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Exercise Programming for Breast Cancer Patients

Jan 13, 2012

Fitness Forum

I enjoyed Jennifer Salter’s article “Exercise Programming for Breast Cancer Patients” (September 2011). However, I thought the article left out important limitations regarding strengthening clients after various reconstruction surgeries. As both a [cancer] survivor and a physical therapist who works with many of these women, [I believe] it is paramount to consider not strengthening the pectorals with implant patients; to gently strengthen the lats with those who have had latissimus dorsi flap reconstruction; and to take abdominal precautions for those who have had tram flap procedures. Often these considerations are overlooked by MDs when clearing survivors for exercise, so it is up to us to know how to retrain these patients.

Nataly Pluta, PT, YT

Solana Beach, California

I enjoyed Jennifer Salter’s article. She provided a great deal of excellent information. I’ll keep this article for future reference. In the sidebar “Effective Communication Skills,” the author mentions ensuring that clients have “adequate emotional, social . . . support.” What is considered adequate, and what would you suggest doing if a client does not have such a network in place?

Gayle Gray, ACE-PT

The author responds:

  • Positive support from family. Sometimes husbands can have a hard time, especially if the woman has to have a mastectomy, so you can gently ask questions to see if this may be the case for the client.

  • Support from friends. This can include prearranged logistical support (i.e., providing meals; accompanying the client to medical appointments; providing company at home while she is recovering; and helping with childcare). People often want to help but don’t know what support is most needed.

  • Counseling at the treating hospital. Most oncology teams have social workers who can be accessed for counseling.

  • Breast cancer buddy programs and support groups. There are programs that match women who have gone through treatment with women who are starting treatment.

  • Online discussion groups.

Jennifer Salter, MSW


Love Learning on!

Being active on has been one of the best decisions that I’ve made for advancing my knowledge in the industry. I love learning, and this is one of the best places to do it.

Marlan Eller

Brooklet, Georgia

Consider a PTA Career

“The Pursuit of Higher Education” by Biray Alsac, MS, (July–August 2011) caught my attention because I am living this story! I was happy to see that IDEA is thinking in this direction and providing insight to its members on how to proceed. When I was exploring my options, the guidance was not there and it was a very time-consuming project.

I noticed that the author overlooked the career field I have chosen to explore: physical therapist assistant (PTA). This field can be a wonderful progression in our careers as personal trainers. We are still working with human movement while also improving the quality of life for individuals with impairments. During study, we acquire a much greater understanding of body mechanics through anatomy and physiology (a prerequisite), kinesiology, therapeutic exercise, advanced orthopedics and neuromuscular and cardiopulmonary rehabilitation—along with four internships. The U.S. Bureau of Labor Statistics puts the field of physical therapy at a high employment rate, which is awesome, especially at a time when we see so much attrition.

This degree and license make a personal trainer/instructor much more valuable due to the higher level of education and training, which is a plus for those who want to continue working with clients as a supplement to a PTA income.

Jill Teller

Naperville, Illinois

USDA MyPlate Feedback

I have been anticipating the move to the USDA MyPlate model for some time (“MyPlate Replaces MyPyramid,” Food For Thought, September 2011) .

A few years ago I invented a similar way of tracking food intake. I developed the “füdoo (food + do) Board” for my family to use as we learned together how to eat healthy. The key is taking one meal at a time and learning to think in food groups. Finding variety on your plate and having less worry about portions, counting and measuring are also key.

I have been an ACE fitness instructor since 1999, and although I don’t combine my instructing with my füdoo Board business, my participants learn about my nutrition tool as they get to know me and my family. I do refrigerator makeovers, host “clean out the cupboards” parties and keep an active parenting group centered around the füdoo fülosophy. The füdoo Boards help families begin their journey toward better health. Learn more at

Sarah Vinch

Eat! Drink! Move! Think!


As a registered dietitian, I use the MyPlate recommendations every day. It is a great tool to help people easily visualize healthy eating. The article in the September Food for Thought column stated that “Dairy foods—a discretionary group—are off to the side.” Dairy foods are considered essential foods. Discretionary calories, now called empty calories, contain added sugars and added fats with little or no nutrients. I want to point out that the dairy group is an important component of MyPlate, not a discretionary group.

Ruth Frechman, MA, RD, CPT

Burbank, California

ACSM Position Stand and Isometric Exercise

Upon reviewing the new ACSM standards for exercise prescription in “From 1998 to 2011: ACSM Publishes Updated Guidelines” (Research, October 2011), I’m wondering where isometrics exercises fit into resistance training. I’m hoping the author, Len Kravitz, PhD, and IDEA have some guides or suggestions for me to utilize.

Lani Muelrath, MA, CGFI, CPBN

The Plant-Strong Fitness Expert

The author responds: That is an excellent question. Here is a quote from the ACSM position stand: “A resistance training program emphasizing dynamic exercises involving concentric and eccentric actions that recruit multiple muscle groups is recommended . . .”

I do not see any mention of “isometric” exercise in the ACSM position stand. From my perspective, following the intensity guidelines is the best evidence-based application I can share with you. For example, 40%–50% of 1-RM, or very light to light load, for beginning older persons and for beginning sedentary persons; 60%–70% of 1-RM, or moderate to hard load, for novice to intermediate adult exercisers; and ≥80% of 1-RM, or hard to very hard load, for experienced weightlifters.

Len Kravitz, PhD

Are You Incorporating Massage Therapy Into Workouts?

Editor’s note: Our November–December Mind-Body-Spirit News “Question of the Month” asked readers if they were incorporating massage therapy using sticks or foam rollers. Here is how one reader responded:

Yes, I incorporate both yoga and foam rolling (along with a technique called “mashing” which is part of Ki Hara Approach ( After a 45-minute cross-training session with a small group of clients (3–5), we then do 45 minutes of intervals with yoga, myofascial release with foam rollers, mashing (where I literally walk on their hamstrings, glutes, etc.) and a final relaxation. It’s a combination of self-massage, mashing, stretches, breathing and relaxation. They love the combo: they get their cardio and strength training with a sports conditioning coach, and their flexibility, mini-massage and recovery with me.

Karen Dubs, RYT

The Flexible Warrior


IDEA Fitness Journal, Volume 9, Issue 1

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