Painful joints on aromatase inhibitors?


Question from Cyndal: I exercised throughout my treatment, from surgery through chemo and radiation. Now I am on Arimidex and my hips get so painful after I exercise that they throb.
Answers - Anne McTiernan, M.D., Ph.D. Some women do experience joint discomfort on aromatase inhibitors, and you might want to take some non-steroidal medicines like ibuprofen to ease the pain. However, many who are not on medication experience pain in the hips from exercise. Often, the pain is due to overuse, and the best way to combat overuse is to cross-train—do different types of exercise on different days so you're using different muscle groups and not overstressing one area.

Doing weight training a couple of days a week can also be helpful—on the lower as well as the upper body. This will strengthen the muscles around your joints, which, in turn, will reduce your risk of pain and injury. Most experts recommend stretching after exercise to reduce pain.
Marisa Weiss, M.D. How about stretching before exercise?
Anne McTiernan, M.D., Ph.D. Studies do not show that stretching before exercise reduces the risk of injury, but it does reduce pain. There's an excellent book on stretching called Bob Anderson's Stretching Book, and it's available at all the usual bookstores.
Marisa Weiss, M.D. You don't burn many calories stretching, however.
Anne McTiernan, M.D., Ph.D. But stretching is important for flexibility and pain reduction. The book I recommended shows pictures of stretches for many types of exercise.
Marisa Weiss, M.D. What do you advise a patient who says she can't exercise because she has problems with her knees, hips, or some other body part that may be getting in the way of exercise?
Anne McTiernan, M.D., Ph.D. If someone is having a problem with a specific part of her body, the muscles around that area are probably weak. People often have knee problems if their quadriceps muscles are weak, for example. Strength training exercises that concentrate on muscles around specific joints are very important, and there are many strength-training videos available. I recommend Strong Women Stay Young, by Miriam Nelson. It's a video and a book, but I especially recommend the video. It has very simple strength training exercises to help women gain strength around the joints that cause them the most problems.

Another way to help with problem areas is to cross-train. Don't do the same type of exercise everyday; varying your routine will make working out more fun and reduce your risk of injury.
Marisa Weiss, M.D. If a woman has lymphedema (swelling of the arm due to backed-up lymph fluid), what accommodations should she make while exercising? For example, can she lift weights with that arm? And if so, how much weight is it safe for her to lift?
Anne McTiernan, M.D., Ph.D.

There's not a lot of information about exercise with lymphedema*; however, one recent clinical trial showed that strength training did not have any adverse effect on lymphedema.

Women starting out should begin with the lowest possible weight, which is the weight of the arm alone. Do the exercise with no added weight at first, and then add one pound, and move up very slowly. We usually recommend doing eight repetitions and then resting from that exercise for a couple of minutes. During that "rest" time you can work another muscle group and then do eight repetitions of the first exercise again. Many women with lymphedema find that exercise is much more comfortable if they wear a special sleeve or bandage.

*Editor's Note: In April 2012, Breastcancer.org introduced a new section on Lymphedema, including information on Lymphedema and Exercise.

Marisa Weiss, M.D. If you get an elasticized sleeve, make sure it is measured specifically for your arm by a physical therapist or an expert in medical supplies. If you apply bandaging, make sure you get proper instruction from an expert. These bandages are applied in very specific ways. Generally, the amount of pressure increases as the bandage goes from the hand up to the shoulder. It has to be applied firmly but not too tightly. With training you can avoid wrapping it in such a way that there are holes between the bandage strips, and so it's applied evenly all the way up.

On Wednesday, May 21, 2003, our Ask-the-Expert Online Conference was called Taking Care of YourselfAnne McTiernan, M.D., Ph.D. and Marisa Weiss, M.D. answered your questions about exercise and nutrition, and other things you can do to nurture your body, along with strategies for finding emotional support, boosting your mood, and feeling good again.

The materials presented in these conferences do not necessarily reflect the views of Breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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Copyright 2010. All rights reserved.

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