Slow is definitely the way to go when it comes to exercise after surgery to prevent muscle atrophy

Exercises to speed breast Ca surgery recovery: slow is definitely the way to go when it comes to exercise after surgery to prevent muscle atrophy

Willibald Nagler

A major problem in patients who are undergoing rehabilitation after cancer surgery or chemotherapy is that platelet counts go down, and patients develop thrombopenia and bleed easily.

In addition, the peripheral nervous system may be impaired, and patients may lose some sensation–for example, they may not feel the floor beneath them when they step down.

Although movement is crucial to prevent muscle wasting in cancer patients, slow is definitely the way to go. Patients should move carefully as to avoid trauma, because too much friction can cause bleeding.

To avoid friction, cancer patients should avoid using weights, especially early in recovery.

When patients can do 10-12 repetitions of an exercise comfortably, they can add weights, but they should be sure to pad their wrists and ankles before using weights, to reduce the risk of cuts and infections.

In this month’s column, we will look at some exercises for patients recovering from mastectomy. (See illustrations and instructions for patients shown at right.)

Even if they feel weak, patients must be encouraged to get out of bed and take a few steps every day to reduce the risk of atrophy.

What we often do is to bring parallel bars right to the bedside, so people can help themselves stand between the bars or take a few steps.

Ambulation is extremely important. If patients are immobile for extended periods of time, the rate of infection is high. It is much better to have a patient periodically limping or walking with a walker than to have her sitting or lying down constantly.

Patients should have their thrombocyte (platelet) levels checked before doing exercises. If the thrombocyte levels go up to 100 or 150 million cells per mL of blood volume, then the risk of bleeding is extremely low. But if the thrombocyte levels are less than 100 million cells per mL, patients should wait until they increase before starting to exercise.

After a mastectomy, or even a lumpectomy, patients may suffer from a stiff shoulder, which may evolve into frozen shoulder syndrome if inactivity begins to slow blood circulation to the area.

Patients should start stretching as soon as the physician allows, usually 3 weeks after surgery.

RELATED ARTICLE: Exercise Rx: After Cancer Surgery

Exercises for patients who have undergone mastectomy/lumpectomy:

* Scapular elevation (shoulder circles).

Stand or sit in a chair with arms straight down at your sides, and palms facing in. Lift both shoulders slightly, and roll them backwards simultaneously. Repeat 10 times. Reverse the motion and roll the shoulders forward. Repeat 10 times.

* Horizontal shoulder adduction stretch.

Stand or sit in a chair and bring the right arm across the chest, placing it on the left shoulder. Place your left hand on your right elbow and gently pull the arm across the chest. You should feel a stretch in the back of the arm and in the shoulder. Hold for 6 seconds. Relax. Repeat 6 times. Repeat on opposite side.

EMILY BRANNAN, ILLUSTRATIONS

BY WILLIBALD NAGLER, M.D.

DR. NAGLER is physiatrist-in-chief, emeritus, and professor of rehabilitation medicine at Weill Medical College of Cornell University, New York City.

COPYRIGHT 2005 International Medical News Group

COPYRIGHT 2005 Gale Group