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Ask The ExpertWelcome to our "ASK THE EXPERT Series" for breast cancer now what
On a regular basis a leading oncology expert will be available to answer questions during a real time Special Guest Chat session. After the chat hour, the transcript of the chat is placed in the breast cancer now what discussion board for members to read if not able to attend. Our expert will take that transcript and create a response article like this one below. Check out past topics posted in the Ask the Expert Achives.
Physical Activity and Breast Cancer
Is weight lifting okay if I have arm swelling lymphedema?A new study confirms what British Columbia researchers and dragonboaters have been long suggesting; that weight lifting for women with lymphedema is not to be avoided, but encouraged. The study of female breast cancer survivors with lymphedema, found that slowly progressed weight lifting did not increase limb swelling and resulted in fewer women with worse lymphedema1.
The new findings are important because following surgery for breast cancer, women have commonly been advised to avoid lifting anything over five pounds and to avoid vigorous, repetitive arm movements to reduce the risk of developing lymphedema or worsening lymphedema. This advice meant that women often stopped doing activities they enjoyed, had to change their job related and household duties, and missed out on the health benefits of physical activity.
This latest study is the first study large enough to rigorously test the safety of weight lifting in breast cancer survivors with lymphedema. 141 breast cancer survivors with lymphedema were recruited to participate in the study and were randomly assigned to either a 12-month weight lifting program or to maintain their usual lifestyle. For the first 13 weeks, those in the exercise group had two 90-minute sessions per week supervised by a fitness professional at a local community fitness centre. This provided time for participants to learn the correct techniques for each exercise and also how to progress the weight (or "resistance") and number of times to lift the weight (or "repetitions") safely. Then the exercise group was asked to continue the sessions on their own at the fitness centres for the remainder of the year. The control group was offered a 12-month fitness centre membership and 13-weeks of supervised instruction once the study was completed. Participants' arms were measured monthly, and those in the exercise group wore custom sleeves for all exercise sessions.
Not surprisingly, the exercise group got stronger, but in addition, fewer exercisers had lymphedema flare-ups or exacerbations; 14% compared to 29% in the control group. Those in the control group also had more treatment sessions for these exacerbations (195 versus 77 in the exercise group). Overall, there was no difference in arm swelling between the women who exercised or women who were in the control group.
The study, suggests that breast cancer survivors should not rush into weight training, as that could trigger problems, but should:
1. Have a certified fitness professional, preferably with experience working with breast cancer survivors, teach you to do the exercise 2. Start slow, with a program that progresses gradually (starting as low as 1 pound weights) 3. Wear a well-fitting compression garment during workouts Another part of the study was to look at whether weight lifting can reduce the risk of developing lymphedema in the first place and results are expected soon. The effect of exercise on leg lymphedema still needs to be researched. Also, BC now has the BC Lymphedema Association, a newly formed organization, comprised of people living with lymphedema, caregivers, therapists and a medical advisory team. The organization's website has general public information, as well as, additional content for members. Information on lymphedema is also available from the BC Cancer Agency website. Does physical activity level affect cancer recurrence?Some research suggests that many women tend to decrease their usual physical activity at the time of breast cancer diagnosis and often never get back to their pre-diagnosis physical activity levels. Physical activity has numerous health benefits, such as reducing risk of heart disease, type II diabetes and diabetes. The worry is that breast cancer survivors are therefore, at higher risk for these chronic diseases if they are not meeting physical activity guidelines. Therefore, physical activity is important for everyone's health, breast cancer diagnosis or not.
Emerging research now suggests that being physically active after a breast cancer diagnosis may reduce the risk of dying from breast cancer. This is the result of a small number of only five studies which relied on observational data. In these studies women were asked to self-report their usual leisure time physical activity and then were followed over time; a method which can have some limitations. In general, however the studies show a reduced risk of dying due to breast cancer and also a reduced risk of dying of any cause during the duration of study follow up (usually 5-10 years). There is less evidence for the role of physical activity in reducing the risk of a breast cancer recurrence. The majority of studies have found no association with recurrence.
Why would physical activity impact the risk of recurrence or dying from breast cancer? The suggestion is that physical activity may help by reducing exposure to hormones that may be linked to breast cancer and improving the immune system. But future research is needed to better understand the biological link. Furthermore, all the studies have used self-report physical activity which is difficult to measure so future studies that have a more objective measure of physical activity, such as a step counter, are needed.
The overall message, is that being physically active can help you to be healthy, reduce your risk of many chronic diseases, and may help to improve your risk of dying related to breast cancer, but more research is needed.
How much physical activity should I do?This will differ by whether you have still having treatment (i.e., chemotherapy and radiation) or not. During treatment and just following treatment fatigue is common. The research shows that being physically active during treatment can help to reduce fatigue but it can sometimes be difficult to be active. The best thing to do is to be as active as you can, such as a daily walk, and pick a time of day to be active when you feel that you have more energy. Being inactive reduces your fitness level and this can make some of your usual activities seem more difficult and tiring, so you may be less inclined to do them and you get into a vicious cycle. Therefore, if fatigue is an issue, even a little physical activity can help to prevent or lessen this deconditioning and feelings of fatigue. However, there are also medical causes for fatigue, such as low levels of red blood cells in your blood, so if fatigue is an issue for you, speak to your health care provider.
The American Cancer Society (ACS) guidelines for physical activity after treatment suggest that all survivors achieve at least 30 minutes per day of moderate to vigorous activity on 5 or more days per week, and that 45-60 minutes of intentional activity may be preferable. Information on physical activity following cancer diagnosis from the American Cancer Society - please click here.
Examples of moderate intensity activity (I can talk while I do them, but I can't sing) are brisk walking (like you have an appointment to go to), biking on level ground, and doubles tennis. Examples of vigorous activity (I can only say a few words without stopping to catch my breath) are things like walking or hiking up a hill, jogging, fast dancing, and swimming laps. You can also think about breaking physical activity into 10 minutes blocks, 3 times per day to achieve 30 minutes of activity, for example a brisk 10 minute walk after breakfast, lunch and dinner.
Some people should check with their doctor before they start being more physically active. Please click here for more information:
For more examples of moderate or vigorous physical activity and how to get started, check out the Canada's Physical Activity Guide.
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