Physical activity, exercise and primary breast cancer

The terms “physical activity” and “exercise” are often used to mean the same thing.

We use “exercise” to refer to structured and purposeful movement, such as going to the gym, attending an exercise class or going for a run.

“Physical activity” refers to unstructured movement, such as gardening, taking the stairs instead of the lift or parking further away and walking when you visit the shops.  

Being active has many benefits.

Regular exercise and physical activity can help maintain or improve your physical and mental health during and after treatment.

They can also: 

• Help avoid or reduce some side effects of cancer treatment, such as fatigue, weight gain, osteoporosis and lymphoedema
• Improve your long-term health, reducing the risk of heart attacks and strokes
• Prevent or reduce the loss of muscle tone and general fitness that can happen during and after treatment
• Help your mental wellbeing by reducing anxiety, stress, depression and improving your mood and sleep

Physical activity may also reduce the risk of the cancer coming back (recurrence).  

As well as being active, it’s important to eat a healthy diet.  

Everyone should do moderate exercise or physical activity for 30 minutes, 5 times a week.

However, this may feel overwhelming, especially if you’re having or have just finished treatment. If this is the case, breaking up the 30 minutes into three 10-minute sessions can still provide benefits.

Any amount of activity is better than none. You can start by trying to reduce the time you spend sitting down or being inactive. You can gradually increase the time you spend being active.

It’s important to wait a few weeks after surgery before beginning more intense exercise, especially if it involves the arm on the side of your surgery.

Visit the NHS website for more information about the physical activity guidelines, including what counts as moderate, vigorous and muscle-strengthening activity.    

Before starting any type of vigorous physical activity or exercise, talk to your treatment team or GP. 

How physically active you are and how much exercise you do will depend on several different things, including:

• Your level of fitness before your treatment
• Whether you’ve had breast reconstruction and the type of reconstruction you had
• Whether you have any side effects from treatment
• Whether you have any other health conditions, such as osteoporosis or heart problems

If you have a medical condition that means you can’t be as active as you would like to be, remember that even a small increase in how active you are can benefit your health. You can ask a healthcare professional about the most suitable types of activities for you.

You can start by making physical activity and exercise an enjoyable part of everyday life.

Setting realistic goals, keeping a record of how much physical activity and exercise you do and sharing your progress with other people may help you stay motivated.

Making physical activity part of your day

There are many ways to be more physically active as part of your daily routine, including:

• Energetic housework or gardening
• Parking your car further away from the shops or work and walking the rest of the way
• Getting off the bus a stop earlier than you need to and walking the rest of the way
• Using the stairs instead of taking the lift
• Sitting less and standing more (for example, you could walk around when talking on the phone)

Making exercise part of your day

It’s best to start slowly with an exercise activity you enjoy and gradually build up the amount you do. Anything that gets you a bit warmer and slightly out of breath counts.

For example, if you enjoy walking, start walking a short distance regularly. If you’re managing this easily, gradually build up the:

• Distance
• Number of times a day you walk
• Speed you walk
• Difficulty of the walk (adding in hills, for example)  

A step counter or pedometer app for your phone can help you monitor your progress. There are also several apps that aim to motivate people to be more physically active and track their progress.

You may prefer to do structured exercise with other people. There may be a local group you can join where people inspire, encourage and keep each other company while being more active. This might be walking, running or cycling, for example. Or you could see what exercise classes your local gym offers.

Shoulder and arm exercises are important to help you regain the movement and function you had before breast cancer surgery.

How soon you start, the other forms of physical activity and exercise you do, and how much you do after surgery will depend on:

• The type of surgery you had
• Your recovery
• Your fitness level before surgery

Many people feel well enough to go for a short walk a few days after surgery, but others need longer to rest.

Build your activity levels up gradually. It may take time to return to the level of activity you were doing before your surgery.

You may be advised not to lift or push with the arm on the side of your surgery and not to lift anything heavy. Your breast care nurse or a physiotherapist will tell you more about this. 

If you've had reconstruction

If you’ve had any type of breast reconstruction, ask your surgeon, breast care nurse or a physiotherapist which exercises they recommend. The types of activities you can do may be limited for some time, depending on the type of reconstruction you’ve had. 

Swimming after surgery

You can swim once your wounds have completely healed. This will avoid any risk of infection. 

If you've had a mastectomy, you may feel comfortable being flat. However, you can use a prosthesis if you prefer. A prothesis will not get damaged by chlorine or salt water. Or you can use a silicone or foam leisure prosthesis if you rinse it well afterwards. 

Other activities

With all forms of physical activity and exercise after breast cancer, it’s important to start slowly and pace your progress.

Activities like Pilates and yoga can be really helpful to build strength and reduce the risk of lymphoedema. However, some poses place more pressure on the arms and upper body. These include:

• Planks
• Downward dog
• Inversion yoga poses

These poses may need to be adjusted over time as you gain more strength.

Speak with a qualified yoga or Pilates instructor about the type of surgery you’ve had and what modifications you need to make.

Swimming during and after chemotherapy

You may be advised to avoid swimming while having chemotherapy. This is because chemotherapy affects your immune system, so your body is less able to fight infection. This means you may be more at risk from any germs in the water. Open water swimming carries a greater risk of infection.

Your doctor will advise you not to swim if you have a PICC or Hickman line. This is because swimming may introduce infection or the PICC or Hickman line may become dislodged.

If you would like to go swimming during or soon after chemotherapy, discuss it with your treatment team first.

Other activities

Chemotherapy affects people in different ways.

Some people have very few side effects and can continue with their usual activities. 

Others feel extremely tired or unwell and unable to carry on as usual. This can be frustrating if you want to be active.

There will be times when you do feel able to do some type of activity, and anything is better than nothing. Walking can boost your energy, help you feel less tired and improve your mood. It may be possible to continue with other types of exercise such as Pilates and yoga. 

If chemotherapy drugs are affecting the nerves in your hands and feet (peripheral neuropathy) some types of exercise, such as holding weights, balance activities or running, might be more difficult. If this is affecting you, you may want to try using a stationary bike instead.

Talk to your treatment team about any activities you would like to do while you’re having treatment. They can tell you which activities are suitable for you.

Swimming during and after radiotherapy

You may be advised to avoid swimming during radiotherapy and shortly afterwards. This is because radiotherapy can cause skin reactions which can be irritated by chlorine or chemicals in the pool. Swimwear can also rub the skin and cause discomfort.

It’s possible to continue swimming if you don’t have any skin problems. However, you should still check with your treatment team first. They may recommend that you rinse the treated area in the shower after swimming to remove any chlorine.

Other activities

If you’re having radiotherapy you may be advised to continue with your shoulder and arm exercises. 

You could also do any other exercises that feel comfortable, such as walking, yoga and Pilates. There’s no reason not to exercise during radiotherapy if you feel up to it. 

Taking hormone therapies may increase your risk of developing osteoporosis. This is where bones lose their strength and are more likely to break.

Regular weight-bearing exercises can help bones to grow and become stronger. Find out more about looking after your bones, including how exercise and diet can help. 

Hormone therapies may also cause pain and joint stiffness and hot flushes. Regular pain relief and regular exercise, such as walking or swimming, may help to relieve pain and joint stiffness. This type of exercise may also help reduce hot flushes.

The NHS website has a wide range of information about exercise.

Ramblers Wellbeing Walks help people become more active.

We are Undefeatable is a national campaign to support people with long-term health conditions to be active.

MOVE Charity aims to support and inspire people to MOVE Against Cancer through 5k Your Way support groups for all ages.