Breast Cancer Recovery: How Prehabilitation and Post-Treatment Fitness Help Senior Rebuild Strength

At 65, Darlene knew she might develop breast cancer. Her mother had died of it and both of her sisters are survivors. Still, the recently retired animator was shocked when she got the call that she had an aggressive triple-negative cancer.

Unlike her sisters, whose HER2-positive diagnoses were treated with surgery and radiation, Darlene would also need chemotherapy as part of her treatment plan.

That’s when her medical team at the Orlando Health Cancer Institute Breast Care and Gynecologic Cancer Center suggested a holistic approach to complement her medical journey: a combination of prehab exercises, post-surgery rehab and a post-healing fitness program. The goal? Get strong before surgery and even stronger afterward.

“My radiologist, Dr. Tomas Dvorak, is very much into this whole health thing and pushing people to become stronger after the radiation and everything,” Darlene says. “He helped me realize there is a life after breast cancer.”

Preparing for Cancer Treatment with Prehab and Lymphedema Care

During Darlene’s initial cancer assessments, Dr. Nikita Shah, an oncologist with Breast Cancer Center at the Orlando Health Cancer Institute, discovered she had lymphedema, meaning fluid collects in her arms. In addition to swelling, she had “lymphatic cording,” the words used for what feels like uncomfortably tight ropes under the skin.

This push for health made the whole experience better. It helped me realize that I can see breast cancer as a little six-month detour and I can have a full life afterward.— Darlene

Maria Valladares, a physical therapist and certified lymphedema specialist, established baseline measurements, and then she performed special massages and lymphatic-drainage techniques on Darlene’s affected areas to minimize her discomfort. She also taught Darlene arm and shoulder exercises to build muscle and reduce pain, all while guiding her patient through emotional upset and treatment choices.

As part of Orlando Health’s new The Breast Cancer Program, Valladares also included a set of “prehab” movements designed to help cancer patients build up physical and heart strength before beginning treatments. This aligned well with Darlene’s weight-loss efforts. Borderline obese upon retirement, the married mother of two grown children was already walking 5,000 steps a day to try to lose weight.

“Darlene’s doctors feel strongly that cancer patients who do safe exercises and have good education before treatment can begin their medical journey with stronger cardiovascular health, strength and endurance,” Valladares says. She helps patients like Darlene reach a goal of up to 30 minutes of cardio exercise five days a week along with moderate strength training twice a week.

After her lumpectomy but before radiation, Darlene visited Valladares again to check for swelling, which could mean the lymphedema needs more treatment. Once the lymphedema was resolved, they transitioned back to the Breast Cancer Program, including cardio exercises “that make patients sweat while still able to talk” to increase endurance, Valladares explains; that can help reduce radiation-induced fatigue.

Light weight-lifting is involved, too. Darlene received a guide that talks about precautions to take and specific instructions for various circumstances during the healing process. It also deals with scarring-related pain.

“We walk with patients through their journey until they can manage on their own,” Valladares says.

Managing Fatigue and Recovery During Cancer Therapy

Florida’s summer heat, together with exhaustion from a lumpectomy, chemotherapy and then radiation sapped Darlene’s energy, so her exercise efforts waned. Still, she walked laps through her house and did stretching exercises with weights at home when possible.

During appointments with Valladares and Dr. Dvorak, Darlene spotted posts for another cancer-related exercise opportunity called the LiveStrong Program. It’s a post-cancer endeavor offered free to patients at the Dr. Phillips YMCA and several other locations via the Orlando Health Foundation.

Darlene made sure she got into the second-ever group to do this at her local Y.

“I knew when I finished radiation, I’d want to keep doing exercise to lose some weight and make myself stronger,” she says. She met with five fellow former patients and a personal trainer twice a week for 12 weeks.

First, Darlene and her peers were tested for balance, strength and speed. Their trainer taught them how to lift weights safely and get their heart rates up, urging them to increase their efforts a little each week. Over time they learned self-defense techniques along with medical meditation.

At the end, Darlene knew she was in better shape. “I feel like my clothes fit better,” she says. “I also know I can balance on one foot for longer than I could at first. I’ve gotten better at chest- and leg- press machines. My arms aren’t as swollen and there’s less fat on them.”

The group members, who had all been through similar traumas, bonded. “It was helpful to be with people who are going through similar things,” Darlene says.

“It is not a cookie-cutter treatment,” Valladares says. “It can involve gym machines, dumb