Abreast in a boat--a race against breast cancer.

Abstract

Many patients trying to get back to “real life” after a serious illness are disheartened to find that the post-treatment phase of their care is sadly wanting. Survivors of breast cancer are no exception. Many women describe a period of uncertainty and depression, often of considerable length, after active treatment ends. Their anxieties and concerns about the illness remain, but they lose contact with the medical support network. There are no standardized guidelines for the management of survivors of breast cancer. Recommendations with regard to physical activity are generally conservative and direct patients as to what they cannot do rather than what they can or should do. The treatment of breast cancer commonly involves lumpectomy or mastectomy with axillary node dissection, followed by adjuvant radiotherapy and chemotherapy as indicated. This treatment improves survival but can result in pulmonary fibrosis, restrictive lung disease and diminished exercise capacity. Physical activity affects the production, metabolism and excretion of the female hormones, as well as energy balance, and these factors may be linked to the lower risk of breast cancer in habitually active women. Formal exercise programs for women with breast cancer are few and limited to small groups of patients, although the general consensus is that exercise helps to maintain functional capacity in these patients. Current opinion suggests that avoidance of strenuous activity is necessary to prevent lymphedema after treatment for breast cancer, although some women with breast cancer have recently begun to challenge this taboo. In fact, there are many reasons to believe that upper body exercise has a role in recovery from breast cancer and lymphedema because it can improve range of motion and reverse muscle atrophy, activate skeletal muscle (which may help pump lymph), stimulate the immune system and reset the sympathetic tone of the lymphatic vessels.