The Role of Exercise in Breast Cancer Recovery

exerciseThe right exercise is a vital component of integrative oncology.  There are different limits, demands and benefits for the various types and stages of cancer treatment and recovery.  When exploring exercise, it is imperative to work with someone who has specific training in cancer exercise therapy and understands possible contraindications. As always, talk with your oncology provider before beginning any exercise program. The following article by Andrea Leonard speaks to those issues as they relate to breast cancer.

The most common issues that plague post-mastectomy patients are “round shoulder” syndrome  (rounded shoulders & forward head) and range of motion limitations in the shoulder on the side of the lymph node dissection, mastectomy site, and/or radiation site. As a result of these issues (mastectomy, lymph node dissection, and/or radiation), the chest muscles may become tight, shortened and spastic. This not only exacerbates the postural deviations, but may limit the ability of the patient to move their arm/shoulder in all of its various planes of motion (forward, backward, sideways, etc..). While this is a general statement, the majority of patients will present with these symptoms. This is compounded even more if the woman undergoes reconstructive surgery. Not only will it further exacerbate the rounded shoulders and forward head, it will create a muscle imbalance in the area of surgery, if either the rectus abdominis (abdominal muscles – “6 pack”) or latissimus muscle (largest muscles on the sides of the back) are used for reconstruction.

The most important factor in the safety and efficacy of the exercise program is the initial assessment. At the very least this should include a comprehensive postural assessment as well as shoulder range of motion measurements taken with a goniometer. The well-trained fitness professional will be able to deduce, from the results, which muscles need to be stretched and which need to be strengthened. By selecting the wrong combinations of exercises, the results may not only be undesirable, they may in fact be detrimental. For example, if a client presents with moderate to severe rounded shoulders and forward head, performing any kind of “pushing” exercise that would involve the chest muscles (chest press/push-ups), could make theses deviations even more pronounced by causing the chest muscles to tighten and contract. Instead, the goal need to be on stretching the chest wall and strengthening the opposing muscles in the back; particularly the muscles that stabilize the shoulders.

Prior to adding a load (resistance/weight) of any kind, the patient should have close to full range of motion through the particular plane of motion (forward, backward, sideways, etc.). Without correcting the range of motion first, the patient will reinforce the negative movement pattern by performing strength-training exercises throughout a limited pattern of movement. Therefore, initially the focus should be on range of motion exercises. These may include very basic exercises that the patient can do on their own; front wall walks, side wall walks, pendulum swings, and corner stretch, or stretching that can be executed with the assistance of a professional. The combination of both will increase the speed of improvement in most cases.

Once close to full range of motion is achieved, the emphasis can be on strength training. Not only will this help to correct the postural and range of motion deviations, it will help increase bone density and lean muscle mass. Many women will either be of menopausal age, or thrown into menopause from their cancer treatment. With estrogen no longer being produced, the risk of osteoporosis increases. To make things even more complicated, the long-term side effects of chemotherapy include osteoporosis, diabetes, and damage to the heart and lungs; all of which can be avoided or improved through proper exercise recommendations.

The last part of the equation is the risk of lymphedema of the affected arm/shoulder. Lymphedema is the swelling of the extremity following the removal of, or radiation to the lymph nodes on that side. Even if someone has undergone a sentinel node biopsy, and only had one node removed, they can still get lymphedema. Lymphedema is progressive if untreated and can be very painful and disfiguring. It can happen at ANY time after surgery; one hour or fifty years. The risk doesn’t increase or decrease with time, however a higher percentage of body fat, infection, age, and poor nutrition can all increase the risk once someone is at risk.

About the Author: Andrea Leonard

Andrea Leonard is a cancer survivor of 30 years. She founded The Cancer Exercise Training Institute (CETI) in response to a growing need to provide scientifically based, current information on exercise therapy as a critical component of cancer recovery.

CETI provides health and fitness professionals with comprehensive coursework on twenty-five types of cancer, their surgeries and treatments, breast reconstruction, upper and lower body lymphedema prevention, identification, and management, cancer pain and fatigue, and comprehensive fitness evaluations including postural assessment and goniometry. For more information, please visit:

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