What are some things you can do to help your client recover and thrive after Breast Cancer treatment? What are important things to know to work with BC clients?
(The information for this post is adapted from “Return to Life: Breast Cancer Recovery Using Pilates”, a continuing education course offered by Fitness Learning Systems.)
As the number of breast cancer survivors continues to grow, so does the need for compassionate and knowledgeable health-fitness professionals. Survivors need a trusted professional who can help them safely and effectively bring their life full circle through recovery to a new normal.
Breast cancer affects many anatomical structures in the body requiring creative exercise programming. What you do for BC clients depends on the type of cancer, treatment, surgery, and reconstruction if chosen.
Some of the structures in the body affected include:
- The breast consists of lymphatic tissue, fatty tissue, milk ducts, glands, skin and a nipple. If the cancer in the breast is close to the chest wall, the pectoralis major and other muscles may be impacted. This can be a huge chunk of one’s anatomy if it needs to be or is chosen to be removed.
- The lymph system can be impacted increasing risk for lymphedema. The degree of impact can be removal of one sentinel lymph node to removal of several lymph nodes increasing the risk of lymphedema. Lymphedema is a painful and debilitating condition (swelling/fluid in the arm and hand) that has serious impact on quality of life. It is critical to thoroughly understand and properly manage lymphedema risk in breast cancer patients. Many upper torso exercises must be adjusted or are contraindicated for breast cancer clients.
- There can be pain and decreased range of motion due to impact of surgery on the myofascial system and skin.
- The brachial plexus runs under the clavicle and through the axillary area. The lateral pectoral nerve innervates pectoralis major and the medial pectoral nerve innervates pectoralis minor. Nerves can be severed during surgery, resulting in numbness, motor atrophy, and decreased sweat production in the armpit and arm. Fortunately, this is uncommon. But some nerve damage is inevitable in mastectomy and reconstruction, and can sometimes lead to Post Mastectomy Pain Syndrome.
- Breast reconstruction can further complicate the magnitude of changes to a woman’s anatomy. Breast reconstruction using flaps can result in a loss of sensation dependent on where tissue has been taken from. Tissue for reconstruction can be taken from the back, stomach, and gluteal regions, affecting muscle and nerve function in those areas. The shoulder joint and shoulder mechanics can also be altered.
Many muscles can be affected by surgery and reconstruction. It is important to understand the myriad of anatomical alterations or changes that may occur. It will affect exercise ability, strength, range of motion, tolerance, and lymphedema risk in the area of the body where surgery occurs and what areas are used/affected by breast reconstruction.
Psychological, psychosocial, and cognitive issues affect the quality of life of breast cancer survivors on a daily basis. Breast Cancer affects men/women of all ages and it’s important to know when to refer an individual out for professional guidance, a support group, or a psychopharmacology evaluation by a medical professional. If you note changes in appetite, sleep, fatigue, or concentration, clients should be referred for professional guidance.
Following are some General Guidelines for working with breast cancer clients:
- Before starting any exercise program, be sure to have a doctor’s approval to begin.
- Adhere to medical recommendations provided by the client’s medical team.
- Complete medical history: orthopedic, metabolic, cardiovascular, chronic medical conditions and thyroid issues should be noted.
- Medication taken should be reviewed for possible side effects.
- Previous and current exercise and activity participation should be evaluated.
Following are Questions to Ask Your Client in the screening process:
- What kind of breast cancer surgery did you have and when?
- Were lymph nodes removed?
- What other kinds of treatment did you receive and when?
- Do you have any side effects from treatment?
- What medications are you taking?
- Do you have any other health problems?
- Are you undergoing or will you have any reconstructive surgery?
Aaronson N, Turo AM. (2015) Return to Life: Breast Cancer Recovery Using Pilates. Fitness Learning Systems Continuing Education Course.