Exercise After Breast Cancer

Last Modified: March 2, 2008

Dear OncoLink "Ask The Experts,"

Although my wife and I have been told that squash and tennis (which my wife played before her mastectomy) is not recommended, I am curious to know why? Whereas weight training seems to be getting a cautious 'green light', are there specific reasons why racket sports and the type of arm movement involved would definitely be a 'red light' for arm lymphedema sufferers?

Linda McGrath Boyle PT, DPT CLT-LANA, Cancer Rehab Specialist and OncoLink Lymphedema Team Editor, responds:

The issue here appears to be one of gradually increasing activity. If you weight lift or run or play racquet sports, there needs to be a gradual increase in exercise duration and intensity. Before breast cancer, it was fine to be a weekend warrior; you would be sore and then heal. The problem is that your lymphatic system in the axilla (armpit)/chest wall/ clavicular (collar bone) areas no longer works at 100%. Therefore, you must monitor your body's response to increased blood flow, which in turn can increase you lymphatic flow tenfold. If your lymph nodes in the affected area cannot handle this sudden increase in lymphatic volume, you run the risk of swelling due to sudden lymphatic overload.

Everyone's lymphatic system has a maximum transport capacity that prevents swelling. This is inherited, meaning it is set at birth. This transport capacity is reduced following surgery and radiation.

Rules of engagement

Warm up gradually, for 10 minutes before working out.
Cool down for 10 minutes after exercising.
VERY gradually increase duration (time) and intensity (effort) of exercise. This increase in activity must be at a rate that is MUCH more gradual than before breast cancer. Monitor arm girth and symptoms of lymphedema onset (numbness, tingling, heaviness, achiness, fullness, swelling). If you develop symptoms, you need to decrease your activity duration and intensity.
Exercise regularly. Sudden sporadic increases in lymphatic activity may lead to swelling.

If your doctor is in agreement...

Racquet sports are very demanding due to high repetition, high velocity muscle contractions. You would do well to stretch your neck, shoulder and entire arm/wrist/hand, as well as gradually strengthen your core muscles and upper body/arms in preparation for participating in racquet sports.

Do not discontinue strengthening/stretching once you add racquet sports, or you will lose flexibility and strength. This could lead to injury. Proper form is very important if you are to play racquet sports.

Warm up with a walk for 10 minutes. Do not play cold. Begin with 5 minutes at 25% effort and monitor your body's response. Very gradually increase your activity if you do not become symptomatic. Cool down for 10 minutes after playing.

If you injure your arm or chest wall on the breast cancer side, your body will swell in response. Because your lymphatic system is compromised, it may be difficult for it to handle the sudden increase in volume that is normal in response to an injury. This injury could trigger lymphedema.

The best thing to do is discuss with your physician/ nurse practitioner and consult a person who specializes in the treatment of lymphedema (CLT-LANA--certified lymphedema therapist who has passed the Lymphology Association of North America's national certification examination).