Returning to exercise

Were you fit before being treated for breast cancer and wondered if you’d ever regain that fitness again? Dunedin woman Kirstin Mills wondered just that after she underwent treatment.
Words: Kirstin Mills

She spoke to two medical professionals, Dr Simone Petrich, surgeon from Dunedin Hospital and breast surgeon, Dr Belinda Scott of Breast Associates about treatment and exercise, and two women (Vinnie and Judith) who have made their endurance sport comebacks after breast cancer.
Exercising following surgery
Your immune system takes a hit during surgery, both from the anaesthetic and trauma to tissue, and Belinda’s advice is it is important to rest for two weeks before gradually introducing exercise. This is to avoid the chance of post-op bleeding, infection, increased blood pressure and bruising.
“You’ve had tissue breakdown so the body has to then repair any damage and you do lose some blood in surgery so you have fewer red blood cells around the body to use for repair. It’s a very busy time for the body.”
Belinda says women need to heal and gain strength to deal with other treatments like chemo and radiotherapy.
Chemotherapy?
Chemotherapy drugs are toxic and indiscriminate - they destroy cancer cells, but also affect your immune system.
“So you’ve basically got very little support structures if you get sick,” says Belinda.
It is important not to swim in public pools where bugs are notorious.
Simone reports that American Cancer Society (ACS) guidelines state that anyone with anaemia caused by treatment should avoid exercise until it improves. People with indwelling catheters (such as a Hickman Line - not the more commonly used portacaths) should also be careful to avoid water or other microbial exposures that may result in infections.
Fatigue is a major side effect during and after chemo, but a review of studies in this area showed exercise is beneficial for women with fatigue, says Simone.
Some women develop peripheral neuropathies or ataxia from chemotherapy treatment which can reduce their ability to use the affected limbs because of weakness or loss of balance. For such women Simone suggests it is better to exercise on a stationary reclining bike, for example, than walking on a treadmill.
Belinda says exercising too much during chemotherapy can put a strain on your heart. “Your body is under a lot of strain with chemotherapy. If you put more strain on it you’ll get into trouble. Having said that, people can still go for 20 minute walks and do other things, but they’re certainly not advised to do anything greater while they are on chemotherapy.” Fortunately, your body recovers quickly once chemotherapy finishes, usually within two to three weeks. Of course by then you may have not been exercising for some time.
“If you’ve had six months off you need to take six months to get back into it again,” Belinda advises. “You’ve been through your own marathon - you do not need to put another marathon on top of it!”
Belinda mentions there is little information about getting back into endurance sport after chemotherapy and says it is a case of trial and error. “After chemotherapy give yourself a plan of exercise, but don’t overdo it - your body is very good at telling you. If you go for an hour’s walk and you come back and you’re absolutely stuffed the next day, you know you’ve done too much, so go for half an hour next time. You have to build up for any training for something like a marathon.”
Radiotherapy
Belinda says that during radiotherapy any increase in body heat (through exercise, for example) may cause chaffing. “The effects carry on for at least three months after the last rays.” People should look at the irradiated skin and make sure it is healed with no skin break down. Belinda suggests women get advice about exercising from people - such as Pink Pilates instructors - who understand the treatment.
Simone adds that women should avoid chlorine exposure to irradiated skin, so avoid swimming pools.
Hormonal treatments
Belinda explains weight gain is not a side effect of tamoxifen itself, although many women believe it is. She says it is probably caused by tamoxifen use starting when women’s other treatments have ceased - along with the formal and informal support they received during treatment. Coupled with the emotional ups and downs the drug may cause, many women find themselves eating more.
Belinda says the newer post-menopausal drugs, the aromatase inhibitors, are very good, but can cause joint pain. Simone adds that aromatase inhibitors (e.g. anastrozole, letrozole) can cause a loss in bone density (and osteoporosis for some women). “Physical exercise helps the joint pain. It is also recommended for the prevention of osteoporosis, so these are two good reasons for women undergoing this treatment to exercise.”
Why exercise?
Both surgeons are advocates of exercise after treatment and Simone says her most important message is that exercise is protective against breast cancer recurrence. She refers to numerous studies showing patients with early stage breast cancer who exercised regularly (e.g. the equivalent of walking at an average pace for three hours a week) had a significantly lower risk of breast cancer recurrence and may also enhance their survival from breast cancer. There is ongoing research investigating the benefits of exercise after a cancer diagnosis, including quality of life and potentially overall survival.
Women reducing their risk of recurrence!
Before getting breast cancer Vinnie Duncan had run a few marathons, and Judith Ansell was about to attempt her first half marathon. These are their stories about how they overcame the effects of treatment and a lack of fitness to make it to the starting line.
Vinnie Duncan – Ironman racing
Vinnie Duncan (47) of Auckland was given poor odds of surviving when she was diagnosed with breast cancer in April 2004. Three years later when she crossed the finish line at Ironman New Zealand (a race made up of a 3.8km swim, a 180km bike ride and a 42.2km marathon) she was “really flipping the bird at the Big C.”
During treatment it was an effort to just get to the letterbox. After treatment, including chemotherapy, surgery and Herceptin (then arimidex followed by tamoxifen) she felt shattered, unfit and was a different shape thanks to steroids and menopause. “I was breathless, sore, aching, tired and lethargic, with deep bone and muscle pain from the arimidex. I remember the first walk I went for being frightful. It never even occurred to me at that stage that I would ever feel normal enough again to exercise in a way that I had before cancer.”
She started off just being outside and then began walking, increasing distances and pace and then re-introducing running. “I got fit again slowly, in small and achievable stages.”
Her comeback race was the Rotorua Marathon. It was her slowest ever, but gave her an enormous feeling of accomplishment and gratitude that she was around to do it.
Then she decided to do her first Ironman. “Having been given a second chance, and with the constant awareness of your own mortality, I felt that opportunities needed to be grasped when they presented themselves.” She has since done five more Ironman-distance races and has no plans to stop any time soon.
Vinnie says she would struggle without exercise. “Without it I feel sluggish, tired, lethargic, and grumpy and also tend to put on weight very easily. With it I feel energised, motivated, can eat what I want, set and achieve goals, as well as provide a role model for the kids.”
Vinnie says if people have a dream they should just get out and do it. “It will make you feel better. I am just an average person, of average ability, but that doesn’t mean that it is any less of an accomplishment to go and do an event than the super talented athletes.”
Judith Ansell – running
Auckland woman, Judith Ansell was diagnosed in October 2008, aged 51, and after surgery and chemotherapy was keen to regain her fitness. Before diagnosis she was training for her first half marathon and was frustrated when she had to withdraw after getting so fit. “After the chemo I wasn’t sure if I was ever going to be able to get back there. Inside my head I really wanted to, but I just didn’t know how far I could push it.” The tamoxifen gave Judith sore joints but she found that, along with glucosamine and fish oil, exercise helps.
“And I think that was part of the incentive that really pushed me into thinking, ‘Okay, you need to see how far you can go. You need to actually just keep pushing through’. With the help of a personal trainer and guidance from Pink Pilates, Judith started training again after treatment, slowly at first due to low energy. She learned to manage fatigue - taking ‘pyjama days’ where she would stay in her PJs, a signal to herself and others she was resting.
She gradually started running again and when Pink Pilates’ Lou James invited her to take part in the Great Wall of China half marathon, as part of Team Run for Your Life that raised money for Pink Pilates and promoted awareness of breast cancer, Judith jumped at the chance. She ran her first half marathon in April, making the May half marathon in China her second.
Judith says fitness not only helps her do activities she enjoys like tramping, but is great for stress.
“All sorts of stressful stuff was going on yesterday. I went out and did a short, but reasonably hard, stair session in the afternoon and it just changed the way the day felt.”
She says surviving is not just about surviving treatment. “I actually want to live the rest of my life. I don’t want to be defined by breast cancer. There is a perception that surviving breast cancer is enough, but without wanting to sound greedy and ungrateful, it’s not. Breast cancer gave me more reason than ever to want to live my life.”