Making Exercise Part of Your Metastatic Breast Cancer Treatment Plan

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Many organizations, including the American Cancer Society, recommend that people diagnosed with cancer complete 150 minutes per week of moderate exercise or 75 minutes per week of vigorous exercise, plus two sessions per week of strengthening and flexibility/stretching movements. Research has shown that these same recommendations are safe and effective for people diagnosed with metastatic disease, including metastatic breast cancer.

Why should people with metastatic breast cancer exercise? Among other things, exercise can:

  • reduce your risk of falling and breaking a bone
  • help you keep doing daily activities such as shopping, walking, and driving
  • reduce your risk of osteoporosis
  • boost your self-esteem
  • reduce the risk of anxiety and depression
  • improve your sleep quality
  • ease treatment side effects such as nausea, fatigue, and pain

Still, it can be hard to create and stick to an exercise plan if you’re tired and sore from treatment or have to spend time traveling to and from treatment centers.

Sami Mansfield, a certified cancer exercise trainer and CrossFit Level 1 coach with extensive exercise and nutrition experience, offers the following six tips to help you start and keep exercising. However, you should talk to your doctor before starting an exercise plan.

Tip 1: Think about what you want exercise to do for you

Do you want to improve your strength? Do you want to have more endurance for your daily tasks? Do you want to improve your body composition? Do you want to control or lessen a specific side effect?

“I usually ask someone I’m working with to choose a top two,” Mansfield said. “Then we can talk about exercises that will achieve those goals. It’s important to understand that not all exercises are the same. Given time and energy limitations that people with metastatic disease commonly have, you want to focus on your priority goals first.”

Tip 2: Do you have any barriers to exercise?

Do you have side effects from treatment, such as neuropathy (numbness and/or pain), that may be causing balance challenges? If so, you may need to do seated exercises or work on exercises that use the muscles in your feet to gain strength and improve balance.

“I ask about side effects,” Mansfield said. “Maybe holding a barbell overhead doesn’t seem feasible. Does the person have access to a gym? Does she or he need to exercise at home? Does someone have lung metastases that compromise their cardiovascular function? We take all these things into account and then come up with a plan.”

Tip 3: Try these three exercises that are safe and effective for everyone

Mansfield recommends the following exercises for everyone.

  • Use a chair to do stand-to-sit and sit-to-stand movements. Mansfield explained that this exercise is basically a squat, an important movement that’s necessary for using the toilet, getting out of bed, getting dressed, getting into a car, and other daily activities. “Strengthening the muscles used for squatting movements is key to so many things in life,” she said. “No matter where the metastasis locations are, it’s a very safe and effective exercise.”
  • Strengthen your core by sitting on the edge of your chair for 20 to 30 seconds at a time. “Use your core muscles to keep yourself sitting up straight,” Mansfield said. “Don’t lean on the back of the chair, and really engage the center of your body. That’s going to help everything from walking, to turning a corner, to carrying a purse or a child.”
  • Work on lifting your arms all the way overhead to a full extension. “In the exercise world, that’s known as a shoulder press,” she said. “But it’s a really important movement for things like washing your hair, or putting a coffee mug on the top shelf, or being able to reach around the seat of a car to buckle in a child.

    “A great way to do this is to stand against a wall, or sit in a chair if that’s more comfortable, put your arms at 90 degrees — so your upper arms are parallel to the floor, your elbows are bent at 90 degrees, and your hands are pointing up — and then work on stretching your arms all the way overhead, so that the inner part of your arm is close to your ear. You may realize that you have compromised flexibility. This could be because of surgeries or treatments. So you start where you are and keep working on it.”

Tip 4: Know the difference between exercise soreness and other pain

To gain strength and muscle mass, you need to make your muscles work. According to Mansfield, it’s OK for someone with metastatic disease to “feel the burn” from exercise. This is short-term burn due to lactic acid build-up when a muscle is worked.

When you work a muscle effectively, small tears are created in the muscle tissues that are signals to the brain to build up these muscles, she explained. This pain, known as DOMS (delayed onset muscle soreness), lasts about 2 to 3 days and is a dull, achy feeling or stiffness in the muscles. As your muscles get stronger and more developed, this soreness will ease, but keep in mind that when you do a more vigorous or more intense workout, you’ll likely feel this pain again, even when you’re in better physical condition.

“Just because someone has metastatic breast cancer doesn’t mean that the exercise should be gentle or easy,” Mansfield said. “I think we can all agree that cancer is not easy, so we need to find the right intensity so that someone feels the burn, but is not doing so much that she or he is sore for more than 2 or 3 days.”

Mansfield emphasized that any shooting, stabbing, or searing pain, or pain that comes from joints catching, is concerning. If you feel any sharp pain like this, stop what you’re doing and lessen the intensity.

Tip 5: Include resistance training in your program

Resistance training is simply overloading a muscle to make it stronger. For some people, sitting in and standing up from a chair multiple times may be enough resistance training. For other people, this may not be challenging enough, so they may need to hold on to a weight or another object.

“Resistance training is the most important place to focus your exercise if you are feeling any fatigue or deconditioning,” Mansfield said. “Muscles atrophy, meaning they get smaller, through lack of use or more sedentary behaviors. While walking is a great form of exercise, it’s not as effective to reduce fatigue and in many cases, it’s not as safe.”

Tip 6: Start small and work up

Doing 150 minutes of moderate exercise per week can seem daunting if you haven’t exercised in a while, so many people don’t even try. Mansfield recommends starting with small exercise “snacks,” such as spending a minute or two every morning sitting up straight on the edge of your bed or the edge of a chair.

“Even though that doesn’t feel like you’re exercising, you’re actually exercising muscles that you need to support you in everything that you do,” she said. “Doing that multiple times per day makes a much greater impact and is much more attainable and sustainable than trying to hit the gym for 20 to 30 minutes or more.

“People say to me, ‘Sami, seated exercise?’ And I say, try it. Even for me, if I’m sitting down and I’m having to isolate, you can’t cheat and use your legs. You really have to have strength, and it’s hard. You can grab a set of small soup cans and put them by a chair in your dining room, and you go to your chair and you do one exercise 10 times and you’re done. I think those truly attainable little exercise snacks, done frequently over time, are going to build up more energy and muscle mass that will contribute to doing longer and larger exercise programs.”

Listen to our podcast interview with Sami Mansfield to hear more about exercise for people diagnosed with metastatic breast cancer.

Learn more about the benefits of exercise for people diagnosed with breast cancer, as well as how to find a qualified trainer.

Written by: Jamie DePolo, senior editor


Sami Mansfield

Sami Mansfield started her career as a cancer 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 and CrossFit Level 1 coach with extensive exercise and nutrition experience.


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