Goals: All my goals are about optimizing health. I want to be strong and functional as I age and bank some additional muscle mass as a reserve for the future. Exercise is the lifestyle intervention most correlated with avoiding bc recurrence. (Nearly all studies are based on cardio or combo of cardio and resistance training) and exercise also seems to be one of the lifestyle interventions that might prevent or at least delay the Alzheimer’s that runs in my family. Improving V02 max is another priority.
My questions are related to how to balance the need for cardio with the need for strength training and how to best work around ROM issues.
Medical background: (This is a lot of detail, but since the issues are not uncommon among breast cancer survivors, I thought it would be helpful to others who may come to your site and also might be needed to inform your opinion.)
At diagnosis with bc, I was in my mid-50s, obese (31.9) , had all symptoms of metabolic syndrome except elevated glucose. I am 8 years out now and in my early 60s.
After treatment, I was determined to reclaim my health. I began to exercise vigorously and consistently, ate along the lines of the DASH diet, lost 60 pounds, cholesterol & triglycerides are in normal range, and HDL went up into the normal range for the first time. Hypertension improved markedly and I now use only a minimal dose of a beta blocker. Normal BMI 24.3, but still large waist size.
I am now trying to revamp my exercise, particularly strength training. There are several factors that I have to consider- most related to cancer treatment,:
SHOULDER ROM: Surgery (mastectomy) + radiation led to some really wicked scar tissue especially in the armpit area. I cannot raise my arm straight up. Today, I went back to the PT who specializes in BC patients to see if there is anything to be done and she thinks it can improve to at least some extent.
Surgery+ radiation + aromatase inhibitor resulted in issues with my shoulder joint which eventually led to a frozen shoulder. External rotation (the kind that looks like a football goal) is severely impaired.(I had had frozen shoulder on the other side several years back. That side is is not normal, but not as bad as the surgery side.) It’s like 30-40 degrees from vertical so no way I can do a back squat yet. I have lymphedema, but I don’t think it affects anything nor is it affected by exercise. That ROM hasn’t been an issue to me in ADL, but now that I want to do more barbell work, it is. I’m going to find out what I can do to improve it, but imagine it will take a while. (I was able to move to Tamoxifen after 2 years, so am off the AI)
HEART: Slightly thickened wall of left ventricle, as per Echo a few years ago—perhaps from Herceptin, perhaps from the years when I had hypertension. Ejection fraction is 50 % subsequent to Herceptin. Sports cardiologist told me 45-60 min of cardio 4- 5x per week could open up the chamber of the left ventricle. I could not keep that up and also do strength training, so I dropped it back to 2-3 x/wk I recently read that strength training can also open up that left ventricle chamber but I don’t know how to evaluate quality of studies nor what dose is needed.
V02MAX: Improving VO2 max is a priority since it takes a hard hit with cancer and chemo. I was in a research study right after treatment and that’s when I learned about the issues with V02 max. The lead researcher was encouraging and believed that with training, it could improve,. I had the impression that though I could make significant gains, it would not be as much as the same amount of exercise would produce had I never had chemo. So I have to shoot high.
Though I am at a normal BMI, my waist is 37” measured as per Jordan’s “Measure your waist” video. I’ve decided in consultation with my endocrinologist (Hashi’s) to go ahead and try to lose enough to get it down below 35”. That will probably be about 10% of my bodyweight. I lose weight slowly (1 pound every week or two) by increasing fruits and veges so I’m full. I’ll maintain protein.
Recent exercise background:
I did cardio almost exclusively for a year or so after bc treatment, but then found strength training, mostly bodyweight.
I’ve been doing about 150 min cardio (in addition to strength training) per week. For most cardio that I do, there is a HIIT aspect. E.g. if walking or swimming, I’ll throw in a few sprints.
For the past 7 months, I had been doing RDLs (first pull a regular deadlift), prone rows on an inclined bench, and knee push-ups. I’ve managed a full push-up a couple times in the last 2 weeks. After meeting with a Starting Strength coach 3 weeks ago (on vacation—none around here), I am doing regular DLs. I learned to bench press (hoping to get a rack soon). Because ROM issues prevent an overhead press or a back squat, she showed me the landmine press and arms-crossed front squat as alternatives.
Questions: 1. Which should I substitute for the back squat—leg press and/or front squat or___ ? I can press a lot more than I can squat—like 200 lbs more—as I’m still on a learning curve with balancing the bar in the front.
2. I looked at part 1 of your beginner template and it looks like I could use that with substitutions. But I wonder about the Bridge (Looked at my son’s copy) since there are so many variations and I’m sure all have a particular reason for being there. With my issues, could I follow a template like the Bridge since I have to modify both the squat and the overhead press? Would I just follow the sets, reps, and RPE and do whatever variation I can do or would I lose too much of the program?
3. I really want to continue cardio both because I actually enjoy it and some health goals such as prevention of BC recurrence appear to require cardio. I am not clear about when and how it impacts strength training , but does it matter for someone with my goals? Can I do more than 150+ min/wk ? (I probably need to in order to lose the weight. That’s what I did before.)
BTW, I think your acknowledgment that there is a range of responses to any intervention is so important, and your use of RPE is genius. Looking at your templates, I had an aha moment as to why I have disliked strength training: I had been doing everything but warm up somewhere between RPE 9 and failure and I dreaded it. Also your way of computing estimated 1 RM seems to give me what I think is a more accurate 1RM.
So thanks so much! You guys are great! I really like how tied you are to the research. It gives me confidence to trust what you are saying. (Though I also like to look up the studies.)
I also very much appreciate the lack of overt sexism –and ageism—that is present in so much other weight training material.
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