In the United States alone, 3 million individuals have survived breast cancer; experts predict this number will increase by another million survivors within the next ten years. Healthy lifestyle habits, with an emphasis on regular physical activity, positively correlate with breast cancer survival. Read on to learn how personal trainers and lifestyle coaches can have a significant impact on the lives of those dealing with, or living in the aftermath of, breast and/or ovarian cancer and its various stages of treatment.
Exercise Correlates to Quality of Life
Research has proven that regular physical activity following a breast cancer diagnosis improves survival rates as well as one’s quality of life (QOL). However, breast cancer survivors rarely meet guidelines for recommended levels of physical activity. Wellness coaching interventions have improved exercise and health behaviors in other populations but until recently have rarely been studied in breast cancer.
A new study assessed the feasibility and effectiveness of wellness coaching/personal training for increasing the levels of physical activity in breast cancer survivors. The study followed 20 overweight breast cancer survivors upon completion of their treatment. Over a 12-week time period, each individual received an in-person wellness coaching session as well as 4 follow-up telephone calls. They each received 12 weekly emails containing recommendations for a variety of wellness tips. Subjects also reported on their physical activity, dietary habits, weight, and perceived quality of life during this time period.
The startlingly positive results indicated that the 20 breast cancer survivors demonstrated 100% adherence to the initial wellness coaching visit, and 96% adherence to the 4 telephone calls. Subjects also reported significant improvements in their physical activity engagements, improved dietary habits and revealed an uptick in a least some aspects of quality of life. 40% of the participants achieved the desired 3% postintervention weight-loss goal.
If personal trainers can capitalize upon the positive results of this study, we can begin to sense the importance of our role alongside traditional medical treatments.
Life After Chemo
Cancer survivors face unique health challenges. The assault often seems like a 2-prong attack: the psychological/emotional changes that occur with the diagnosis itself, and the physical impact of surgical disfigurement and difficult treatments. For some individuals, it seems, these changes take over their lives. For example, cancer survivors often experience declines in physical functioning and quality of life while simultaneously facing an increased risk of cancer recurrence and overall mortality compared to the general public. The 2010 American College of Sports Medicine Roundtable stands out as the first to conclude that cancer survivors could safely engage in significant enough exercise training to elicit remarkable improvements in physical fitness and physical functioning. They also noted how such training could enhance quality of life and mitigate the dreaded cancer-related fatigue.
The Role of the Trainer
Developing programs consisting of specific doses of aerobic conditioning, combined aerobic and resistance training, and/or resistance training by itself have all demonstrated the ability to improve common cancer-related health situations, including anxiety, depression and fatigue.
What can one-on-one coaching offer? Aside from the aforementioned, it simply helps to have a partner.
A dedicated and informed personal trainer can serve as a partner who provides evidence-based education, resources, self-care techniques, emotional support and therapeutic exercises to help clients optimize their healing and recovery.
Working closely with their clients, trainers can take on the role of a partner who offers empowerment as clients reclaim their strength, optimism, health, wellness, and life after/during breast cancer.
Some of the attributes that clients observe when working closely with an educated personal trainer include the following ~
- Reduce risk of cancer recurrence
- Improve the look/feel of surgical scars
- Improve movement and flexibility following surgery/radiation therapy
- Reduce risk of lymphedema
- Fight cancer-related fatigue/increase energy levels
- Help manage stress/negative emotions
- A safe and structured return to physical activity
Evidence of Physical Activity Offering Lifestyle Benefits
A recent study documented 1,780 women with newly diagnosed cases of breast cancer over an average of 4.7 years. Compared with sedentary patients, those who engaged in regular strenuous physical activity at age 35 saw a 14% decrease in their risk of future breast cancer. Scientists also observed decreases in cancer recurrence with the addition of strenuous physical activity, in patients between the ages of 18 and 50. Women who chose brisk walking (1.25-2.5 hours each week) as their preferred mode of exhibited an 18% decreased risk of breast cancer compared with inactive women. Interestingly, the most pronounced effect occurred in women with the lowest body mass index; but even women with a BMI ranging from 24.1-28.4 witnessed a diminished cancer risk of recurrent cancer.
Benefits Not Limited to Breast Cancer
Women at higher risk for breast cancer often discover that they also have an increased chance of developing ovarian cancer during their lifetime. Similar to post-surgical or post-treatment with any cancer, many patients struggle to begin or maintain an exercise routine after a diagnosis of ovarian cancer.
While nausea, pain, poor appetite and fatigue seem to ubiquitously affect all cancer patients at some point during their treatment, ovarian cancer comes with added challenges. The sudden onset of menopause can in many cases send a woman into psychological tumult. The limits on physical activity after abdominal procedures, such as removing the ovaries and as much cancerous tissue as possible, can thwart even the most zealous of patients.
Prue Cormie, PhD, a physiologist who is the founder of the Australian nonprofit EX-MED Cancer, stated in a webinar entitled “Exercise and Cancer” that professionals should include regular exercise in cancer treatment plans. “If the effects of exercise could be encapsulated into a pill, it would be demanded by every single cancer patient. It would be prescribed by every single cancer doctor,” Cormie says.
A study conducted in South Korea examined results of a supervised exercise program conducted among women following surgery for ovarian cancer. Patients participated in one of two groups: those who engaged in aerobics, walking and eventually light jogging, and those who remained fairly sedentary. Researchers discovered that, in addition to a reduction of body weight and fat mass in the group of exercisers, they found evidence that exercise could boost parts of the immune system that fight the spread of tumors.
The Importance of Tailoring Exercises Appropriately
Jocelyn Chapman, MD, a gynecologic cancer surgeon and Assistant Professor of Gynecologic Oncology at the University of California San Francisco, says patients recovering from ovarian cancer surgery should naturally avoid exercises that target abdominal muscles. However, in general Dr. Chapman encourages women fighting ovarian cancer to continue their activity due to its ability to help them manage the emotional stress associated with a cancer diagnosis. “Exercise is an important part of healing; and although patients might feel weakened, I do encourage them to start back slowly into an exercise routine,” Chapman says.
The American College of Sports Medicine (ACSM) suggests that individuals with cancer should take realistic steps toward increasing (or first engaging in) their physical activity. Starting with something fairly basic, such as taking a few laps around the living room, walking the dog, or venturing out to the mailbox, one can gradually build up to more significant movement and longer duration.
Options Abound in Addition to Walking
While surgeons and oncologists often start by suggesting walking to their patients who want to re-engage in activity, several other options likewise fit the bill ~
- Tai chi – Offering a combination of mind/body benefits, this practice involves slow deliberate movements which can provide a gentle way to tone muscles, focus on breathing and posture, and reduce stress.
- Yoga – Among the many different kinds of yoga, there lies a common thread: physical movement, breathing exercises, and meditation to make a connection between the mind, body, and spirit. Typical yoga sessions may last 20-60 minutes, depending upon one’s energy level.
- Water activities – Swimming and/or water aerobics classes provide gentle, low-impact exercises perfectly suited for surgical recovering.
Dmitriy Zamarin, MD, PhD, a medical oncologist at Memorial Sloan Kettering Cancer Center, recommends weight-bearing exercises to reduce the risk of osteoporosis. However, “before initiation of weight-bearing exercises, I typically recommend for the patients to discuss with their surgeons to ensure that their wounds have healed and that weight-bearing exercises would not predispose them to development of hernia.”
Unique Programs Show Great Promise
In 2014, a program called Active Living After Cancer came into play. Since its inception, close to 900 cancer survivors have participated, and they consistently report improvements in their quality of life. Likewise, these participants demonstrated measurable progress in their physical fitness. Slowly the program expanded from just breast cancer to include all types of cancer survivors. By the time they completed the program, nearly 50% of participants measured above the 50th percentile as compared to a mere 30% prior to beginning the program.
Active Living After Cancer showed that cancer survivors tend to engage in physical activity when programs include the involvement of their caregivers. Studies have shown that many cancer survivors struggle to achieve/maintain the recommended levels of physical activity; yet some initiatives can get these cancer survivors moving more by supporting them in the communities where they live, and by encouraging caregivers to also engage in more activity.
Cancer survivors and caregivers participated in a 12-week program conducted through Active Living After Cancer. Upon completion of the program, the percentage of patients hitting the targeted amount of exercise jumped from 29% to 60%. Survivors also reported improvements in their physical functioning and overall quality of life. Caregivers, too, noticed similar gains in all three areas. The findings appeared in the April 30th issue of the Journal of the National Cancer Institute.
“I was surprised to see such substantial improvements,” said the study’s lead investigator, Dr. Scherezade K. Mama of the University of Texas MD Anderson Cancer Center. “I think it speaks to the need” for such community-based physical activity programs.
Lindsey Page, Ph.D., M.P.H., of NCI’s Office of Cancer Survivorship, commented on how the results confirm the value of efforts to help improve physical activity among survivors, since medical professionals now acknowledge that a lack of activity significantly leads to cancer health disparities. “It’s really important to have programs like this, so that all cancer survivors have equitable access to physical activity,” Dr. Page said.
Exercise Guidelines for Cancer Survivors
In 2019, the American College of Sports Medicine released exercise guidelines that recommended cancer survivors should strive to get 30 minutes or more of moderate-intensity aerobic activity 3 times/week. Many guidelines recommend at least 150 to 300 minutes of moderate activity weekly, including 2 or more days/week of strength training.
The Bottom Line
Today’s clinicians seem to have a strong understanding of the unique medical and psychosocial needs of cancer survivors. To proactively help with the psychosocial issues in particular, a growing number of resources exist that can assist patients, caregivers, and even health care providers as they travel the challenging path that comes with the various phases of cancer survivorship. Personal trainers who cultivate a deep understanding of the post-diagnosis state of women recovering from surgery/undergoing treatment can make significant inroads in these clients’ physical abilities, endurance, strength and overall outlook on life. This just might prove to be one of the most important services we can offer the public.
References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7486982/
https://pubmed.ncbi.nlm.nih.gov/24890451/
https://pubmed.ncbi.nlm.nih.gov/15914748/
https://www.fredhutch.org/en/news/releases/2010/10/10-tips-breast-cancer-patient-treatment.html
https://www.mskcc.org/cancer-care/patient-education/exercise-during-after-cancer-treatment-level-1
https://thebreastcancer-pt.com/breast-cancer-coach
https://pubmed.ncbi.nlm.nih.gov/31626055/
https://www.webmd.com/ovarian-cancer/ovarian-cancer-and-exercise
https://pubmed.ncbi.nlm.nih.gov/12966124/
Cathleen Kronemer is an NFPT CEC writer and a member of the NFPT Certification Council Board. Cathleen is an AFAA-Certified Group Exercise Instructor, NSCA-Certified Personal Trainer, ACE-Certified Health Coach, former competitive bodybuilder and freelance writer. She is employed at the Jewish Community Center in St. Louis, MO. Cathleen has been involved in the fitness industry for over three decades. Feel free to contact her at trainhard@kronemer.com. She welcomes your feedback and your comments!
