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When Rebecca, a Toronto-based wedding coordinator, was 29 years old, she felt a lump in her breast. Friends told her it was probably nothing, but she knew it needed to be checked out.
She was soon diagnosed with stage 4 breast cancer and was treated with a lumpectomy and radiation and put on Tamoxifen to help prevent reoccurrence. A few years after starting Tamoxifen, Rebecca and her partner wanted to try to have a baby. She went off the drug, but wasn't successful getting pregnant.
The breast cancer came back when she 34 years old.
"I knew the mastectomy was coming when I found out about my reoccurrence," Rebecca says. "I didn't want to worry anymore. I was happy to do it and have it taken care of."
She had a mastectomy on one breast and recovered over a couple of months. After her reconstruction surgery, she had another five months of bed rest. There were further surgeries as part of the reconstruction – and in total it was about two years of multiple surgeries and recovery time.
Getting back into fitness post-treatment
"Before breast cancer, I was an athlete – a runner," Rebecca says. "After two years of intense surgeries and recovery, I had gained weight and barely used my arms. I felt gross.
"When I knew I could start moving again, I was nervous about exercising without causing damage."
She enrolled in
Toronto Rehab's HEALTh Program – a breast cancer rehab program based on the cardiac rehab model that teaches women how to manage their chronic disease. It brings together exercise, specialized education and peer support to improve the women's fitness levels and quality of life while they're in cancer treatment or post-treatment.
The six-month program has approximately 50 women enrolled at any time and meets once a week.
Recent research finds HEALTh Program improves fitness and quality of life
A recent study led by Dr. Lianne Dolan, a Toronto Rehab post-doctoral fellow at the time, and Dr. Paul Oh, Medical Director, Cardiovascular Prevention and Rehabilitation Program, Toronto Rehab, found that the application of the cardiovascular rehab model improves physical and mental health in breast cancer survivors. The study assessed approximately 150 recent participants from the HEALTh Program retrospectively.
"These results support the approach of applying the existing cardiac rehab model to breast cancer patients who experience treatment-induced decline in cardiopulmonary fitness, quality of life and the high incidence of depressive symptoms," Dr. Oh says.
The study provides evidence-based validation for Toronto Rehab's approach to breast cancer rehab.
"Our plan is to strengthen our collaboration with Toronto cancer programs and share this program model more widely to grow it provincially, nationally and internationally," Dr. Oh says.
Tailoring exercise for breast cancer survivors
For many of the women during treatment or post-treatment, their fitness stamina and strength are a concern. Chemotherapy, for instance, can have a negative effect on the heart and patients are coming into the program with low VO2 (fitness levels) – in many cases, below the 50 per cent fitness level mark.
"Most of the women feel like they finish their breast cancer treatment and their doctor says they're done and they're better," says Gerilyn Danischesky, Rebecca's case manager with the HEALTh Program at Toronto Rehab.
"But, they get home and they don't feel better. And, they don't get back to their normal life. They're fatigued and they've lost strength. Our program helps guide them to feel better as they settle into their new normal."
Rebecca says when she arrived at the program based at Toronto Rehab – Rumsey Centre she was exhausted walking one kilometre but now she’s walking/running seven kilometres. (Photo: UHN)
When Rebecca began the program in fall 2016, her peak fitness level or VO2 was 32 ml/kg/min (90th percentile for the general population).
"I remember when I arrived to the program and did one kilometre of walking – that felt exhausting," Rebecca recalls. "I eventually progressed to three kilometres of walking/running and now I'm up to seven kilometres."
After three months, she had a 15 per cent increase in her fitness level – up to 36.3 (105th percentile). The average in the Program is a five per cent increase. In addition, she had a 2.5 per cent decrease in her body fat over that time period.
"If not for this program, I'd probably still be on the sofa. I was so far out of shape."
Gerilyn explains that "the more we can push the women in the program, the better it is for them long-term. We know that the more muscle they can build, the better their body will be able to deal more effectively with unhealthy sugars and fats."
The program also has a special emphasis and approach to weight training tailored for breast cancer patients and survivors. Weight training begins earlier for this patient population compared to cardiac patients. It's an emphasis because it builds bone density in order to help prevent cancer reoccurrence in the bones (which is a common area for a tumour to reappear).
"Weight training pulls on the bone so it makes them stronger – and we know that weak bones are a common finding in women with breast cancer," explained Gerilyn.
Rebecca was pleased with the benefits of the tailored weight training approach.
"I had a hunch as a result of my mastectomy and reconstructive surgeries. The program provided exercises that targeted the back muscles to help correct the hunch."
The power of peer support
Rebecca contributes part of her fitness success to a friend she made in the program. They've become running buddies and push each other during the weekly class and via text during the rest of the week.
"I don't know if I'd push myself that hard without her," Rebecca says.
Gerilyn explains the peer support is an important part of the program's success in improving quality of life for the women and likely contributes to the high completion rate of 80 per cent.
Overall, building relationships with other women who have been through a similar health experience helps address self-esteem, motivation and mental wellness.
Specialized education series for breast cancer survivors
The HEALTh Program also features education sessions that address issues many of the patients are facing or may face. For example: nutrition for breast cancer survivors; how to manage lymphedema; sexual health post-treatment; cancer reoccurrence.
Based on patient feedback, they have also introduced a social worker who dedicates her time to group and individual sessions around their overall wellness and an oncologist who comes in twice a month for a walk-and-talk about any topics the women would like to discuss.
Breast cancer a chronic disease
Women are surviving breast cancer at higher rates, but living with the impact of the disease, treatment and surgery.
"Breast cancer is a chronic disease and we're teaching the women on how to better manage it," says Gerilyn.
Rebecca felt that impact firsthand and required the HEALTh Program to help guide her return to a quality life.
"It put me in a routine and gave me knowledge and education I needed to continue the exercise and nutrition regimen to stay healthy," she says.
"There's something about exercise that makes you feel better about yourself. I'm feeling back to my normal self and positive about the future."
Learn more about how to get referred to the HEALTh Program.