Gaining Strength

Gaining Strength

Post-op exercises help breast cancer survivors win control

When a woman is first diagnosed with breast cancer, it can feel like her body is under assault with endless procedures: surgery, radiation, chemotherapy and reconstruction. Fortunately, many local medical centers have programs that emphasize regaining movement and strength after breast cancer surgery.

Postoperative programs for women who have had breast cancer surgery include physical therapy, occupational therapy, yoga and Pilates. These programs help survivors stretch and strengthen the shoulder, chest, back and abdominal muscles in order to allow patients to regain full range of motion and to feel like they’ve got their bodies back under their control.

When Chicagoan Laura Davis was diagnosed with breast cancer in September 2014, she faced grueling treatment: a mastectomy followed by chemotherapy, radiation treatments and reconstruction surgery at the Mark M. Connolly Center for Cancer and Specialty Care at Presence St. Joseph Hospital.

When her 20 rounds of chemotherapy began, Davis saw occupational therapist Charlene Giraldo every week to restore range of motion for everyday activities. “She had me doing different exercises to keep up my strength and stamina, and stretching to make sure I had enough mobility in my shoulder to move and turn my arm without any pain,” Davis recalls.

Davis had an ambitious plan of her own to accomplish: walking an annual 60-mile breast cancer walk. “I’ve been doing the three-day Susan G. Komen walk every year, so I did that after surgery and before I started chemo.”

Restoring physical movement is key for breast cancer recovery to strengthen the body, reduce scar tissue and prevent lymphedema, a dangerous swelling (edema). When lymph nodes are removed during breast cancer surgery, the body’s drainage system is compromised, and fluid can build up in the arms, hands, breasts, underarms, chest or back.

Exercises and treatment are designed to prevent lymphedema or to minimize the condition. “We have the patient do exercises to facilitate drainage. [We also] do compression bandaging and teach the patient how to manage the condition,” Giraldo says.

As part of the holistic approach to treating breast cancer patients, a nurse navigator at Presence St. Joseph also suggested that Davis take yoga classes during her treatments, taught at the hospital by instructor Anjali Kingsley.

“When patients come in, they are often overwhelmed and fatigued mentally and physically,” Kingsley says. “The poses and the breathing techniques help to release tension and tightness, which allows them to gain a sense of control over their body. This, in turn, helps them to feel the connection between the body and the mind. The focus is not only on a physical workout but also on relaxing the mind.”

Yoga provides a positive release, Davis says. “Chemo is completely draining and so is radiation,” she says.

“The yoga kept me moving and was relaxing, because the focus wasn’t on getting drugs that made me feel bad but on something that made me feel good mentally and physically.”

At Reach Pilates in Chicago, co-owner Kim Mazzella and two other Pilates instructors offer private classes in the six-week Pink Ribbon Program. The program, developed by breast cancer survivor Doreen Puglisi, provides postoperative therapeutic exercises designed to help women regain strength and mobility.

“Because there are a wide variety of surgeries and treatments available, each breast cancer patient is unique. We like to work with them individually,” says Mazzella, a 19-year breast cancer survivor who had a lumpectomy and her lymph nodes removed when she was 30 years old.

The series of exercises—which at first gently stretch and strengthen the neck, chest, shoulders and underarms—helps reduce the risk of lymphedema, frozen shoulder and scar tissue and increases blood flow and mobility. The focus gradually expands to the rest of the body as well. “When you have surgery in one part of your body, it affects the entire body,” Mazzella says. “So toward the end of the program, the exercises strengthen the muscles of the arms and legs, the core and the back so a woman can be the strongest, healthiest person she can be and get her life back to normal.”

The program also helps women decrease stress and anxiety. “This program comes at a very crucial time in a woman’s recovery. It begins when all treatment, surgery and physical therapy have ended. She is left with the feeling of ‘What do I do now?’

The Pink Ribbon Program allows the patient to continue the transition back to a normal life,” Mazzella says.

At Advocate Good Shepherd Hospital in Barrington, physical therapist Patty Jasonowicz, a specialist certified in treating lymphedema, is also certified in The Pink Ribbon Program. Although the hospital doesn’t offer formal Pink Ribbon classes, Jasonowicz incorporates the moves into her treatment of breast cancer patients. Phase one of the program uses gentle range-of-motion exercises for the shoulder, chest and back as well as exercises to improve the patient’s breathing. Phase two features exercises that include the whole body. In phase three, exercises are designed to gradually improve the patient’s strength.

After their formal therapy program has concluded, patients often benefit from a transition into programs such as yoga or stretching and breathing exercises to help continue with their recovery process.

“As we often have only a limited window of opportunity for direct one-on-one care with our patients, it’s nice to know that we can refer them to Pilates classes in our hospital’s fitness center or suggest they find a Pilates instructor certified in The Pink Ribbon Program,” Jasonowicz says. At that point, breast cancer patients can become the navigators of their own healing process.

Originally published in the Fall 2016 print edition