Modifications for older breast cancer survivor with leftover medical issues from tx?

Training Q&A [Moderated]
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​ Sorry this is long, but several medical issues impact my lifting. I tried to make it easy to skim , though.

I had progressed to Phase 2 of the Beginner’s Template by fall of 2020, but then pandemic+ major life events= stopped lifting. So after over a year off, I started Phase 1 again in Jan and was able to get back to my former DL max within 4 weeks’ worth of lifting!
I would like advice on appropriate modifications wrt

  1. fatigue (no pain, feel fine the next day for cardio, but day of lifting, NEAT plummets to next to nothing and sometimes Session RPE is 9 or 10 after 2 exercises)
  2. advice on Squat variations in Phase 2 due to ROM issues.

Basic data: Age 65
BMI 23 ish after 55lb or so (about 28%) weight loss sustained for several years after breast cancer dx ( I was determined to reclaim health.)
Still have an elevated waist measurement 93 cm (Cauc) but all metabolic markers are now normal after weight loss (I had every symptom of metabolic syndrome before except abnormal glucose. Now off bp meds.) Still, I am in a minor calorie deficit (-1 lb every other week) to try to whittle that waist away, but based on previous weight vs waist correspondence, I probably need to lose another 15% of bodyweight . So I’ll do the best I can.
DL 160 (BW 149), SBSq 101, BP 70.
Goals: lengthen healthspan; add muscle mass if possible

Q1: any other suggestions for managing fatigue?

Medical factors that could possibly be affecting my fatigue:

1)Tx with Herceptin resulted in impact on EF: it’s 45. Cardiologist not particularly concerned, but IDK whether that could contribute to fatigue.

  1. VO2 max—I learned during participation in a study comparing breast cancer chemo survivors to control that VO2 max is severely impacted by chemo. (They were cheering for how “well” I had done: the level was in the “very poor” range. WTH? But apparently that was actually good for a bc chemo survivor.) The lead researcher (all his work is in BC + exercise) said it could be raised with rigorous training, but would likely not get back to where it could have been otherwise. I wasn’t nocebo’d; I took it as incentive to train hard.
    3)I have Hashi’s but am well medicated so I doubt that would be an issue.

Other factors
RPE: I think I am good at estimating RPE @ 8 for lower body; less good for upper (probably bc there is something like a 2 lb difference between sets of @ 6 to @7 to @8. However, if I underestimate RPE for upper, it doesn’t seem to contribute to fatigue. ) But maybe I am not as good at estimating as I think… or maybe I could drop RPE?

Cardio: I think I’m in good shape cardio wise. I’ve done 150+ min mod/vig pretty consistently since after cancer tx. (11 yrs) I’m so acclimated to “brisk” walking that I cannot get my HR up high enough to count as moderate w/o a significant hill so do jogging intervals, dance, stationary bike, and heavy gardening to get into moderate to vigorous range. (Someday, I’d like to chat with Austin about his frequent pooh-poohing of gardening as exercise! Digging in clay/rocky soil, prying out rocks, tree roots, hauling mulch, compost, etc. is part of gardening and most definitely exercise! :slight_smile: )

What I’m doing now to manage fatigue:

This go round, I switched from 3 sessions per wk to 2 training sessions per week . (So I get 3 weeks done in 4 weeks.) This schedule seems to suit me well and seems consistent with guidelines for people my age.

For phase 2, I will incorporate your previous suggestion from 2020 on the forum to cut 20-30% for the back off set.

But you really didn’t like the idea of sometimes doing the third exercise the next day. Do you have any other suggestions to keep all three exercises in one day? (I don’t plan ahead to do this: depends on fatigue.)

Q 2 Recommendations for Phase 2 squat variations #2, #3 given my ROM and current weights?

ROM issues from combo surgery/radiation deep scar tissue + frozen shoulder = FS (arms crossed), safety bar, or dumbbell. Home gym is limited for dumbbells (25lb max) I hate FS because I feel significant effort is directed at not pitching forward, but I used FS to work up to being able to use a safety bar (61 lbs.)
I would like to continue to use the safety bar including for the squat variations because I can lift so much more than FS, but would like advice on which ones to use and how to modify given that most of the variations seem like they would be harder than regular squats and I have just recently graduated to the weight of the safety bar. I do have partial plates if that matters and since it’s a home gym, the other weights are consistent.
x 4 safety bar squat: my last sets were 71lbs @ 6, 81@ 7, 87@ 8
x7 last sets: 61@6, 66@7, 71@ 8
x10 (My son suggested decreasing reps to get to @ 6, @ 7 to avoid using front squats) : so 61x7 @ 6, 61x10 @7, 66 @8.

Should I just choose and decrease reps as I’ve done with the x10s? What are your thoughts?

Thanks so much! While I don’t enjoy the actual action of lifting like I do cardio (I lift for healthspan-- though I do like the results of getting stronger!) , I do very much like your template and am so appreciative of all the advice you offer. I recommend BBM frequently —especially to people I know with “tweaks” here or there that they believe will prevent them from lifting weights. My dream is to be able to attend a seminar at some point!

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Naturegirl,

Thanks for the post and sharing your story. Congrats on your dedication and progress thus far. This is really powerful stuff! Let’s see if I can provide a bit of help here based on your the information provided.

With respect to the training, I do think that twice weekly resistance training is a reasonable choice in keeping with the activity guidelines. While I’m of the opinion that more resistance training likely provides additional health and fitness benefits, I do think that you’re likely to get the lion’s share with 2x/wk. Additionally, this would be a potential strategy for managing fatigue- particularly if you’re good for 1 session with 3-4 exercises, but subsequent sessions suffer. In that case, doing a Monday-Thursday or Tuesday-Friday split (or similar) for resistance training may work fine. If you’re feeling extremely fatigued after 2 exercises on all sessions however, I’m not sure that singular change will be sufficient. In that case, I’d reduce the RPE prescription by 1 or 2 and choose a 3rd (and/or 4th) exercise that is/are relatively “less fatiguing”, e.g. machine, body weight, or dumbbell-based variants. I’d also make these very light, again reducing RPE by 1 or 2 in order to make them more manageable.

In general, we need to deliver enough training stress to drive health and fitness adaptations, many of which have a dose-dependent relationship with training volume. This includes work capacity, the ability to complete multiple tasks/exercises in a given setting. I fear that if we reduce volume too much and focus primarily on performance/completion of the first two exercises, we’ll miss out on some of these adaptations. Thus, I’d prefer to keep in the 3rd exercises and make them “easy enough” to complete by hook or by crook. If you have to take weight off the bar to complete the prescribed work, do it!

For the ROM, I think doing the safety bar squat (normal tempo, no pause) would be fine for your “main” squat variation for sets of 4-6 reps. For higher rep sets, you could do hatfield squats- though maybe not with the frozen shoulder. It also may be too challenging to do sets of 6-8 reps with a slower tempo or pause with the SSB and in that case, I’d just do normal SSB squats again. For the highest rep sets, e.g. 8-10 reps, you can do ascending reps to achieve the prescribed RPE, yes. You may also do dumbbell or bodyweight split squats, goblet squats (may not be possible with the frozen shoulder), step-ups (box just below knee height), lunges, etc. I’d almost prefer some sort of unilateral exercise (split squats, lunges, step-ups) if you can swing them. For the split squats or lunges, I’d start out with one hand on the rack to assist in balance and only use body weight. I’d then add a dumbbell to the hand not assisting your balance on the rack. Finally, I’d then graduate to doing them without holding onto the rack for balance.

What do you think?

-Jordan

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Thanks so much, Jordan!

I do my first session of Phase 2 this afternoon and am looking forward to it.

I should have added above that I don’t get the “wiped out” level of fatigue on Day 2 when the x4 exercise is upper body and there is only one lower body, only if I start with x4 squat or DL. The fatigue from squat or DL days doesn’t affect subsequent sessions or the cardio I typically do the next day. I just sometimes feel totally wiped out for the rest of the day after x4 DL or squats.

Also re: Frozen shoulder: I’ve had it 3 times, both shoulders–last time 10 years ago. I can raise my arm on the nonsurgery side straight up, but on the surgery side I am about 30 degrees short of vertical. I’ve tried PT, US guided cortisone injections, stretches, etc. but I think at this point that it “is what it is.” No pain.

Clarity about fatigue suggestions:

So, I could back off RPE on either the first x 4 set or the 3rd set ofx 8 or x10. If I understand correctly, that first x 4 set is for strength and the 3rd x 8 or 10 set is more for endurance? At my age, which in your opinion is most important to maintain RPE given my goals of health span and “banking” if possible, some more muscle mass? Personal preference is the x4 bc I am self-competitive —former college athlete—and get bigger numbers! haha. But I honestly will accept your suggestion :slight_smile:

I am a little unclear about your recommendation for adding a 4th exercise to I provide volume for the 2x/wk schedule. On a day with 2 lower body exercises, would the 4th be upper or lower? On a day with 2 upper, would the 4th be upper or lower? If it’s bodyweight, do I just do it until fatigue or just short? Do I try to estimate @6, 7, 8? 3-4 working sets? (I already make a game of adding bodyweight squats to my day though I don’t “count” them into my strength training. E.g. I squat each time I take a plate out of the bottom rack of the dishwasher. Takes slightly longer, but I get in some more squats. Same with picking up granddaughter’s toys, etc.)

Thanks for the ROM suggestions, too.

I am happy continuing with the safety bar squat for squat [NODE=“1”]Home[/NODE] and [NODE=“2”]Forums[/NODE] since I just started with it (or I will try out the hatfield squat once I can trust the bar isn’t going to fall off (!) and I’d need to order pins. We only have safety arms)

I like your suggestion of lunges for the 3rd variation. I appreciate your concern for balance. While I do have “subclinical” balance per neurologist (as does my mom), I practice balance daily (standing on one foot to brush teeth), and part of my physical activity is multicomponent exercises (from the 2018 Guidelines ) that incorporate balance: dance, hiking, & Austin’s favorite—gardening–hopping up on a shovel with both feet or pushing a wheelbarrow!.).

With granddaughter’s toys strewn around, I do trip fairly often, but still have the power/speed to recover quickly with a hop. I have only fallen once and it was running downhill on a trail and there was a root hidden by dead leaves. I went down well so I think I’m good even with the neurological- whatever- it- is. I think lunges would be a good choice without needing to hold on to something since I’m sure I have muscle memory from “flicks” from my field hockey days. I would just be limited to a total max of 50 pounds in dumbbells. I would be more hesitant with split squats without one arm to balance bc I wouldn’t have the other foot available to recover from a loss of balance. I could also add lunges to my daily “games” of incorporating BW exercises while I do other stuff.

Thanks so much for your advice and support! While I know you need to earn a living, it’s also very clear that what you do is also a mission to help as many people achieve health as possible. That mission mindset definitely shines through.

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Don’t know what happened with the “Home” and “Forums” above and I couldn’t edit. It said Squat number 1 and number 2 but I used the sign instead of the word number, so maybe that did it!

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Copy that. I think this is somewhat common and I would advise to reduce the load as needed to get the training in.

You could do either, neither, or both. It’s really up to you and how you’re feeling. Our goal first and foremost is to bolster adherence to exercise that’s dosed appropriately- so if we have to reduce RPE on both some days to make that happen, let’s do it. If I was creating an algorithm for you, it’d be to first lower the RPE target on the 3rd and/or 4th exercises to a point that will get you to do them. If you need to do this on the 1st and/or 2nd exercises, that’s fine too, but I’d start with exercises 3 and/or 4 (if there’s a 4th exercise programmed for the day. There aren’t many in the Beginner Template as I recall).

An aside, all of the rep ranges produce an increase in strength, though there are different types of strength, e.g. maximal strength, strength endurance, high velocity strength, etc.

Let us know how it goes and thanks again for the kind words.

-Jordan

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