Breaking Down the Barriers to Exercise
With so much progress in breast cancer treatment options and far more survivors available for clinical studies, some researchers are now focusing on long-term benefits, says Cheryl Rock, Ph.D., R.D.
According to Rock, professor of family and preventive medicine at the Cancer Prevention and Control Program, University of California, San Diego Medical Center, breast cancer survivors who eat five servings of fruit and vegetables each day plus exercise cut their risk of dying by half. Rock and her colleagues followed 1,490 women diagnosed with early-stage breast cancer for 11 years. Their findings, published last summer in the June 10 issue of the Journal of Clinical Oncology, make clear that this combination of diet plus exercise was key in cutting the risk of death. Importantly, these findings were consistent regardless of weight. Exercise is essential, Rock says, and yet it is challenging, because we are in an environment that does not encourage exercise. We can break down these barriers, however, with extensive planning and good time management.
"Exercise doesn’t just happen for anybody, because everyone is busy,” she says. Thinking very practically, Rock runs an American Cancer Society-funded study called the Survivor's Health and Physical Exercise (SHAPE) Study. She and her research staff help overweight breast cancer survivors design individual exercise programs that will be successful in the long term. The way to do this, she says, is to break down routines into activities that are convenient, enjoyable and that fit into your lifestyle.
For example, if you like quiet meditative kinds of activities best, you might enjoy walking alone. If you like walking but are more social, you could join a hiking club and meet like-minded people. Many sign up for gyms and health clubs, but they must be close to home or work or the inconvenience becomes an issue. In that case, exercise at home is a good option.
"Many of my study participants park their treadmill or bike in front of a TV so they can put movies on, and they put in a rack for reading. Otherwise, the treadmill can just be another place to hang clothes,” she says laughing, repeating her advice that you should enjoy what you are doing, so you are not bored.
There are many potential barriers to exercising. By anticipating them, you can individualize a program that works for you. “The hardest thing is getting started,” says Rock. Whatever your needs, don’t hesitate to ask for help from family and friends. “Tell your husband, ‘I really need to exercise. It will reduce the risk of recurrence, as studies have shown, but I need help. Would you pack the kids off to school, so I can work out?’ If you give people a very specific request, they will be more likely to be helpful,” says Rock.
Plan multiple activities that you like to do. Walking before or after work is a great Plan A, but may not be feasible in the winter when the sun rises late and sets early, so you need alternate activities. Plan B might be a treadmill set up near
the TV.
"We encourage people to cross train, too, so if you normally walk, but twist a knee, you can join the ‘Y’ and have access
to a pool.” Plan C, then, could be the pool.
Another problem for some breast cancer survivors is fatigue. “It’s counterintuitive, but if you just exercise, you will feel less tired,” Rock says. She suggests that you do some “self talk” to get motivated.
Tell yourself, “I don’t have to exercise for long. I’ll just do it for 10 minutes and then see how it feels.” In most cases, when people exercise for 10 minutes, they start to breathe a little better. There is more oxygen in the brain and more blood flowing everywhere, and they say, “Oh, what the heck, I’ll do it for another 10 minutes,” and then they keep going. You may not have control over your genetic make up, but you do have control over life choices like exercise.
Gloria Suardiaz Alvarez, 50, could certainly validate Rock’s passion for exercise. Alvarez, a Breast Cancer Network of Strength National board member from Naperville, Ill., has had two bouts with breast cancer. She is a firm believer in the benefits of exercise—even during treatment.
Alvarez was first diagnosed in 2000, just weeks after her mother passed away from the same illness. At that time, she had two lumpectomies and a 7-week course of radiation. A certified personal trainer through the American Council on Exercise, Alvarez had long been a believer in exercise. She had a personal training business for years and leads group exercise classes. With her enthusiasm, Alvarez kept exercising while going through radiation.
"I recall that most of the individuals getting radiation were crawling home and taking numerous naps,” she says. "Obviously, the therapy affected me too, but I kept a regimen
of exercise. I think it helped me maintain a higher energy
level and to recover quicker.”
Exercise helps her mood, too, Alvarez says. “Being told that you have breast cancer knocks your socks off and turns your world upside down. If you can just get up and do a little walk or stretch, then mentally and physically you feel so much better.”
Alvarez became a member of the Breast Cancer Network of Strength National Board of Directors in 2005. In September 2007 her cancer returned. She had a simple mastectomy with reconstruction and had to stop exercising temporarily. Within two weeks, she resumed stretching exercises, added yoga and soon after, she started
walking for exercise again. A few weeks later, she was on her
Stairmaster, with her doctor’s blessing.
Alvarez found her understanding of anatomy helpful when
she was exercising. She suggests the importance of finding a personal trainer experienced in working with individuals who have had surgery or breast cancer.
"I absolutely felt better and the stretching made a great difference with my arm’s flexibility,” Alvarez says. “Full use and range of motion are coming back now.” Alvarez recently went back to teaching her exercise class after a 4-month hiatus, she says. “I feel unbelievably alive again. Coaching, motivating and inspiring other people to exercise has always brought me a lot of happiness, but after breast cancer, it means even more to me.”
"Exercise helps women feel invigorated and powerful,” Rock
agrees. “This is very empowering.”
This article was first printed in the spring 2008 issue of Lifeline.