physical or occupational therapist review the Eighteen Steps to Prevent Lymphedema with the therapist and make sure your concerns are understood. Also ask the therapist to have a conversation with your surgeon.

SETTING YOUR OWN PACE No one can know your body as well as you, therefore you must set your own pace. If you feel pain, stop at once. Pain is an indicator that you are doing too much. Don't listen to the old adage "no pain, no gain." Focus on Healing is not based on this bad advice. When you are doing the exercises in this book I want you to concentrate on feeling better than you already do, not worse.

Likewise, if you feel out of breath, take a rest for a few moments or call it a day. Work only to the point where you become fatigued, and no further. Then stop and rest. Should you go past the point of fatigue, you may end up feeling exhausted at the end of the program. Whereas if you stop before you become fatigued, you will likely feel more energized. You don't have to prove to anyone that you are Wonder Woman. The goal here is to make steady, confident progress.

Please be patient and gentle with yourself. I promise you, your strength and endurance can and will increase over time. The human body is amazing. When it is called upon to work it musters resources to make the movements possible. Then it keeps a muscular memory of how it adapted to the challenge. So as long as you keep moving your body on a regular basis, it will continue to perform at the peak of its abilities.

Part of the program is aerobic, which means that you will find yourself breathing harder and that your heart rate has speeded up. It is a good idea to ask your doctor, a trained physical therapist, or another exercise professional to help you determine your target heart rate. This is the number of heartbeats per minute that you should reach but not exceed, and it depends on your age, weight, and level of fitness. It is different for everyone. You should take your pulse at intervals during the workouts to check how you are doing.

To check your heart rate, place two fingers flat against the inside of your wrist (your radial pulse point) or in the groove under your jaw (your carotid pulse point). You will know you're in the right spot if you feel a slight throbbing. Count the pulses for ten seconds, and then multiply the number by six. This is your actual heart rate.

When your actual heart rate is higher than your target heart rate, you should slow down or take a rest for a moment. When it is lower, you have the option of working harder should you choose to do so. Other indications that you are working too hard include shortness of breath long after you stop exercising or feeling undue fatigue and soreness long after exercise.

HOW TO DRESS FOR WORKING OUT There are no special outfits required to do this program. All you need are loose-fitting clothes and comfortable shoes without heels. Even doing the exercises barefoot is okay.

If you have a prosthetic breast form, you should wear it during the workouts. In order to develop a strong sense of balance, it is important to exercise the same way that you walk around in your daily life. If you have lymphedema, you must wear your sleeve to help keep your swelling under control.

PREPARING YOUR ENVIRONMENT You will need enough room to spread out your arms in every direction (plus a foot or two more for good measure). For most women this is approximately a six-foot-by-six-foot area. You should remove any obstacles within this space that you could accidentally hit or collide with while you are practicing your routines. Double check by turning in a slow circle.

You may also need to eliminate distractions. Turn off the telephone and shut the door to the room, if that helps. Ask your family to respect the time you have allotted for stretching and moving. This should be "you" time, so program a half hour into your schedule.

SUPPLIES Whenever you need a special item for an exercise, I clearly list it. Here are some of the items you may wish to have handy:

* CHAIR: Depending on which exercise routine you are doing, you may need a supporting chair for balance. Seated exercises are also included in some of the workouts. A kitchen-type chair without arms is preferred.

* ELASTIC WORKOUT BAND: See "Building Strength" (p. 176) for comprehensive details.

* WATER: It is beneficial to drink water frequently during and after your workouts.

* TOWEL: You may want this for your comfort when you perspire.

* SOAP BUBBLES: These are optional in Basics 1 (p. 15).

MUSICAL SELECTIONS Music is an important component of the Focus on Healing program. For one thing, music will elevate your spirits. But being able to follow a rhythm also supports the movements.

For the Basic Warm-up, which prepares you to do every routine in the Focus on Healing program, it would be helpful to pick something slow and flowing, such as classical music or ballads. For the rest of your workout, choose something with a faster tempo. Music that has four main beats works best. Let it be music that makes you want to dance--whatever gets your toes and fingers tapping, head bobbing, or hips swinging. Varying your musical selections from time to time will help keep the program fresh.

The survivors and instructors from Focus on Healing classes throughout North America have given me a list of their favorite CDs and performers. Often they prepare their own song mixes for the program on a cassette tape or CD. These suggestions may guide you in your own selections.

SLOW MUSIC

* The Best of Doo Wop (Rhino)

* Michael Bolton, Love Songs

* Sarah Brightman, Time to Say Goodbye

* Down in the Delta (movie soundtrack)

* Fall (Telarc)

* Kenny G, Classics in the Key of G

* Herbie Hancock, Gershwin's World

* Frank Sinatra, Swinging Around the World

* Spring (Telarc)

* Barbra Streisand, Barbra Back to Broadway

* Summer (Telarc)

* Vangelis, Escapes

* Where the Heart Is (movie soundtrack)

* Winter (Telarc)

* Zamfir, Intemporal

FAST MUSIC

* Abba, More Abba Gold

* Lou Bega, Little Bit of Mambo

* Ray Charles, Visionary Soul

* The Conga Kings (Chesky Jazz)

* Dance with Me (movie soundtrack)

* Gloria Estefan, Gloria

* Fleetwood Mac, Greatest Hits

* Aretha Franklin, Love Songs

* "I Feel Pretty" (West Side Story cast recording)

* Tom Jones, The Complete Tom Jones

* Jennifer Lopez, On the 6

* Ricki Martin, Livin La Vida Loca

* Ricki Martin, Sound Loaded

* Mary Mary, Thankful

* Dolly Parton, Nine to Five and Odd Jobs

* Santana, Supernatural

* Saturday Night Fever (movie soundtrack)

* Donna Summers, Alive and More

* Swing (cast recording)

* Manhattan Transfer, The Swing

* VH-1 Divas Live '99 (BMG/Arista)

CHOOSING THE RIGHT WORKOUT Now you are ready to begin the Focus on Healing exercises. Start with the Basic Warm-up in the next section. The Basic Warm-up is the first thing you should do every time you exercise, whether you are still in treatment or a long-term survivor. It gently establishes your breathing pattern and increases your circulation.

Then choose a full-length workout program that fits your special needs from Part Two, "Adjusting to the Needs of Your New Body," or do the full-length program from Part Three, "The Ultimate Movements." It's a good idea to stick with the same program for as many days or weeks as it takes to perform it successfully. Above each of the programs there is detailed information to help you determine when that program is suitable for you and what you need to keep in mind as you do it.