Answers (10)
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I have only worked with people whose surgeries have been a thing of the past. My approach depends on the kind of surgery but also the emotional fallout from it.
Surgeries dating many years back seem to be have been more radical and with less regard to muscular implications. I often noticed shoulder problems which I usually handle as ratator cuff weaknesses. I tend to inch my way forward and like to use forms of resistance like bands or tubing where the client can self-select the amount of resistance.
Lymphedema is another issue entirely but people there usually have protocols from a physican therapist, and I like to operate closely in conjunction with the therapist.
The other issue are re-constructions and how they were done. If a part of the rectus abdominus has been used then this has implications on the way I approach core strenghtening.
I want to talk about the emotional side of it as well. The first client I ever worked with seemed to have no problem at all with her double mastectomy. She did not try to conceal it and talked about it without reserve. The next client with the same outward issues was very upset about it, and every workout became a walk on egg-shells.
In summary, I do not have a standard protocol but evaluate every person and then try to find the best way to help her.
Surgeries dating many years back seem to be have been more radical and with less regard to muscular implications. I often noticed shoulder problems which I usually handle as ratator cuff weaknesses. I tend to inch my way forward and like to use forms of resistance like bands or tubing where the client can self-select the amount of resistance.
Lymphedema is another issue entirely but people there usually have protocols from a physican therapist, and I like to operate closely in conjunction with the therapist.
The other issue are re-constructions and how they were done. If a part of the rectus abdominus has been used then this has implications on the way I approach core strenghtening.
I want to talk about the emotional side of it as well. The first client I ever worked with seemed to have no problem at all with her double mastectomy. She did not try to conceal it and talked about it without reserve. The next client with the same outward issues was very upset about it, and every workout became a walk on egg-shells.
In summary, I do not have a standard protocol but evaluate every person and then try to find the best way to help her.
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Hello Naomi,
I believe we had occasion to meet at an IDEA convention a couple of years back at a pilates session. Nice to connect with you again.
I'd like to start by saying that I had the opportunity to take the Breast Cancer Recovery Exercise program continuing education course put together by you and Anna Schwartz a couple of years ago. In addition to that, I was able to attend the Cancer Exercise Specialist course held at the University of Northern Colorado and found their approach to exercise testing and exercise program design excellent.
It's a little challenging to give you a precise answer as I don't know the stage of the the cancer nor the intervention used to remove the cancer.
For sure I would utilize established clinical exercise testing guidelines in addition to established clinical guidelines for program design.
However, as you are aware breast cancer survivors who have undergone the TRAM flap procedure experience different functional challenges as far as mobility is concerned that someone who undergoes a lumpectomy would never experience. Too, the effect that chemotherapy and radiation have on the breast cancer survivor would also have to be taken into consideration as far as exercise program design is concerned. We know the effects of chemo and radiation last long after the intervention.
Exercise programming for cancer survivors whether they are breast cancer survivors or survivors of another type of cancer are highly individualized.
The clinical exercise specialist/physiologist should be guided by established industry guidelines as far as cancer is concerned and write the exercise prescription based upon the results of the clinical fitness assessments.
Of course, the client would need to have a release from his/her doctor/oncologist, should have completed physical therapy and should be pain free before working with a clinical exercise specialist or physiologist or as in your case a licensed occupational therapist.
I believe we had occasion to meet at an IDEA convention a couple of years back at a pilates session. Nice to connect with you again.
I'd like to start by saying that I had the opportunity to take the Breast Cancer Recovery Exercise program continuing education course put together by you and Anna Schwartz a couple of years ago. In addition to that, I was able to attend the Cancer Exercise Specialist course held at the University of Northern Colorado and found their approach to exercise testing and exercise program design excellent.
It's a little challenging to give you a precise answer as I don't know the stage of the the cancer nor the intervention used to remove the cancer.
For sure I would utilize established clinical exercise testing guidelines in addition to established clinical guidelines for program design.
However, as you are aware breast cancer survivors who have undergone the TRAM flap procedure experience different functional challenges as far as mobility is concerned that someone who undergoes a lumpectomy would never experience. Too, the effect that chemotherapy and radiation have on the breast cancer survivor would also have to be taken into consideration as far as exercise program design is concerned. We know the effects of chemo and radiation last long after the intervention.
Exercise programming for cancer survivors whether they are breast cancer survivors or survivors of another type of cancer are highly individualized.
The clinical exercise specialist/physiologist should be guided by established industry guidelines as far as cancer is concerned and write the exercise prescription based upon the results of the clinical fitness assessments.
Of course, the client would need to have a release from his/her doctor/oncologist, should have completed physical therapy and should be pain free before working with a clinical exercise specialist or physiologist or as in your case a licensed occupational therapist.
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HI Joanne!
I asked this question due to curiosity about what was happening across the country. Are clients being referred for exercise after rehabilitation? Are you seeing women who receive rehabilitation after breast cancer? Yes, I agree that programming is very individualized ,and should be after any surgery or treatment.Do you follow a protocol after TRAM Flaps? When do you usually see these women? I am finding Pilates to be excellent when working to establish pelvic stabilization. Thanks for your input! By the way, I have a new course entitled Return to Life: Breast Cancer Recovey Using Pilates which details our 3 phase program specifically for women after TRAM Flap reconstruction.
Naomi
I asked this question due to curiosity about what was happening across the country. Are clients being referred for exercise after rehabilitation? Are you seeing women who receive rehabilitation after breast cancer? Yes, I agree that programming is very individualized ,and should be after any surgery or treatment.Do you follow a protocol after TRAM Flaps? When do you usually see these women? I am finding Pilates to be excellent when working to establish pelvic stabilization. Thanks for your input! By the way, I have a new course entitled Return to Life: Breast Cancer Recovey Using Pilates which details our 3 phase program specifically for women after TRAM Flap reconstruction.
Naomi
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Thanks Naomi for responding.
First of all I want to encourage you to join the ACSM Cancer Interest Group. I am a member and must say I need to be a little bit more involved. The chair person is Catherine Jankowski.
Regarding following a protocol after TRAM flaps. Yes. It's the protocol developed by Dr. Carol M. Schneider at the University of Northern Colorado. Somehow I believe you are familiar with her work.
Regarding my cancer clients, I have only one and she did not have the TRAM procedure.
I agree with you that pilates is a very effective approach when working to establish pelvic stabilization in survivors who have had the TRAM flap surgery.
I do believe, however, Naomi, that participation in pilates/exercise before the intervention is very important as far as rehabilitation and recovery are concerned.
FYI, one of the things that I am currently doing is taking a course with Dr. Mike Jones (AAHFRP) as a Medical Exercise Specialist. I have already earned my ACSM RCEP and it is my hope that this credential will enhance the RCEP credential. Dr. Mike Jone's tag line is "Bridging the Gap Between Health Care and Fitness." Naomi, I am sure you would agree that this is very important particularly as far as clinical exercise programming is concerned.
I've already developed good relationships with two MDs and I hope this knowledge will put me in a position to further collaborate with the medical community.
Great to chat with you. Reach out if ever you'd like to brainstorm.
First of all I want to encourage you to join the ACSM Cancer Interest Group. I am a member and must say I need to be a little bit more involved. The chair person is Catherine Jankowski.
Regarding following a protocol after TRAM flaps. Yes. It's the protocol developed by Dr. Carol M. Schneider at the University of Northern Colorado. Somehow I believe you are familiar with her work.
Regarding my cancer clients, I have only one and she did not have the TRAM procedure.
I agree with you that pilates is a very effective approach when working to establish pelvic stabilization in survivors who have had the TRAM flap surgery.
I do believe, however, Naomi, that participation in pilates/exercise before the intervention is very important as far as rehabilitation and recovery are concerned.
FYI, one of the things that I am currently doing is taking a course with Dr. Mike Jones (AAHFRP) as a Medical Exercise Specialist. I have already earned my ACSM RCEP and it is my hope that this credential will enhance the RCEP credential. Dr. Mike Jone's tag line is "Bridging the Gap Between Health Care and Fitness." Naomi, I am sure you would agree that this is very important particularly as far as clinical exercise programming is concerned.
I've already developed good relationships with two MDs and I hope this knowledge will put me in a position to further collaborate with the medical community.
Great to chat with you. Reach out if ever you'd like to brainstorm.
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HI Joanne!
I have worked with TRAM Flap, DIEP Flap and Latissmus Dorsi Flap patients. There are many physical therapy resources that I use when working with these patients. Exercise before surgery is always better, but not usually the situation. My orientation and scope of practice is different as an occupational therapist, and these surgeries are musculoskeletal issues which effect daily function. I am a CET certified by ACSM (did the Beta testing) and they used my breast cancer book Breast Cancer Recovery
Exercise Program as one of the resources. I am familiar with Dr. Jones. Knowledge is power!! It is very important to connect with physicians and they are starting to value exercise for cancer patients. This is a good thing!! How can I connect with Carolyn? My professional organization AOTA has started to become involved with cancer rehabilitation too finally! Kee up your good work!!
Have a great day!
Naomi
I have worked with TRAM Flap, DIEP Flap and Latissmus Dorsi Flap patients. There are many physical therapy resources that I use when working with these patients. Exercise before surgery is always better, but not usually the situation. My orientation and scope of practice is different as an occupational therapist, and these surgeries are musculoskeletal issues which effect daily function. I am a CET certified by ACSM (did the Beta testing) and they used my breast cancer book Breast Cancer Recovery
Exercise Program as one of the resources. I am familiar with Dr. Jones. Knowledge is power!! It is very important to connect with physicians and they are starting to value exercise for cancer patients. This is a good thing!! How can I connect with Carolyn? My professional organization AOTA has started to become involved with cancer rehabilitation too finally! Kee up your good work!!
Have a great day!
Naomi
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Joanne: Thank-you for all of the information you sent. I got each email several times!
Naomi
Naomi
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When to begin exercising is dependent upon the physical condition of the woman, the length of the healing process, type of surgery involved, courses and types of adjuvant treatments, and the recommendations of doctors, nurses and physical therapists.
There are also other variables such as low blood counts, fatigue, nausea, muscle, joint or bone pain which may exist temporarily and may change. All these will and should effect particular exercise choices at given times.
As a cancer survivor myself, I began to exercise after my operation when I had clearance from my doctor and was told I could exercise during my radiation treatments. Most women receive breast rehab exercises to perform at home dependent upon their specific surgery.
There are also other variables such as low blood counts, fatigue, nausea, muscle, joint or bone pain which may exist temporarily and may change. All these will and should effect particular exercise choices at given times.
As a cancer survivor myself, I began to exercise after my operation when I had clearance from my doctor and was told I could exercise during my radiation treatments. Most women receive breast rehab exercises to perform at home dependent upon their specific surgery.
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Debbie: HI! Yes, I totally agree with your comments. I am interested whether people in different parts of the country are exercising sooner than later. There have been numerous studies which demonstrate that exercise is both safe and effective for cancer survivors both during and after treatment. The type/ frequency/ duration of exercise will depend on the other variables you mentioned . A few recent studies have recommended therapy earlier than later post breast cancer surgery. Previous concerns were related to the amount of drainage. I believe that all women should receive some rehabilitation after surgery to prevent complications such as frozen shoulder and lymphedema. Many of my patients are fearful of moving after the surgery which then sets up a bad situation. Home exercises may not be enough, and women need to be shown how to do the exercises correctly as well as use the right muscles. There is a lot of guarding and protection of the affected arm.
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I got my first client today who is 70 years old with type 2 diabetes, a breast cancer survivor (2 times), and has had a mastectomy, among her health concerns. She is a lovely woman and I didn't even notice the missing breast. I listened to her very carefully, asked about her concerns and what, if anything, her doctor has recommended or restricted, and she was a joy to work with.
Honestly, I can't say that I treated her any differently than anyone else who comes to me with medical conditions, restrictions, and old injuries. We need to listen, ask questions, and err on the side of caution.
Honestly, I can't say that I treated her any differently than anyone else who comes to me with medical conditions, restrictions, and old injuries. We need to listen, ask questions, and err on the side of caution.
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HI Wendy,
Thank-you for your response.
I agree with you regarding the need to listen, ask questions, and err on the side of caution. However, breast cancer requires special precautions and care. For example, what kind of mastectomy did she have? Did she have any lymph nodes removed. If so, this will effect strength training regimens as she is at risk for lymphedema. What about treatment? Did she receive any radiation or chemotherapy? Both can cause long term effects that will change one's ability to exercise . For example, adriamycin (chemo drug) causes cardio- toxicity . I have a web site with lots of information ,as well as distance courses if you would like to learn more. Remember education is power!
Sincerely,
Naomi Aaronson MA OTR/L CHT CPI CET (ACSM)
www.recovercisesforwellness.com
Thank-you for your response.
I agree with you regarding the need to listen, ask questions, and err on the side of caution. However, breast cancer requires special precautions and care. For example, what kind of mastectomy did she have? Did she have any lymph nodes removed. If so, this will effect strength training regimens as she is at risk for lymphedema. What about treatment? Did she receive any radiation or chemotherapy? Both can cause long term effects that will change one's ability to exercise . For example, adriamycin (chemo drug) causes cardio- toxicity . I have a web site with lots of information ,as well as distance courses if you would like to learn more. Remember education is power!
Sincerely,
Naomi Aaronson MA OTR/L CHT CPI CET (ACSM)
www.recovercisesforwellness.com
