How then does one even begin to wrap their head around creating a safe and effective class with so many variables?
Start with a few parameters:
- The class should be for a scheduled period (6-8 weeks, 8-12 weeks…)
- The same participants should begin and end together. Allowing new participants to join once the session has begun makes it more difficult for the instructor and can be distracting for the existing members of the class. The instructor would need to pay special attention to the new member and potentially neglect existing members.
- Keep the group small until you feel more comfortable in this setting. Start with 4-6 people.
- Try and find similarities amongst the participants such as age-range, gender, type of cancer/surgery/treatment, currently undergoing treatment or completed treatment, beginner/intermediate/advanced, etc.
You may start off with something like this:
Beginning Exercise Class for Breast Cancer Patients & Survivors
If you are currently undergoing treatment for breast cancer and are between the ages of 35-50, we encourage your participation!
Classes will begin on Feb. 3, 2020 and run every Monday and Wednesday from 4-5 p.m. through April 1st.
- Increase stamina/decrease fatigue
- Prevent/manage upper extremity lymphedema
- Reduce body fat & increase lean muscle mass
- Increase self-esteem and self-confidence
- Prevent/minimize the risk for osteoporosis, lymphedema, diabetes, future cancers, damage to heart and lungs
- Increased ability to perform day-to-day activities
- Regain control of your body and return to your previous level of activity or BETTER!
You must schedule an individual assessment, complete health history, and provide doctor’s medical clearance prior to beginning class.
The cost is XYZ and payment plans are accepted. If you need financial assistance please email Jane Doe to apply.
I suggest that you create a cheat-sheet similar to this:
Pink – limited shoulder flexion
Red – limited shoulder extension
Orange – limited shoulder abduction
Yellow – limited shoulder internal rotation
Green – limited shoulder external rotation
Blue – upper-crossed syndrome
Purple – lower-crossed syndrome
Black – upper extremity lymphedema
White – lower extremity lymphedema
These are just examples. You can modify them based on the group you are working with. Go to https://www.wristbandexpress.com/silicone-wristbands/1-2-solid-color-silicone-wristbands/ (or any other site you chose) and order a variety of wrist bands in different colors. Pay attention to the pricing based on how many you order.
You are probably wondering what you are supposed to do with this rainbow of wristbands… you hand them out according to the “issues” that the individual group members have. If you are instructing the class to perform “push-ups,” you might instruct the people in the class with blue wristbands to perform a chest fly or a row instead (they are typically shortened through the pectoral muscles and a push-up will exacerbate that). If you have members who are wearing black bands, make sure that when you have the class perform poses that require holding their arms in a certain position for a prolonged period of time, or applying pressure or weight to that area for a prolonged period of time, that they start and progress slowly. They should monitor for swelling in the affected arm over the next 24-28 hours. If you have someone with a green wrist band you can instruct them to work on range of motion in anything requiring external rotation such as “cactus arms” (refrain from holding a pose in this position until they achieve 90% of the lowest norm). Hopefully this makes sense! It’s a great way to help you monitor the class when you can not possibly remember everyone’s individual assessment!
Prior to the start date, gather your data from each participant and try and find similarities in the group. Ask yourself what are the most important issues to begin with. Most people will need to work on body composition and do cardio to strengthen heart and lungs. Does anyone in the group have neuropathy? Will you need to focus on balance exercises? How will you progress/regress accordingly? Are they at risk for lymphedema? How will you progress safely and what modifications will you need to make (avoid holding a position for an extended period of time if it puts pressure on the affected arm/shoulder). Do they have limited range of motion?
If a participant has limited range of motion in a particular plane of motion, you will want to modify movements so that they “flow” as opposed to holding a position. Imagine that you are instructing the class on how to properly perform Warrior I. You notice that Sarah’s right arm is about 15 degrees lower than her left in flexion. Rather than having her hold the pose, consider having her keep the movement fluid; each repetition she tries to reach a bit further. Keep in mind that holding a pose requires isometric contractions. Much like isotonic or isokinetic exercise, this will increase strength over time. If we strengthen a limb and it’s muscle groups by holding a particular pose prior to having full range of motion, it may prevent further progress as well as exacerbate the existing limitation.
I would love to give you a perfectly formulated equation but unfortunately there is no such thing! This is where your individual skills as a yoga instructor or yoga therapist will be necessary.
Begin the yoga class with deep diaphragmatic breathing. This gentle pumping action to the central lymphatic vessel in the chest cavity (the thoracic duct) will help to stimulate the flow of lymph. Encourage your students to use this breathing technique throughout the day as it will also increase oxygen to tissue throughout the body, lower their heart rate, decrease their blood pressure, and relax their muscles which may be tight and spastic following surgery and radiation.
If this is a beginner class and/or the participants are undergoing treatment and functioning at a lower level, consider cutting the class back to 1/2 an hour vs. the standard one hour and modify the timing accordingly. For a deconditioned or lower-functioning class consider chair yoga and gradually work toward standing using the chair for balance.
Next have the class perform upper extremity lymph drainage exercises. We always begin with pelvic tilts and “crunches.” If anyone in your class is unable to do so on the floor, you can have them perform this ALTERNATIVE for crunches and perform pelvic tilts in an upright position.
Make sure to include a variety of poses that will address range of motion, balance, multi-planar movements, and breathing. Be aware of the students that have undergone various surgical procedures, including reconstruction, and teach them how to modify poses so that they are not in pain. Understand the limitations that may be places on certain members who have reconstruction using rectus abdominis, latissimus, or gracilis muscles and how to chose/modify poses accordingly.
Keep in mind that some people will progress at different rates than others. It is critical to set realistic goals for each individual in the class to ensure their success. Always encourage everyone to work at their own level and praise them for even the smallest of improvements and accomplishments.
At the end of class we cool down by incorporating the lymph drainage exercises and finishing in supine position with some visualization, mediation, and gratitude.
Remember that the camaraderie of fellow class members can be an amazing support system within the group. Many people thrive in this environment while others will prefer one-on-one training. There is something for everyone and it is only through practice and safe experimentation that we can determine the best path for each individual.
For modifications and programming ideas, you can purchase Cancer Exercise Yoga by Stephanie Adams and Andrea Leonard.
If you are interested in working with cancer patients at all stages of treatment and recovery, but are not yet a Cancer Exercise Specialist, REGISTER NOW to learn how to safely and effectively work with this population while building your client base.