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Breast Cancer Survivor

Breast Cancer and Exercise

The most common issues that plague post-mastectomy patients are upper-crossed syndrome and range of motion limitations in the affected shoulder. Upper cross syndrome is the combination of protracted (rounded) shoulders, forward head, cervical lordosis, winged-scapula, and thoracic kyphosis. As a result of these postural deviations, 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 through flexion, extension, abduction, and external rotation. 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 with it further exacerbate upper-crossed syndrome, it will create a muscle imbalance in the area of surgery, if either the rectus abdominis or latissimus muscle are used for reconstruction.

a trainer helping a senior woman doing fitnessThe 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 upper-crossed syndrome, performing any kind of “pushing” exercise that would involve the chest muscles (chest press), could make the syndrome even more pronounced by causing the pectoral 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 scapular stabilizers.

Prior to adding a load (resistance) of any kind, the patient should have close to full range of motion through the particular plane of motion. 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 active isolated 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. In my sixteen years of working with cancer patients, I would say this is the number one “overlooked” issue amongst cancer patients. More often than not, they will not even be told about lymphedema. Following lymph node dissection and/or radiation, the lymphatic pathways do not operate with the same efficacy that they did previously. Therefore, we no longer know what the individuals exercise threshold is. It is critical to START and PROGRESS SLOWLY. This allows for a gradual increase in frequency, intensity, and duration of the exercise program. If at any point there is swelling, the patient should be advised to stop exercising and see their doctor immediately to determine if, in fact, they do have the onset of lymphedema. They should come back with a medical clearance form and the exercise instructor should take a step back with the frequency, intensity, and duration to the point prior to the onset of swelling.

Putting all of these pieces together is very much like solving a mathematical equation. If you are missing any of the information, you will never solve the problem. A typical exercise session should begin with cardiovascular exercise. This too should be gradually increased at a rate that the client is comfortable with and their body responds favorably to. They should stay well-hydrated, they should not wear tight-fitting or restrictive clothing on their upper body, and they should not overheat (all of these factors can increase the risk of lymphedema). Following the warm-up they should be instructed to do a series of lymph drainage exercise to open up the lymphatic pathways and prepare the body for exercise. I reference these exercises in CETI’s Cancer Exercise Specialist Handbook and Breast Cancer Recovery with the BOSU® Balance Trainer Book.

Meta Slider - HTML Overlay - Women wearing pink tops and ribbons for breast cancer on white backgroundFollowing the warm-up and lymph drainage exercises, the exercise specialist should determine what the areas of “need” are for the client. Remember to begin with stretching and range of motion exercises until they have close to “normal” range of motion. At that point the goal becomes strength training and choosing exercises that will strengthen the weaker muscles and stretch the tight and shortened muscles. Weight/resistance should also be very gradually increased and attention paid to any potential swelling of the extremity. Typically I chose exercises that will stretch the chest (chest fly, corner or door stretch, assisted stretching) and will strengthen the back (low/high rows, reverse flies, lat pulldown). They often [present with winged scapula following a node dissection. If this is the case, I will incorporate exercises that will strengthen the serratus anterior. If they have undergone an abdominal TRAM procedure, core work will be of the greatest importance in preventing, or minimizing, low back pain.

Because every muscle in the body works synergistically, an imbalance in the shoulder can lead to a multitude of imbalances from the hips to the knees to the ankles etc… Choose your exercises carefully. Put emphasis on the areas of need. This is not and can never be a cookie-cutter workout. No two breast cancer patients are the same. Not only are you taking into consideration their surgery, reconstruction, and treatment, you have to also factor in the remainder of their health history and any additional orthopedic concerns. I urge anyone who wants to work with cancer patients to undergo specialized training. It is very complex and the untrained professional can end up doing more harm than good.


Andrea Leonard is the Founder and President of the Cancer Exercise Training Institute. She is a certified as a corrective exercise specialist by The National Academy of Sports Medicine (NASM), as a personal trainer by The American College of Sports Medicine (ACSM), the National Academy of Sports Medicine (NASM), the American Council on Exercise (ACE), and as a Special Populations Expert by The Cooper Institute. She is also a continuing education provider for the National Academy of Sports Medicine and The American Council on Exercise.

 

Exercising woman

Lymphedema: Personal Trainer Perspective

Cancer surgery and treatment often results in survivors suffering debilitating physical impairments. These can often be ameliorated by a good exercise program that has the added benefit of helping survivors to engage in those activities in which they participated prior to their diagnosis. This article addresses some of the physical side effects cancer survivors may face, including lymphedema and a series of safe and effective techniques to restore functional fitness for those with or at risk for lymphedema.

feel better

Surgery, chemotherapy, radiation, and hormonal therapy have side effects, which exacerbate the problems faced by cancer patients. Surgery can create adhesions that can limit range of motion, and cause pain, numbness and tightness. Removal of lymph nodes creates scars and may decrease range of motion. Radiation can cause fatigue, tightness and stiffness. It also can increase the risk of developing lymphedema. Chemotherapy may affect balance, a patient’s immune system, and cause neuropathy, fatigue, sarcopenia, and anemia. Hormonal therapy can cause joint pain and early menopause and the side effects associated with menopause.

Before beginning a cancer exercise program, a patient must receive medical clearance. A medical history, base line range of motion and girth measurements, and a general fitness assessment are taken. It is important to note that many exercises and movements may be contraindicated based on a person’s fitness assessment, medical conditions, and particular surgery. There are different exercises necessary for each type of reconstruction. For those who were active prior to surgery it is imperative to slowly work back up to the previous level of activity. It is not wise to go back to a gym and immediately continue with a pre-cancer exercise routine.

Research has shown that exercise is safe for cancer survivors, even those with or who are at risk for lymphedema. Dr. Schmitz stresses the importance of starting slowly and using proper form with a well trained certified professional. Her study demonstrates the importance of exercise after cancer with slow progressive improvement in order to decrease risk of lymphedema. The research shows that breast cancer survivors no longer have to give up activities that they enjoy doing and avoid activities of daily living. Aerobic exercise is essential to good health and we advise a patient to walk as much as possible. Initially, one might start by walking around their house or up and down their block and then slowly increasing the distance walked. Many physicians recommend that their patients try to walk during chemotherapy. This may decrease fatigue. If using aerobic equipment, make sure not to grip on the railing.

Unfortunately, there is no way to know which patients with lymph node dissection will get lymphedema. This makes it imperative to follow the established guidelines and take a prudent approach to exercise. Patients who have lymphedema need to progress slowly and use a properly fitted garment. Our goal is to promote physical activity without exacerbating lymphedema. Severe range of motion issues and cording problems are referred to lymphedema specialists. Moreover, measurement of the limbs that are at risk for lymphedema are performed frequently to make sure they have not changed in size. Symptoms can be managed easier if they are addressed promptly. Progress is monitored in order to make appropriate modifications to a patient’s program. It is important to learn the right exercises for a patient’s particular situation and how to do them properly and with good form. The patient should learn which exercises to perform, the sequencing, and quantity of repetitions. Exercise smartly and under professional guidance!

Lymphedema can be debilitating and painful and can affect the emotional health of the patient. Our bodies work better if engaged in regular physical activity, but it must be done in a safe manner if lymph nodes have been removed or radiated. A cancer fitness program for someone with lymphedema should begin as an individualized program. The patient must be supervised to make sure there are no subtle volume changes to the limb. Ultimately, we want a patient to be able to exercise on his or her own.

The starting point is a low impact exercise program, performing range of motion stretches and techniques to improve venous drainage. First, we elevate the affected area above heart level. Over time, stretches are incorporated until a patient can achieve 80% of range of motion. At that point, we start adding strength training. A stretching program for those with upper body lymphedema begins with moving or stretching the neck and shoulder areas. If a patient is still healing from breast cancer surgery, begin with pendulum arm swings. The arm is then moved and stretched in all directions, going across the chest and behind the head and back. Stretches that move the arms in shoulder flexion, extension, abduction, and adduction are added. Finally internal and external rotations are addressed. Patients suffering from fatigue can perform many of the stretches while in bed. An easy-to-follow DVD is Recovery Fitness Simple Stretching, which can be found on www.recoveryfitness.net.

All of the exercises incorporate abdominal breathing, which can stimulate lymphatic drainage. This intra-abdominal pressure may help move sluggish lymph fluid, stimulate lymph flow, and act as a lymphatic system pump. This type of breathing enables oxygen to get to the tissues. Abdominal breathing and relaxation breathing, along with the proper exercises can also reduce stress, a common cancer side effect. If weak, it may be best just to stretch and breathe deeply.

Strength training may help pump the lymph fluid away from the affected limb. Exercise helps the lymphatic fluid to April / June 2013 ~ NATIONAL LYMPHEDEMA NETWORK 13 move. Muscles pump and push the lymph fluid and can help move the lymph from the affected area. Strength training may also strengthen the arm so that it can handle those activities that may have otherwise led to swelling with a greater level of ease. Always wear a sleeve and stop if there is swelling or pain. Start with light weights and slowly increase repetitions and eventually weight.

Cancer survivors should follow a systematic and progressive plan. Exercise starts with a warm-up and cool down. Begin with deep breathing. Keeping a strong core should be emphasized. It is important to remember that following treatment the body may have become weaker. Even if a patient had exercised using 10 pound weights before surgery, if one is at risk for lymphedema they must start with a light weight. We teach patients to always listen to their bodies and to stop if they feel tired or if their limb aches or feels heavy. Patients must be aware of any changes in their body.

Exercising womanProgression of exercise should be gradual. A deconditioned person should start without using any weight and concentrate on proper technique. If 8-10 repetitions can not be executed, repetitions should be decreased or the weight lowered or resistance band used changed to less resistance. The exercise routines have to be adapted for the day-to-day changes that that can affect the ability to work out. Our program will start using a very light weight, with few repetitions, typically 10. In subsequent sessions, patients can add repetitions. After performing 2 sets of 10 repetitions with no problem then a small amount of weight may be added in 1 pound increments. We also alternate between a strength training exercises with a stretch for each muscle group and to alternate an upper body and lower body exercises. Pilates exercises are great way to incorporate deep breathing with strengthening the core. The deep breathing helps to pump lymphatic fluid and will also help reduce stress.

Every patient is unique. Many patients have pre-existing medical issues. The exercise program should be modified to accommodate all body types and needs. Some might need pillows for comport or postural problems. Also if osteoporosis is an issue, a cancer therapist should have experience working with this population. Always monitor the affected limb. Look for feelings of fullness or aching. We do not want to overwhelm the lymphatic system. Drink plenty of water and stop immediately if any pain. Lymphedema patients should elevate their limbs after a session.

Learn which aerobic exercises are considered safe. Walking, biking, and swimming are considered very safe. Hot tubs, pools, and warm lakes may increase risk of infection. In choosing an activity, consider the risk of injury, prior medical condition, and fitness level. Injuries can create further complications for those with lymphedema. It is still unclear whether certain sports can be safe. For example, tennis can put a lot of stress or repetitive activity on one’s limbs. It is important to know if the activity was something performed prior to lymphedema. If the patient wants to resume the activity in order to exercise, have fun, and to have good quality of life, a sports fitness program can be instituted. This should be performed under medical guidance. In a sports fitness program, the muscles used in the sport are progressively strengthened so that the sport can be resumed. Patients must use caution as they return to a sport.

One of the most important things that can be done to decrease the risk of lymphedema is to keep weight at a good level. Those individuals with whom I have worked who have had lymphedema typically see a marked reduction of swelling in conjunction with weight loss. My students who are successful in losing weight have the most success in lymphedema control. Proper nutrition is important and decrease salt intake. Evidence suggests numerous benefits of exercise: improved fitness level, physical performance, quality of life, and less depression and fatigue. Exercise is part of a healthy lifestyle and will help in weight control and emotional health. There are exercise programs that are targeted at cancer survivors but not all of them will meet the needs of someone at risk for lymphedema.

My goal is for cancer survivors to participate in individually structured and group exercise programs at all cancer centers or facilities close to their homes.

Article reprinted with permission from Carole J. Michaels.


Carol J. Michaels is the founder and creator of Recovery Fitness® LLC, located in Short Hills, New Jersey. Her programs are designed to help cancer survivors in recovery through exercise programs. Carol, an award winning fitness and exercise specialist, has over 17 years of experience as a fitness professional and as a cancer exercise specialist.

beans-legumes

How fiber-rich foods protect against breast cancer

Breast cancer —  two words that strike fear in every woman.  The good news is women can help lessen their risk.  One important defense is to consume a high fiber diet.

A 2011 meta-analysis of 10 scientific studies found that higher fiber intake is associated with lower risk of breast cancer.1 In 2012, another meta-analysis of 16 studies came to the same conclusion.2 In the Nurses’ Health Study, higher fiber intake during childhood and adolescence was linked to a decrease in the risk of breast cancer in adulthood.3

How fiber impacts breast cancer risk

Given that animal products, refined grains, sugars and oils contain little or no fiber, fiber intake is a marker for greater intake of natural plant foods, many of which are known to have a variety of anti-cancer phytochemicals. Some breast cancer protective substances that have already been discovered include isothiocyanates from cruciferous vegetables4, organosulfur compounds from onions and garlic,5 aromatase inhibitors from mushrooms,6 flavonoids from berries,7,8 lignans from flax, chia and sesame seeds,9 and inositol pentakisphosphate (an angiogenesis inhibitor) from beans.10

Influence of fiber, glucose, insulin on breast cancer

High-fiber foods help to slow emptying of the stomach and absorption of sugars, which decreases the after-meal elevation in glucose. This is meaningful because elevated glucose levels lead to elevated insulin levels, which can send pro-cancer growth signals throughout the body, for example via insulin-like growth factor 1 (IGF-1).11 As such, high dietary glycemic index and glycemic load (characteristic of refined grains and processed foods) are associated with an increase in breast cancer risk.12-14  Accordingly, a study on Korean women found that higher white rice intake was associated with higher breast cancer risk.15

Fiber, estrogen, and breast cancer

Increased exposure to estrogen is known to increase breast cancer risk.16-18 A woman may be exposed to estrogen via her ovaries’ own production, estrogen production by excess fat tissue, or environmental sources such as endocrine-disrupting chemicals (like BPA, a chemical added to many consumer products). Fiber can reduce circulating estrogen levels, thereby reducing breast cancer risk, because it helps to remove excess estrogen from the body via the digestive tract. Fiber binds up estrogen in the digestive tract, accelerates its removal, and prevents it from being reabsorbed into the body.19-21

In addition, soluble fiber (as shown in studies using prunes and flaxseed) seems to alter estrogen metabolism so that a less dangerous form of estrogen is produced, whereas insoluble fiber (wheat bran) did not have the same effect. 22,23  For this reason, beans, oats, chia seeds and flaxseeds may provide some extra protection due to their high soluble fiber content.

Foods rich in fiber

Although most people probably just associate whole grains with fiber, beans contain more fiber than whole grains, and vegetables and fruits (and some seeds) contain comparable amounts – here are a few examples:

  • 1 cup cooked quinoa – 5 grams fiber
  • 1 cup cooked brown rice – 4 grams fiber
  • 1 cup cooked kidney beans – 11 grams fiber
  • 1 cup cooked broccoli – 6 grams fiber
  • 1 cup blueberries – 4 grams fiber
  • 1 tablespoon chia seeds – 6 grams fiber

Overall benefits of fiber: promotes weight loss and digestive health

Fiber, by definition, is resistant to digestion in the human small intestine. This means that during the digestive process, fiber arrives at the large intestine still intact. Fiber takes up space in the stomach but does not provide absorbable calories, and it also slows the emptying of the stomach.24 These properties of fiber make meals more satiating, slow the rise in blood glucose after eating and promote weight loss. In the colon, fiber adds bulk and accelerates movement, factors that are beneficial for colon health. Soluble fiber (primarily from legumes and oats) is effective at removing cholesterol via the digestive tract, resulting in lower blood cholesterol levels. Some types of fiber are fermented by intestinal bacteria. The fermentation products, short-chain fatty acids (SCFA) such as butyrate and propionate, have anti-cancer effects in the colon and also serve as energy sources for colonic cells. These SCFA are also thought to contribute to promoting insulin sensitivity and a healthy weight.25,26

Fermentable fiber also acts as a prebiotic in the colon, promoting the growth of beneficial bacteria. Fiber intake is associated with a multitude of health benefits, including healthy blood pressure levels and reduced risk of diabetes, heart disease and some cancers.24,27

Importance of choosing high-fiber and high-nutrient foods

Yes, fiber itself has some breast cancer-protective properties, like limiting glycemic effects of foods and assisting in estrogen removal, but we get optimal protection when we focus on foods that are both rich in fiber and rich in micronutrients and phytochemicals.

G-BOMBS contain fiber along with numerous anti-cancer phytochemicals, however, green (cruciferous) vegetables, mushrooms, flax and chia seeds in particular contain anti-estrogenic substances in addition to fiber, making them more effective breast cancer fighters than whole grains. Remember, beans are higher in fiber (and resistant starch) and lower in glycemic load than whole grains, making beans a better carbohydrate choice.

A Nutritarian diet is designed to include a full portfolio of the most protective foods to prevent cancer and slow the aging process.  Advances in nutritional science make winning the war against cancer a reality in our lifetime.

Dr. Fuhrman has created a Breast Cancer Lecture Series that Will Help Educate On How to Avoid Breast Cancer Through the Power of Nutrition. CLICK HERE to rent or buy!

Originally printed on DrFuhrman.com. Reprinted with permission.


Joel Fuhrman, M.D. is a board-certified family physician, six-time New York Times bestselling author and internationally recognized expert on nutrition and natural healing, who specializes in preventing and reversing disease through nutritional methods. Dr. Fuhrman coined the term “Nutritarian” to describe his longevity-promoting, nutrient dense, plant-rich eating style.

References:
  1. Dong JY, He K, Wang P, et al. Dietary fiber intake and risk of breast cancer: a meta-analysis of prospective cohort studies. Am J Clin Nutr 2011.
  2. Aune D, Chan DS, Greenwood DC, et al. Dietary fiber and breast cancer risk: a systematic review and meta-analysis of prospective studies. Ann Oncol 2012.
  3. Farvid MS, Eliassen AH, Cho E, et al. Dietary Fiber Intake in Young Adults and Breast Cancer Risk. Pediatrics 2016, 137:1-11.
  4. Liu X, Lv K. Cruciferous vegetables intake is inversely associated with risk of breast cancer: A meta-analysis. Breast 2012.
  5. Powolny A, Singh S. Multitargeted prevention and therapy of cancer by diallyl trisulfide and related Allium vegetable-derived organosulfur compounds. Cancer Lett 2008, 269:305-314.
  6. Chen S, Oh SR, Phung S, et al. Anti-aromatase activity of phytochemicals in white button mushrooms (Agaricus bisporus). Cancer Res 2006, 66:12026-12034.
  7. Stoner GD. Foodstuffs for preventing cancer: the preclinical and clinical development of berries. Cancer Prev Res (Phila) 2009, 2:187-194.
  8. Kristo AS, Klimis-Zacas D, Sikalidis AK. Protective Role of Dietary Berries in Cancer. Antioxidants (Basel) 2016, 5.
  9. Bergman Jungestrom M, Thompson LU, Dabrosin C. Flaxseed and its lignans inhibit estradiol-induced growth, angiogenesis, and secretion of vascular endothelial growth factor in human breast cancer xenografts in vivo. Clin Cancer Res 2007, 13:1061-1067.
  10. Maffucci T, Piccolo E, Cumashi A, et al. Inhibition of the phosphatidylinositol 3-kinase/Akt pathway by inositol pentakisphosphate results in antiangiogenic and antitumor effects. Cancer Res 2005, 65:8339-8349.
  11. Gallagher EJ, LeRoith D. The proliferating role of insulin and insulin-like growth factors in cancer. Trends Endocrinol Metab 2010, 21:610-618.
  12. Dong JY, Qin LQ. Dietary glycemic index, glycemic load, and risk of breast cancer: meta-analysis of prospective cohort studies. Breast Cancer Res Treat 2011, 126:287-294.
  13. Romieu I, Ferrari P, Rinaldi S, et al. Dietary glycemic index and glycemic load and breast cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC). Am J Clin Nutr 2012, 96:345-355.
  14. Sieri S, Pala V, Brighenti F, et al. High glycemic diet and breast cancer occurrence in the Italian EPIC cohort. Nutrition, metabolism, and cardiovascular diseases : NMCD 2012.
  15. Yun SH, Kim K, Nam SJ, et al. The association of carbohydrate intake, glycemic load, glycemic index, and selected rice foods with breast cancer risk: a case-control study in South Korea. Asia Pac J Clin Nutr 2010, 19:383-392.
  16. Hankinson SE, Eliassen AH. Endogenous estrogen, testosterone and progesterone levels in relation to breast cancer risk. J Steroid Biochem Mol Biol 2007, 106:24-30.
  17. Pike MC, Pearce CL, Wu AH. Prevention of cancers of the breast, endometrium and ovary. Oncogene 2004, 23:6379-6391.
  18. Bernstein L, Ross RK. Endogenous hormones and breast cancer risk. Epidemiol Rev 1993, 15:48-65.
  19. Aubertin-Leheudre M, Gorbach S, Woods M, et al. Fat/fiber intakes and sex hormones in healthy premenopausal women in USA. J Steroid Biochem Mol Biol 2008, 112:32-39.
  20. Aubertin-Leheudre M, Hamalainen E, Adlercreutz H. Diets and hormonal levels in postmenopausal women with or without breast cancer. Nutr Cancer 2011, 63:514-524.
  21. Goldin BR, Adlercreutz H, Gorbach SL, et al. Estrogen excretion patterns and plasma levels in vegetarian and omnivorous women. N Engl J Med 1982, 307:1542-1547.
  22. Haggans CJ, Travelli EJ, Thomas W, et al. The effect of flaxseed and wheat bran consumption on urinary estrogen metabolites in premenopausal women. Cancer Epidemiol Biomarkers Prev 2000, 9:719-725.
  23. Kasim-Karakas SE, Almario RU, Gregory L, et al. Effects of prune consumption on the ratio of 2-hydroxyestrone to 16alpha-hydroxyestrone. Am J Clin Nutr 2002, 76:1422-1427.
  24. Higdon J, Drake VJ: Fiber. In An Evidence-based Approach to Phytochemicals and Other Dietary Factors New York: Thieme; 2013: 133-148
  25. Canfora EE, Jocken JW, Blaak EE. Short-chain fatty acids in control of body weight and insulin sensitivity. Nat Rev Endocrinol 2015, 11:577-591.
  26. Sonnenburg ED, Sonnenburg JL. Starving our microbial self: the deleterious consequences of a diet deficient in microbiota-accessible carbohydrates. Cell Metab 2014, 20:779-786.
  27. Carbohydrates. In Nutritional Sciences: From Fundamentals to Food. Edited by McGuire M, Beerman KA; 2013
Portrait of smiling women wearing pink for breast cancer in parkland

Training Cancer Survivors

Once a virtual death sentence, cancer today is a curable disease for many and a chronic illness for most. With continued advances in strategies to detect cancer early and treat it effectively along with the aging of the population, the number of individuals living years beyond a cancer diagnosis can be expected to continue to increase.

Approximately 15.5 million Americans in the United States are cancer survivors. By 2026 that number is expected to reach 20 million. Anyone who has been diagnosed with cancer, from the time of diagnosis through the rest of his or her life is considered a cancer survivor.  And while not all cancer survivors are older adults, many are simply because of the cumulative effect of years of lifestyle issues that are risk factors for their disease. Survivors less than or equal to 19 years old comprise 1% of the cancer survivor population, 6% of survivors are aged 20–39 years, 33% are aged 40–64 years and 60% (more than half) are aged greater than or equal to 65 years.

Breast cancer survivors are the largest constituent group within the overall population of cancer survivors (22%), followed by prostate cancer survivors (19%) and colorectal cancer survivors (11%) (3). Gynecological and other genitourinary cancers each account for 9% of cancer survivors, followed by hematological cancers and lymphoma (7%) and lung cancer (4%). Other cancer sites account for much smaller percentages and together are responsible for 19% of the total number of survivors. In terms of stratification by gender, more than two thirds (69%) of all female cancer survivors have a history of breast (41%), gynecological (17%) or colorectal (11%) cancer. For male survivors, two thirds (66%) have a history of prostate (39%), other genitourinary (such as testicular or renal) (14%) or colorectal (13%) cancer.

Not surprisingly, cancer survivors are often highly motivated to learn more about things like nutrition, supplements and herbal remedies, and exercise that might improve treatment outcomes and ultimately their survival and quality of life. For many of the most important nutrition and physical activity questions faced by cancer survivors, the scientific evidence comes only from observational and laboratory animal data, or unreliable reports from poorly designed clinical studies. Moreover, the findings from these studies are often contradictory. Very few controlled clinical trials have been done to test the impact of diet, nutritional supplements or nutritional complementary methods on cancer outcomes among cancer survivors.

In an effort to identify and evaluate the scientific evidence related to optimal nutrition and physical activity after the diagnosis of cancer, the American Cancer Society (ACS) convened a group of experts in nutrition, physical activity and cancer. The findings of this group guide healthcare providers, cancer survivors and their families through the mass of information and help them make informed choices related to diet and exercise.  The Expert Committee reviewed all of the scientific evidence and best clinical practices for different types of cancer and “graded” both the quality and certainty of the scientific evidence for factors affecting the most common cancers. As was already mentioned, there are few clear answers to many questions, a wide range of sources and often conflicting information. But, these experts agree that even when the scientific evidence is incomplete, reasonable conclusions can be made that can help to guide choices in the areas of nutrition and physical activity.

Physical activity may help cancer patients build up their physical condition; decrease the number of comorbid conditions (like heart disease and diabetes); reduce drug interactions; help cancer patients cope with treatment; restore good health; improve quality of life during and after treatment; and help cancer patients and survivors maintain independence as long as possible

Physical rehabilitation programs similar to those for cardiac rehabilitation may be effective in managing, controlling or preventing adverse medical and psychosocial outcomes manifested during cancer survivorship. For example, exercise programs are being developed as interventions to improve the physical functioning of persons who have problems with mobility as a result of therapy and are also being shown to be efficacious for weight control after breast cancer treatment, lessen the effects of chronic fatigue, improve quality of life, prevent or control osteoporosis as a result of premature menopause and prevent or control future or concurrent comorbidities.

Diet, weight and physical activity interventions carry tremendous potential to affect length and quality of survival in a positive manner and prevent or control morbidity associated with cancer or its treatment.

General Physical Activity Guidelines for Cancer Survivors

In general, physical activity is likely to be beneficial for most cancer survivors. Recommendations on the type, frequency, duration and intensity of exercise should be individualized to the survivor’s age, previous fitness activities, type of cancer, stage of treatment, type of therapy, and comorbid conditions.

Particular issues for cancer survivors may affect or contraindicate their ability to exercise. Effects of their cancer treatment may also promote the risk for exercise-related injuries and other adverse effects.

The following specific precautions are from the American Cancer Society:

  • Survivors with severe anemia should delay exercise, other than activities of daily living, until the anemia is improved.
  • Survivors with compromised immune function should avoid public gyms and other public places until their white blood cell counts return to safe levels.
  • Survivors who have completed a bone marrow transplant are usually advised to avoid exposure to public places with risk for microbial contamination, such as gyms, for 1 year after transplantation.
  • Survivors suffering from severe fatigue from their therapy may not feel up to an exercise program, so they may be encouraged to do 10 minutes of stretching exercises daily.
  • Survivors undergoing radiation should avoid chlorine exposure to irradiated skin (e.g., swimming pools and whirlpools).
  • Survivors with indwelling catheters should avoid water or other microbial exposures that may result in infections, as well as resistance training of muscles in the area of the catheter to avoid dislodgment.
  • Survivors with significant peripheral neuropathies may have a reduced ability to perform exercises that use the affected limbs because of weakness or loss of balance. They may do better with a stationary reclining bicycle, for example, than walking outdoors.

For the general population, the ACS and other health organizations recommend at least 30 minutes of moderate physical activity at least 5 days per week to reduce the risk for cancer, cardiovascular disease and diabetes. These levels of activity have not been studied or tested specifically in cancer survivors, however. For the general population and for cancer survivors, any movement is likely beneficial. Therefore, although daily and regular activity may be preferred and may be a goal, any steps that are taken to move from a sedentary to an active lifestyle should be encouraged. For survivors wanting maximum benefit, the message should be that the health benefits of exercise are generally linear, with benefit related to higher intensity and duration, although extremely high levels of exercise might increase the risk for infections.


Tammy Petersen, MSE, is the Founder and Managing Partner for the American Academy of Health and Fitness (AAHF). She’s written a book on older adult fitness and designed corresponding training programs. SrFit Mature Adult Specialty Certification is used nationwide as the textbook for a college based course for personal trainers who wish to work with mature adults. SrFit is also the basis for a specialty certification home study course that qualifies for up to 22 hours of continuing education credit with the major personal trainer certification organizations.

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How To Overcome Stress When Diagnosed With Cancer

“CANCER”. For those who are not diagnosed with this condition, just saying the word out loud to yourself highlights many negative connotations associated with it.

Depression. Anxiety. Loneliness. Weakness.

jack-article1We all consider the undesirable aspects associated with cancer and think to ourselves how lucky we are not to have that added stress in our life. But what about those who are diagnosed with cancer?

Life can already be quite overwhelming when considering the financial strains, family events and various appointments scheduled into each day. But then add cancer into the mix and what do you get? You get a situation that can be very debilitating both physically, socially and emotionally, and can cause an array of adverse behaviours such as excessive alcohol consumption, sedentary behaviour and smoking. There is some evidence to suggest that elevated stress levels heighten the inflammatory response associated with stress hormones which may be directly related to cancer development and growth, however, there is an abundance of research showing an in-direct link between stress and cancer growth due to the adverse behaviours mentioned above. Thus, having the ability to conquer stress, identify the best way for you to deal with stress, and to become resilient to it will positively impact the management of your cancer and the fighting process.

So we know that stress and anxiety are typically elevated in people with cancer, and we know through available research that we need to lower or eliminate these stress levels to stop risky adverse behaviours associated with stress, but how do we go about doing that?

Recently at our training studio we began an exercise program for clients diagnosed with cancer called Lift For Life.  Our trainers discussed the idea of stress and anxiety with our cancer clients and what that means to them. During our discussion we identified many situations which cause stress in their lives, both related and not related to cancer. Some of these situations were:

  • Family
  • Work
  • Negative thoughts
  • Feeling lonely
  • Feeling as though they have no one to talk to
  • Cancer Doctor appointments and the negative connotations associated with them
  • Waiting for results
  • Feeling as though people are sick of them talking about their cancer
  • Finances

After identifying what causes heightened stress levels, we brainstormed ideas we could implement to help overcome such stresses:

  • Joining cancer education groups and classes
  • Counselling
  • Communication with family and friends
  • Joining stress management, meditation or relaxation classes
  • Download stress relief applications

We recognize that stress factors in to a large degree. In the treatment of this deadly disease, and while we see the need for exercise and nutrition, there must also be a focus on improving the lifestyle habits and the personal ability of the person to be mentally healthy as well. Far too many programs focus on just the physical component or treat the physical symptoms, neglecting the importance of addressing the psychological and emotional needs to assist the body in healing itself. This is why our program is designed around exercise and education. There is an abundance of research illustrating the physical, health and emotional benefits of exercise for those suffering and over-coming cancer. Cancer brings with it atrophy, osteopenia, increased risk of cardiovascular disease and falling. The benefits of exercise and stress reduction can help alleviate many of these ancillary negative conditions associated with cancer. Some of these benefits include:

  • Regulation of blood flow (reducing your risk of blood clots)
  • Improved muscular and bone strength/health
  • Reduced risk of falling
  • Improvement and maintaining of functional capacity and independence
  • Reduced risk of secondary cardiovascular diseases and co-morbidities associated with cancer
  • Improved mental status
  • Improved quality of life.

After the Lift For Life brainstorming session I had with my cancer clients I was surprised to find that no one had identified what I perceived as being the most important elements in overcoming stress and anxiety. Exercise and rhythmic breathing. Of course once I mentioned this, all clients agreed that these were both extremely important.

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It is at this point you may be thinking “yes I know about the importance of exercise and the benefits associated both physically and mentally, but what has breathing got to do with it?”

Why is breathing so important?

When I think of someone being stressed or anxious, I picture someone hyperventilating into a brown paper back and trying to slow down their breathing. Most people who are stressed are stuck in a constant state of over breathing and hyperventilation. Often when people are stressed they are told to “take a deep breath and relax”. This is, however, quite problematic as this action reinforces anxiety and stress symptoms by overstimulating the sympathetic nervous system, and eventually causes habitual over breathing actions. Even when the stress is no longer present, a person will continue to breathe this way as this is how they have taught themselves to breath. Dr James Mercola (of the Game Changer) emphasizes this further when he stated “When you feel tense and anxious, the sympathetic fight-or-flight aspect of your nervous system turns on, quickening your breathing and increasing your heart rate, blood pressure and stress hormone production. Uncontrolled, rapid, chest-oriented respiration can actually initiate your sympathetic nervous system — even if no other stress factors are present — locking you into a state of breathing-induced stress”. Hence, learning how to breathe slowly and softly through the nose is critical.

What can I do to start breathing better and help reduce my stress and anxiety?

There are many breathing exercises which can help to reduce stress levels, improve your health and calm your body. A simple breathing exercise which can be done anywhere and has been reported to help reduce stress and anxiety symptoms is as follows:

  • Inhale through your nose for 5 seconds
  • Hold for 5 seconds
  • Exhale through your nose for 5 seconds
  • Repeat 5 times.
  • Once completed make sure you continue to breath normally through your nose and not your mouth otherwise you won’t be able to crack this over breathing habit you have taught yourself.

The 4-7-8 breathing technique taught by Dr Andrew Weil is also quite effective in reducing stress levels and regulating your breathing.

Conclusion

We must acknowledge the damage that stress can cause on our health and when we are already in a state of poor health, a little bit more than normal is enough to create more problems. Stress cannot be avoided for it is something we will all encounter at many times in our lives.  However, being stuck in an extended state of stress will do serious damage to your body. Learning different strategies and having tools and resources to combat the symptoms associated with stress and anxiety are essential in the prevention and treatment of cancer as well as all kinds of other health problems and diseases.

References:
http://www.mercola.com/
http://www.cdc.gov/

Cancer Council Australia


Nick Jack is owner of No Regrets Personal Training a Rehabilitation & Sports Training Studio located in Melbourne Australia. Having worked as a Trainer for over 10 years and has qualifications as a CHEK Exercise Coach, CHEK Golf Performance Specialist & Master Rehab Trainer and Twist Conditioning Sports Conditioning coach he specializes in working with rehabilitation and injury prevention programs. You can check out his website at www.noregretspt.com.au

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Cancer, Lifestyle and Health Coaching

A cancer diagnosis is tremendously overwhelming and often takes away the feelings of control over one’s life. After diagnosis comes the whirlwind of information and new decisions that revolve around living with cancer. Health & Wellness Coaches work with clients in a variety of ways to help them navigate through the healthcare system and develop a self-created plan for treatment and lifestyle that supports the client in managing and re-gaining control over their lives.

Senior Couple Exercising In Park

The Right Exercise

I have mentioned many times thus far, not just that exercise is the managing partner of integrative oncology, but I try to be really careful to say the right exercise. As much as exercise does hold the key to our magic kingdom of health within, there are contraindications, both in terms of prevention and recovery, and prevention of recurrence.

fresh green salad with arugula and beetsTo understand this, let me give you a very brief intro to oxidative stress. We have all read about the importance of eating our fruits and vegetables to provide much needed antioxidants. This is because we live a life where oxidative stress is in abundance. As exercise is the one and only Rx with no bad side effects, the truth is, we should always say “the right exercise”.

Unfortunately in our world of extremes and quick fixes, we think of exercise as bop till you drop. Pushing hard, sweating — and as some celebrity trainers like to take pride in — push till you
throw up.

OK… I will NEVER support the latter, under any circumstance, but for some people pushing to the point of sweaty, dirty, pumped, driven, is a great thing.

I do believe the fountain of youth is our own sweat! And yes, that level of intensity to achieve that state differs greatly amongst people.

The danger exists, when people exceed their optimal levels, which we can do unknowingly. Given the chronic illnesses, the data seems to support most people are not exerting themselves in terms of exercise or physical activity anywhere near that optimal level.

Medical staff with senior people at gymHowever, with people recovering from cancer, it is very important to work at the right level, and know that slow and steady wins the race. And just to throw in another caveat – yes this level of intensity will vary drastically, depending on the type of cancer and treatments utilized.

Oxidative stress occurs when the production of reactive oxygen species (ROS), often referred to as “free radicals,” exceeds antioxidant defence. There are many perpetrators in our world to the production of reactive oxygen species: alcohol, sugar, toxins, certain chemicals… a very long list, and the truth is we have to add exercise to this list if we are doing it beyond the appropriate point. Or if exercise is counterproductive to…

The balance between the ROS and antioxidants is out of whack, upsetting our inner ecosystem, creating an environment for cancer to survive and thrive. As always, its all about balance.

And this is yet another reason it is critical to have a well balanced, nutrition packed diet. The expression often used is “eat a rainbow”, because eating an assortment of colors (fruits and vegetables, not candy) is a great way to ensure getting a variety of antioxidants our bodies need to combat those free radicals. And by the way, the danger of an imbalance in this equation is a factor in not just cancer but many other diseases, including heart disease, Alzheimer’s, depression, macular degeneration, autoimmune disorders. Now, let’s think about the many possible side effects of treatments (medications) for these diseases… cancer. OK, let’s eat our antioxidants! (I promise, much more about antioxidants in another article)

Or as my chick flick heart insists: Exercise & Nutrition are the greatest love affair of all times. One just cannot live without the other.

The point is NOT don’t exercise because it might be a source of oxidative stress. The point is we must expand our view of what exercise is. The point is to understand physical activity vs. exercise, dynamic vs. static exercise. Exercise is NOT about pushing in misery until you drop in a gym you don’t like! The point is there are many types of exercise that can be performed multiple times through out the day to tweak our immune & circular systems, and to accomplish that flow of Qi, that inner ecosystem.

The other point we have to remember, in all of our wonderful forms of exercise: training, cardio respiratory, strength, yoga, pilates, Qi Gong Tai chi, they all have wonderful benefits and healing powers. However, there are boundaries & contraindications for all of them. There are a number of parameters involved when deciding on an exercise program for cancer recovery & beyond. To name a very few: the type of cancer, treatment, potential for lymphedema, other pre-existing medical conditions, level of conditioning, goals of the program, fat loss suggested, preservation of muscle mass, side effects of treatment. And every one of these categories opens up many
other considerations.

Couple bikingBut the most important factor of all is the F factor, FUN. What will we actually, enjoy, embrace, do, and want more. We learn very quickly in the fitness business, “no time” is an excuse. When we know the literally infinite possibilities for physical activity, no time is an excuse, or, a very limited knowledge of what exercise is.

But step one is MOVE. Whether we move and pump those muscles when seated or standing, get it moving and pumping. Please consult a trained professional in cancer exercise training.

Even if the professional tells you they have worked with many cancer patients, it does not mean he or she has been trained in cancer exercise, and knows the many forms of exercise available, not just their own platform, and is aware there are contraindications, and potentially could have an adverse effect on recovery.

There is no one Rx for each cancer. We cannot say, “For breast cancer do this, for prostate cancer do that.”

Cancer exercise is both art and science, supports a mind body connection and creates an environment within to optimize treatment outcomes. Yes, always get permission from the health care professionals, but don’t let them think you are considering training for Ironman, This is not what cancer exercise is all about.

In exercise, we follow the FITT formula: Frequency Intensity Type Time

For cancer exercise I have modified this formula. FFITTT: FUN Frequency Intensity Type Time Telomeres…. leaves you hanging for another blog!

For a constant supply on recent studies on cancer prevention and recovery, please join me on Facebook.


Shira Litwack is the Director of International Relations and Master Trainer at, Cancer Exercise Training Institute and creator of Best in Health Radio.

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Rebounding and Lymphedema

Rebounding is a complete cellular exercise, stimulating the activity of the lymphatic system (a critical part of the immune system).  Rebounding 3-5 times per week at a minimum of 10-15 minutes at a time is highly beneficial.*  It is effective at a minimal bounce, using acceleration and deceleration, with each bounce, to open and close the one-way valves between the lymphatic system and the cells.  Lymphatic fluid surrounds all of the cells of the body.  While bounding toxins, poisons, and metabolic waste are pulled out of the cells into the lymph fluid, while oxygen and nutrients (transferred previously at the capillaries, from the blood) are pulled in the cells from the lymph fluid.  Within the lymph system are lymphocytes, for example- white blood cells, which consume metabolic waste, bacteria, and dead cells. Rebounding keeps the lymph system moving and unplugged, so lymphocytes have free reign to do their job.  More importantly, bounding does this without stressing the hips, knees, or ankles, or creating shin-splints.  It can be done on a daily basis or multiple times per day without creating overuse injury.

What is the Lymph System and how does it help me?

The lymphatic system acts as a secondary circulatory system, except that it collaborates with white blood cells in lymph nodes to protect the body from being infected by cancer cells, fungi, viruses or bacteria.

The lymphatic system is a system of thin tubes that runs throughout the body. These tubes are called ‘lymph vessels’.

Unlike the circulatory system, the lymphatic system is not closed and has no central pump. It is not under pressure and only moves because of exercise or muscle contraction.

When the lymphatic system is congested, the cells become deprived of oxygen, affecting the body’s ability to rid itself of its own waste material. Over time, other body systems that rely on the lymphatic

It takes only two minutes of rebounding to flush the entire lymphatic system, while cleansing and strengthening cells and lymph nodes. A further benefit to the body is that during this brief time span the white blood cells of the immune system triple in number and remain elevated for an hour. These specialized cells play a major role in the body’s defense against illness and disease.

At this point another two-minute rebound session would increase the demand for white blood cells as the process of cleansing, strengthening, and the flushing away of spent cells and other cancerous debris is repeated.

When beginning a program of regular rebounding it’s best to gradually increase time and intensity as the body – including bones and internal organs – adjusts to the increased gravitational load and becomes stronger.

12 Reasons to Jump for your Health & Fitness

  1. Rebounding provides an increased G-force (gravitational load), which strengthens the musculoskeletal systems.
  2. Rebounding aids lymphatic circulation by stimulating the millions of one-way valves in the lymphatic system. Your lymphatic system acts as your body’s internal vacuum cleaner.
  3. Rebounding circulates more oxygen to the tissues- and where the is oxygen there cannot be disease.
  4. Rebounding establishes a better equilibrium between the oxygen required by the tissues and the oxygen made available.
  5. Rebounding increases capacity for respiration
  6. Rebounding increases the functional activity of the red bone marrow in the production of red blood cells.
  7. Rebounding improves resting metabolic rate so that more calories are burned for hours after exercise.
  8. Rebounding improves circulation. It encourages collateral circulation (the formation of new branch blood vessels that distribute blood to the heart) by increasing the capillary count in the muscles and decreasing the distance between the capillaries and the target cells.
  9. Rebounding strengthens the heart and other muscles in the body so that they work more efficiently.
  10. Rebounding improves coordination between the proprioceptors in the joints, the transmission of nerve impulses to and from the brain, transmission of nerve impulses and responsiveness of the muscle fibers.
  11. Rebounding improves the brain’s responsiveness to the vestibular apparatus within the inner ear, thus improving balance.
  12. Rebounding for longer than 20 minutes at a moderate intensity increases the mitochondria count within the muscle cells, essential for endurance.
  13. As our planet has become dangerously congested with debris so does our body. We are neither helpless nor hopeless in this dire state; we can also take measures to reduce, eliminate and cleanse toxins from the blood, tissues and organs of our bodies. One of several effective methods of detoxification is through lymphatic cleansing.

Among the various functions of the lymphatic system is its ability to carry waste away from the cells and bloodstream to the body’s organs of elimination. The system consists of veins and capillaries, with one-way valves, that contain a clear fluid called lymph. This fluid also surrounds cells throughout the body and collects cellular debris before draining it into the lymphatic system. Lymph carries the waste on a one-way path toward the heart and passes through many filters (lymph nodes) where special white blood cells attack and eliminate foreign molecules.

Once the lymph fluid approaches the heart it is returned to circulation and makes its way for further cleansing of toxins by the liver and kidneys. The lymphatic vessels are not connected to the blood circulatory system, and unlike blood which is pumped by the heart, lymph fluid relies on bodily movement and exercise to drive it through the lymphatic system. Forceful flushing of the system cleanses lymph nodes, contributes to healthy, clear lymph fluid, and boosts the immune system. Stagnant, slow-moving and thick lymph fluid is due to a lethargic, toxic body and weakened immune system.

When the lymph fluid remains sluggish the lymph nodes become clogged and lose their filtering ability. Without routine flushing of the lymph, debris becomes trapped in the body, creating a toxic overload and contributing to the onset of disease.

It takes only two minutes of rebounding to flush the entire lymphatic system, while cleansing and strengthening cells and lymph nodes. A further benefit to the body is that during this brief time span the white blood cells of the immune system triple in number and remain elevated for an hour. These specialized cells play a major role in the body’s defense against illness and disease.

At this point another two-minute rebound session would increase the demand for white blood cells as the process of cleansing, strengthening, and the flushing away of spent cells and other cancerous debris is repeated.. Therapeutic rebounding has been shown to reduce cancerous tumors and improve or heal a host of other ailments (3).

When beginning a program of regular rebounding it’s best to gradually increase time and intensity as the body – including bones and internal organs – adjusts to the increased gravitational load and becomes stronger.


Doreen Puglisi, MS is the Founder and Executive Director of Pink Ribbon Program. The Pink Ribbon program works to give every woman the ability to regain a sense of well-being that had been lost from diagnosis through surgery into recovery.

References:

  • Brooks, Linda: Rebounding and Your Immune System. Urbana, OH: Vitally Yours Press, 29; 33-46, 2003
  • Brooks, Linda: Cancer – A Simple Approach. Urbana, OH: Vitally Yours Press, 33-6, 2002
  • Brooks, Linda: Rebounding to Better Health. Sixth Printing, KE Publishing, 51-2; 39-56; 71-6, 2006