Women receiving a diagnosis of breast cancer have a lot to do. They must arrange doctor visits, eat a healthy diet, take vitamins, drink enough water, and arrange time off from work.
One activity that is often overlooked, however, is exercise. Maintaining a healthy level of physical activity after breast cancer surgery, chemotherapy, and radiation should be a serious topic of discussion between doctor and patient for all women diagnosed or undergoing treatment. I encourage my radiation oncology patients to keep up their exercise regimens as long as they have the energy and their skin is intact.
It’s difficult for them to do, however. The diagnosis of cancer itself can lead to depression and weight gain. In addition to the common symptom of nausea during chemotherapy, many patients describe losing energy, so they tend to exercise less. Hormonal therapy like Tamoxifen can lead to fatigue, change in metabolism, and weight gain.
Patients have confided in me that they feel that having cancer makes them ask “what’s the point in working so hard on my body if it has failed me?” Others complain that friends and family members tend to bring too much food over to show support and give comfort. Comfort foods often lead to weight gain.
Some women are given the impression that exercise might somehow inhibit their recovery after surgery. Nothing could be further from the truth. Breast cancer patients should discuss exercise with their physicians and ask for the green light to get back into it slowly.
When I was preparing to have prophylactic mastectomies and reconstructive surgeries, one of my first question to my doctor was, “how long will I be sidelined from running?” I was determined to stay in shape despite undergoing this life-altering procedure. I ran—or rather, trotted—12 days after my surgery.
Exercise is an integral component to physical and mental health, and obesity is a risk factor for breast and many other cancers. A 2005 study found that breast cancer survivors who exercised regularly after diagnosis experienced a lower risk of a fatal recurrence than survivors who did not exercise. A 2012 study published in the journal Cancer found that obese survivors of certain types of breast cancer were 40 percent more likely to have a recurrence than survivors whose weight was in a healthy range. Even women who were overweight but not obese were more likely to experience a recurrence.
Hot off the presses are the results of a study from the Carolina Breast Study that found that only 35% of women diagnosed with and treated for breast cancer actually met the minimal physical activity recommendations of two and a half hours of moderate activity or one and a quarter hours of vigorous activity per week. Even more troubling was the finding that almost 60 percent of women in the study reported a decrease in activity after diagnosis. This decrease was even more pronounced among lower income and obese women.
The Carolina study, which sought to correlate reduction in physical activity with race, showed that African-American women tended to decrease activity more than white women in the study. However, it was inconclusive whether race was the prime factor, or whether income and obesity played a more dominant role. More than half the women studied were African-American, and were more likely to fall into lower income segments and to be obese.
The study found that those who had surgery or received chemotherapy only exercised the least, possibly because of pain, nausea or general fatigue. However, exercising through these side-effects is often a good way to overcome them and regain a sense of well-being.
The study found that women who were obese at the time of diagnosis were more likely to decrease their level of exercise after diagnosis and/or treatment. This was even more likely if they were of low income and had surgery rather than just chemotherapy and/or radiation. Possible reasons for this are that these women had less ongoing contact with the medical community than those who had cycles of chemotherapy or 6 weeks of radiation and daily visits with health professionals. It’s also possible that they had a hard time finding a sufficiently supportive exercise bra or an exercise group to motivate them after treatment.
Obese women are already at significant health risk. They are more likely to die of complications of heart disease, diabetes and stroke than their lighter counterparts. They are also more likely to be poor, because healthy food is often more expensive. So obesity, which comes partly from lack of sufficient exercise, partly because of socioeconomic means, is impacting the survival and overall health of a growing group of cancer patients.
Exercise is never a bad thing, and doctors should encourage each of their patients to exercise and keep up with existing routines, if possible, after a breast cancer diagnosis, or to begin a new exercise routine if she’s never done so.