Staying physically active with metastatic breast cancer

As we all know, a number of studies have suggested that regular mild to moderate exercise can reduce the recurrence risk of breast cancer. But what about exercise if the cancer does return? Is it still considered helpful and safe? There have been fewer studies about this situation, but early research indicates that regular mild exercise may decrease fatigue, pain, and anxiety, and may make it easier to keep up with the demands of daily life.

It is unlikely that there will be definitive studies about this situation because there are so many variables that can't be controlled. Every woman's situation is different, and any results would need to consider hormone and HER2 status, areas of metastatic spread, current and past treatments, and the usual age, weight, baseline activity and strength level measurements. This leaves us in the familiar area of advice and suggestions, but no hard recommendations.

Generally speaking, whatever our circumstances, staying active makes us all feel better. If athletics and exercise have been important in your life, they will still be important after a metastatic diagnosis. If, on the other hand, you have avoided gyms and teams, you are not now likely to become an exercise zealot. Paying attention to quality of life is especially important, and that includes activities and habits that have brought pleasure to you.

Per usual, it is important to say that everyone is different, and that everyone's situation will change over time. Depending on treatment, side effects may be challenging. Fatigue or neuropathy may make aerobic exercise difficult. If the cancer has spread to some areas of the body, it may be even harder. For example, lung metastases can reduce air intake or cause earlier shortness of breath and bone metastases to vulnerable bones (think weight-bearing bones such as hips) may increase the risk of fracture. It is important to speak with your doctor about your exercise program and be careful of any particular concerns that are discussed.

It is always possible to adjust and adapt. If you have been away from exercise for some time or if you are hoping to increase your activities, it can be helpful to speak with a physical therapist first. It is often useful to meet with a trainer to develop a safe and useful program. Make sure that either the PT or trainer with whom you consult is someone who is experienced with women in this situation. The usual advice about no pain, no gain is unhelpful now. You need to listen carefully to your body and not push yourself in ways that can bring harm.

As always, and as is especially true for people living with advanced cancer, there must always be a balance between prudence and activity. Restricting yourself too much won't help your overall physical state and likely will increase your feelings of sadness and worry. I remember Liz, a lovely woman who lived well with metastatic breast cancer for a number of years. I have a wonderful picture of her jumping on a trampoline with her children. Against the repeated advice of her oncologist (and I am definitely not recommending this), she continued to ski because she so loved it. She never fell.