Weight Training & Lymphedema (for the Pink & Plaid Warrior and everyone else)

I get questions both here and through Life-Cise.com about lifting weights and lymphedema. I try to write about it periodically because it's so important. As someone who had a mastectomy with free TRAM reconstruction, a full axillary node dissection, 6 weeks of radiation immediately after chemo, and has had a couple of incidents with swelling in my hand and arm, but who also loves to do a lot of high-intensity upper body activities, this is a subject near and dear to my heart (and should be to yours as well).

When I had my surgery back in 2001 (yes, I'm an old-timer now), recommendations were still to basically avoid doing anything with the arm on the affected side: don't carry a purse on that side, don't carry a suitcase or groceries. In fact, it was commonly recommended to never lift anything heavier than 5 pounds - forever!

Since I was determined to not be limited by either my disease or my survival, I was convinced those recommendations couldn't possibly apply to me. My natural assumption is that exercise is good for me, and I figured that must be true in this case as well. So I started doing my own research. I found there were women who were doing lots of cool things like climbing, dragon boat racing, playing some serious high-powered tennis, and weight lifting.

I spoke to a couple of lymphedema therapists who said yes, those are the medical recommendations, however anecdotal evidence is showing that women can probably do much more. One of them told me to try it and see what happens. But she recommended starting off slowly to see how my body reacted.

The relationship between exercise and lymphedema is not straight forward. Exercise does increase the amount of lymph that your body has to process. And any muscle strain or injury would also increase the workload for the system. The idea was that that increase might overload an already-stressed lymph system. But on the other side, increased deep breathing from exercise and the constricting of muscles can help the body pump lymph.

Into this unknown territory we stepped - myself and a lot of other women who refused to be pushed to the sidelines simply because we were unlucky enough to have breast cancer. We started slowly and discovered that, yes, we can be strong.

And finally, research has caught up with us. Last year, a study from the University of Penn. School of Medicine found that women with lymphedema who took part in a regular, progressive weight training program had fewer flare-ups compared with non-weight lifters. Lifting weights had no detrimental effects and showed significant benefits for women with lymphedema. (I wrote about the study back in August of 2009) Further results found that breast cancer survivors who took part in the weight lifting program had markedly improved feelings about body image and their intimate relationships. (Yea - lifting weights might improve our sex lives!??!?!) This improvement was not based on how strong the women were or how much strength was gained. The benefit seemed to come simply from the act of taking part in a regular program.

So, yes, lift weights. But do it right.

It's a good idea to take measurements of your arm before starting. Measure around your arm in several places: upper arm, just above the elbow, forearm, wrist. Write it down, and periodically recheck it. That way you'll be able to keep track of any early signs of swelling. If you do start to have some swelling, talk to your doctor or see a lymphedema therapist.

Start off very easy to see how your body reacts. Your body learns to compensate for the damaged lymph system. It learns to redirect the lymph to other nodes. But it's important not to overload your system all at once. So begin with no or very little weight. No weight exercises can be highly effective. Do them slowly and perfectly controlled. Make sure you lower just as slowly. I like to use water bottles to begin adding weight. They only weigh a pound or two, and you can vary the amount of weight if you need.

Once you've gotten started, you'll want to progress - presumably you want to be able to lift more than a water bottle. A safe progression is just as important as starting off slowly. When you're ready to increase, you must do it gradually. You can increase the number of repetitions or the amount of weight. Don't increase both at the same time! Only increase one element at a time. You don't want to overload your system at any point - you could end up with a flare-up or an injury. A good rule of thumb is to increase only 10% at a time. If you're doing 10 reps., increase just 10% - do 11 reps. If you're lifting 5lb. weights, increase just 1 lb. (You can round up). This is just a guideline, it doesn't have to be exact. But keeping this in mind can help you avoid injury or burnout. Once you've made an increase, stick with that for at least a week or two before another increase. You have to give your muscles time to gain adequate strength before another increase.

If you are used to being active, this can seem slow and frustrating. But remember, you're in this for a lifetime, not just a month. An injury or strain can set you back weeks, months, or more.

And also remember, lymphedema is a lifelong risk. If you take some time off and lose muscle tone, start off a little easy again. Build back up to where you were. I always make sure to build up slowly to any of my higher-intensity activities like windsurfing or climbing. I never just jump into it.

Weight lifting is an important component in a complete exercise program. The risk of lymphedema is real and should not be ignored, but it's not a reason to avoid weight training. You need a safe, slowly progressive plan. A good trainer can help with that if you need some guidance.

So, Tonya, Cheryl, Rita, I., A., and everyone else: lift weights - just do it right.

Julie

Lifting Weights Safely

As a trainer, I get questions and comments sometimes about pain while lifting weights. A lot of  people are hesitant to take part in a regular strength training program because they've experienced joint pain or discomfort in the past.

I hear this especially from some of my musician colleagues who worry about injury to hands and shoulders. I can't count how many times I've been told that I should be careful about exercising too much, that it's dangerous, that it can ruin my hands.

Of course, I usually tell them that I (and they) are far more likely to suffer an injury or strain if I don't have adequate strength to accomplish normal daily activities.

But weight lifting doesn't have to be painful or dangerous. Lifting weights with proper form will alleviate most problems. Here are some things to keep in mind:

* Always lift and lower weights in a slow, controlled manner.
* Related to the first point is never lift more weight than you can lift in a controlled manner.
* Don't lock your elbows or knees.
* Don't clench your fists. Try to keep your hands as relaxed and easy as possible, using just enough     tension to keep control of the the weights.
* Keep your wrists and elbows as relaxed as possible.
* Don't hunch your shoulders. Keep your shoulders down and back - as in, use good posture.
* Keep your neck and jaw relaxed - tensing them will not help you lift weight.
* If you find yourself getting tight and straining, take a short break, relax your shoulders and arms.
* To repeat, because it bears frequent repeating, Always lift and lower weights in a slow, controlled manner.

These tips will go a long way toward preventing strain and injury. Lift happily, but safely.

And remember, you are far more likely to suffer strain and injury if you are weak and don't have adequate strength to do the things you need to do in your daily life.

Julie

To Stretch Or Not To Stretch, That Is The Question

Stretching: yes or no? The answer to that question depends on when you're stretching. I posted new research on the News page at Life-Cise about stretching before long-distance running. Researchers at Florida State University found that stretching before running decreased endurance and increased energy expended. College runners who performed static stretches before running ran 3.4% less far than runners who did not stretch. In addition, in spite of running less far, the stretching runners expended about 5% more energy.

I paid attention to this study since I've recently started trying to run longer distances, but this is not the first study to question the old wisdom of stretching before exercise. In recent years, physiologists have found that stretching before exercise actually weakens the muscles temporarily. And more bad news: stretching before exercise does not appear to prevent injury.

So, should we stop stretching? Is there a place for stretching in a healthy exercise program? 

No, and yes.

Another study, published in the Journal of Strength & Conditioning Research, found that static stretching improved strength. College students who were not already involved in a weight training program were randomly assigned to one of two groups. One group took part in weight training, 3 days per week, for 8 weeks. The other group took part in the same weight training, but in addition, performed static stretching 2 days per week on days they did not weight train. Both groups saw increases in strength, but the stretching group had significantly greater increases. 

The important difference between these studies is when the stretching took place. Stretching before exercise weakens the muscles temporary. But it appears that stretching on other days improves strength. 

Don't stretch as a warm-up. - I know that we all did that in gym class back in the day. But we've learned that's not the best way. Instead, warm up by moving. Get your muscles moving with gentle movements like walking or jogging slowly. Your muscles will warm up and you'll be ready to go.

Save the stretching - always slow, controlled, static stretching - for tomorrow.

Julie

Company

Got in another 8-mile run today. It felt better than the first one. But today I had company. My parents are visiting us in Old Mission. So today, my father accompanied me to the lighthouse - me on foot, him on the bike. Nice to have the company for a change. And nice that it can be my father.

Julie

Striving

Because of my forced respite from windsurfing (not enough wind), I’ve had a few great runs. I’ve been running out to the Old Mission Lighthouse, one of Michigan's great historic lighthouses. It’s out at the end of the peninsula, about an 8-mile run for me. It’s a new distance for me, so it’s a challenge – I’ve been running 4-5 miles at a time. I’m trying to log in longer distances; I have something in mind. I’m not ready to commit or talk about it, but I have something in mind.

Mostly, I’m alone with my thoughts as I run, but I do pass the occasional cyclist. We exchange a breathy “hey”, or just nod. For a brief moment we catch each other’s eyes and recognize something familiar.

We are the strivers. We are the ones whose shirts are drenched in sweat on a day when everyone else is bundled in sweaters and hats. We walk; we run; we move ourselves in all manner of ways. We have our friends carry our wheelchair to water’s edge to slip into the water where our failing body can still move. We leave our comfortable porches to walk, in spite of the rain.

Whatever reason pushes us, we are striving for something better. We hope to stave off our family history of early heart attacks, or lose the last pounds of baby weight. We struggle to walk after an accident. Or we hope to prevent a recurrence of our cancer. We are trying to slow the process of aging because over the years we’ve realized that when we move, our bodies and our minds stay sharper. We have learned to love how our bodies feel when we push them. We may simply have a number in mind – a weight, a distance, a time. Or maybe we’re an Iron Man in the making.

We may not feel this way every day; our determination may wane. But for today, we do. For today, we recognize that familiar glint in each other’s eyes. For this moment, we are striving.

Julie

No Wind for Windsurfing?

After a week of great wind (and cold rain), the wind has finally died down here in Old Mission. I've been windsurfing every day; it's been great! But now the sun has come out and the wind settled, so I get a break from windsurfing.

My workout will change for a couple of days. I went for an 8 mile run yesterday. Today, I had a good long swim, and will go for a long walk in the Preserve.

Since this is the only time of year I get to windsurf, I'm sorry to see the wind die down. I hate missing a day of windsurfing while I'm here. But it is good to work my muscles in a different way for a few days.

Our muscles get stronger by being stressed. To continue getting stronger, or even maintain our level, we need to continue stressing our muscles. We can do that by increasing how hard we're working - adding more weight, or running faster or longer. Or we can stress our muscles by using them in different ways.

Changing up our workout keeps our muscles working hard, and also helps keep us from getting bored. If we do the same workout every day, it's easy to lose interest.

But changing our workout should be done in an organized way. That's where a good trainer can help. A good trainer will help you develop a program that will continue to challenge you over time - body and mind. Even with my Life-Cise clients who just want a single workout, I try to give them a plan for developing their workouts as they gain strength.

Once you have a good overall plan, you can adjust your workouts as circumstances change. No wind, snowing, too hot outside? No problem. There's always a way to work in effective exercise.

Julie

Fears - fish and otherwise

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I’m on vacation: Old Mission, Michigan. We come here every year to relax, swim, eat, and windsurf. This is the only time I get to windsurf, so it usually takes me a couple days to refresh my body’s memory of how it all works. This year, however, I didn’t have a chance to ease into it. I arrived in the middle of a big storm. The first two days were cold, rainy, and very windy. Although I wasn’t really warmed up, I couldn’t pass up the wind.

So, I spent the first days of vacation doing battle with the elements and my fears. The wind here in our little bay is famously fluky; it bends and shifts as it crosses over the peninsula and heads out across the water. During the last few days, we’ve had strong gusts coming from seemingly every direction, but the general trend was a direction that would blow me straight out of the bay into the channel of what I’m told is the deepest water in Lake Michigan.

I headed out in the cold wind and rain, somewhat nervous. Windsurfing scares me a little. I enjoy it, but it scares me. I fear that my skills are not up to the challenge of the weather. I fear being overpowered and blown out into the channel, unable to get back. I fear losing control in spectacular fashion and being injured. I fear breaking an arm or being knocked unconscious by the falling mast. I fear drowning, even though I am a strong swimmer. I fear getting caught in really bad weather - is that thunder?

And I fear fish. Yes, that’s right, I fear fish. I love eating them; I enjoy catching them; I think they’re beautiful creatures. But when I’m swimming in deep water, I have this completely stupid fear that a big fish might come up out of the deep and bite me. It’s embarrassing, but true. Knowing the fear is ridiculous doesn’t lessen its grip on me.

One of the things I appreciate about windsurfing (or climbing), besides the physical challenge, is that I am forced to face my fears. I guess I’ve always worried that I wasn’t up to a particular task, but with so many activities it’s easy to pass. I could always choose not to take an audition, take a hard class pass/fail, not apply for a job, or write the book, or simply find some excuse for not completing the particular task. But if I’m on the side of a mountain or in the middle of the bay, I have to get over my fear and act. I can’t just ignore it and do something else.

The thing is, these fears are real. They are legitimate (well, maybe not the fish fear). On a beautiful, sunny day they may fade to the background, but they still exist. However, when I’m getting tossed around in the dark, roiling waters, with gusts whipping me every which way, all my fears are right at the surface.

But floating in the middle of the bay, I have no choice but to catch my breath, get back on the board and sail. I can’t succumb to my fears. I have to proceed, one step, then the next. Make a plan, pick a point to head towards, and sail. If I fall off, I have to do it again: get on the board, pick a point, sail. Just continue doing one step, then the next, until I’m back to shore.

A friend of mine, who recently started chemo for colorectal cancer, asked me how I dealt with the fear when I was in diagnosed and in treatment. For me it wasn’t so very different than climbing or windsurfing. Although I really might want to, I couldn’t pretend I was somewhere else, and I couldn’t ignore the fears. The fears were very real – pain and death. Ignoring them was not possible. Staying where I was, refusing to act was not possible. As much as I might hate it at that moment, I had no choice but to catch my breath, make a plan, pick a point to head towards, and go. And if the whole plan was too overwhelming, I concentrated on the very next step, then the next: go to the doctor today, pick up the drugs, go for treatment, find something I can eat, stay hydrated, sleep. Yes I’m afraid of dying, but right now I have to drink a glass of juice….

Get on the board, get the sail up, pop & drop, get in the harness, now point, now head further up-wind (fall off – damn!), now get back on the board, get the sail, pop & drop, keep your balance, don’t get overpowered, grab that gust, go!

In the midst of my epic battle with my fears, there are also moments of fantastic speed and balance and grace, when everything hums with power and excitement. Those are the moments I remember later. Those are the moments I’ll talk about excitedly at dinner and replay in my mind as I drift off to sleep.

And the next morning, the sun might come out, and the fears fade to the background.

Julie

How Strong Is Strong?

What is enough strength? How strong is strong?

Of course, strong enough is entirely up to you. There is no absolute. What is strong enough for you may not be strong enough for your best friend. What is strong now may not be strong enough for you next year.

What do you want to be able to do? What is your goal? Do you want to look a certain way that you don’t now? Do you want to be strong enough to play basketball with your son? Or manage some house repairs? Or carry the groceries without having to ask for help? Or do you just have a number in mind? Maybe you’ll be satisfied when you can bench press….
I like being strong. I like being the one people will ask for help. I get a kick out of walking off with the heavy bag after the cab driver has struggled to lift it into the trunk. I was tickled when I overheard a friend telling someone that the difference between men and women was that men, and Julie, have upper body strength.

But after I was run down by a cab and had a spinal cord injury, I just wanted to be strong enough to play the viola again. After my mastectomy, lifting a plate was a worthy strength goal. After chemotherapy, I wanted to have the strength again to go skiing.

One of the reasons I am so proud of the fact that I do pushups is how hard I had to work to get strong enough. I may not always be able to do a lot of them, and they may not be easy for me, but there was a time when lifting a plate was my worthy goal.

Our abilities and our goals change over time. It’s important to understand the difference between them. Our current abilities are just that – current. They are only what we can do today – not what we can do next week or next year. Our goals are the ideals we want to attain. Our goals need to be something greater than what we can do now, something greater than our current abilities.

But we need a clear understanding of our current abilities in order to plan on how we will reach those goals. If we look at where we are and where we want to go, we can figure out the path between the two.

So, what can you do now? What do you want to do? How do you get from here to there? How strong is strong?

Julie

Strong Girls - Be One!

I was catching up on some of the blogs I follow and came upon a great post on female strength (and an equally great reader response). Josh Hanagarne, at World's Strongest Librarian, wrote a powerful Female Strength Manifesto. Here's a little of what he had to say about women and strength:

I grew up with two beautiful sisters, and I have a lovely wife, but I have never been able to convince any of them that they are anything but fat monsters. It is like they can’t hear me. My life sometimes feels like an endless pep talk as I try to convince the women in my life that they are beautiful enough. That they are strong and desirable and worth so much more than any magazine might suggest. Honestly, I’d probably feel like they do if I was a woman.

They have been taught that female strength is not as desirable as jutting clavicles and pouty lips.

Ladies, if I could snap my fingers and change the world, you would all be lifting heavy, living happy, and ignoring the unreasonable expectations from the nonsensical world of magazines, movies, and television.

Men and women worth knowing will not be intimidated or terrified of your strength and confidence.

Josh

I LOVE this! And that post was followed up by a beautiful response by Breset "Sterling" Walker. 

I love training. I’m a woman, and I love the Big Kid weights, running around in circles, and hitting things, and it hasn’t been but the last ten months in my life that I thought this was okay or, get this, wasn’t something that I had to hide. Because as an American Woman I think this is unfeminine, and as an American Woman it took twenty-nine years to stop reflexively sticking in an equals sign between “unfeminine” and “unlovable.”

She goes on to describe her journey into and acceptance of the world of strong women. 

These two posts should be required reading for all women and girls. Please read them in their entirety at World's Strongest Librarian.

I am a BIG advocate of strength training for women. It's especially important for any woman who's had surgery and treatment for breast cancer, but all women should be strong. I'm not talking Arnold Schwarzenegger strong - unless that's your goal. If that is your goal, you go! But generally I'm talking about not being afraid to be strong. 

Strong is confident. Strong is capable. Strong is functional. Strong is independent. Strong is strong. And strong is BEAUTIFUL and SEXY!

Julie