Exercises to Speed Recovery After Cancer Surgery

A major problem in patients who are rehabilitating 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—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 the way to go. Patients should move in ways that 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'll look at some exercises for patients recovering from mastectomy or radical prostatectomy. (See illustrations and instructions for patients below.)

Even if they feel weak, patients must get out of bed and take a few steps every day to reduce the risk of atrophy. There are various ways to make this easier.

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's better to have the patient periodically limping or walking with a walker than 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 levels are less than 100 million cells per mL, patients should wait until they increase before starting to exercise.

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

After prostatectomy, the stomach muscles are often weak—which predisposes the patient to low back pain—and the hips are very stiff.

Most men having radical prostatectomy are aged 55 or older and already developing osteoarthritis, so they are especially susceptible to low back pain.

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

Next month: Exercises for lumbar stenosis.

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 backward 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.

Exercises for patients who have undergone prostatectomy:

▸ Abdominal strengthening. Lie on your back with a pillow under your knees, and your arms at your sides. Start to exhale slowly while lifting your head, lifting only far enough to see your navel. Exhale slowly while counting to six, then slowly relax to the floor, and gently roll your head from side to side. Repeat 6 times.

▸ Tensor fascia lata (hip) stretch. Lie on your left side on the edge of a bed, facing the middle of the bed. Prop your head up on your left hand. Bend the left leg upward toward the chest. Keeping the top (right) leg straight at the hip and knee, lift it behind your back, and let it dangle over the edge of the bed. Do not arch your back. Hold for 15 seconds. Gently bend the right leg and bring it back up onto the bed. Repeat 6 times with each leg.

A major problem in patients who are rehabilitating 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—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 the way to go. Patients should move in ways that 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'll look at some exercises for patients recovering from mastectomy or radical prostatectomy. (See illustrations and instructions for patients below.)

Even if they feel weak, patients must get out of bed and take a few steps every day to reduce the risk of atrophy. There are various ways to make this easier.

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's better to have the patient periodically limping or walking with a walker than 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 levels are less than 100 million cells per mL, patients should wait until they increase before starting to exercise.

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

After prostatectomy, the stomach muscles are often weak—which predisposes the patient to low back pain—and the hips are very stiff.

Most men having radical prostatectomy are aged 55 or older and already developing osteoarthritis, so they are especially susceptible to low back pain.

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

Next month: Exercises for lumbar stenosis.

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 backward 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.

Exercises for patients who have undergone prostatectomy:

▸ Abdominal strengthening. Lie on your back with a pillow under your knees, and your arms at your sides. Start to exhale slowly while lifting your head, lifting only far enough to see your navel. Exhale slowly while counting to six, then slowly relax to the floor, and gently roll your head from side to side. Repeat 6 times.

▸ Tensor fascia lata (hip) stretch. Lie on your left side on the edge of a bed, facing the middle of the bed. Prop your head up on your left hand. Bend the left leg upward toward the chest. Keeping the top (right) leg straight at the hip and knee, lift it behind your back, and let it dangle over the edge of the bed. Do not arch your back. Hold for 15 seconds. Gently bend the right leg and bring it back up onto the bed. Repeat 6 times with each leg.

A major problem in patients who are rehabilitating 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—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 the way to go. Patients should move in ways that 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'll look at some exercises for patients recovering from mastectomy or radical prostatectomy. (See illustrations and instructions for patients below.)

Even if they feel weak, patients must get out of bed and take a few steps every day to reduce the risk of atrophy. There are various ways to make this easier.

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's better to have the patient periodically limping or walking with a walker than 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 levels are less than 100 million cells per mL, patients should wait until they increase before starting to exercise.

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

After prostatectomy, the stomach muscles are often weak—which predisposes the patient to low back pain—and the hips are very stiff.

Most men having radical prostatectomy are aged 55 or older and already developing osteoarthritis, so they are especially susceptible to low back pain.

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

Next month: Exercises for lumbar stenosis.

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 backward 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.

Exercises for patients who have undergone prostatectomy:

▸ Abdominal strengthening. Lie on your back with a pillow under your knees, and your arms at your sides. Start to exhale slowly while lifting your head, lifting only far enough to see your navel. Exhale slowly while counting to six, then slowly relax to the floor, and gently roll your head from side to side. Repeat 6 times.

▸ Tensor fascia lata (hip) stretch. Lie on your left side on the edge of a bed, facing the middle of the bed. Prop your head up on your left hand. Bend the left leg upward toward the chest. Keeping the top (right) leg straight at the hip and knee, lift it behind your back, and let it dangle over the edge of the bed. Do not arch your back. Hold for 15 seconds. Gently bend the right leg and bring it back up onto the bed. Repeat 6 times with each leg.