Returning to Exercise After Cancer Surgery

NCI is blunt about this. Recovery from cancer surgery may take a single day or many weeks. It depends on the anesthesia used, the type and extent of the operation, and what your daily life demands of your body. Minimally invasive surgery, done through small cuts with a scope, generally takes less time to recover from than open surgery through one large incision.

That means advice from a friend who had "the same operation" is not usable. The plan has to come from your surgeon, keyed to your incision.

In the first days, the highest-value movement is breathing and walking. Both prevent complications rather than build fitness.

MedlinePlus gives the deep breathing routine:

1. Sit upright, or raise the head of the bed as high as you can.
2. Take a few normal breaths, then breathe in slowly and deeply.
3. Hold that breath for 2 to 5 seconds.
4. Breathe out gently through pursed lips, as if blowing out birthday candles.
5. Repeat 10 to 15 times, as your provider directs.

If the incision is on your chest or belly, hold a pillow firmly against it while you breathe or cough. That is called splinting, and it makes the whole thing bearable.

If you were sent home with an incentive spirometer, the device with a rising indicator, MedlinePlus describes the technique: sit upright, seal your lips around the mouthpiece, breathe out normally, then breathe in slowly to raise the indicator as high as you can, hold for 3 to 5 seconds, and breathe out slowly. Use it every 1 to 2 hours, about 10 to 15 breaths each time.

Walking counts as treatment here too. MedlinePlus notes that sitting still for long stretches raises clot risk, and that getting up to walk or stretch the legs helps. Short and frequent beats long and occasional in the first week.

"Take it easy" is not a discharge instruction you can act on. Before you leave, get these written down with numbers and dates:

• The lifting limit. How many pounds, and until what date? Ask what a realistic milk jug, laptop bag, or toddler weighs so the limit means something.
• The movement limits. Which motions are off the table, and for how long? Reaching overhead, twisting, pushing, pulling, and getting up from lying flat are all different questions.
• The wound rules. When may the incision get wet, and how? Showering and soaking in a tub or pool are separate permissions.

Then ask the question that unlocks the rest: what has to happen before each limit is lifted? Answers are usually tied to the first postoperative visit, drain removal, or wound closure.

If you have a surgical drain, ask when it is expected to come out, what movement is allowed while it is in, and how to secure it when you walk. Most people find that a lanyard or a pinned pouch makes walking possible again.

Track your incision daily. MedlinePlus lists the signs that mean you call, not wait:

• More redness, pain, swelling, or bleeding at the wound.
• Drainage that increases, or becomes thick, tan, green, or yellow, or smells bad.
• A temperature of 100.4 °F (38 °C) or higher.
• A wound that looks larger, deeper, dried out, or dark.

For cleaning an open wound, MedlinePlus says to use normal saline or mild soapy water, and to avoid skin cleansers, alcohol, peroxide, iodine, and antibacterial soaps.

This changes the exercise conversation for life, not just for six weeks.

NCI describes lymphedema as swelling from a buildup of lymph fluid between the skin and muscle. Risk rises after lymph node removal, especially in the underarm during breast cancer surgery, after radiation that leaves scar tissue blocking lymph flow, and after surgery near lymph nodes in the abdomen or genital area. It is chronic, and it can be treated but not cured.

Learn the early signs: a heavy, full, or tight feeling in the area where you had surgery, visible swelling, and numbness or tingling. Later changes include skin discoloration and hardening.

The old advice was to protect the limb by not using it. That has been overturned. NCI states that exercise acts as a natural pump for the lymph system and can improve the flow of lymph fluid, and that staying at a healthy weight helps keep lymphedema under control. NCI also reports that the 2018 ACSM roundtable found exercise safe for people with or at risk of breast cancer-related lymphedema, and that twice-weekly resistance training does not raise lymphedema risk.

The practical rules that go with that: start light, add load slowly, and get taught by someone who does this. Ask for a referral to a certified lymphedema therapist. NCI advises wearing compression garments daily when you are up and moving, and at night as that therapist advises.

Progress one thing at a time. A workable sequence:

1. Breathing and walking. Several short walks a day, adding a few minutes at a time.
2. Range of motion. Gentle movement of the joints near the incision, within the limits you were given. This is where a physical therapist earns their fee.
3. Bodyweight and bands. Light resistance once lifting clearance arrives, starting well below what you think you can do.
4. Load. Add weight only after you can do the movement with clean form and no pain the next day.

The targets to build toward come from the federal Physical Activity Guidelines for Americans: 150 to 300 minutes a week of moderate aerobic activity, or 75 to 150 vigorous, plus muscle-strengthening on at least 2 days a week. For adults with chronic conditions, the guidelines say to be as physically active as your abilities allow, avoid inactivity, and stay under the care of a provider.

NCI's summary of the ACSM roundtable gives a smaller, closer target for the months after treatment: about 30 minutes of aerobic exercise three times a week and resistance training twice a week improved fatigue, anxiety, depressive symptoms, quality of life, and physical function.

Expect fatigue to lag behind the incision. Feeling wiped out at week five when the scar looks fine is normal, not a setback.

• What is my lifting limit today, and what is it next month?
• Which movements should I avoid, and until when?
• Can I swim, and if not, when?
• Do I need physical therapy or a cancer rehabilitation referral, and can you write it now?
• Were lymph nodes removed, and am I at risk for lymphedema?
• Is there any bone involvement or implant that changes what is safe?
• What sensation in the incision area is expected, and what is a warning sign?
• Is more chemotherapy or radiation coming that will change my energy?

Call 911 or go straight to an emergency department for:

• Sudden shortness of breath, chest pain, or coughing up blood. A leg clot can travel to the lungs, and that will not wait for a clinic call.
• New warmth, tenderness, pain, swelling, or redness in one leg, which MedlinePlus lists as signs of a deep vein clot.
• An incision that splits open, or a wound with tissue bulging through it. Cover it with a clean damp cloth and go in.
• Bleeding that does not stop with steady pressure.
• Fever with shaking chills, a racing pulse, confusion, or feeling faint, which can mean sepsis. Any fever at all counts as an emergency if you are also having chemotherapy, because your infection-fighting cells may be low.

Call your surgeon the same day for:

• A temperature of 100.4 °F (38 °C) or higher on its own, or the threshold your team gave you.
• Pus, foul-smelling drainage, or a wound turning dark.
• Redness, pain or swelling around the incision that is spreading rather than settling.

See Recovery Timeline After Cancer Surgery and What to Expect: Cancer Surgery for the operation itself, and Wound Care During Cancer Treatment for the incision. Also useful: Exercise After Cancer Treatment, Gentle Movement on Low Energy Days, and Strength Training During Cancer Treatment.

• Surgery to Treat Cancer, National Cancer Institute
• Lymphedema and Cancer Treatment, National Cancer Institute
• Physical Activity and Cancer Fact Sheet, National Cancer Institute
• Prescribing Exercise as Cancer Treatment, National Cancer Institute
• Physical Activity Guidelines for Americans, 2nd edition (PDF), U.S. Department of Health and Human Services
• Deep Breathing After Surgery, MedlinePlus, National Library of Medicine
• Using an Incentive Spirometer, MedlinePlus, National Library of Medicine
• Surgical Wound Care: Open, MedlinePlus, National Library of Medicine
• Deep Vein Thrombosis, MedlinePlus, National Library of Medicine