Exercise and secondary breast cancer

What kind of exercise should you do if you have secondary breast cancer – and what should you avoid?

Here Dr Emma Scott from the Breast Cancer Recovery Project at Sheffield Hallam University gives some advice:

'There’s been little research into the benefits of exercise for people with secondary breast cancer. There have been a few case studies, but the majority of exercise and breast cancer research has focused on women with a primary diagnosis. This work has explored the effects of regular exercise on women both during and after treatment, and the results are good. Many benefits occur soon after the exercise programme begins, and there’s no reason to think that women with secondaries would not experience these benefits too.

'The presence of secondary cancers within the body does, however, mean that you may need to take a little extra care when starting to exercise.

The benefits of regular exercise

'Most people are aware that regular exercise helps increase fitness, strength, stamina and flexibility, as well as helping with weight management when combined with a healthy diet. Over 60 per cent of women diagnosed with breast cancer gain weight during and after treatment, making weight management a key concern for many. There are various reasons why women gain weight after diagnosis – some eat more, others are less active, and sometimes weight gain is a side effect of prescribed drugs – but the best way to safely lose weight is to combine a healthy diet and active lifestyle.

'Exercise can also help reduce fatigue, both during and after treatment. In fact women who exercised, even gently, during treatment (e.g. chemotherapy or radiotherapy) tolerated treatments better, experiencing less pain, nausea, insomnia and fatigue. Regular exercise also helps reduce blood pressure and boosts your immune system.

What do we mean by 'regular exercise'?

'Scientifically, what we mean by 'regular exercise' is 30 minutes of moderate intensity exercise at least three days per week, but that's a lot for anyone to start with! Before you start any exercise it’s important that you discuss it with your doctor, and then begin gently and build up gradually. It doesn’t need to be half an hour in one session.

'Moderate intensity means you may breathe harder, become warmer and may be aware of your heart beating slightly faster than normal, but you should still be able to talk. You should know that you are doing something but not going full throttle. If you are currently receiving treatment you may need to exercise at a slightly lower level. Remember, always listen to your body and if it feels too hard or hurts, stop!

'When choosing your exercise try to focus on aerobic-type activities such as walking, swimming or cycling. It doesn’t need to be structured exercise – activities such as dancing and gardening can also be beneficial. You could also include some light toning or conditioning exercises and stretching. The most important thing to remember, though, is whatever you choose to do, choose something you enjoy.

Bone metastases

'Bone metastases are the most common type of secondary breast cancer. The most common symptoms of bone metastases, bone weakening and fracture risk, are also seen in people with osteoporosis. In these people, regular exercise increases bone strength and reduces fracture risk, and there’s no reason to think that these benefits would not be available to people with bone secondaries. Research shows that regular weight-bearing exercise, such as walking, is the best choice for strengthening bones. As your bones are at a greater risk of fracture you should avoid high impact activities, such as contact sports.

'Spinal cord compression is a rare condition but is a potential concern for people with spinal secondaries. It happens when a vertebrae (spinal bone) collapses and puts pressure on the spinal cord. Symptoms can include unexplained back pain, difficulty walking, numbness or pins and needles in the fingers, toes or bottom, or problems controlling urine and/or bowel movements. Spinal cord compression can be serious if not diagnosed quickly, so it’s important that you seek medical advice if you have these symptoms. To minimise your risk you should try to avoid activities that involve twisting the spine or large forward bends of the spine.

Lung metastases

'Breathlessness, coughing, pain, tiredness and loss of appetite can all be symptoms of secondaries in the lungs. These symptoms are similar to those experienced by people with long-term respiratory diseases such as chronic obstructive pulmonary disease (COPD) and asthma. Research has found that when people with respiratory disease exercise regularly they are less breathless, have more stamina, are better able to perform everyday tasks and have a better quality of life.

'The biggest difficulty faced by people who suffer from breathlessness is getting enough air into their lungs to be able to exercise comfortably, but there are some things you can do to help with this. Firstly, try to avoid exercising in very cold or dry conditions as this makes it more difficult for your lungs to expand, whether you are exercising or not. Swimming is ideal because the pool hall is usually quite warm and the air is damp. Secondly, always start your exercise session with a gentle warm up to get your body, especially your lungs, ready to exercise and to slowly increase how hard you are breathing so that your lungs have time to adjust to the new demands. Finally, you could try 'pursed lip breathing'. This just means pursing your lips and breathing in and out through the narrowed opening. This reduces the air pressure, making it easier for your lungs to expand and contract.

Liver metastases

'Some people with liver secondaries have no symptoms while others have a combination of pain, nausea, loss of appetite, hiccups, tiredness and fatigue. Anaemia, however, has the greatest effect on exercise. Anaemia means that the iron levels in your blood are low. Iron is an essential part of haemoglobin, which carries oxygen round the body. People who are anaemic often find that they get tired easily and may become breathless when they exert themselves. If you find that this happens, you may need to be a little more cautious when you begin exercising and build up slowly. There is no particular type of exercise that offers any special benefit for people with anaemia as this type of breathlessness is due to your blood's reduced capacity to carry oxygen, not your ability to get air into your lungs.

Brain metastases

'The symptoms associated with secondaries in the brain depend on where the tumour is, but may include headaches, nausea, blurred vision, seizures, weakness, dizziness or balance problems. While these symptoms themselves do not prevent you from exercising, it is important to choose a suitable form of exercise to make sure you don’t put yourself at unnecessary risk of injury. For example, an exercise bike may be a better choice for people with balance problems than cycling outdoors. If you suffer from seizures, always try to avoid exercising alone.

Lymphoedema

'Finally, a word about lymphoedema. There is little research on exercise and lymphoedema. Current opinion, however, is that exercise does not cause or worsen lymphoedema and may help manage symptoms in women who have already developed it. When choosing your exercise focus on aerobic activities and exercises to increase muscle tone. Try to use only light weights/resistance and avoid activities that involve sudden vigorous movement or impact on the affected side. Lastly, if you have a compression garment, you should always wear it during exercise.

'This page provides only a brief outline of the benefits of exercise and the key things to consider when beginning an exercise programme. It’s always advisable to consult your doctor before you begin, and if you feel you’d like more detailed, personal advice and support with starting to exercise you could consult a qualified exercise professional at your local sports centre or ask your doctor whether you are eligible for a GP referral. But wherever you choose to exercise and whatever you choose to do, always listen to your body – and make sure it’s fun.'