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Woman Receiving Massage

Oncology Massage by Kathy Flippin

Oncology massage is simply a massage in the context of someone going through cancer treatment. The most common cancer treatments are surgery, radiation and chemotherapy. Because these treatments often leave “injured areas” such as surgical incisions, radiation burns and general system fatigue, we have to know how to work with these conditions, to be able to give a good massage without hurting them. Studies have also shown that individuals that receive massage require less anti-nausea and pain reducing medication.

Infection of alimentary canal

The Cops & Robbers of Cancer

One of our favourite games as kids is now one of the most powerful determinants of sickness or health – the cops and robbers in our intestinal tract – better known as “good bacteria” or “bad bacteria”. Over the last ten years, the function of our “gut microbiome”, is finally gaining the research and respect that it so deserves.

man in window

Could Emotional Patterns Make Us More Susceptible To Cancer?

There is a lot of research, clinical data and statistics related to cancer – types, causes, and treatments – available to anyone interested in looking them up. There are, of course, the usual suspects /causes of cancer (more on that later). But there could be a case made out to look beyond the obvious. Scratch deeply and look below the surface. There is another omnipresent trigger we lug around and don’t give this Machiavellian it’s due. It coexists as both cause and effect, feeds off us, is often suppressed, and is usually the last to be addressed, if at all.

‘Unaddressed and unresolved emotions’.

The source of these could be singular, or more likely, multiple. Cracking or crumbling relationships, pressures of work (often tied up with a sense of ‘worth’ & ‘success’), irritants at home (from the mundane to the serious), overwhelming sense of responsibilities as a spouse, parent, child, maintaining a lifestyle, etc. come to mind easily. This tangle slowly and silently claws away at body, mind and soul. Some may immediately label it ‘Stress’. But this emotional web can manifest in other physio-psychological avatars too. It is silent and deadly. It attacks all systems- skeletal, muscular, nervous, circulatory, etc. All organ systems on one hand, and cognitive and emotional on the other, interfering with and impairing our quality of living and coping abilities. While one needs to clearly distinguish and recognize medical reasons for what they are, the truth is, this silent trigger is omnipotent. Abstract though it may seem, emotions wield the power to mess with our tangible systems. They have the capability of producing unwanted, negative, and damaging results in the human body. Sometimes, drastically so.

SHOULD WE BE LOOKING MORE SERIOUSLY AT OUR EMOTIONAL HEALTH IN OUR BATTLE AGAINST CANCER?

A long, relaxed conversation with a cancer survivor friend brought this aspect to the fore yet again. He has overcome cancer twice and tried all treatments – mainstream and alternate, including adopting a complete lifestyle change which most of us can only aspire to. But there remains an unaddressed issue. After years spent on this journey of cancer, getting on and off track, he calmly mentioned this point in relation to his experience of it. It was interesting to hear him analyze his own life experiences. Aware of what’s impacting him (acknowledging the source of his emotional drain), he recognizes the need let it go, and admits that he hasn’t been able to yet. Driven by his emotional moorings, he hasn’t been able to sever this source of recurring negativity in his life despite nudging by family, friends, healers and a few doctors.

He further went on to calmly say that till such time as he lets go, he is not fighting the root causes of cancer completely. (I say ’causes’ so as not to make an oversimplified case of cancer triggers, especially in relation to emotional health, nor is it my intention to present this as a thought in conflict with medical advice or challenge it.) He intends to seriously weigh the worthiness of continuing with this emotional baggage and its impact on his body.

DOES THIS MATTER?

He isn’t the first person – or the last – to have mentioned this connection. There is something more than pure abstraction at play here. And it’s worth acknowledging the elephant in the room. We are, after all, feeding it and it is rolling its weight all over us. Emotions impact us and negative emotions more so. Our bodies respond in myriad ways trying to combat it. Labored breathing, racing/irregular heart beat (cardiovascular), tight muscles (muscular), tingling in fingers/toes (neural), aches and pains (skeletal and muscular), compromised digestion, high/low blood pressure (other body systems)… these are just some common perceptible symptoms and responses to our altered emotional states. We have all experienced them to varying degrees and at different points in our lives. Not to mention what happens to our (emotional) responses and thought process.
It becomes a cause of concern when this altered state continues for a longer period of time. The body appears to adapt and these symptoms become silent and internal in nature. The impact, meanwhile, continues on a wider, cellular level, and various manifestations of this silent aggressor may emerge over a period of time, including possibly, as cancer.

SHOULD WE EMPOWER OURSELVES BETTER?

Does it mean all cancers are somehow the result of negative emotions or negative emotions will always lead to cancer? There is no definite, categorical ‘Yes’ as an answer. But, it could prove helpful investigating and addressing how our underlying emotive states may be leaving us exposed to greater possibility of serious health conditions, including cancer, along with all other clinical causes. As a precautionary tool, I reckon paying attention to emotional health plays a rather important role. We know that a healthy and fit lifestyle has so many advantages in serving as prevention for many health conditions. ‘Fitness’ needs to encompass emotional and mental health (strength and fortitude) too, by constantly sieving out the negative and enhancing the positive. It requires acknowledgement and working upon, with a conscious approach. As a cancer coping mechanism, focusing on positive emotional health and reducing negative (draining/sapping/unhappy/stressful/fearful) emotions plays a powerful role.

Emotions have the power to alter the human state at the conscious and subconscious levels. They can be an ally or a foe in our battle against ill health. They have the ability to align internal systems/processes to either facilitate or hinder external efforts.

So while one may refrain from an outright ‘yes’ to the question raised above, one cannot say an outright ‘no’ either. As science discovers deeper working of the human ecosystem, it is increasingly revealing the intertwining of our emotive state with our physical one.

Humans are emotional beings.

We cannot challenge it nor ignore the fabric that differentiates us. When one goes against the basic grain it creates friction. Prioritizing striving for a residual state of positive emotional health needs a deliberate plan and push. It is not easy. But neither is cancer nor its treatment. Using different techniques to spot and train our emotions, create emotional alchemy, makes sense now more than ever before, with different types of cancers spiraling and affecting all age groups, sometimes with the known triggers missing.

“Until you make the unconscious conscious, it will direct your life and you will call it fate.” –C. G. Jung

Originally printed on bodyinmotion.in. Reprinted with permission.


Vani Pahwa is a Functional Fitness specialist with over fifteen years of experience, and cutting-edge certifications from leading internationally-accredited and globally recognized fitness institutes. She is also a Cancer Exercise Specialist (perhaps one of the first in the country). Sought after for her multi-disciplinary fitness modules and expertise, Vani has conducted fitness workshops for leading corporate houses, conditioning and training camps for various sports communities, training programs for coaches, personal training programs for CEOs of multi-nationals, athletes, junior and senior sports professionals among others. Her combination of specialties, client profile and range, and extensive work experience makes her unique in the country. She is the founder of Body in Motion.

** If interested in further research on the topic you may read up related links including:

mid age man exercising at the beach

Exercise and Prostate Cancer

The rising rate of prostate cancer necessitates developing better methods to prevent and treat prostate cancer. Prostate cancer is the third leading cause of cancer death among U.S. men, according to the American Cancer Society. The country’s 3.3 million prostate cancer survivors account for 21 percent of all cancer survivors.

There are many reasons why a cancer patient should stay as active as possible through cancer treatment and recovery. I will begin by pointing out a few studies that show how exercise can benefit cancer patients.  These studies demonstrate how exercise can reduce certain side effects from treatment, increase energy, decrease stress, and improve quality of life. In the last article of this series, I will suggest ways to develop an exercise program that is based on an individual’s needs and is safe and effective.

There is evidence to support the use of exercise in prostate treatment. Exercise plays a role in the all-around improved physical and mental health and therefore should be considered in the treatment plan. We know that exercise can decrease recurrence for some cancers and the role it plays in weight control, which is correlated with some cancers. For prostate cancer specifically, data indicates that obesity increases the aggressiveness of prostate cancer, and thus mortality. Men receiving androgen deprivation therapy are at higher risk for depression. Exercise reduces depression.

Studies do have their limitations.  Some use self-reported data about lifestyle and exercise. Moreover, there may be a low number of minority participants who may often have higher cancer rates. The following are a few of the published studies, which confirm that exercise should be included in the treatment plan for prostate cancer patients.

Studies have suggested that patients with high levels of physical activity had a lower rate of disease progression and also reduced mortality from prostate cancer. Ying Wang, PhD, a senior epidemiologist in the Epidemiology Research Program at the American Cancer Society in Atlanta, and colleagues analyzed data on 10,067 men diagnosed with non-metastatic prostate cancer between 1992 and 2011.  Men with prostate cancer, which hasn’t spread may have longer survival the more they exercise.  A study demonstrated that men who were the most physically active had a 34% lower risk of dying from prostate cancer when compared with men who were the least physically active. Men who either maintained or increased their exercise level also benefited. Prostate cancer patients who kept up a moderate to high level of physical activity also had better survival prognoses compared with their more sedentary counterparts. Those men who were more active before diagnosis were more likely to have lower-risk cancer tumors and a history of prostate screenings. They were also leaner, more likely to be nonsmokers and vitamin users and they ate more fish. Wang concludes, “Our results support evidence that prostate cancer survivors should adhere to physical activity guidelines, and suggest that physicians should consider promoting a physically active lifestyle to their prostate cancer patients.”

Androgen Deprivation Therapy leads to numerous side effects, which can be decreased through exercise. Side effects of ADT include loss of muscle, increase in fat mass and osteoporosis. Risk for diabetes and heart disease also increases.  Brian Focht, reported at the November AICR convention, that functional ability increased dramatically as did quality of life for those that exercise, and side effects of ADT were reversed.

Exercise can decrease blood sugar levels, which lower insulin levels and also helps to lower inflammation. There does appear to be a positive association between insulin levels, inflammation and prostate cancer risk.

The evidence for physical activity in reducing anxiety and depression, while increasing general-well being is fairly substantial.  Improving well-being can have a dramatic beneficial effect on sexual function.  Consistent exercise will also help to lower insulin, blood sugar, and improve overall cardiovascular health, all of which have positive impact on erectile dysfunction and libido.

In 2016, Rider and Wilson studied the connection between ejaculation and prostate cancer, which was published in European Urology. Men that reported higher ejaculatory frequency were less likely to be diagnosed with prostate cancer. This study showed a beneficial role of frequent ejaculation particularly for low-risk disease.

Some doctors have traditionally told patients to rest during this time but Favil Singh’s research confirms the importance of getting fit prior to surgery. Singh’s research published in the journal Integrative Cancer Therapies has shown that a regular dose of physical activity prior to surgery helps the recovery process. This reduces time in the hospital.

Singh stated “This is the first time we’ve been able to demonstrate the benefits of ‘pre-habilitation’ for prostate cancer patients. It is safe, side effect-free and can be done while undergoing chemo or radiotherapy. Just two sessions a week of resistance and exercise training for six weeks can make a difference to recovery.”

Often, there is a waiting period in between diagnosis and surgery. If fitness level can be improved before surgery the patient, then the patient goes into the surgery stronger and may have a better recovery.

The American Cancer Society and American College of Sports Medicine recommends at least 150 minutes of moderate physical activity or 75 minutes of vigorous exercise each week. This advice is a good goal for those who have been inactive. Unfortunately, in my view this is insufficient for a significant number of cancer patients. Having worked with cancer patients for over 20 years, I believe that this recommendation needs to be changed. It is impossible to include aerobic exercise, strength training, and other exercise methods in the current recommended time frame. 


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. Visit her website, carolmichaelsfitness.com

 

References

Steven C. Moore PhD, et al, Association of Leisure-Time Physical Activity With Risk of 26 Types of Cancer in 1.44 Million Adults. JAMA Intern Med. 2016; 176(6): 816-825.

Lynch B.M., Dunstan D.W., Vallance J.K., Owen N. Don’t take cancer sitting down: A new survivorship research agenda. Cancer. 2013, Jun 1; 119(11): 1928-35 Medicine

Kristina H. Karvinen, Kerry S. Courneya, Scott North and Peter Venner, Associations between Exercise and Quality of Life in Bladder Cancer Survivors: A Population-Based Study, Cancer Epidemiology and Biomarkers Prevention May 2007, 10.1158/1055-9965

Gopalakrishna et al, Lifestyle factors and health-related quality of life in bladder cancer survivors: a systematic review. Journal of Cancer Survivorship, 2016 (5): 874-82

Vallance, J., Spark, L., & Eakin, E.. Exercise behavior, motivation, and maintenance among cancer survivors. In Exercise, Energy Balance, and Cancer (2013) (pp. 215-231). Springer

Cannioto et al., The association of lifetime physical inactivity with bladder and renal cancer risk: A hospital-based case-control analysis, Cancer Epidemiology, Volume 49 August 2017

Cramp F, Byron-Daniel J. Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev. 2012; 14(11): CD006145.

Booth FW, et al., Lack of exercise is a major cause of chronic diseases. Compr Physiol. 2012 Apr; 2(2): 1143-211.

Stephanie Cash et al, Recreational physical activity and risk of papillary thyroid cancer among women in the California Teachers Study. Cancer Epidemiology, Feb 2013,37(1): 46-53

Hwang, Yunji MS; Lee, Kyu Eun MD, PhD; Park, Young Joo MD, PhD; et al, Annual Average Changes in Adult Obesity as a Risk Factor for Papillary Thyroid Cancer: A Large-Scale Case-Control Study, Medicine, March 2016, Mar; 95(9): e2893

Cao Y, Ma J. Body mass index, prostate cancer-specific mortality, and biochemical recurrence: a systematic review and meta-analysis. Cancer Prev Res (Phila). 2011; 4: 486-501.

Galvao, et al. Combined resistance and aerobic exercise program reverses muscle loss in men undergoing androgen suppression therapy for prostate cancer without bone metastases: a randomized controlled trial. J Clin Oncol. 2010 Jan 10; 28(2): 340-7.

Galvao, et al. Exercise can prevent and even reverse adverse effects of androgen suppression treatment in men with prostate cancer. Prostate Cancer Prostatic Dis. 2007; 10(4):340-6.

Winters-Stone KM, et al. Resistance training reduces disability in prostate cancer survivors on androgen deprivation therapy: evidence from a randomized controlled trial. Arch Phys Med Rehabil. 2015 Jan; 96(1): 7-14.

Giovannucci EL, Liu Y, Leitzmann MF, Stampfer MJ, Willett WC. A prospective study of physical activity and incident and fatal prostate cancer. Arch Intern Med. 2005; 165: 1005-1010.

Storer TW, Miciek R, Travison TG. Muscle function, physical performance and body composition changes in men with prostate cancer undergoing androgen deprivation therapy. Asian J Androl. 2012, Mar; 14(2): 204-21.

Focht, Brian C.; Lucas, Alexander R.; Grainger, Elizabeth; Simpson, Christina; Fairman, Ciaran M.; Thomas-Ahner, Jennifer; Clinton, Steven K., Effects of a Combined Exercise and Dietary Intervention on Mobility Performance in Prostate Cancer, Medicine & Science in Sports & Exercise. May 2016:48(5S): 515.

Rider J, Wilson K.et al. Ejaculation Frequency and Risk of Prostate Cancer: Updated Results with an Additional Decade of Follow up, European Urology. December 2016, volume 70, issue 6

Singh F. et al. Feasibility of Presurgical Exercise in Men With Prostate Cancer Undergoing Prostatectomy, Integrative Cancer Therapies (2016). DOI: 10.1177/1534735416666373

Wang et al, Recreational Physical Activity in Relation to Prostate Cancer–specific Mortality Among Men with Nonmetastatic Prostate Cancer. European Urology July 2017 online bit.ly/2tXMK6Y

Gym woman pilates stretching sport in reformer bed

The Role of the Pilates Professional in Cancer Treatment and Rehabilitation

I am a 12 year breast cancer survivor, and experienced what cancer patients go through, not just from theory, but from living it. I’m going to talk about the role that Pilates had in my rehab and why I consider essential for cancer patients and survivors.

After surgery and treatment, most cancer patients are left with lack of flexibility and range of motion, and poor posture because of the scar tissue. Most experience fatigue from chemo and radiation or just stress of the circumstances. Many go through hormonal treatment which reduces the muscle mass, increases the risk of osteoporosis and bone fracture, bone pain, fatigue, mood swings and lack of stamina and stress.

Breathing is an essential part of Pilates. It helps with stress and stamina, reduces fatigue, opens the lungs and helps with mood swings. When we are paying attention to our breathing, we clear thoughts and allow the oxygen and energy flow through our bodies.

Awareness is a principle that helps us increase the consciousness of our body and the parts that are in disharmony and need to be repaired, isolating them from other parts to progressively make them stronger and healthier. Mind –Body connection

Control is another principle helps coordinate the body parts and move them with the correct alignment, avoiding jerky movements used in general workouts (especially using the Core which we call the powerhouse) and increasing BALANCE that is so affected in cancer patients.

Flexibility and range of motion are key in the rehabilitation for mobility and functionality of the limbs or part of the body affected so we start testing the patient range of motion without any resistance at first.

Pilates machines have springs that allow switching among different resistance according to the patient’s condition avoiding injuries and pain,

Allowing the patient to get FLEXIBLE then STRONGER and then MANAGE THEIR OWN BODY improving posture, Functionality, mobility, self-image and self-confidence.

Exercise Samples


Graciela Perez is a National Academy of Sports Medicine (NASM) Personal Trainer, Aerobics and Fitness Association of America (AFAA) Aquatic Specialist, and a Cancer Exercise Training Institute Cancer Exercise Specialist. She’s been helping people reaching their health and fitness goals since 2003. 

dr-nick-rx

The Pharmacologics of Exercise: Yes, Exercise Is Medicine!

It’s been said: “If all the benefits of exercise could be placed in a single pill, it would be the most widely prescribed medication in the world.” Scientific evidence continues to mount supporting the numerous medicinal benefits of exercise. In fact, there’s hardly a disease that I can think of that exercise won’t help in one way or another, be it prevention, treatment, or even cure in some instances.

caruso1

Why Exercise When You Have Cancer?

Exercise is important for everyone even individuals who have cancer. It is important to understand your body and know what you can do. An Exercise Specialist can help you to figure out an exercise plan that works for you. Everyone is unique and therefore needs an individualized exercise program.

It is important to notify your Exercise Specialist when you have treatments. The exercise program may need to be modified for a few days after treatment. Modification is important to help preserve energy and wellbeing. You may need to do two sets of an exercise instead of three for a training session or two. Exercise can help you to stay strong and relieve stress even if you are only able to do twenty minutes every other day.

There are also some precautions to take. While exercising, you may want to wear gloves. Wearing gloves helps you to keep your hands clean during workouts. This is important because the immune system is already weakened. Wiping equipment before use will also help you to be as clean as possible. It is important to wipe mats and dumbbells as well.

caruso1Start your exercise program slowly and progress when you are ready. Fitness is an individual journey and everyone starts at a different place. It is important to not compare yourself to others and keep focused on your goals. Your exercise prescription will depend on which phase of cancer you are in.

There are many ways that exercise can benefit individuals during treatment such as: maintaining your physical capabilities, lessen nausea, maintaining independence, improve quality of life, control weight, decrease anxiety and depression, and improve self-esteem.

When you are recovering from treatment you may notice that the side effects linger. Your Exercise Specialist will adjust your program according to how you feel. Eventually, you will be able to progress and feel less fatigued. It is important, however, to continue to be active after treatments have been discontinued. Research shows that there is less chance of cancer recurrence in active individuals.


Robyn Caruso is the Founder of The Stress Management Institute for Health and Fitness Professionals. She has 15 years of experience in medical based fitness. Contact Robyn by email at: tsmi.caruso@aol.com

 

References

American Cancer Society (2014). Physical Activity and the Cancer Patient. Retrieved http://www.cancer.org/treatment/survivorshipduringandaftertreatment/stayingactive/physical-activity-and-the-cancer-patient

Web MD (2007). Exercise for Cancer Patients: Fitness After Treatment. Retrieved http://www.webmd.com/cancer/features/exercise-cancer-patients?page=3

 

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.