The Cancer Exercise Training Institute

Andrea's passion for improving other people's lives through exercise, is infectious.
Since attending the workshop, I have helped people with cancer to make positive changes in their lives, using the information from Andrea. You've been a true inspiration.
CTF, Certified Personal Trainer, Denver, CO

Cancer Exercise Training Institute • 3269 Forest Court • West Linn, Oregon • 97068 • (503) 502-6776 • Email Us

Where do I find a personal trainer who works with cancer patients? Click on the CES Directory to find a trainer in your region.

What are the stages of lymphedema?
Stage 1 (mild) - when you awake in the morning your limb may be a normal size. The tissue is till in a “pitting” stage (when pressed by a finger the area indents and holds the indentation). This is called “Pitting Edema.”
Stage 2 (moderate) - the tissue does not “pit” (when pressed by a finger the tissue bounces back without leaving an indentation). The tissue has a spongy consistency.
Stage 3 (severe) - the tissue at this stage is hard (fibrotic) and will be unresponsive to the touch. The swelling is irreversible and the limb is very large and swollen.

Who is a candidate for lymphedema?
Anyone who has had radiation to, or removal of the lymph nodes anywhere in your body. Being overweight, elderly, in poor health, poor nutrition, and having an infection, can increase your risk. For specific exercises to prevent and manage lymphedema, contact your doctor or Cancer Exercise Specialist.

How can I prevent lymphedema?
Avoid insect bites, burns, skin irritants, hangnails, and torn cuticles. Wear loose fitting clothing on affected area. Avoid tight fitting jewelry on the affected arm or hand
Don’t overheat – avoid saunas, whirlpools, steam rooms, hot baths, and sun bathing.
Don’t receive shots, have blood drawn, or have blood pressure taken on affected arm.
If you are overweight and have experienced swelling, losing weight can help reduce it by reducing the amount of fatty tissue which retains fluid and blocks lymphatic pathways.
Remember that tennis, racquetball, golf, and bowling are all considered risky sports for upper extremity lymphedema and that soccer, running, skating etc…. are risky sports for lower extremity lymphedema.
Keep the at-risk area(s) spotlessly clean and use lotion after bathing.
Avoid repetitive movements with the affected area · Avoid heavy lifting with the affected or at-risk arm. Never carry heavy handbags or bags with over-the-shoulder straps on the affected arm.
When traveling by air, wear compression sleeves or stockings.

Why is my posture so bad following my mastectomy?
Following a mastectomy, there may be scar tissue and adhesions across the mastectomy site causing tightness and muscle spasm in the chest wall. If the area is not stretched following surgery, it can become spastic and lead to round shoulder syndrome (the rounding forward of one or both shoulders). Round shoulder syndrome can also be exacerbated by the inherent “guarding” of the area after surgery. Prior to mastectomy, many of us have some degree of round shoulder syndrome as a result of poor posture and weak upper back muscles which seems to be compounded by the surgery. Matters can be made even worse following reconstruction which can cause muscle imbalances as well as additional scar tissue at the mastectomy site.
It is essential to address the resulting muscle imbalances following a mastectomy and/or reconstruction. . Most if not all of these issues can be corrected with the proper combination of stretching and strength training. Please consult a Cancer Exercise Specialist in your area for safe and effective guidance and programming.

Will I be able to do abdominal (stomach) exercises after TRAM reconstruction?
What you will be able to do following reconstruction will depend greatly on your fitness level prior to surgery. If you had strong abdominal muscles and a strong lower back prior to surgery, your recovery and subsequent return to your previous fitness level will be much easier. If you did not have a strong “core” to begin with, the TRAM procedure will leave you weakened even more and subject to low back pain and possibly even hernia.
Another consideration is whether you had a single or bi-lateral reconstruction; in other words, did they use part or all of your rectus abdominis to create one, or two new breasts? For obvious reasons, having both parts of your rectus used will leave your core tremendously weakened and can lead to postural deviations (swayback) and low back pain. It is highly unlikely that you will be able to do “crunches” or Pilates if you have had bi-lateral reconstruction. It will be very important, however, to work your obliques, intercostals, and erector muscles of the lower back to reinforce your core stability.
It is essential to address the weakened core muscles and postural deviations that arise following the TRAM. Most if not all of these issues can be corrected with the proper combination of stretching and strength training. Please consult a Cancer Exercise Specialist (CES) in your area for safe and effective guidance and programming.

Can I lift more than 8-10 pounds following an axillary node dissection?
The National Lymphedema Network recommends that you avoid lifting objects over 8 lbs. following an axillary lymph node dissection to prevent the onset of lymphedema. My recommendation is this; avoid lifting excessive weight whenever possible. What this means is if you don't have to take out the trash, carry your luggage with the affected arm, or carry your twenty pound child on the affected side, DON'T! On the other hand, if you take proper precautions to avoid lymphedema, including measuring your arm and not overheating, you can gradually begin to increase your weights at the gym. Following your surgery, you will need to begin with the lightest weight and just a few exercises/repetitions, regardless of how much you were lifting prior to surgery. As your arm tolerates it (no visible swelling), gradually begin to add a few more repetitions and then a few more exercises. Other than not letting yourself overheat, there are no limitations for your lower body (unless you have a pre-existing issue). The bottom line is be safe; start and progress slowly and realize that you may have to take two steps backward before you can take one step forward. For those of you who did not lift weight prior to surgery, you will need to take it even more slowly. I strongly recommend that anyone who has undergone lymph node surgery contact a Cancer Exercise Specialist prior to beginning or resuming a weight training program.

Why can't I raise my arm to the side or over my head anymore after my mastectomy?
Following a mastectomy, lymph node dissection, and/or radiation, the muscles may react by going into painful spasms affecting range of motion and posture. While the pectoral (chest) muscles are not removed, they undergo quite a bit of stress during the process. The incision across the chest, as well as the one under the armpit, may be bound down with scar tissue and adhesions. The skin may also be damaged by radiation. Depending on the degree of limitation, you may need to consult a physical therapist to help you with such modalities as ultrasound, massage, and electric stimulation. You should have a Cancer Exercise Specialist assess your range of motion and posture to determine whether or not you need a physical therapist and, if not, what the most effective exercise programming will be to help you regain your range of motion as well as correct postural deviations that may have resulted from the surgery and/or treatment. It is essential that you do not "push through" pain. Listen to your body and take it slowly. The degree of recovery will vary from person to person, but with the proper balance of strengthening/stretching exercises, there should be significant noticeable improvement in a very short time.

How do I lose the weight I've gained on steroids and/or hormone therapy?
If you are still taking steroids or hormonal therapy, you may find it quite difficult to lose weight. It can be extremely frustrating because no matter how well you eat, or how much you exercise, you continue to gain weight. For starters, consult with your doctor so that you can eliminate the possibility of diabetes. If he/she gives you the green light, you should consult with a nutritionist or dietician who specializes in working with cancer patients. Lastly, consult with a Cancer Exercise Specialist to help you put together a comprehensive and safe exercise program to help you build lean muscle mass and lose body fat.

How can I regain my precancerous strength and energy level?
If you are still undergoing chemotherapy or radiation, your body will not have the same physiological response to exercise as it will when your treatment is completed. All of your energy is currently going towards healing yourself and fighting cancer. If you have been exercising throughout your treatment, your return to your pre-cancerous strength will be much quicker than if you have been sedentary. You must start slow and realize that there will have been a natural decline in your performance. This is completely normal and expected. Even if you were a triathalete prior to your diagnosis, you will have to start slowly and progress according to how your body tolerates each newly introduced exercise protocol. I urge you to consult with a Cancer Exercise Specialist to help you reach your goals safely and effectively. Don't give up, with a bit of will-power and perseverance, you will return to your pre-cancerous strength, and then some!