By Madison Malette, B. Sc., R. Kin, CLT, CYT200
A breast cancer diagnosis has a way of turning life upside down- your calendar is filled with appointments, scans, treatments, surgeries, and follow-up visits. Your focus becomes getting through the next appointment, the next treatment, the next milestone and then gradually things begin to slow down. For many, this is when a different question starts to surface… Now what?
As a Kinesiologist and Certified Lymphedema Therapist, this is a common sentiment I hear during my appointments with patients. Once active treatment ends, many people are left wondering what they should (or shouldn't) be doing, and a quick Google search or scroll on social media often provides a lot of conflicting advice and not a lot of help. So, let's walk through what we know, and practice based on the strongest research we have today.
Exercise and Chemotherapy
Fatigue is one of the most common and frustrating side effects of chemotherapy and although it can feel counterintuitive, the research consistently shows that regular movement is actually one of the most effective ways to reduce cancer-related fatigue. Activities such as walking, cycling, or swimming combined with strength training can also help improve mood, maintain muscle mass, support cardiovascular health, and even lessen the intensity of the notorious "chemo brain." There are times when exercise should be modified or temporarily paused during chemo, such as when experiencing a fever, severe nausea or vomiting, significant anemia, low blood counts, or balance changes from peripheral neuropathy. This is why working with a healthcare professional familiar with cancer rehabilitation is important.
Exercise and Radiation
In the early stages of radiation treatment, fatigue and skin irritation can be common. Gentle walking, stretching, and range of motion exercises are generally well tolerated, while vigorous exercise that causes excessive friction or sweating may need to be paused or adjusted to avoid further skin irritations. One of the longer-term complications of radiation treatment is radiation fibrosis and it is characterized by a feeling of tightness around the chest, shoulder, or underarm and it can lead to extra scar tissue and reduced tissue flexibility in the radiated area. Daily stretching, mobility work, and maintaining regular shoulder movements can help preserve flexibility and reduce long-term stiffness before it becomes limiting.
Exercise After Breast Cancer Surgery
Whether you’ve had a lumpectomy, mastectomy, lymph node surgery, reconstruction, or a combination of procedures, movement plays an essential role in all recoveries. One of the biggest progressions in breast cancer rehabilitation over the last decade has been the scientific research support and confirmation that just rest is not always best.
Older advice often encouraged people to protect the affected arm by avoiding lifting or delaying exercise for weeks or even months following surgery, but we now know this approach can actually cause a whole host of complications. Research and rehab guidelines consistently support early, gradual movement and progressive strengthening as safe and effective for most people following surgery. So, what does this actually look like in practice?
While it is important to seek exercise and movement advice from a professional to ensure you are receiving a tailored plan that is safe for your specific body, here are some general guidelines.
0-14 Days Post-Op: Our focus at this stage is recovery, and comfortable reintroduction of movement. Which often includes deep breathing exercises, walking as tolerated, hand and wrist movements, gentle shoulder mobility (within your surgeon’s recommendations), and posture exercises.
Weeks 2-6 Post-Op: During this phase of recovery, we want to shift our goal towards obtaining full shoulder range of motion (or back to your pre-operative baseline). Gentle stretching and range of motion exercises help rebuild confidence while gradually restoring normal movement and return to normal daily activities. It is important to note that although we aim for full range of motion restoration at 6 weeks post-op, this can be impacted by many factors including pre-existing conditions, reconstruction procedures (this could be a lesson all on its own!), post-operative complications and more.
6+ Weeks Post-Op: This is the point in recovery where we generally start to shift towards rebuilding strength and movement confidence- AKA the best part! Whether you’re returning to the gym, gardening, lifting grandchildren, or simply carrying groceries, your body needs strength to return to the activities that matter most to you. If exercise was a part of your regular routine before surgery, begin by performing roughly 25-50% of your previous workload and gradually build back up (and surpass!) your pre-surgery weights and repetitions. If strength training is new to you, resistance bands, bodyweight exercises, or light dumbbells provide an excellent starting point. In any case the key is to progress comfortably, consistently, and gradually.
Exercise and Survivorship
Completing treatments and crossing that finish line or becoming stable with your disease is often what we think of as the “I’ve made it through” moment, and although it is an exciting milestone, it is the point in your journey that often comes with the most questions and feelings of being lost in where to go next. In our clinical rehab model, we encourage people to continue with all aspects of their care throughout the survivorship journey including nutritional guidance, mental health support, symptom monitoring/reduction through regular maintenance massage appointments (with an RMT certified in lymphatics), and of course exercise.
At this point exercise and physical activity shifts from a rehabilitation focus and becomes more about building long term, sustainable habits that help protect your future health and wellbeing.
Although we are advocates for any and all physical activity at this phase of your journey, strength training deserves special attention because many breast cancer treatments, particularly aromatase inhibitors and treatment-induced menopause, increase your risk of accelerated bone loss. This places women at a greater risk of osteopenia, osteoporosis, and fractures related to such conditions. Progressive resistance training is one of the most effective non-medication-based strategies we have to help maintain bone density or even improve it. It also preserves muscle mass, improves balance (especially important if you’re experiencing long lasting neuropathy symptoms from your treatments), supports healthy aging, and makes everyday activities easier and safer.
The exact exercises that should be completed are very individualized and should be tailored to your unique needs. For example, someone who has had a lumpectomy versus someone who has had a DIEP reconstruction will have very different exercise needs and abilities. Additionally, someone who is undergoing long term chemotherapy treatments and someone who has had an oophorectomy for hormone suppression will also have very different needs. This is why it is important to work with a professional to get started safely.
So, What About Lymphedema?
As a Kinesiologist and Certified Lymphedema Therapist working in cancer rehabilitation this is certainly one of the most common questions I am asked.
The old-school train of thought was to avoid lifting heavy weights to avoid lymphedema; however, we now have excellent research showing that this is not the best advice. Current research shows clearly and confidently that appropriately prescribed and monitored resistance training (including lifting heavy weights) does not increase the risk of developing breast-cancer related lymphedema. It also shows that when people engage in regular exercise and strength training it can improve arm function, reduce the risk of lymphedema, and increase quality of life.
I see people all the time that are afraid to return to, or begin strength training, following a breast cancer diagnosis/treatment and I am a huge advocate for seeking out professional support from a physiotherapist or kinesiologist to get started early and safely.
While I encourage individuals to get moving early and often, that doesn't mean everyone should jump straight into heavy lifting. Every person has a unique surgical history, healing timeline, and level of lymphedema risk. The goal is to progress safely with guidance from a clinician who understands both exercise prescription and cancer rehabilitation.
The Main Takeaway
Exercise isn’t something to be feared or simply treated as a rehab tool it is something to help you move forward and sustain your health long term. Whether you were just diagnosed last week, you’re 15 years into survivorship or somewhere in the middle, physical activity is a safe an effective lifestyle habit that can and should be incorporated into your daily habits. It can help improve your strength, bone density, balance, mobility, limb function, confidence, fatigue, and overall quality of life.
There is “no one-size fits all” program, and individualized care is important, but with guidance and support exercise can become one of everyone’s most powerful tools during their entire breast cancer journey.
If you're unsure where to begin, know that you don't have to figure it out alone. Working with healthcare professionals who understand both breast cancer treatments, its long term affects and exercise protocols can help you return to activity safely, confidently, and at a pace that's right for you.
About the Author
Madison Malette is a Registered Kinesiologist, Certified Lymphedema Therapist, Certified Yoga Teacher and the founder of the Ottawa Cancer and Lymphatics Centre. With a background in Kinesiology and specialized training in oncology rehabilitation and lymphatic health, Madison is passionate about helping individuals navigate the physical changes that can come with cancer treatment, surgery, and survivorship. Her approach is grounded in evidence-based care, with a focus on helping people rebuild strength, restore function, and feel confident in their bodies throughout recovery and beyond.
About the Ottawa Cancer and Lymphatics Centre
The Ottawa Cancer and Lymphatics Centre is a multidisciplinary clinic dedicated to supporting individuals affected by cancer, lymphedema, and related conditions. Our team of physiotherapists, registered massage therapists, kinesiologists, dietitians, and psychotherapists work collaboratively to provide personalized, patient-centred care across the cancer journey. From rehabilitation and lymphatic management to exercise, nutrition, pelvic health, and emotional support, we aim to provide comprehensive care that empowers patients and helps improve quality of life.
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