Breast Cancer Support, Movement Support & Education

Unfortunately Pilates this morning will be cancelled
If anyone is keen I’ll be teaching at Botanic Gardens Mt Cootha 9.30am
It is held in the Band Stand
Otherwise I look forward to seeing you all next week

Back for the last term of 2025
Tuesday mornings St John’s Avenue Park Ashgrove 8am
Botanic Gardens Mt Cootha 9.30am
🌱

Stretch, strengthen and feel good – for free! 💪🧘🏼 Enjoy free Pilates and yoga classes in parks across Brisbane. Whether you're a beginner or a seasoned pro, there’s a session for everyone.

This last term of Pilates in the park has seen increased interest & numbers which has been pleasing. If you are considering attending it is an all inclusive event & held in a relaxed & peaceful setting.

Here is the timetable for the remainder of the 2025.

Resuming Tuesday 7th October

* St John’s Avenue Park, Ashgrove (near playground) 8am

* Botanic Gardens Mt Cootha (Bandstand - N.B. Change of location) 9.30am

Classes will run for ten weeks with the last class of the year 9th December & returning 27th January 2026.

If you have any questions please feel free to contact me or contact the Brisbane City Council & ask about their free & low cost events. Looking forward to seeing you all on the 7th October 🌿

This activity is funded by the Brisbane City Council as part of the Council’s Active & Healthy Living Program.

I teach Pilates in the park as part of the Brisbane City Councils Active & Healthy Living Program. Classes remain true to the fundamental Pilates principles, Concentration, Control, Centre, Breath & Precision.

There are a number of low cost & free events available to the residents of Brisbane, all are listed on the Brisbane City Council website.

My Pilates classes are held on Tuesday mornings at

** St Johns Avenue Park in St Johns Wood Ashgrove - 8am
** The Botanic Gardens Mt Cootha - 9.30am

The dates below are the remaining classes for this term

August 19th
August 26th
Septembert 2nd
September 9th
September 16th

Classes will then resume October 7th

(This activity has been funded by Brisbane City Council as part of Council's Active & Healthy Program)

If you are keen to build core stability, get stronger, leaner & work on your mobility & flexibility I encourage you to come along & give the classes a go. Classes are catered to all levels

Breast Cancer & Bone health

When the structure of the bone becomes weaker or less dense there is an increased risk of breaking. This is Osteoporosis.

Estrogen is important in maintaining bone strength & protecting bones. Reduced levels of estrogen can lead to the weakening of bones & poor bone health.

Breast cancer adjuvant therapy or hormone blocking medication such as Letrtozole, Examestane & Tamoxifen can put you at a higher risk for osteoporosis as these medications are used to block the production of estrogen, the outcome that the patient will have nill or very little estrogen.

Before patients start treatment they undergo a bone density test or DXA scan to determine a baseline of their bone health. Monitoring the patients bone health will determine whether the patient will remain on the same medication. First signs of bone thinning may see a change in the patients medication.

It is very important during treatment that you protect your bone health to reduce the risk of osteoporosis. Activities that will optimise a patients chance of maintaining good bone health include weight bearing exercises, walking, strength training, yoga & pilates. Patients should incorporate any or a number of these into their treatment plan.

Axillary Web Syndrome (Cording)

AWS is the result of some breast cancer surgeries where lymph nodes have been removed. The scar is the closing line where the surgeon has removed lymph nodes. Cording is where the lymphatic vessels have adhesions to the scar.
With your clients permission, inspection of an Axillary scar using stretch (touch) in the location of the armpit you may see cording opposed to no prior visible cording.

Where there is injury, scar is formed. Scars can be invisible & hard to assess, they are under clothing, under the skin & under the fat tissue.

They can also have poor sensation after breast cancer surgery.

Breast cancer surgery scars can be small or large & be in different locations on the chest wall. The location of the scar may be on the skin, superficial (between skin & muscle) or deep (deep fascia + muscle-bone).

It is important when designing an exercise program that we have an awareness of scar adhesions & the impact that they have on the musculoskeletal system so as to:

1/ to reduce the risk of injury
2/ to get the best out of the exercise program for the client

Using the following steps we can then prescribe an exercise plan to suit scar & adhesion severity

1/ Screen a postoperative Breast questionnaire
2/ Use PIR (Passive & active range of motion) to muscles that surround the breast surgery site i.e. pecs, traps, infraspinatus, suprasinatus, terrestrial & latissimus.
3/ Passive range of motion restrictions may indicate location & severity of scar & adhesions
4/ Visual inspection during this task will demonstrate overactivity & dysfunctional motor patterns

Where, as a trainer you feel a client has limited range of motion due to scar adhesions it is good practice to refer them onto an Oncology Scar trained therapist. Why? Due to a lack of services within cancer facilities you may be the first person who has suggested this to a breast cancer survivor.

Reference
CETI
By Andrea Leonard
BA, CES, PES, CPT
Module 2 Handbook
Denise Stewart - Scar awareness
13th Edition

Information that you may be seeking as a breast cancer patient and survivor may be hard to obtain unless you are proactive and unless you ask!
As often heard you need to be your own advocate and push for answers to your questions and trust your own intuition if you think something is not right, insist on referrals or seek second opinions.

As a CES (Cancer Exercise Specialist) we are trained in more than just exercise. The below information is important and it was not available to me, it only now is as a trained CES.

I feel it is my obligation to share this.

Low Vitamin D levels - Vitamin D assists the body in the absorption of calcium. Calicum is essential for good bone health and the prevention of osteoporosis. Vitamin D also helps the immune, muscle, and nervous system function properly. Most Vitamin D is made when an inactive form of the nutrient is activated in your skin when it's exposed to sunlight. Smaller amounts of Vitamin D are in fortified milk and other foods, fatty fish, and eggs.

With all the warning about skin cancer, more and more people avoid time in direct sunlight, or they wear sunscreen when they are in the sun. As a result, vitamin D production from sun exposure is limited.

Reserarch has shown a connection in women with low levels of vitamin D and a higher risk of breast cancer. Vitamin D may play a role in controlling normal breast cell growth and may be able to stop breast cancer cells from growing as well. People who avoid the sun, or live in areas of the country with limited sunshine, should consult their doctor about supplementing with Vitamin D.

While sunblock can protect us from harmful ultraviolet rays, research strongly suggests that some of the chemicals in some sunscreen products may increase our risk of cancer. Many of these chemicals are considered hormone disruptors (they can affect how estrogen and other hormones act in our bodies, by blocking them or imitating them). This throws off the body's natural hormonal balance. Because estrogen can spur the growth of breast cancer in hormone-receptor-positive patients, many women choose to limit use of these types of products. As an alternative to the sunscreen products available at our local drug store, use a sunscreen that contains zinc or titanium. These minerals reflect ultraviolet rays of the sun and aren't potential hormone disruptors. Try to avoid going outside during peak sun hours: usually from 10 a.m. to 4 p.m. during the summer.

Reference
CETI
by Andrea Leonard
BA, CES, PES, CPT
Module 2 Handbook Page 15
13th Edition

Breast cancer surgery is dependent upon many factors including; the size of the breast tissue, the size of the tumour & the stage of the cancer. Not forgetting men can have breast cancer too.
The simplest of procedures is a lumpectomy (breast conserving surgery). This is removing the lump itself with clear margins of the tumour, preserving as much of the breast as possible.

Other surgeries include:
Mastectomies (there are several types)
Axillary lymph node dissection
Sentinel lymph node biopsy
Reconstructive surgery
Preventative Prophylactic surgery

Where there is radiation, skin tissue will be compromised increasing the risk of lymphedema. As a CES (Cancer exercise specialist) we will first take measurements to assess the possibility of lymphedema.
We educate the client of best measures to address lymphedema.
We prescribe upper extremity lymphatic drainage exercises in each & every program, starting & progressing slowly.

Those who undergo any breast surgery are likely to present with upper cross syndrome. Exercises to stretch the chest may simply prove too much for the client, in this instance we may address posture alone.

We measure the clients range of motion in the shoulder girdle. Limited ROM in the shoulder, especially in flexion will restrict any load until the ROM is at at least 90% of the normal range (which is 150-180 degrees).

With the clients ROM at 90% of the normal range we then add isometric exercises. This applies to all populations, athletes too. Any exercise prescription commences at ground zero, adding load only in small increments.

In the consideration of the simplest breast reconstruction of expanders & implants, absolutely no chest or back exercises, nor planks will be prescribed.
Anything that contracts chest muscles is a contraindication. Implants have a slight risk of coming out of their pockets, they may be unstable in horizontal abduction.
Any implant procedure will cease any upper body exercises for 6 weeks & only with medical clearance can a client then commence any exercise program.

Considering the client has had a Trans diep flap, any abdominal contractions are an absolute contraindication.

Any breast cancer survivor can have complete confidence that their CES is well trained & a valuable & unique part of their journey to recovery.

Medical menopause or medical onset menopause is the result from either, surgeries, treatments affecting ovaries or hormones such as chemotherapy & radiation or medications.

Surgery to remove ovaries (Oophorectomy) leads to an immediate onset of menopause because the primary source of estrogen & progesterone is removed.

Chemotherapy & radiation therapies can damage the ovaries, resulting in premature menopause.

Medications such as those to treat endometriosis, or estrogen receptors-positive breast cancer or other hormone-sensitive cancers which block or lower estrogen levels in the body may also induce menopause by altering hormone levels.

Natural menopause will see a natural decline in a person’s estrogen & progesterone levels, medical menopause happens immediately following surgery & is often accompanied by severe menopause symptoms.

Symptoms include:
Hot flashes
Joint pain/stiffness
Bone thinning
Fatigue
Vaginal dryness or irritation
Mood changes
Night sweats
Weight gain
Nausea
Increased risk of blood clots
Endometrial changes
Memory or cognitive changes (chemo brain)

It is essential that a patient/survivor obtain medical clearance from their healthcare provider prior to embarking on any exercise program. A healthcare provider can offer support & advise of strategies to manage menopause symptoms.

Lifestyle changes such as regular exercise, a balanced diet & stress management can help alleviate many side effects.

A CES (Cancer exercise specialist) is trained in cancer surgeries & the contraindications to exercise as well as cancer treatments & their side effects, enabling them to work safely with anyone experiencing medical onset menopause.

Breast Cancer Adjuvant therapy - Letrozole (Femara)Letrozole is an aromatase inhibitor for the treatment of hormone receptive positive breast cancer. It works by blocking the enzyme aromatase which is responsible for converting androgens (male hormones) into estrogen. It works by reducing the levels of estrogen to slow or stop cancer growth. Some side effects the patient/survivor may experience:

Joint pain
Decreased mobility
Fatigue
Bone thinning - Long term use increasing risk of fractures
Hot flashes
Mood, depression, anxiety & irritability
Weight gain
High blood pressure
Increased cholesterol
Cognitive changes such as chemo brain
Swelling & fluid retention in hands, feet & legs
Osteoporosis & fractures

Letrozole is typically prescribed anywhere between 5-10 years. Not everyone will have Letrozole for 10 years because of the serious risk of bone thinning & fractures. A bone scan will determine your baseline looking for osteopenia (early stages) & osteoporsis (thinning). A bone scan should be performed every two years while Letrozole is being prescribed.

Exercise is beneficial in managing some of the side effects to taking Letrozole, including addressing bone health.

Other considerations to benefit the patient/survivor include:

* Physical therapy & stretching to address joint pain
* A diet rich in Calcium & Vitamin D, taking a Vitamin D supplement
* Regular weight bearing exercise & strength training using bodyweight will assist with bone health as well as well as having a dramatic impact on addressing fatigue
* Prioritising rest, balancing activity combined with a healthy diet can alleviate some of the fatigue

With medical clearance an exercise program should be given serious consideration to the cancer patient/survivor. Cancer Exercise Specialists are trained to prescribe exercise & work closely with this population.

Yesterday I saw a lot of debris across the park as a result of ‘Alfred’ 🌀

I will be at the park this morning but not able to say yet if Pilates will go ahead without further assessment

I hope you & your families have not been too badly affected by our recent weather

Sunshine days won’t be far 🌞 🍃
Karen

Today I’m asking Brisbane residents to work together to set up a “Ute Army” in response to ex-Tropical Cyclone Alfred   Help your family, help your friends and help your neighbours clean up all the fallen trees, branches and leaves in their backyards.   If you need help cleaning up green waste, contact our Council call centre.   If you can give help cleaning up green waste, contact your local councillor.   By working together we can get Brisbane back up and running sooner.   To help the Ute Army, we’ve opened up our Resource Recovery Centres to free green waste tipping.   We’re also setting up free satellite sites to make it easier for the Ute Army to drop off green waste.   Meanwhile, our crews will continue to clean up roads, parks and other public spaces. Residents impacted by flooding can place their damaged goods on the kerb for collection, but please do not place green waste on the kerb.   Brisbane has been through its fair share of natural disasters but one thing is for certain - our community always comes together. So if you need help, please get in touch with our Call Centre on 3403 8888. And if you can help, get in touch with your local councillor.

Cancer treatment & the implications for exercise.

An exercise recovery program that will cater to the patient/survivors individual needs both during & after cancer treatment is the goal of a CES (Cancer exercise specialist).

An appropriate program, determined at the initial assessment will consider:

ROM & muscle imbalances + Cancer treatment + Cancer surgeries to equal the individual protocol

It is important to understand the physical changes that may occur during & after cancer treatment. The most common complaint of cancer survivors is fatigue, resulting from the cancer, its treatment & treatment side effects. Clients suffering from fatigue should be encouraged to exercise 3-4 times per week for 20-30 minutes. Clients can break these sessions into smaller segments of time if needed.

Cancer treatment causes muscle wasting which will contribute to the fatigue experienced by the client/patient. Clinical research has established the efficacy of appropriate exercise in counteracting physical impairments such as fatigue.

Exercise intensity must be kept at a low to moderate level in order to stimulate protein synthesis, allowing protein available for tissue repair. Protein synthesis is the process which builds protein, during exercise protein synthesis is triggered for energy use & tissue repair.

Cancer clients should exercise at moderate intensity in order to maximise the splitting up of decomposition of body fat & minimise the production of lactic acid.

Periodic assessment making any changes to the exercise program is necessary on a daily, weekly or monthly basis.