Exercise and breast cancer

Getting regular exercise is important for everyone — and it’s especially critical for people diagnosed with breast cancer. Research shows that meeting minimum weekly exercise requirements as recommended by Physical Activity Guidelines for Americans can significantly reduce the risk of a breast cancer recurrence and the risk of death from any cause.

Exercise is physical activity that is structured and repetitive. And it doesn’t just help reduce the risk of recurrence and improve survival after a diagnosis. Exercise also helps reduce treatment-related side effects including joint pain, fatigue, chemobrain, depression, and anxiety.

Below, we’ll talk more about the specific benefits of exercise and provide guidance on how to get started, weekly exercise recommendations, and ways to find an experienced trainer.

We’ll also share LBBC's BeACTive video series, a three-week workout plan hosted by certified cancer exercise trainer Sami Mansfield, founder of Cancer Wellness for Life and co-author of Exercise, diet, and weight management during cancer treatment: American Society of Clinical Oncology (ASCO) guideline. The BeACTive series is tailored for individuals diagnosed with breast cancer and includes exercises for people just starting out or who are feeling limited by energy level and side effects.

Getting started

The American College of Sports Medicine (ACSM) and the American Cancer Society (ACS) recommend exercising during and after cancer treatment. But even with all the benefits — such as reduced risk of recurrence and improved survival — you may not be sure when you should start exercising, or how. It’s normal to feel uncertain about starting or restarting an exercise routine if you’re in treatment, regaining mobility after surgery, recovering from systemic treatment, or living with metastatic disease.

Unless you are dealing with acute problems, such as an active infection or an elevated heart rate, it is safe to exercise. No matter what your age or stage, you can find exercises that meet your abilities and allow you to stay active and build strength.

Tips for starting or restarting an exercise routine

When you begin an exercise routine, you may get tired more quickly than you are used to, and it may take longer to recover if you wear yourself out. Even if you have only exercised for a few minutes, building on that through a regular routine will be more helpful than wearing yourself out and taking days to recover.

As you get started, it’s OK to challenge yourself a bit. Aim for some discomfort such as burning in your muscles or feeling out of breath. But watch for things like sharp pain, pain that doesn’t go away after a rest, or lightheadedness or dizziness, which may be signs that you are going too fast and need to slow down your tempo.

It’s very common that your body feels different during and after treatment, especially related to energy or endurance. You may find that it’s more difficult to figure out how long or challenging your exercise sessions should be, and once you get to the point of exhaustion, your recovery is likely to be slower than before cancer. Slow down or stop when you start to feel fatigue that’s beyond muscle tiredness. Try resting for a minute or two, and if you don’t feel ready to start again, give yourself some encouragement for accomplishing your exercise and resuming the next day or the day after that. It’s important to know that while exercise should make you tired, it should not make you too exhausted to continue your day.

You can always add to your routine as you get more comfortable with managing your energy.

LBBC's BeACTive video series

To help you get started on an exercise plan that supports both improved survival and increased qualify of life after a diagnosis of breast cancer, LBBC developed BeACTive: Empowering workouts for people with breast cancer.

BeACTive is a three-week exercise series customized to fit all levels of function and energy. This program is designed to help you reach the evidence-based recommendations for people diagnosed with breast cancer. Minimal equipment is needed, and many of the exercises only require yourself and a chair.

While these recommendations are useful to understand, keep in mind that any exercise has benefits to you not only physically but mentally, so just getting started on a regular regimen of any amount will make a difference!

Watch the video above for a brief introduction to the series. You can explore the full series through the YouTube playlist, or click on a video title below to start where you wish.

Week 1

• Day 1: Full body functional
• Day 2: Upper body strength & balance
• Day 3: Aerobic & core

Week 2

• Day 1: Full body functional
• Day 2: Lower body strength
• Day 3: Introduction to HIIT & core

Week 3

• Day 1: Full body functional
• Day 2: Full body strength
• Day 3: HIIT & core

Recommendations for people with early-stage breast cancer

Exercise has been found to be safe and beneficial for people undergoing active treatment such as chemotherapy and radiation therapy for early-stage breast cancer.

Though not everyone will have the same access to equipment, space, and guidance, there are many ways to get exercise, even at home.

How much exercise should I get?

Many exercise recommendations — including those from ASCO, ACSM, and ACS — are based on the Physical Activity Guidelines for Americans, released by the Department of Health and Human Services. These suggest that each week, adults, including those in treatment, get:

• At least 150 minutes of moderate-intensity physical activity, or
• At least 75 minutes of vigorous activity

These recommendations include regular aerobic exercise (“cardio”), along with at least two days per week of exercises to build muscle (resistance or strength training).

Understanding exercise intensity

The intensity of exercise depends on how fast your heart is beating and how quickly you’re breathing during the exercise. Using the “talk test” is an informal way to understand general intensity level:

• With moderate-intensity exercise, you can talk, but not sing.
• With vigorous intensity, saying more than a few words is difficult without stopping to breathe.

You can try the talk test with any kind of exercise — such as walking, yoga, or resistance training — to understand its intensity level. A professional cancer exercise trainer can help you figure out your personal target heart rate during exercise. At the end of this page, you can learn more about finding a qualified trainer.

If you have reduced range of motion in your arm after breast cancer surgery, consider asking for a referral to see a physical or occupational therapist.

What is aerobic exercise?

Aerobic exercise is repetitive and uses large groups of muscles, increasing your heart rate and breathing. Aerobic exercise is often referred to as cardiovascular exercise (or simply cardio) because it helps the cardiovascular system, which includes your heart and blood vessels.

Aerobic exercise can help to reduce side effects such as fatigue, nausea, sleep disturbances, depression, and anxiety.

Examples include:

• Walking
• Running
• Exercising with cardio equipment such as a treadmill, stair climber, rowing machine, or elliptical
• Swimming
• Cycling
• Seated aerobics

What is resistance exercise?

Resistance exercise, also called strength training, consists of movements that create muscle overload, which stimulates your body to build new muscular tissue. Resistance exercise can also help:

• Reduce body fat
• Achieve or maintain a healthy body composition: the balance of muscle and fat in your body

Resistance exercise is associated with relief from several side effects, including joint pain, fatigue, and lymphedema*, a painful swelling condition that can develop in some people after lymph node removal surgery.

Examples include:

• Countertop push-ups
• Chest presses
• Core movements such as planks (any version, such as countertop, elevated, or on the floor)
• Lunges (stationary or adding movement forward or back)
• Squats
• Chair sit-to-stand
• Overhead press
• Bicep curls

*If you have had lymph node removal surgery (sentinel node biopsy or axillary lymph node dissection), read our Exercise and lymphedema information below.

Building up to recommended exercise levels

If you are starting a new treatment regimen or are recovering from surgery, it may take time to build up to the recommended exercise levels. That is OK, and you shouldn’t feel discouraged if you are unable to meet those recommendations.

“There may be times when you don’t feel great,” says Mansfield. “Treatment and energy cycles can have an impact.” If you’re having difficulty, let your healthcare team or cancer exercise trainer know.

Ways to reduce inactivity and increase activity

Regular, structured exercise is an important way to get the recommended amount of activity and to include activities that can help manage specific side effects. But remember that exercise isn’t the only way you can get physical activity. Other activities including brisk walks, gardening, dancing, playing with children, and doing chores can all contribute to your overall activity level.

ACSM and ACS recommend adults diagnosed with cancer limit sedentary behaviors such as sitting and lying down for prolonged periods. You can include both structured exercise time and other activities as you work to increase your physical activity.

If you find that you’ve been sitting or lying down for a while — especially for periods over two hours — try taking a short walk, doing some chores, working in a short exercise or stretching routine, or finding another activity to get you moving.

While it’s ideal to move from sitting to standing to get in some activity, seated marching or stretching, or even lying in bed doing leg lifts or hip bridges, can help.

Exercise and lymphedema

When a diagnosis requires that lymph nodes be removed from under the arm, it’s important to know the risk factors for lymphedema, a painful swelling condition that can happen in some people after lymph node surgery. After this surgery, someone on your surgical team will show you exercises that can help recover arm mobility.

It can also help to get familiar with how your post-surgery arm is responding to different types of movement, including exercise. Mansfield recommends starting low and going slow.

ACSM and ACS guidelines note that resistance exercise does not increase the risk of breast cancer-related lymphedema and has been found to help with its symptoms. In fact, according to ACSM and ACS, resistance training twice a week has been found to help manage lymphedema.

Still, there are reasons to ask your healthcare team for a referral to see a lymphedema specialist as you start an exercise program:

• If you are concerned about your risk for lymphedema and want a risk assessment
• If pain and/or swelling develops in the arm or hand

If lymphedema develops, resistance exercises under the guidance of a lymphedema specialist can help reduce symptoms.

Visit our Lymphedema page to learn more.

Exercise and metastatic breast cancer

Metastatic breast cancer (MBC) is breast cancer that has spread to other parts of the body, such as the lung, liver, bones, or brain. Research shows an association between moderate- and vigorous-intensity exercise and improved survival for people with MBC. Exercise can also help reduce MBC-related fatigue and pain.

If you’ve been diagnosed with MBC, there are many safe ways you can exercise. Learn more in Exercise and metastatic breast cancer.

Benefits of exercise

There are multiple strategies for getting physical activity, but planned, purposeful activity through exercise is linked to reduced risk of breast cancer, reduced risk of breast cancer recurrence, and greater survival. Exercise can also help reduce some treatment side effects. In this section, we’ll share specific ways that exercise can be helpful.

Exercise can reduce the risk of breast cancer and recurrence

Fear of recurrence is a common motivation for people to make lifestyle changes, including getting more exercise. ACSM and ACS recommend at least 150 minutes of moderate-intensity exercise or 75 minutes of vigorous exercise each week to reduce the risk of breast cancer, reduce the risk of recurrence, and improve survival.

Women who get the recommended amount of exercise after breast cancer treatment have been found to have lower risk of recurrence and mortality than those who don’t meet those guidelines.

Maintaining a healthy weight is an important part of this risk reduction. After menopause, being overweight or obese raises the risk of breast cancer, because having extra fat tissue can increase estrogen levels, which can help some breast cancers to grow. Being overweight also raises insulin in the blood, which has been linked to breast cancer.

The good news is that following the ACSM and ACS recommendations can reduce body fat, help you maintain a healthy weight, and improve survival.

Exercise can reduce treatment side effects

ASCO guidelines authors found that a combination of regular aerobic and resistance exercise can help manage side effects in people receiving early-stage breast cancer treatment. Benefits include:

• Reduced fatigue
• Increased energy during physical activity
• Improved physical function
• Improved quality of life
• Reduced depression and anxiety
• Improved sleep
• Improved thinking, memory, and focus
• Improved upper- or lower-body strength

Exercise has also been found to help reduce joint pain for people taking aromatase inhibitors.

Exercise can improve cardiovascular health

Cardiovascular health is the health of the heart and blood vessels. Maintaining cardiovascular health reduces the risk of cardiovascular disease — also called heart disease — which refers to any of several conditions including coronary heart disease, arrhythmia, stroke, and heart failure.

Many aspects of cardiovascular disease are related to atherosclerosis, the buildup of plaque in the walls of the arteries, which causes them to narrow. When arteries are narrowed, the flow of blood can become blocked if a blood clot forms, potentially leading to heart attack or stroke.

LDL cholesterol and high blood pressure increase the risk of cardiovascular disease:

• LDL (“bad”) cholesterol is one of the components in the plaque that can form in the artery walls, increasing the risk of heart attack and stroke.
• High blood pressure also increases the risk of heart attack and stroke.

Extra body fat, especially in the abdomen, also increases the risk of cardiovascular disease.

Still, there’s a lot you can do to lower these risks. Following the ACSM and ACS weekly exercise recommendations can help:

• Lower LDL cholesterol
• Raise HDL (“good” cholesterol that helps rid your body of LDL)
• Reduce high blood pressure
• Reduce abdominal fat

Exercise can reduce the risk of breast cancer treatment-related heart failure

Separate from increased risk of heart disease linked to being overweight and obese, breast cancer treatments such as anthracycline chemotherapy, some anti-HER2 treatments, and left-sided radiation therapy can increase the risk of heart damage that can lead to heart failure in some people.

In heart failure (also called congestive heart failure), the heart can’t pump blood as well as it should.

Studies have found that risk factors for cardiovascular disease, such as smoking, obesity, high blood pressure, and high LDL cholesterol, can increase the risk of heart failure linked to these breast cancer treatments. Following the ACSM and ACS recommendations for weekly exercise can lower this risk. Visit Heart health to learn more.

How to find a qualified exercise trainer

While it is not always necessary to have supervised exercise if you have been diagnosed with breast cancer, there are many benefits to working with someone who has specialized training in understanding cancer and treatment side effects.

If you are having cancer-related side effects such as neuropathy or lymphedema, or are undergoing treatment for metastatic breast cancer, it is recommended to start with supervised exercise to address any functional changes and to find a safe and effective starting point.

There are two main groups in the US that certify cancer exercise trainers: The American College of Sports Medicine (ACSM) and the Cancer Exercise Training Institute (CETI). You can visit their websites to look for trainers in your area:

• ACSM Cancer Exercise Program Directory
• CETI Cancer Exercise Specialist Global Directory

Questions to ask a potential trainer

If you can’t find a certified cancer and exercise trainer near you, there are questions you can ask to see if a trainer may still be a good fit. You can also ask these questions of a certified cancer exercise trainer. Here are some ideas:

• Do you have cancer-specific training and experience?
• Have you worked with someone who has the same diagnosis I do?
• Have you worked with people who are recovering from a major illness?
• Have you worked with people who’ve experienced the side effects I’m experiencing? (examples: fatigue, joint pain, lymphedema, neuropathy, hand-foot syndrome) If so, can you share how you’ve approached training in these situations?
• Have you worked with people as they're recovering from surgery? If yes, how long have you been doing this kind of work? What is your approach?

As you begin working with a trainer, says Mansfield, there should be a balance of feeling that the trainer is pushing your fitness and functional goals while also considering who you are and what you’ve experienced physically.

Moving through cancer downloadable guide

Moving through cancer: A guide to getting and staying active during cancer treatment, published by ACSM, is an additional resource that provides support and information as you start an exercise program. At the links below, you can download English and Spanish versions of this guide.