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1. Know When Exercise is Safe. A postoperative breast cancer patient must have her surgeon’s approval before exercising. Surgical drains should be removed before you begin a formal exercise program, and you shouldn't have any open wounds in your skin from either radiation or surgery.

2. Focus on Function. When you first exercise after surgery, the goal is to decrease pain and increase ROM. Exercise (including ROM exercsies) and the activities of daily living will help you restore your movement. ROM exercises should be more passive at first; your unaffected arm should do most of the work, bringing your affected arm “along for the ride.” Once you feel comfortable exercising this way, you can do more active ROM exercises.

3. Try These Sample Exercises. Use deep breathing in conjunction with these exercises. Breathe in through the nose and out through the mouth, taking twice as long to exhale as to inhale. In addition, hold these stretches for 10 to 30 seconds and do three sets of each:

• Overhead Elevation. Lying on the back with your knees bent and your feet flat on the floor (sit-up crunch position), hold a rod in both hands, resting it over your hips. Keeping your elbows straight, slowly lift your arms until the rod is directly over your face. Take a deep breath and, while exhaling, slowly lift the rod over your head until it is resting on the floor. Hold the stretch and then lower the rod back down to your hips. You can also do this exercise without the rod by holding your affected hand with your unaffected one and doing the same movement.

• Butterfly Stretch. Lying in the crunch position with hands clasped behind the head, push your elbows down toward the floor. To release, lift your elbows back up toward the face.

• Side-Arm Stretch. Sitting in a chair, grasp your affected hand your other hand and bring both hands to the top of the head. Pull the affected arm up over the head, bringing the forearm as close to the opposite ear as possible. Repeat on the other side. Once this stretch can be done with ease, add a torso side stretch. Using a mirror will help you do this exercise correctly.

• Wall Climb. Facing a wall, stand about 6 inches away. Place your palms on wall just above head and “walk” the fingers of your unaffected hand up the wall until you reach full extension. Then do the same with your affected hand.

Angel Wings. Lie on your back with your knees bent, hold your arms flat on the floor in 90-degree angles at the elbows, palms toward ceiling. Maintaining the 90-degree angles, slowly slide your hands above head. Hold at the point of discomfort.

• Diagonal Arm Abduction. Place one of your arms on the opposite thigh, holding it straight, and lift it diagonally overhead. Repeat on the other side.

• Corner Pectoral Stretch. Standing approximately one arm-length away from a corner wall, place a palm about shoulder-high on each wall. Slowly lower your body into the corner until you feel a good stretch.

4. Continue to Safely Exercise. Four to 6 weeks after your surgery, you will probably be able to add more exercises and start cardiovascular activity. Once ROM is restored, get your surgeon’s approval to begin training with equipment. Working with a qualified personal trainer can also help you exercise safely and effectively.

5. Learn More. The following resources offer additional insights:

• Abrest in a Boat Society, www.abreastinaboat.com
• American Cancer Society, www.cancer.org
• Better Than Before Fitness, www.brestfit.com
• Cancer Supportive Care, www.cancersupportive.com

• Essential Exercises for Breast Cancer Survivors by Amy Halverstadt and Andrea Leonard (2000, Boston, MA: Harvard Common Press)
• Recovering from Breast Surgery: Exercises to Strengthen Your Body and Relieve Pain by Diana Stumm, PT (1995, Alameda, CA: Hunter House)

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