By Emilee Shoemaker, MOT, OTR/L, CLT-LANA 
Occupational Therapist, Julie A. Cole Rehab and Sports Medicine Clinic

After a patient has been through the rigorous diagnosis and treatment of breast cancer, sometimes they are looking forward to returning to their typical physical activity or workout routine. Their medical support team has usually educated them on the signs and symptoms of lymphedema, but the patients are still not sure how to return to their daily activities and workout routine safely. 

It is important for individuals recovering from breast cancer, with or without lymphedema, to return to their physical fitness level, as well as return to their desired quality of life. The National Lymphedema Network (NLN) has guidelines to follow when starting and maintaining an exercise regimen. 

General guidelines to follow include increasing your workouts gradually, progressing them slowly, and monitoring the size of your “at risk” limb during and following your exercises. If you have been diagnosed with lymphedema and have been prescribed a compression garment for the affected limb, please wear it while you are exercising. Stay well hydrated and avoid becoming overheated. 

A solid first step to an exercise routine for people at risk for lymphedema includes non-resistive, active motion of the affected arm. When initiating flexibility exercises, avoid over-stretching, as this could lead to muscle sprain. Swimming, yoga and Tai Chi are exercises that improve range of motion, endurance, coordination and strength. Yoga and Tai Chi also incorporate the diaphragmatic breathing that helps initiate lymph flow. Another exercise that also promotes diaphragmatic breathing is singing! So, let’s hear it!

When your body is ready to progress to another level, strengthening exercises incorporated into your regimen may improve your lymph flow by decreasing scarring and tightness. Modifications will need to be incorporated to your workout routine by your therapist to decrease the probability of developing lymphedema. It is also important to rest between your exercise sessions and to modify your program according to your symptom response of the at-risk limb. It is also recommended to avoid wrapping weights tightly around an extremity or your clothing that causes constriction. Another great form of strengthening for breast cancer survivors is aerobic conditioning. 

Specific guidelines for breast cancer survivors, set by the National Comprehensive Cancer Network (NCCN) and the American Cancer Society (ACS), recommend that individuals gradually build up to 150 minutes of aerobic activity a week. Daily flexibility activities are encouraged but to back off resistance after a season of not exercising. If you have a change in upper body symptoms that last a week or longer, it is recommended you have an evaluation by a clinician. Early treatment results in faster response, therefore decreasing the length of therapy. The symptoms that should be monitored during and after an activity are a change in a limb’s size, shape, tissue, texture, soreness, heaviness or firmness. Lymphedema has been verbalized through patients as feeling like tightness or heaviness of the limb, achiness, pins and needles, tenderness, pain of congestion and an “odd” sensation.

Exercise for breast cancer-related lymphedema is the most studied lymphedema condition. The NLN has excellent online resources to inform breast cancer survivors on lymphedema, exercising and healthy habits.