“Even before treatment starts, you can help the healing process begin.” ~ Cathy Leman, MA, RD, LD

 

Prior to my 2014 breast cancer diagnosis, I spent my days working as a nutrition therapist and personal trainer.

If I described my professional life as simply that, it honestly wouldn’t do justice to the work I was privileged to do on a daily basis. The bigger picture is this: I owned a private nutrition therapy practice and personal training studio, helping clients who struggled with body image concerns, weight issues (that had nothing to do with food and everything to do with life’s challenges), eating disorders and disordered eating, and those looking to proactively stack the deck in favor of their health with sustainable nutrition and fitness habits.

I. LOVED. MY. WORK.

I also loved the community I built within my practice and studio; my clients were (and still are!) amazing human beings, a joy to watch grow stronger (mentally AND physically), showed up for their workouts and gave 110%, challenged me as a clinician, and supported each other in their individual health victories and setbacks.

With the help of a small staff, I was able to impact a great number of people through deeply gratifying work.

And then, my world was rocked.

Now What?

Luckily, the community I’d built sustained me through my diagnosis, surgery and radiation – and that community didn’t even realize it.

I kept my diagnosis private and carried on with business as usual, because that’s how I roll, and how I dealt with my newly rocked world.

But during all that time, even as I closed my studio, and moved and downsized my nutrition practice, I thought about how all my years of nutrition and fitness training and experience, and working in the trenches one-on-one with individuals and face-to-face with large groups somehow had to be the foundation for the next chapter in my professional life.

I just didn’t know what that would look like.

Until I remembered an article I’d read shortly after my diagnosis. It was an article about breast cancer prehabilitation in an issue of CURE magazine. I’d never heard of the magazine, but picked it up in the library of Wellness House, my cancer support center. I was so excited about the contents of that article, I wrote a blog post about it’s influence on me: Introducing Breast Cancer PREHAB. You’re Welcome.

It was as if the article jumped off the page, grabbed me by the shoulders and screamed at me to pay attention – this “prehab” thing was an idea that aligned with my entire professional career. It was also this article that introduced me to the work of Dr. Julie Silver, a breast cancer survivor, physiatrist, and associate professor at Harvard Medical School in Boston.

Dr. Silver is a proponent of cancer prehabilitation (prehab), and a co-author of “The Case for Prehabilitation Prior to Breast Cancer Treatment” (as well as a number of other professional papers on the topic).

Breast cancer prehab was a concept I could get behind, one that blended my professional expertise and philosophy (PREVENTION – WELLNESS – PROACTIVE HABITS) with my breast cancer experience.

I’m convinced that although luck, timing and good fortune were absolutely instrumental in my strong recovery and survivorship, my own “prehab” practices prepared me for and improved my outcome from the most physically and mentally arduous experience I’ve ever encountered.

And I didn’t even realize I was “prehabbing.” I simply was doing the things I’ve always done; eating well, getting and staying strong.

Who knew?

In Support of Breast Cancer Prehab

Slowly, over the course of the past 24 months, I’ve gained clarity around how I can best provide value to the breast cancer community.

Producing credible nutrition, fitness and wellness information, products and services for use during the time between diagnosis and the start of treatment has become my passion and purpose.

The formal definition of cancer prehabilitation is “A process on the cancer continuum of care that occurs between the time of cancer diagnosis and the beginning of acute treatment that includes physical and psychological assessments that establish a baseline functional level, identifies impairments, and provides targeted interventions that improve a patient’s health to reduce the incidence and the severity of current and future impairments.” (1)

To me, breast cancer prehab is sort of like the Abraham Lincoln quote; “Give me six hours to chop down a tree, and I will spend the first four sharpening the axe.”

You simply have to prepare yourself for what’s coming.

In “The Case for Prehabilitation Prior to Breast Cancer Treatment”, the authors suggest five core components that may help improve short and long-term consequences of treatment: (2)

  • Total body exercise.
  • Locoregional (restricted to a particular area of the body) exercise pertinent to treatment-related deficits.
  • Nutritional optimization.
  • Stress reduction/psychosocial support.
  • Smoking cessation.

Here’s a brief overview of how each of these components contributes to improved outcomes and expedited recovery:

Total Body Exercise (General Conditioning)
  • Physically fit surgical candidates have lower rates of complications and faster recovery compared to those who are less fit.
  • Women with breast cancer who are active before surgery have an 85% greater chance of enhanced recovery three weeks postoperatively compared to inactive women.
  • Prehabilitation prior to surgery targeting aerobic fitness, combined with postsurgical rehabilitation and prechemotherapy reconditioning may help prevent cardiotoxicity (damage to the heart).
  • Total body conditioning may play a role in cancer outcomes via improved chemotherapy tolerance.
  • Aerobic training and resistance training may improve chemotherapy completion (as measured by relative dose intensity).
Targeted Exercise
  • Minimizes both pain and loss of range of motion.
  • May allow some treatments to proceed.
Nutritional Interventions
  • Patients with breast cancer who are overweight or obese at time of diagnosis are more likely to have an unfavorable prognosis.
  • 20% of breast cancer patients may be malnourished, 60% are overweight or obese.
  • Post-treatment weight gain is common and can increase risk of cardiovascular disease and diabetes.
  • More than half of patients would like nutritional guidance at time of diagnosis or soon after.
  • Aid prevention of sarcopenia (muscle tissue loss) via adequate protein intake (and/or exercise).
  • Recommendations for calcium and vitamin D intake to offset treatment related bone loss.
  • Diet affects the microenvironment of tumors, both favorably and unfavorably.
Psychological Well-Being
  • Depression, self-blame, loss of control and fears for the future are common.
  • Impaired ability to process information, make treatment decisions, and carry out critical behavior changes such as exercise and smoking cessation is common.
  • Psychological screening and intervention immediately following diagnosis may enhance psychosocial adjustment.
  • Relaxation techniques such as breathing, progressive muscle relaxation and meditation, guided imagery, problem solving and coping strategies can positively affect immunologic function.
Smoking Cessation
  • Smoking has been shown to be associated with higher rates of wound infection, reconstructive failure, mastectomy flap necrosis and overall surgical complications in women undergoing tissue resection and breast reconstruction.

Where I Am Now plus Resources To Help YOU!

I’m just getting started on my new business “pivot”, developing the absolute best breast cancer PREHAB nutrition, fitness and wellness resources and services available. While I have a number of exciting projects in progress, I’ve already launched one.

My mission is to create reliable resources that solve your nutrition and fitness challenges, filling the gap of what you’ve been looking for but can’t find (or trust). What info are you searching for? Please leave your ideas in the comments below; I’d love to know what would help you the most.

MY CURRENT RESOURCES TO HELP YOU!
  • The first resource I’ve developed for you is Breast Cancer Nutrition 101: Beyond Turmeric & Green Tea . This program includes a 90-minute audio program (download it and listen anywhere!), companion workbook, and 10-recipe collection of plant-based recipes (hint: plant-based nutrition should be one of your recurrence risk reduction strategies!) designed to help you take control of your nutrition. 
  • My blog is a free resource that I post every, single Friday – which I like to call, “Blog Fri-YAY!” 
  • Facebook LIVE educational events. Like my page here and you’ll never miss my in-the-moment tips and inspiration!

I hope this “prehab” primer has been helpful. Let me know below if you’ve started down the prehab path – I’d love to hear how it’s helped you!

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SOURCES

  1. Cancer prehabilitation: an opportunity to decrease treatment-related morbidity, increase cancer treatment options, and improve physical and psychological health outcomes.
  2. The Case for Prehabilitation Prior to Breast Cancer Treatment.