Consult a physical therapist and tailor workouts to changes in your body. For example, a TRAM flap breast reconstruction will decrease core body strength due to the absence of abdominal muscle, says Carolyn M. Kaelin, PhD, MPH, author of Living Through Breast Cancer (McGraw-Hill, 2005). Likewise, reconstruction using the back latissimus muscle affects shoulder range of motion, she says. To help guide women, Kaelin created a Breast Cancer Survivor's Guide to Fitness DVD with Reebok master trainers Josie Gardiner and Joy Prouty. Profits go to the Quality of Life fund at Brigham and Women's Hospital, which supports educational outreach for breast cancer survivors. Kaelin's latest book, The B.C. Survivor's Fitness Survival Plan (McGraw-Hill, fall 2006), also offers custom-tailored exercises for rehabilitation after surgery and chemotherapy.
Gradually build up to a minimum of three to five hours of cardiovascular exercise a week. Be it walking, bicycling, swimming, or using an elliptical trainer. "Not only does it aid in weight loss, but exercise helps restore heart and lung function, which drops in some women during chemotherapy or radiation, and it helps reduce stress," says Andrea Leiserowitz, a physical therapist at the Seattle Cancer Care Alliance. If you feel too tired to move, begin with even five to 10 minutes a day and gradually build up to 30 to 60 minutes of sustained cardio training.
Weight training will help restore muscle lost from surgery or inactivity. This is particularly vital for women who've undergone chemo, Kaelin says. A Dana-Farber/Brigham and Women's Hospital study shows that within the first year after beginning chemotherapy, those who experienced premature menopause lost up to 7 percent of bone mass from the spine and 4.8 percent from the hips. Furthermore, women who have been diagnosed with breast cancer have an almost five-fold increased rate of spinal fractures compared to women who have not been treated for breast cancer. Don't forsake stretching and range-of-motion exercises to restore mobility to your arm and balance exercises to restore equilibrium, Leiserowitz says.
Buy a pedometer to clip at your waist and note the number of steps you take daily. You may not reach the American College of Sports Medicine's recommended 10,000 steps daily, or roughly 5 miles, but you'll be encouraged. Kaelin is by hers. "With each step, I know I'm improving and on the road to recovery."
To lose weight, calories out must exceed calories in, so eat nutritionally dense, low-calorie vegetables and fruits, while boosting the number of calories you burn. The National Weight Control Registry data on more than 4,500 people who've lost 30 pounds-plus and have kept it off for at least a year show they exercise at least an hour daily.
A recent American College of Sports Medicine study of women ages 40 to 55 who were obese showed diet worked on the short term, helping participants lose an average of 11.5 pounds, or 6.2 percent of their initial weight. But those who kept the weight off a year later also reported greater interest and pleasure in exercising. "People who are just into dieting, or who exercise and quit, are setting themselves up to fail," says lead researcher Timothy G. Lohman, PhD, a University of Arizona at Tucson professor. "With enjoyment and success in exercising, a person feels more self-determined. You feel confident."
You'll be less likely to stray if you see it in writing. Fill up on high-fiber, low-calorie foods, such as carrots, apples, and salads. "All are choices that will quell our hunger and are very good for us," says Kaelin, who personally swears by a small can of V-8 juice when she's hungry. Amy Osteen, an elementary school physical education teacher in Round Rock, Texas, found she had to resist cheese and nuts, which are easy to grab, but highly caloric.
You may find that six hours of sleep nightly no longer is enough after treatment ends. You may need nine to 10 hours to be refreshed and productive.
For some, stress reduction comes through exercise, says Kaelin, and for others, meditation, prayer, or going out with girlfriends is what they need. At the end of the day, try to look at your cancer as an opportunity to change your life for the better. "Thanks to therapies available today, breast cancer can be a bump in the road," Kaelin says. "Many will go on to live their full life expectancies, and physical activity will enable us to live fully."