Breast Cancer Survivors Need Balance Training

Balance and strength exercises can help prevent falls by improving your ability to control and maintain your body's position whether you are in motion or stationery. A strength and flexibility exercise program which includes balance exercises will help you regain function and mobility for daily living activities. Balance training is a key component for recovery after cancer treatments. Stability exercises can help to enhance steadiness and build leg strength to decrease the likeliness of falling.

Some of the chemotherapies can affect your balance, increase the rate of sarcopenia and the rate of bone loss. Cancer survivors are at higher risk for osteoporosis due to chemotherapy and cancer medications. Falls are dangerous for those with weaker bones. Falls and fall-related injuries, such as hip fractures, can limit activities and make it impossible to live independently. Balance training is especially important for those with osteoporosis, sarcopenia, chemotherapy induced peripheral neuropathy, or on aromatase inhibitors and after certain surgeries.

Surgery can affect your balance

Your balance can suffer after surgical procedures. This is especially true with the TRAM flap procedure where the rectus abdominus is altered. Poor core strength, caused by the change in placement of the rectus abdominus, has a negative effect on your balance. After a TRAM flap operation, you need to learn how to compensate for this change of muscle placement through a series of exercises designed to strengthen the remaining muscles such as the obliques. Additionally, a unilateral mastectomy can create a lopsided condition. The good news is that balance exercises can counter some of the effects of muscle imbalances and body asymmetry after surgery.

Joint pain

According to research by Basal, Vertosick, Gillis, et. al.[i] joint pain or arthralgia increases the rate of falls for women on aromatase inhibitors. Women with joint pain were twice as likely to fall compared to those without pain. A cancer team should evaluate and manage arthralgia symptoms and suggest fall prevention techniques for those at risk.

Chemotherapy induced peripheral neuropathy

Chemotherapy induced peripheral neuropathy is a common side effect of some chemotherapy regimens. Platinum agents, taxanes, and bortezomib are known to cause neuropathy. Peripheral neuropathy can cause tingling, numbing, and debilitating pain. It can start immediately or months after chemotherapy and can last for years.

There are a number of studies indicating that neuropathy increases the risk of falls among cancer survivors. For example, a study by Bao, Basal, et. al.[ii]demonstrates a correlation between neuropathy severity and rate of falls among breast cancer survivors. Their study found neuropathy doubled the fall rate and can decrease breast cancer survivors’ quality of life. It can cause a cancer survivor to lose their independence.

Neuropathy can affect gait patterns and the ability to walk. It can also make it difficult to sit and stand easily.

The exercises that follow are aimed at improving your balance and lower body strength. These are just a few examples of the hundreds of exercises that are included in the Cancer Recovery Fitness program.

Start your balance exercise routine with the following Level I exercises:

· Stand on one foot: Hold for 10 seconds and switch legs. Increase to 30 seconds. Start to add arm movements and head turns. To experience the importance of vision in balance try some of the balance exercise with your eyes closed.

· Tightrope: Put your heel in front of the toe of the other foot walking a narrow path as if walking a tightrope.

· Calf or heel raise: stand in place and raise each heel up and down.

· Grapevines: step sideways, put one foot in front, and then behind the other

· Pelvic Tilt: Lie on your back with your knees bent and your feet flat on the floor. Inhale and fill your torso with air. Exhale while pressing your abdominals downward, bringing your navel to your spine. Lower and repeat.

· Bridge: Lie on your back with your knees bent and your feet flat on the floor. Squeeze your glutes to lift your pelvis and ribs off the ground, leaving only your shoulders on the floor. Hold the bridge position for a few seconds, then lower and repeat.

A level II balance program includes core and lower body strength exercises. Perform strength exercises – such as front, back, and side leg lifts – at least two days per week. Begin by holding onto a sturdy chair for support with one hand. When you are ready, hold the chair with only one finger and eventually perform the exercise without holding the chair. As you progress add ankle weights, resistance bands, arm movements, head turns, and dynamic movements. Our goal is to move the body in a way that you would in everyday life.

[i]Joint Pain and Falls Among Women With Breast Cancer on Aromatase Inhibitors, Basal, Vertosick, Gillis, Li, Bao, Vickers, et. al. doi: 10.1007/s00520-018-4495-4. Epub 2018 Oct 10. [ii]Chemotherapy Induced Peripheral Neuropathy Among Breast Cancer Survivors: Prevalence, Risk Factors, and Fall Risk. Bao, Basal. et. al. Breast Cancer Res Treat 2016 Sep;159(2):327-33.doi: 10.1007/s10549-016-3939-0. Epub 2016 Aug 10.