Why Exercise Is Important for People With Breast Cancer, and the Best Workouts to Do

Not only is it possible to exercise if you're undergoing or have recently finished treatment for breast cancer, but being active can go a long way toward improving your health and helping you cope with the emotional side of treatment.

The key is knowing how to adapt to your body's current normal — which might be pretty different from your pre-cancer capacity — and being gentle on yourself.

"Exercise in breast cancer survivors has many potential benefits," says Carmen Bergom, MD, PhD, an associate professor of radiation oncology and pharmacology and toxicology at the Medical College of Wisconsin in Milwaukee. "In general, the vast majority of activities are safe for all my patients as long as they go slowly and don't overdo their activity."

Getting started can sometimes feel overwhelming, though. Here's a look at why it's so important to be active when you're dealing with breast cancer, the possible downsides and what you need to know to kick off your workout regimen.

If you've been diagnosed with breast cancer, you should aim to be active for at least four hours a week, per the American Cancer Society.

Breast cancer statistics show the most active breast cancer survivors had around a 40 percent lower chance of dying compared to those who were sedentary in an analysis of 10 studies published in April 2019 in the journal ​Breast.​ August 2013 ​Breast​ research shows that regular exercise is also linked to a 40 to 50 percent lower risk of breast cancer recurrence.

What makes physical activity so powerful? Exercising helps keep excess fat tissue at bay. That's important, since fat tissue contains estrogen — the hormone that spurs the growth of many breast cancers, according to the nonprofit BreastCancer.org.

And that's just the beginning. Research shows that when you're active during and after your breast cancer journey, you'll reap other important benefits like:

• ​Fewer side effects from treatment.​ Being active can ease chemo-related nausea, reduce the risk of blood clots and fight constipation.
• ​More energy.​ People who exercise during breast cancer treatment report having up to 50 percent less fatigue compared to those who are sedentary, according to the National Comprehensive Cancer Network.
• ​Improved mood.​ Breast cancer patients who follow a regular exercise program have significantly better quality of life and less anxiety and depression than those who aren't active, concluded a review of 61 studies published in December 2018 in the ​Archives of Physical Medicine and Rehabilitation​.
• ​Better range of motion.​ Targeted stretching exercises can ease tightness in the arm and shoulder muscles that can develop from surgery- or radiation-related scar tissue.
• ​Healthier bones.​ Breast cancer treatment can increase the risk for osteoporosis, but weight-bearing exercises like walking, jogging and strength training can help fight bone loss.
• ​Stronger muscles.​ Resistance exercises can play an important role in helping you regain your strength, making everyday activities easier. They'll also help stave off muscle loss that can occur as a result of treatment.
• ​Better sleep.​ Exercise is a known insomnia-fighter, including for those with breast cancer, according to April 2017 ​Breast Cancer Research and Treatment​ findings.

Experts agree that it's safe to exercise during and after breast cancer treatment. But it's important to follow any instructions or precautions laid out by your doctor, start at an easy pace and up the intensity gradually.

Surgery, chemotherapy and radiation can put you at risk for lymphedema — when the soft tissues of your arm, hand, trunk or breast fill with fluid. "This fluid can build up and not be appropriately drained, causing swelling in the arm and sometimes pain and even an increased risk of infection of the skin of the arm," says Simona Shaitelman, MD, EdM, an associate professor of radiation oncology at the University of Texas MD Anderson Cancer Center in Houston.

"It's important to respect what your body is going through or has gone through as you deal with your cancer diagnosis."

There's some concern that lifting heavy weights or doing lots of reps could raise lymphedema risk. But that doesn't necessarily mean that all strength training is off the table. Starting off with very light weights and gradually increasing the intensity isn't thought to increase the odds for lymphedema, according to BreastCancer.org.

"There's very little risk of developing lymphedema from routine or guided physical activity, and, in fact, such activity may be helpful to possibly prevent lymphedema," Dr. Bergom says. That's true even if you had surgery or radiation on your axillary (underarm) lymph nodes, she notes.

Also important to keep in mind: While regular exercise can go a long way toward managing treatment-related fatigue, there might be times when you're just too zapped to work out. If that's the case, don't push yourself.

"It's important to respect what your body is going through or has gone through as you deal with your cancer diagnosis," says Karen Hock, PT, a physical therapist specializing in oncology rehabilitation and lymphedema management at the Ohio State University Comprehensive Cancer Center.

There may be other risks you need to consider, too, depending on your treatment plan and any health issues you might be dealing with outside of your cancer. "It's very individual for each patient," Dr. Shaitelman says.

Once you've gotten the green light from your doctor that it's OK to start exercising, build up to getting in at least 30 minutes of activity daily, per the National Comprehensive Cancer Network.

"Immediately after surgery, patients need to follow the guidelines given by their breast surgery team regarding when it's safe to resume exercising," Dr. Shaitelman says. "Once patients have medical clearance to exercise, I suggest gradually ramping up with both aerobic and anaerobic exercise."

Walking is a good place to start. "It's easy to set a goal either with distance or number of steps and see yourself improve. Once you get started and find some confidence in being active, try something else," Hock says. Other activities, per BreastCancer.org, might include:

• Running or jogging
• Cycling
• Dancing
• Swimming laps with a kickboard
• Yoga, with some modifications. (Let your instructor know about your breast cancer or seek out a class for breast cancer patients.)
• Tai chi
• Pilates
• Weight lifting and resistance exercises, initially under the guidance of a physical therapist.

Starting off your workouts with a physical therapist who specializes in cancer care can be particularly helpful. "We always teach a slow progress of exercise, especially if the patient was sedentary prior to the cancer diagnosis," Hock says.

As for what ​not​ to do? Activities that stress your arms or shoulders might be risky for a while. You should consult your doctor or a physical therapist specializing in oncology before trying exercises like:

• Swimming laps with arm movements
• Push-ups or pull-ups
• Resistance band exercises
• Elliptical or rowing machines
• P90X
• Tennis
• Cross-country skiing

Whether you exercised before your diagnosis or are brand new to working out, you might have to take it slower than you expected at first. That's OK — and completely normal.

In fact, it's a good idea to go easy on yourself in the beginning to get a sense for what feels comfortable. "Even if you know you can do more, starting slow and progressing slower than you would normally will lead to a better adaption to exercise and reduce the risk of injury," Hock says.

"After surgery and radiation, kindness to oneself should be a focus."

Working with a physical therapist specializing in oncology or talking with the instructor of a group class are good ways to learn more about what moves you might need to avoid — and how to make modifications starting out and adjust them over time. For instance, Child's pose can be a restful alternative to yoga poses that might tax your arms or shoulders, like Downward-Facing Dog.

Finally, even though regular exercise is essential for your health, know that it's important to take a break when you're just not feeling up to it. "It takes time for one's body to heal," Dr. Shaitelman says. "After surgery and radiation, kindness to oneself should be a focus."