Exercise following breast cancer surgery

Saadia Jantjes explains why exercise is an important part of your recovery following breast cancer surgery and shares nine exercises for you to try.

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Exercise can help reduce limitations in the range of motion of your shoulders following surgery. It will help you regain normal movement in your arms and reduce pain in your chest, neck and back. Functionally, exercise will help you in your activities of daily living, like dressing, bathing and driving, as well as improve your overall well-being and mood. 

Concerns following breast surgery are seroma (collection of fluid) formation, wound healing and fluid drainage. Excessive fluid production can result in seroma formation, and inadequate drainage of seromas is known to cause infection, pain, discomfort and longer periods of hospitalisation. 

Research shows that delaying exercises can delay your progress. So, exercises need to start as early as day one post-op.  

Points to remember before exercise 

• Make sure you take your pain medication 20-30 minutes before exercising. They usually aren’t muscle relaxants so muscle receptors and stretch spindles will still be active in the event of a patient over-stretching or over-exerting themselves.
• Breathing is important. Due to the trauma around the chest wall, patients tend to shift away from proper chest expansion. Make sure you breathe deeply with each exercise, inhaling through the mouth and out the nose, to get good chest expansion. 
• Do the exercises three times daily for six weeks.
• Get into a routine. Try to do the exercises at the same time every day so that you don’t forget. 
• It is safe to do light housework during the first six weeks after surgery. Do only short periods at a time and rest in between. You can start heavier activities after six weeks.

Always let pain be your guide. A little discomfort is okay but more pain could mean you are doing too much.

PHASE ONE EXERCISES

These exercises will have two phases. Phase one exercises are to be done while you still have the drains in place. 

Pump It Up

This exercise helps reduce swelling after surgery by using your muscles as a pump to improve the circulation in your affected arm (on the same side as your surgery).

1. Lie on your unaffected side with your affected arm straight out, resting on top of a pillow.
2. Slowly bend your elbow while making a fist at the same time.
3. Next, slowly straighten your elbow while opening your fist at the same time.
4. Repeat this pumping motion 15 to 25 times.
5. If you had surgery on both sides of your chest, repeat the exercise lying on the opposite side of your body.

Shoulder Rolls

This can be done sitting or standing. It’s a good warm-up exercise and helps relieve tension in your shoulders.

1. 1Lift both shoulders up toward your ears. Keep your chin tucked in slightly.
2. Gently rotate both shoulders forward, and then slowly down and back, making a circle.
3. Make five slow circles in one direction, then switch and make five slow circles in the opposite direction.

Arm Lifts

This exercise helps improve movement in your shoulders and can be done sitting or standing. 

1. Clasp your hands together in front of your chest. Point your elbows out.
2. Slowly lift your arms upwards until you feel a gentle stretch, but no pain.
3. Hold for five to 10 seconds and then slowly return to the start position. 
4. Repeat five to 10 times.

Shoulder Blade Squeeze

This can be done sitting (without resting your back on the chair) or standing. It helps to stretch your chest muscles.

1. Hold your arms at your side against  your body with your elbows bent.
2. Slowly bring your elbows straight backwards, while squeezing your shoulder blades together to feel a gentle stretch.
3. Hold this position for five to 10 seconds and then slowly return to the start position. 
4. Remember to keep breathing throughout the stretch.
5. Repeat five to 10 times.

PHASE TWO EXERCISES

These are are done once the drains have been removed. Phase one exercises can be done as a warm-up. 

Wand Exercise

You will need a wand to do this exercise. A broom handle, stick, cane, or rolling pin can be used as a wand.

1. Lie on your back with your knees bent. Hold the wand with both hands. Your hands should be as wide apart as your shoulders
2. Lift the wand over your head as far as you can until you feel a stretch. Your unaffected arm will help lift the wand higher.
3. Hold for five seconds, then gently lower arms.
4. Repeat five to 10 times.
5. To progress, repeat exercise with hands slightly wider than your hips or shoulders.

Winging It

This exercise helps stretch the front of your chest and shoulder.

1. Lie on your back with your knees bent. Touch your fingertips to your ears with your elbows pointed to the ceiling.
2. Move your elbows apart until you feel a gentle stretch, but no pain.
3. Hold this position for five to 10 seconds and then slowly return to the start position.
4. Remember to keep breathing throughout the stretch.
5. Repeat five to 10 times.

Snow Angel

This helps to stretch the tight tissue in the armpit area and increases movement in your shoulders.

1. Lie on your back and extend your arms out at your sides.
2. Move your arms up over your head, leading with your thumbs, eventually touching your fingers at the top.
3. Next, move your arms back down to your sides (as if you’re making an angel in the snow).
4. Repeat five to 10 times.

Wall Climbing

This helps increase movement in your shoulder. Try to reach a little higher on the wall each day. This exercise is done in two positions: A – facing the wall and B – with your affected side to the wall.

A – Facing the wall

1. Stand facing the wall.
2. Place the palm of your hand (of your affected arm) flat against the wall.
3. Slowly slide your hand up the wall as high as you can go until you feel a stretch, but no pain.
4. Hold for five to 10 seconds
5. Return to the start position.
6. Repeat five to 10 times.
7. If you had surgery on both sides of your chest, repeat this exercise with your other arm.

B – Side wall stretch

1. Stand with your affected side to the wall.
2. Place the palm of your hand flat against the wall.
3. Slowly slide your hand up the wall  as high as you can go until you feel a stretch. Do not rotate your body toward the wall. Keep your body facing forward even if it means you can’t go up as high.
4. Hold for five to 10 seconds.
5. Return to the start position.
6. Repeat five to 10 times.
7. If you had surgery on both sides of your chest, repeat this exercise with your other arm.

Side Bends

This exercise is more advanced and can be performed once a day when you feel ready.

1. Sit in a chair and clasp your hands together in your lap.
2. Slowly lift your arms over your head.
3. Bend at your waist to move your body to the right. Use your right hand to gently pull your left arm a little farther to the right. Keep yourself firmly planted on the chair.
4. Hold this position for five seconds and then slowly return to the start position.
5. Repeat this stretch to the left side, using your left hand to pull your right arm farther.
6. Repeat five to 10 times on each side.

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PLEASE NOTE

It may take six to eight weeks to regain full movement of your arm(s). If you continue to have difficulties regaining full movement in your arm(s) and shoulder(s) after this time, please ask your surgeon for a referral to physiotherapy and occupational therapy for follow-up.

* The exercises in this guide have been adapted from the booklet Exercises after Breast Surgery, Canadian Cancer Society, 2015.

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