Staying Active During Quarantine: Tips for People With Breast Cancer

Jamie DePolo: Hello. Thanks for listening. Our guest today is Sami Mansfield. Sami started her career as an exercise specialist in 2003. Since being inspired by coaching her first client who had been diagnosed with cancer 15 years ago, her career has been dedicated to helping people with cancer — any type and any stage — live as well as possible. Sami’s experience encompasses work in both community- and hospital-based cancer centers, nonprofit organizations, developing and consulting on clinical trials, and as a speaker presenting to both patients and healthcare professionals. She is a Certified Cancer Exercise Trainer, a CrossFit Level 1 coach with extensive exercise and nutrition experience, and the founder of Cancer Wellness for Life.

Because of the COVID-19 pandemic, gyms are closed and personal trainers can’t visit their clients. So, how can people with breast cancer stay active and continue their exercise programs? Sami is going to give us all some advice and tips. Sami, welcome to the podcast.

Sami Mansfield: Thanks for having me back, Jamie.

Jamie DePolo: So, for people who are used to working out in a class or with other people at a gym, this quarantine situation can be really, really tough. And — I’m speaking from my own personal experience — I’m finding it very hard to motivate myself to work out alone in the garage, especially when the weather is not good. So, what can we do to keep this exercise mojo going during these really tough times?

Sami Mansfield: Well, I think that one of the biggest things that we should first say is that we are all experiencing it. And we need to remember that right now, everything normal is requiring extra motivation. And even though we know we should, it just feels so abnormal to do it in — like you said — our garage or without the music we like, the equipment we like. And I think the first thing that we need to recognize is, we’re in a different time, and it’s okay to do different things. And I think it’s really important that we understand your barrier to finding the motivation.

I’m a lot like you, Jamie. I have been used to doing stuff in a group or a community, and I had a hard time really even programming my own workout. So, one of the things that I told everybody else to do — or suggested — I said, take a look around at other workouts that might exist and follow someone else’s YouTube channel or get an exercise regimen from maybe a social media, like an Instagram that you like, or whatever that may be.

First of all, don’t feel that you have to do every single thing yourself, including the motivation and the exercise programming. Just take a step back and have some fun. Personally, there’s a ton of free resources that exist, and trainers even are offering remote programming. You probably have friends in the same situation, so find a friend and say, “Hey, every day at noon, let’s do a workout together via maybe a live feed or just talking on the phone or checking in after.” Just taking a step differently, right now, is really what we all need to do.

Jamie DePolo: Okay. Yeah, I have tried that. A couple of friends and I have been FaceTiming, and we do our workouts together. Even if we’re not doing the same workout, it’s just kind of fun to encourage each other. So, that’s a really good idea.

And I do want to sort of take a step back, just in case anybody forgot, because this may help with motivation. Could you talk a little bit about the benefits of exercise, in general — because I know there are some mental health benefits — but also specifically for people who have been diagnosed with breast cancer and why it’s so important?

Sami Mansfield: Absolutely. I mean, the number one thing that pretty much everybody going through, has gone through, breast cancer experiences is general deconditioning. This happens, in large part, because we’re going to different appointments, we’re taking different medicines that may not make us feel well, we’re having surgery and down time. And so just general deconditioning happens naturally with just life, and then, additionally, with the process of breast cancer. So one of the number one benefits for exercise is energy and endurance. Like, being able to live your life, going to the grocery store functionally — carrying in your groceries, et cetera. So, that’s the number one thing.

Especially in the breast cancer world, the number one reported side effect from treatments and surgery is fatigue. So, having muscle mass really helps just general fatigue, as well as emotional fatigue. Sleep is a tremendous challenge for a lot of breast cancer survivors, again due to medicines or even fear and anxiety and worry. So, having a good exercise regimen — even 5 or 10 minutes a day — really improves sleep. Bone density, another really important one long-term. Regulation of hormones — both in just the hormones such as estrogen, progesterone that have a correlation into breast cancer — but also things like stress hormones, things like cortisol, that can come from a stressful situation, all benefited by exercise.

Long term, I know as we sit in COVID, we’re really concerned about the short term, but we need to remember to keep our eye out on the horizon a little bit. And thinking about being more sedentary increases our long-term risk of cardiovascular disease and long-term implications from a lifestyle perspective. So, it’s really the basics that I think we need to always remember of the why’s and really thinking about it from a simple standpoint.

But Jamie, going back to where we are today, it’s really important to know that exercise is a really key strategy to helping our mental health, and it’s something we actually can control. And I don’t know about you, but a lot of times we think about this really long-term horizon. We take a step back and we look about the whole picture of where we want to be in 6 months to a year. And we’re at this time that we’re looking at something in a really short standpoint. And I had somebody tell me recently that it’s taking a look at something through more of a telescope. And I think that’s a really important thing about, “What can I do today to make today better? So, how can moving help my mood? How can moving help my fear and anxiety?” And I think that’s really where we’re at in this next short term.

Jamie DePolo: And you know, as you were talking, something came to mind because we’ve been hearing from our community that a number of people are having their treatments delayed, whether it’s surgery or chemotherapy or something. And especially with surgery, I’ve read a few studies that say people who are in a little bit better physical shape before they go into surgery recover maybe a little bit faster, their side effects aren’t as severe. So I guess that might be something, too, that people could think about if they’re looking for motivation to exercise, and they know they have a breast cancer surgery coming up, maybe if they start exercising now while they’re in isolation, when they do finally have the surgery, their recovery may be a little bit easier.

Sami Mansfield: Yeah. Absolutely. I mean, the healthier you are — physically and mentally — the better you’ll recover from a surgery in all capacities. But thinking about the muscular structure of the shoulder girdle — which is the number one joint that’s going to be affected from a breast surgery — that having tissue that is stronger, more flexible, has better range of motion, is always going to be more beneficial to recovery. Not only early range of motion, but lowering your risk of things like lymphedema, making sure that you have less dysfunction in your neck and up in supporting your head or down your back, and really just long-term having the strength and the capacity to be able to recover quickly and get back to normal activity.

We often send people to occupational therapy post-surgery, just to make sure they have range of motion. But people that are stronger and their joints are more supple going in, they breeze through that occupational therapy and get back to normal life at a much faster pace, and that really is the evidence that we’re starting to see. So, I think that’s really important to be mindful is, a lot of times, it’s crisis mode, and it’s actually sometimes okay to put the brakes on a little bit and really work on building your foundation.

Jamie DePolo: Okay. Now, in a practical sense, if someone’s used to going to a gym, like me, we don’t have a lot of equipment at home. We’ve got maybe a dumbbell or two, maybe nothing. So, what can people do at home even if they are, say, as you said, using something on YouTube or following videos? If you don’t have any equipment, what can you do?

Sami Mansfield: Actually, I think body weight is great. I mean, body weight — we need to be able to move our bodies. So, I always tell people, take a look around and see what you have. Even if you don’t have a dumbbell. Functional fitness — which is the kind of love of what we preach — is not being able to just do a bicep curl with a nice set of free weights. But functional fitness means being able to go out into your yard in the spring and put out mulch, or dig around, or carry something from your garage to your yard or up the stairs.

So, take a peek and see. Do you have a suitcase lying around? You could put a little bit of weight or even a few soup cans in it. Do you have a laundry basket, an odd-shaped chair, something like that? Even carrying an odd object up and down your hallway or around your kitchen island is a really great form of exercise that uses muscles that you maybe haven’t used before. And it’s just kind of a fun, interesting thing to do, and you don’t need to have a lot of equipment.

Some people that really want to have structure — I always tell them, get a water jug or a milk jug. If you have a full gallon of liquid, it’s a little over 8 pounds. So, then you kind of know what your resistance is. But in general, just moving interesting objects is going to be actually more fun. And going back to our first conversation; maybe putting a little bit more mojo into, “Oh, I never thought about moving my laundry basket loaded up with odd objects through the house, and now my kids are having fun with this, too.”

So, I think it’s really important to be creative here. I think if you have stairs in your house, if you live in an apartment building, up and down stairs is a great form of exercise. If you have balance issues, make sure you have a handrail or even just work up and down one stair. But don’t think about buying anything right now. I mean, honestly, I would not suggest anybody buy a set of 5-pound free weights to do some home-based exercise. I think that just learning to move is a lot more fun and a lot more beneficial in the long run.

Jamie DePolo: Okay. Okay. That sounds great. Now, kind of on the other end of things, maybe there’s someone who’s been very active and they have weights and things at home. They have a home gym set up, but now maybe they don’t have anybody to spot them because their friends can’t come over and work out with them. How could somebody use their home equipment safely because there’s not going to be anybody to check their form and as I said, not somebody to spot them or anything like that?

Sami Mansfield: Right. Well, I think first of all, we need to remember that most people aren’t going to be lifting super, super heavy, especially in the population that we’re talking about. So I think that, number one, if you are concerned about your form, if you can find a mirror, that would be great. Also, use your phone or your computer and take a little video of yourself doing a few movements. Kind of go back and watch. You’ll probably be able to notice if your shoulders round forward or your back or your hips are moving in an odd way just by kind of watching your video. It’s also something great that you could send to a friend. I think that’s probably the number one thing to really think about if you want to get feedback.

The other thing to think about is just really listening to your body. I think that sometimes when we go into a group situation, we kind of stop listening to ourselves and our internal dialogue because we’re listening to somebody else. Or maybe pushing ourselves based upon wanting to keep up with the class, which has great goals, as well. But some people, you know… see how you’re feeling. Also, keep in mind that if you are doing activities that are abnormal, like sitting at a different chair working during the day, or even relaxing in the evening, your back may not feel the same as it did before what we’re going through right now. You just functionally are going to be maybe tighter in different joints, so you’re going to have to listen to your body anyway.

I think it’s really important, lastly… we’ve had a lot of people — we’ve been in the Midwest, or we are in the Midwest — and the weather has been sporadically nice. And every time it’s nice — I don’t about you, Jamie, but I see a lot of people out running right now. And I think that’s great, but I always tell people, have you been running? And if you haven’t been running, maybe now going and running for an hour is not an ideal place to start. So, make sure that you’re listening to how your body feels. If you don’t have the right running shoes, and you don’t have access to them, maybe running isn’t ideal. So, make sure that you’re listening to how it feels not only when you’re doing it, but after. Because I think that we’re in this place that we just want to do something and so we’re looking for simplicity, and we don’t always listen. And right now, we’re having to listen more. So, I think keeping simple, staying focused on how it feels to you, having fun should be really what we focus on right now. Make it enjoyable.

Jamie DePolo: That’s great advice. And I do want to ask you because I am of the mindset that — well, if somebody wants to run, that’s great — but I think walking is really undervalued. Because I know a couple people — who I value their opinions, who are sort of exercise gurus — and they really recommend walking as much as you possibly can during the day at, you know, you don’t have to powerwalk, but just at a good pace, and that that is really a good thing to do. Do you have an opinion on that?

Sami Mansfield: Well, I agree we should definitely walk and move as much during the day as possible right now. Because most of us are in this quarantine, our steps are less, naturally. Thinking about walking versus running, I think it really depends on the individual and also their goals. So, if your goal is to run… As an example, I had a conversation recently with someone, and she actually is a metastatic breast cancer female, diagnosed about 5 years ago. She has quite a bit of bone metastasis, and prior to her diagnosis — she’s in her 40s — she used to run. And she has not been able to run mostly because she had had, actually, a foot issue — not related to her bones — and she really wanted to start running, and her doctor was kind of against it. And my comment back was, if your bone metastases are stable — she doesn’t have bone mets in her femur or thigh bones, they’re just in sort of non-weight-loading bones — and it feels good for you to run, not only mentally, but also right now feeling you have control of something, then start running, but be smart about it. Start running maybe a little bit at a time.

But going back to your basics, walking should be the basic of everything that we do. So, I always tell people: walk, jog a little, if it feels good. You can walk and jog continuously, maybe working up to a run, but let’s make sure that we have a nice, steady foundation. There’s a lot of physical benefits to walking. You can add resistance by loading weight in a backpack. We were walking around last night downtown, and there’s these two women that we see in our area, and they have small dogs, and they both load them in these little pouch backpacks. I think that’s a great form of exercise.

But I think you’re right, Jamie. We almost complicate things because we want to make things more challenging, and the simplicity of walking every day and just looking around and enjoying stuff is also where we should be right now. Really maybe enjoying slowing down a little bit and leveraging that, walking with kids or animals or whatever. So, definitely don’t discount that. If it feels good, make that your form of exercise for the next period of time and go forward. No big deal.

Jamie DePolo: Okay. Now, what about somebody who has not been very active and now has a lot more time on their hands because of the quarantine and is thinking like, “Okay, now I should do it. I’m going to start being more active.” Do you have some suggestions for somebody like that about where to start?

Sami Mansfield: Absolutely. So, I think the number one thing that I’d suggest is, make a plan every day to get 20 minutes of planned exercise. Alternate your days; one day you do aerobics. Example: walking, biking, up and down stairs, jogging or running, if you choose. Make that your day one. On your second alternative day, focus on resistance training. Those could be things — like we talked about earlier with body weight — like sit-to-stand from a chair or squats. Or, a great exercise to do at home is pushups on your vanity in your bathroom, or your kitchen countertop, so you can actually get a nice straight line of the body — you’re not arching your back or you’re dropping down to your knees and kind of flexing forward. It’s a great thing that you can do.

I tell people, do a pushup competition every other day with your family or your friends. But alternating those exercises will give some muscles and the joints a break between days. But it’s really important to get into the habit, so I really encourage doing something every single day and trying to make a schedule for it and make a plan. Because honestly, right now, we may not feel like it and then all of sudden, it’s 5:00, 6:00 p.m., and we still don’t feel like it. So, put it in your schedule the same way that you do your lunch or your work meeting, or whatever that may be. Make it a priority right now. It’s really important to take care of ourselves.

Jamie DePolo: Okay. And I’ve also noticed that — I have an Apple phone, so the App Store keeps sending me suggestions for all of these different workout apps every day. It’s like, “Oh, there’s 10 more,” and I’m assuming that Google Play is doing the same thing for people with Android phones. So, are there any particular apps that you think are pretty good that people might want to check out?

Sami Mansfield: You know, I think it depends on what you’re looking for. I have followed things — like Fitbit has some advanced programming, and Peloton, which has been a really progressive company — extending a lot of their workout. Things, like Nike and ASICS, I believe, also has just full workouts that are available through their apps. And I don’t think those are the only ones, but those are some of the ones right now that have little or no charge — or fee — associated with them. I also saw that Daily Burn is another one that puts out a lot of exercise and nutrition and has a lot of content that’s available.

I personally tend to not download a bunch of apps, because it’s a little bit too confusing for me to go back and forth. So, sometimes I might find one. But really one of the things that I think is a great resource right now is YouTube. There’s so much on YouTube that’s free and that’s literally a full workout where all you have to do is push play, and follow through the workout, and you’re done. And it takes that mindset out we talked about at the beginning of our conversation, like, “I don’t want to think about it.”

So, as an example, most facilities like Planet Fitness have a YouTube they’re posting every day that has a lot of levels. Orangetheory has a YouTube that they’re posting. There’s a great yoga YouTube called Yoga With Adrienne. They have tons of everything from power yoga to gentle yoga to breathing and meditation. We’re putting out our own YouTube with our functional fitness to our classes. I mean, there’s tons of things that are out there.

So, I think it’s important to look around in what speaks to you and then follow it from there. And a lot, again, [of] these things are free, which is also a great perk right now, if you’re just worried about your finances.

Jamie DePolo: You know, it’s a very scary time, and we know that exercising your mind and your body can help with mental health. So, what are the top three tips about exercising right now for somebody with breast cancer, what would you want to leave them with?

Sami Mansfield: Number one, make it part of your daily routine. Just make it, again, as regimented as you would brushing your teeth and bathing for the day. I think it’s important to make this time to take care of ourselves a priority. If you need to schedule, it’s great, although — like we talked about — find an accountability partner. Whatever works for you; I think that just making it part of your routine.

Let yourself be coached in a different way or be open to new things. I think — we just talked a little bit about this in the beginning — I was saying earlier this week, I used to do XYZ workout, and I’m not doing XYZ workout anymore. And as I heard myself verbalize it, that made me really recognize that we are in a different time, and different times may call for different things. So, be okay trying new things right now, but just make it something that you enjoy. Don’t force yourself to do something that you should just because you don’t love it.

And the last thing to do, keep it simple. So, as we mentioned earlier for the new person — on day one, 20 minutes of aerobic exercise. On day two, 20 minutes of resistance exercise. Just make that your simple regimen. Find a simple routine that fits into that and just enjoy doing a little bit every day. And be proud of yourself because it is definitely something that’s going to make a difference in your short- and long-term physical and mental well-being.

Jamie DePolo: Oh, Sami, that’s so great. Thank you so much. I really appreciate your insights on this topic.

Sami Mansfield: Thank you very much for having me. It’s good to catch up.