As you begin this third part of our phase-one programming for breast cancer survivors, it’s critical to acknowledge the importance of parts one and two of the program; to adhere to the goals of each part; and to honor your client’s readiness to progress. There is no definite time frame allotted for each part—it truly depends on the client’s success and comfort level.

Follow these simple guidelines to assess whether a client is ready to progress:

  • has developed a good understanding of basic Pilates biomechanical principles
  • applies Pilates principles both during the sessions and in daily life activities
  • remembers from session to session the skills previously reviewed (The lessons are becoming second nature.)
  • can maintain proper alignment throughout each repetition
  • leaves the session energized, not fatigued
  • experiences no residual soreness or discomfort following the workout

Part Three Movements

As previously stated, the exercises here do not replace those shown in parts one and two; they are a continuation of those moves. All exercises are meant to be executed in the order in which they have been outlined.

If you have been scheduling your client’s workouts for 30 minutes, two to three times per week, you may opt to increase one of those weekly sessions to 40 minutes. This will help develop the client’s endurance and give you an arena in which to add the new repertoire.

It’s important to work within the guidelines outlined in part two: add only one or two new exercises at a time, and vary between upper- and lower-body exercises in each session, to avoid overtaxing one area.

You will note we have added the STOTT PILATES® Flex-Band® exerciser and 1- or 2- pound STOTT PILATES Toning Balls™ to support the weight of the limbs and/or to provide gentle resistance. Note: The movements may be done without the props.

Side-Lying Arm Circles With STOTT PILATES Toning Balls

Benefits. This move improves shoulder joint mobility and increases blood flow to the joint. The ball provides proprioceptive feedback and adds gentle resistance. The light load helps recruit the deep stabilizing muscles (e.g., rotator cuff). Note: Include this exercise only if the client is comfortable lying on her side.

Start Position. Lie on one side with both knees bent and a spacer between thighs to keep hips more neutral. Rest head on pillow or cushion, keep spine in neutral and reach top arm toward ceiling. Hold ball in palm, facing forward.

Exercise and Breath Pattern

  • Inhale: make tiny circles in one direction for 5 counts.
  • Exhale: make tiny circles in other direction for 5 counts.
  • Repeat for 5 full breath patterns.

Beneficial Cues

  • Keep the movement very small, and execute the circles slowly.
  • Feel as though the ball is resting gently in your hand; do not grip.
  • Keep the arm directly over the shoulder joint.
  • The movement should feel like a shoulder massage.

Hip Rolls

Benefits. This exercise encourages proper sequencing and fluidity of the spine, pelvis and femurs. The goal is to strengthen the abdominals and the hip and spinal extensors, while relieving tension. Although appropriate for all breast cancer clients, the exercise is especially beneficial for those who have had TRAM (transverse rectus abdominis myocutaneous) flap surgery and who experience core weakness and lumbar-spine and hip flexor tension.

Start Position. Lie supine on mat with spine neutral, knees flexed, legs hip distance apart and arms long by sides. You may use a spacer between knees to encourage proper alignment (place pillow under arm of affected side if necessary).

Exercise and Breath Pattern

  • Inhale to prepare.
  • Exhale: engage abdominals to rock pelvis away from femurs. Activate glutes and hamstrings, and lift pelvis, rolling through lumbar spine until hips are in line with shoulders.
  • Inhale: stay at top of movement.
  • Exhale: roll down—starting at upper spine—all the way back to start position.
  • Repeat 3–5 times.

Beneficial Cues

  • Activate the abdominals first, then the glutes and hamstrings.
  • Use your exhalation to activate the deep abdominal muscles and take the tension out of your neck and shoulders.
  • Re-engage the abdominal muscles before rolling back down from the top position.

One-Leg Circle

Benefits.This exercise focuses on spinal stability in neutral against a circular leg movement. It brings blood flow to the hip joint, mobilizing the hip, and draws attention to the use of breath to activate the inner-core musculature (transversus abdominis, pelvic floor and multifidus). This is another exercise that very specifically develops strength and stability in the core and spine for those who have had TRAM flap surgeries.

Start Position. Lie supine on mat with spine neutral, both knees bent with band wrapped around one leg (which is in tabletop position). Place other foot flat on mat. Arms are bent, hands hold band with overhand grip, and palms face body. (Do not wrap band around wrist). Note: If client needs arm support on affected side, place cushion under elbow.

Exercise and Breath Pattern

  • Inhale: allow leg with band around it to cross midline of body.
  • Exhale: continue to circle leg downward, outward and around back to start position, maintaining neutral spine throughout.
  • Repeat 3–5 times for each leg.

Beneficial Cues

  • Use your exhalation to maintain core stability as you circle the leg.
  • Keep the range of motion small enough that you can maintain core stability.
  • Allow the band to support the weight of the leg; avoid gripping in the hip.
  • Press against the band to activate the hamstrings, releasing the hip flexors.

Swimming Preps

Benefits. This exercise helps retrain oppositional movement patterning between the upper and lower body, which is essential in daily functional movements. For example, when we walk it’s natural to swing our arms and legs in opposition. The exercise also brings awareness to how our abdominals support our spine against gravity. Four-point kneeling is a perfect position in which to notice and feel this effect. Note: It may be uncomfortable for a client to bear weight on her arms. Avoid this exercise if it creates tension.

Start Position. Kneel in “four points,” hands directly under shoulders, and knees under hips. Entire spine is in neutral, and knees are hip distance apart.

Exercise and Breath Pattern

  • Inhale to prepare.
  • Exhale: engage abdominals with the breath and lift opposite arm and leg.
  • Inhale, and return back to the start position.
  • Repeat 3–5 times consecutively with one side, and then do the other side (opposite arm and leg).

Beneficial Cues

  • Think length, not height, when lifting the arms and legs.
  • Engage the abdominals to keep the spine from sinking.
  • Activate the glutes to lift the leg.
  • Visualize the hips as headlights shining on the mat in front of you.
  • Hold a ruby in your navel and do not let it drop.