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The Breast Cancer Survivor's Fitness Plan
Reclaim Health, Regain Strength, Live Longer
By CAROLYN M. KAELIN, FRANCESCA COLTRERA, JOSIE GARDINER, JOY PROUTY
The McGraw-Hill Companies, Inc.Copyright © 2007President and Fellows of Harvard College
All rights reserved.
More than two million women living in the United States today have been treated for breast cancer, according to the American Cancer Society. Fortunately, we live at a time in medical history when increasingly sophisticated, lifesaving treatments are changing the course of this disease for hundreds of thousands of women. Just a handful of years ago, some of the most remarkable advances in surgery, radiation, and anticancer drugs were not yet widely available. Now, for most women, a breast cancer diagnosis may prove in hindsight to be a rough bump in the road, while the length of that road ultimately remains unchanged. For those living with metastatic breast cancer, an expanding list of treatments may be life-extending, also.
Yet whether breast cancer treatments have been tested over decades or emerge as new stars, they may take a heavy toll on a woman's body. "In barely a year, I've aged a decade," one breast cancer survivor succinctly reported, ticking off unwanted side effects of treatments that pile on pounds and weaken muscles and bones. Surgery to reconstruct the breast, which many women find life-enhancing, often presents additional challenges.
Now a growing body of research strongly suggests engaging in exercise reduces your risk for a recurrence and boosts the likelihood of living a longer, healthier life. What's more, a well-conceived, comprehensive exercise program can help you mini–mize or avoid many other concerns that arise after breast cancer treatments and reconstructive surgery.
No matter how uncomfortable or weak you might feel today, the simple, safe, and powerful program described in this book can help restore ease of movement and the strength and energy for daily tasks and pleasurable activities. Our goal is to enable you to rise to the joys and challenges each day brings. In essence, we hope to help you turn back the hands of a clock that spun forward far too quickly.
Laying the Foundation
Much of our program revolves around a series of progressive workouts. Yet safely and slowly stepping up your activities is only one part of your overall goal. Three other cornerstones of the program are a healthy diet, rest, and stress relief. What does this quartet have in common? Unlike so many aspects of breast cancer treatment, all four lie largely within your control. Together, they can significantly improve your health and the quality of your daily life. What's more, they can help you regain a sense of control over your own life that a cancer diagnosis so often undermines.
In the following sections, key facts and strategies are outlined. More in-depth information on paring off pounds, rebuilding muscle, and shoring up bones appears in Chapter 2.
In a nutshell, exercising regularly can help you:
Optimize longevity. Being active cuts down the likelihood of breast cancer recurrence and boosts the odds of living longer. The long-term Nurses' Health Study surveys more than 120,000 female registered nurses about lifestyle factors and chronic diseases every two years. In 2005, researchers reporting on data drawn from nearly 3,000 study participants diagnosed with breast cancer found that those who engaged in even modest physical activity (such as walking for three to five hours over the course of a week) lessened the likelihood of recurrence and improved survival when compared with those who were sedentary or less active.
Gain energy. One common concern stemming from breast cancer treatments is fatigue. Often, women report that their energy fluctuates day to day during treatment. Afterward, some women find energy returns fairly quickly, while others remain at low ebb for many months or longer. Slowly rebuilding endurance through easy cardiovascular exercise can help. According to the National Cancer Institute, some small, preliminary studies suggest that light to moderate walking or other activities may boost energy.
Improve mobility. Discomforts that stem from mastectomy, lumpectomy, or lymph node surgery, radiation, and reconstructive surgery sometimes may be quite long-lasting, as Clara Walton can attest. Ever since her mastectomy and reconstructive surgery, her limited range of motion—that is, how far and in what directions someone can comfortably extend her arms, let's say, or turn her body easily—has bothered her. Nine years into survivorship, she says, she still hasn't recovered entirely. On a scale of 1 to 10, with 10 being the movement she had before her treatment began, she rated her ability to move easily and comfortably the first year after her surgeries at 3 or 4. Now, she says, it's closer to a 6 or 7. "Range of motion is still a problem," she notes.
What causes this? Tightness created by scar tissue after surgery, radiation, moving muscle and tissue during reconstructive surgery, or simply disuse can limit your range of motion. Tightness also can lead to poor posture, which may contribute to other problems like an aching back. Over time, careful stretching expands a limited range of motion and helps release tightness.
Rebuild muscle and regain strength. Sarcopenia is a simultaneous loss of muscle and gain in fat tissue. Aging, inactivity, chemotherapy, menopause, and possibly other hormonal changes brought on by breast cancer treatments all may cause muscle to dwindle while fat tissue builds up. Typically, excess weight accumulates as well. Exercise helps pare off unwanted pounds and rebuild muscle. Tipping the fat-muscle ratio of your body more favorably in the direction of muscle helps reverse losses in muscle and gains in fat that frequently occur during chemotherapy. Fat cells release estrogen, which fuels some breast cancers, and excess weight is associated with higher mortality in women who have had breast cancer.
Moving muscles during reconstructive surgery—a latissimus dorsi flap, for example, uses a large back muscle to re-create the breast—affects strength. Your body is quite practical, however, and often can use other muscles to help compensate for those no longer in their original place. Strengthening the appropriate compensating muscles helps ensure that you will be able to perform simple tasks like closing the hatchback or trunk of a car or lifting heavy groceries and comfortably engage in enjoyable activities such as cross- country skiing or tennis. Strength training also addresses muscle imbalances, which affect posture in ways that can spell future pain.
Keep bones healthy. Research suggests that chemotherapy may speed bone loss in premenopausal women. In a Harvard study detailed in Chapter 2, researchers have found that within one year after beginning chemotherapy, particularly if chemotherapy induces premature menopause, a woman can lose 7 percent of the bone mass from her spine and 4 percent from her hips. For a woman going through natural menopause, this amount of bone loss usually takes five years to occur. Weight-bearing exercise, such as walking and strength training, coupled with calcium and vitamin D supplements as well as bone-saving medication, when appropriate, helps preserve bone.
Quell treatment-related nausea. Some research shows that exercise may lessen nausea during chemotherapy, which will certainly improve your quality of life.
Enhance appearance. Often, changes stemming from treatment undermine appearance and self-esteem. A 40-year-old woman undergoing chemotherapy commonly experiences a 2.5 percent increase in body fat in one year. That's the equivalent of what typically occurs ov
Excerpted from The Breast Cancer Survivor's Fitness Plan by CAROLYN M. KAELIN. Copyright © 2007 by President and Fellows of Harvard College. Excerpted by permission of The McGraw-Hill Companies, Inc..
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