Cancer, Breast

Overview of Breast Cancer

Breast cancer is the most common malignancy in women, with adenocarcinomas being the most common form of breast cancer. These carcinomas can affect breast ductal tissues and axillary lymph nodes, leading to malignancy. Treatment is based on the staging of the carcinoma and the client's hormonal sensitivity. Treatments usually include a combination of surgery, radiation and chemotherapies, and hormonal drugs. Clients become deconditioned due to the disease process and treatment programs that produce persistent fatigue and decreased tolerance to physical activities.^1,2

Benefits of Exercise Programs for Clients With Breast Cancer

Comorbidities to Consider

• Damage to or removal of axillary lymph nodes during treatment increases the risk of clients developing an upper extremity lymphedema.³

Client Examination

Keys to Examination of Clients

• Determine clients' physiological status and preparedness for engaging in the physical activities by assessing results of blood tests for platelet levels, hemoglobin, and white blood cell levels.

• Clients undergoing chemotherapy may not be able to participate in aerobic activities when hemoglobin levels are <10 g/dL and platelet counts are <50,000/mm³.

• Clients who have undergone surgical excisions and other procedures may have limited mobility due to slowed wound healing and fibrotic scar formations.

Recommended Baseline Testing of Fitness Levels

• Use a walking or a cycle ergometer test to assess tolerance for exercise and to predict a Vo₂ maximum.

• Assess clients' mobility and flexibility before clients begin exercise activities. Clients who have undergone surgical removal of lymph nodes should have the upper extremities assessed for mobility; volumetric measures should be taken to assess for changes in edema levels.

• Upper- and lower-extremity strength can be assessed using hand weights, resistance tubing, or weight-lifting machines.

• Quality-of-life measures and fatigue levels can be assessed by the Functional Assessment of Cancer Therapy for breast cancer.^4,5

Exercise Prescription

Type: Walking, cycling, aquatics, and resistance training^{1,2, 6,7,8}

Intensity: Start at 60% of Vo₂ maximum^2,6

Duration: 15–20 minutes

Frequency: Three times per week

Getting Started

Exercise sessions can be used on days alternating with chemotherapy treatments. This allows clients to adapt to the exercise program while maintaining tolerance to adjuvant therapies for breast cancer. Yoga has been used to address persistent fatigue and emotional well-being.⁹ Progressions of aerobic activities are recommended for up to 80% of Vo₂ maximum for 45 minutes, five ...