This transcript was extracted from the ‘Exercise after breast cancer‘ video.

If you have any questions for Leah, please help me today. Oh, thank you to Kelsey for helping Leah today as well. Thank you Kelsey. So now we’re on to our final speaker. What about that? Ooh, we’re nearly out into the sunshine, guys. So this is Maeve McGillian, our physiotherapist. So over to over to over to Maeve No notes, look at you.

I know, thank you very much. Hello, everybody. Some one of these events I’ll get to go first, Amy. I know. So, I’m sure you are if your brains are anything like mine, they’re maybe almost at full capacity, but if I could give you a little bit more information to take home with you. Just before we start, if you’re able to,

I want everybody to stand up. Sorry. I know I’m that person, but as long as it’s evidence based, I’m allowed to do it. So if you’re able to stand up, if you need a wee bit of balance, please hold on for balance. So we’re just going to get marching on the spot. This is all proven to increase your concentration and information retention.

So marching on the spot if you’re able to, lovely. We’re going to shrug our shoulders. Nice big circles. Good. Do some forward, some backwards. Lovely, lovely. So we’ll go right hand up to the ceiling, left hand up, both hands up. Touch your nose, touch your head, and sit down. as that. So, as Amy has introduced me, my name’s Maeve.

I’m an oncology/haematology physiotherapist in the Northern Trust. I recognise a lot of faces and so with going last, there’s going to be an overlap in a lot of the presentations, the excellent presentations that have went before me. So I’ll try not to dwell on stuff because I don’t want to go over the same stuff again.

But basically I’m here to talk to you about exercise and breast cancer. So there was a massive report done a couple of years ago here in Northern Ireland and one of the biggest takeaway messages, was that our cancer population is not active enough. And there is more and more research being done to show that exercise and physical activity and movement, not only help, you know helps survivorship, but it helps your outcomes on the other side when you get on the other side of your cancer.

So by definition of “physical activity can be defined as any bodily movement, produced by skeletal muscles that requires energy expenditure”. So physical activity refers to all movement, leisure time, transport to and from places, as part of a person’s work and it varies between both moderate and vigorous intensity. And both are known to improve your health.

So, with breast cancer, as a lot of the stuff that’s been touched on already today, there are many physical challenges. Your most common being fatigue, your pain obviously, people don’t really want to move if they’re in pain, but it’s just that reassurance that exercise will help, lack of energy, diminished appetite, your loss of muscle mass, cording and lymphoedema, which we’ll I’ll talk about later. I get a lot of questions and emails and phone calls asking about cording and lymphoedema from breast cancer patients. And the treatments and their side effects are obviously a challenge that we need to work through.

You know, if you’ve had surgery, you’re going to have wounds that are healing you’re going to be sore. You know, radiotherapy, if you have any potential burns. You know, even the fatigue that comes with radiotherapy, your multi-agent chemo’s, your targeted therapy and your hormone therapies.

As Ashlene talked upon yesterday, our joints and our bones love estrogen and a lot of the ladies here and in the community are on a treatment that essentially is specifically designed to reduce your estrogen.

So you do get those widespread pains and it’s a very cliche saying, but motion is lotion. So, you know, if you are having those widespread pains, you know, just move your joints. So, so many benefits of exercise. Oh, sorry that’s supposed to say breast cancer. I don’t know why that didn’t save, but basically, energy we’ve talked about earlier, one I want to talk about is mood.

You know, there’s been more studies, they did MRI studies of brains of patients before and after exercise and the MRI specifically showed that there was increased activity in the parts of the brain that show those happy hormones and endorphins. So, exercise is proven time and time again to help improve people’s mood. It’s just really any form of movement and exercise releases those happy hormones.

You know your heart, helps with your strength, your balance, your confidence. So to even just maybe talk about balance. Anybody here when they’re parking have the car that has the sensors, the beep-beepers. Yeah, show of hands who’s a great parker? But no, as you get older, those little, the beep-beepers as you talk about, they’re located all over your joints and as you get older, those little sensors diminish and and don’t be as sharp as they used to be. And maybe and putting on top of that, the effects of chemo and what they have on your nerves. So you do you know, and with as well as that, as the girls talked about earlier, you know, the peripheral neuropathies, you are a chance of your balance not being as good.

You know, you know, strengths. You know, you do lose some of, you know, your muscle mass. Some people come in to see me and say, you know, I just have great muscles in my arms, you know? So it does just is that effect of that, the whole picture, loss of appetite, you’re not moving as much, the effects of your treatment, you do lose a bit of your muscle, muscle mass, lose a lot of confidence and I have a lot of conversations with patients you know to try and encourage them to get back exercising because again, it has proven to improve people’s confidence.

And we’ll just talk a wee bit more on this next bit. So, when people talk about being fit and oh, I used to be fit, I want to get fitter. So to be fitter means that your heart and your lungs work at a good, they’re a well-oiled machine.

They’re efficient at moving blood around your body. So that’s what we talk about, you know for your gradually increasing your exercise and exposing yourself to more activity. Your lungs and your heart will start to become more efficient. All right. As we talked about, it strengthens your bones and muscles, it reduces risk of Type two diabetes, weight control as the dietetics you know if you’re going to be burning more calories, you’re going to you know potentially lose weight.

For some people, it helps build muscle. You know, it’s not you know, some people come and they want to regain weight and regain muscle. Helps with your energy. As our occupational therapist talks about it is proven to reduce the risk of dementia and loss of cognitive decline.

So what do the guidelines say? There was, the American College of Sports Medicine, supported by the National Cancer Institute has said that it is safe at all stages. So I had a I remember going to see a lady up in the ward, up in Antrim, up in Ward C7, and the doctor had asked for me to go in and get, the lovely little lady up, and both the patient and the family stopped me and said, whoa, whoa, whoa, whoa, what mummy’s going through mummy’s going through chemo, she has to stay in bed. I was like, no, no, no, I’m physiotherapy. I’ve been asked to come and get your mummy up, we’re to get her moving. But do you not know she’s on chemo? And I was like yes, yes, yes, I know it is very much encouraged, the evidence is there to back it up.

As Ashlene talked about earlier, I think in years gone by, everybody got the one surgery, the one chemo and you essentially took to your bed. But no, the evidence has moved on so much from then. I was at a course last year where they were trialing over in England, where people were receiving chemo and they were on the static bikes.

Now we’re a long way off that. It’s only it’s only trialing at this stage. So it is safe, you try to get back to your normal activities ASAP. I had a phone call last week. Somebody asked me for come through to the department. They really wanted to get back walking their dog. I said, why don’t you start with your unaffected arm first, then go back to both hands, you know, and do it very, very gradually.

You’re building up slowly and you’re avoiding being inactive. That’s a biggie to say to people and I am as guilty as anybody. If you put a good Netflix, show in front of me I could sit 4 or 5 shows in and realise I haven’t moved. So it’s just trying to avoid being inactive is one of the other key takeaways.

So this you’ll see in walls, different departments, you’ll see it in your GP’s. So generally it’s encouraging either 150 minutes of moderate activity a week or 75 minutes of more vigorous activity a week. Ok and that is anything from, you know, up and down stairs and running would be your more vigorous or 150 minutes walking, gardening, swimming, housework, and or else as we talked about earlier, our joints love to be loaded.

As you get older, changes happen in your joints. Has anybody heard the expression wear and tear? Yes and but our joints love to be loaded. You want to incorporate two elements of strength sessions a week and as we talked about earlier, as you get older and possibly you know the side effects of the chemo, you want to be incorporating two balance sessions into your week and the message again of sitting less.

So those ten, those little orange boxes are ten minutes, you know, who initially seen 150 minutes and thought, oh, gosh. Oh, you know, whereas I know I have no doubt possibly the majority of people in this room maybe are reaching 150 minutes, maybe don’t realise it.

That could be ten minutes at a time, before you know it you’ve done could have done 30 minutes at the end of the day. If you do that over five days, you’re reaching your 150 minutes. Ok. So as I talked about there, you know walking, gardening, swimming, sport, stairs, dancing. You know, anybody who has grandchildren, you know, they would soon burn your energy if you’re out running round after them.

All right. So other activities, strength, you could be doing your Pilates, carrying things, whether that be washing, groceries if you’re, you know, if you want to go if your, even with guidance or if you have weights in your house or if you were previously attending classes. Weights, your squats, lunges, press ups, getting up and down from a chair and then elements of balance.

Dancing, yoga, if anybody does bowls. Ok, so just just wee examples. With you do have to, just air on a little side of caution on exercising, as the whole it is safe and effective, but sometimes individualised exercise programmes may be more suitable. Bone problems. So for example, if you have bone thinning or if you have quite severe osteoporosis, if you’ve had bad fractures in the past, if you maybe have metastases in your bones, you would want to seek a little bit more individual advice.

If you have any brain tumours or metastases that may impact, you know, your thinking or your balance, you want to reach out. I’m not going to go into peripheral neuropathy but as we touched on earlier it effects the nerve endings and therefore, you know, if you maybe can’t feel the same or, you know, you maybe can’t feel the objects, you are maybe at slightly more risk of perhaps hurting yourself.

Lymphoedema we’re going to talk about at the end of the exercise chat. Lymphoedema is perfectly safe to exercise with, but you may want to go and seek the treatment first to get it more under control and then proceed with your exercise.

And if you’ve you know, if you’ve any severe heart or lung problems, asthma, COPD, metastases, you know, pulmonary fibrosis, anything like that you would just want to seek good advice alongside your exercise.

So top tips. My first I remember the first day I started this job, my predecessor who’s now head of the lymphoedema service, said to me he said, if I give you any advice, says some people when they’ve beat cancer, they they have a new lease of life and they maybe want to run a marathon and just be a wee bit cautious if Joe Bloggs maybe never would have exercised beforehand.

So you just kind of want to reel them people in a little bit. By all means, do your marathons or whatever it may be, but you just want to start slowly, gradually increase. Do it with company. I put my hands up, I need to exercise with people.

Keep a diary and seek advice if needed. All right. This is a question now we get asked a lot, you say what how do I know if I am exercising moderately or vigorously? So a nice wee scale here. So, you can rate out of you know, out of ten or out of 20, you know, you’re at the lower numbers, you’re at no exertion and at that stage you should be able to do it for a long period of time.

Your breathing’s comfortable and you should be able to whistle. Ok so that’s how you know that you’re just doing a nice, light, low intensity exercise or if you’re coming walking and you’ll be able to sing along to your songs on your iPad or whatever, it’s gentle. If you’re doing more moderate activity, you’re starting to feel a little bit warm, sweating slightly your breathing will increase, but you should still be able to hold a conversation.

All right and then more vigorous exercise. Then your breathing increased where you’re really only able to speak in short sentences, you’re sweating more. Now extremely hard you’d be gasping. But we’ll try to avoid that. But that’s just a nice guide. So if you’re, starting to sweat a bit more, you’re feeling out of breath. Then, you know, then you’re starting to do more moderate activity.

Is that ok? I would get asked that a lot. And once you go into the more moderate activity, which would go without saying then you can’t just, you know, that would be your exercising for a shorter amount of time because you’re expending more energy. All right. Ok. So getting started. So, there’s loads of information, both online and there’s some information here today. There is the move more the move more group.

Fantastic way of sort of continuing on or getting back into exercise. There’s walking groups, there’s Pilates. Some of the folk here earlier, they have the lovely walks that run up around the North coast. You are spoiled with your beaches. And there’s also, there’s also initiatives being run through local leisure centres.

If you want to contact your local leisure centres, there could be initiatives running there. So cording, I was specifically asked include this. So cording, if I had a pound for every time I heard the word annoying, I would be a very wealthy lady. Thankfully it is nothing sinister or serious to worry about, but it is also known as Axillary Web Syndrome, so it’s a condition that can develop after breast cancer surgery, particularly when nodes are removed from under your arm.

So I’ve two pictures here. Can you see how there is like the little bands of hard tissue? So it’s characterized by the formation of cord-like structures or webs under the skin, which can cause pain, tightness and limited range of movement in the arm and shoulder. It’s still up for debate what causes it. It’s there are two main things of what people you know as the the edu the educational world thinks is generally either fibrous, your lymph system has become hardened and fibrosed, or it’s more your nerve system.

Some people are lucky that it can snap some cording can be a bit more stubborn and can hang around for a year or two. So how do you treat it? Simple. You do your stretches, so you’re gradually doing your stretches that you’re provided with after your surgery.

And you are just, you know, gradually, gradually, gradually, increasing your stretch to you can get and really put a full stretch on your cording. You can get in and you can massage it. You can get in and you can also if you have scarring in and around your cording to get in and around it and get it moving and general exercise is terrific for hopefully just getting rid of the cording or helping soften it.

I once heard the analogy of if you could imagine sometimes like pulled pulled pork or pulled meat some are lucky where it just snaps, some it kind of tethers and can be a bit more stubborn. But at the main the main takeaway is it’s nothing to worry about and you just have to keep working at it and hopefully it will either go with time or be lucky enough that it could snap on you.

And we’re all very familiar with this. This is the accredited exercise leaflet that you get after your surgery. The Breast Care Now ladies at the back so if you lose it, you can get it online. So even just particularly just working through the stretches that are provided in this, this leaflet to help, if you had do have cording.

Ok. Lymphoedema, lymphoedema as an entire, presentation, if not, course, on its own, I do not by no means put my hand up to pretend to be a specialist in lymphoedema but we’ll go through a few of the main points. Everybody’s terrified of developing lymphoedema it’s as soon as I even mention the word you know, people become nervous.

But if I could even help if you leave today with a wee bit of confidence that should you develop it that you know how to manage it. So just a wee bit of a boring slide. So lymphoedema is a chronic long term condition that causes swelling in the body’s tissues. It can affect any part of the body but usually develops in the arms or legs.

While it is not curable it can be successfully managed with the correct treatment, self-Management and support. So the lymphatic system. So can everybody see on that wee skeleton there there’s little green like what looks like we grapes, wee tiny tiny little balls. So I want to keep it very very simple. So they are your lymph nodes. They’re scattered all over your body.

And so all those, little nodes and those little lines, those little wires ok, they are a network of channels and glands throughout the body that help fight infection and remove excess fluid. They collect, those little nodes collect fluid which is leaked from cells and tissues throughout the body and they recycle it back into your bloodstream. So lymphoedema develops when the lymphatic system does not work properly.

So in the instance of breast cancer usually it’s either those nodes under your arm have been surgically removed or they’ve been damaged as a result of the, the radiotherapy. Or maybe another reason, but those are generally the most common reasons. So as a result of that, you are a bit more at risk or vulnerable to developing lymphoedema in and around your arm, breast or you know around that chest wall area.

So treating lymphoedema. So anybody that’s been to see me will hopefully know these four, things off by heart and are saying them in their sleep. We talk about all the research talks about the four pillars of lymphoedema management. So you have your exercise, daily skin care, you have compression bandages and garments and specialised massage techniques and everything always comes back to those four pillars of management.

So exercises, you know it is utilising your muscles to get that muscle pump in your muscles to in the affected limb to improve lymph drainage. So your getting your muscles to act like a pump. Daily skincare, so the recent guidelines that were published basically say you’re washing that area with soap and water and reapplying your moisturizer to keep the skin in good condition and you want to reduce the chances of infection. Compression bandages and garments is to help with, the compression is to help move fluid out of the affected limb and then it’s to try and minimise further buildup. And the most common forms you will see would be in the sleeves and or that some of the compression gloves and especially massage techniques.

And that is to help stimulate the flow of fluid in the lymphatic system and reduce swelling. So if I take you back to this slide here, so should say for example, this patient’s left arm was affected with lymphoedema. We would be trying to use special massage to move that fluid over towards your healthier, unaffected lymph nodes and help them you know the excess fluid to be drained there and recycled back into your bloodstream.

So, that was a whistle stop tour on the getting back into exercise and cording and lymphoedema. But please you know speak to your GP, your oncologist, your nurse specialist, your occupational therapist, or myself if you feel that you would benefit from a 1 to 1, or an individualised programme. And that is me. Thank you very much.

Hello. Thank thank you very much Maeve. So before I conclude the event, I have a message from Ashlene. So if anyone was speaking to Ashlene at the tea break and you didn’t write, write down your name and phone number with Ashlene, please speak to her again at the end so that she has your contact details to be able to call you.

Ok. So I I’m Bernie McGarry and I job share the role of Macmillan information and support manager with Amy. So it is my pleasure to conclude the event today. We are on time, so I won’t keep you long, because I know the weather’s fabulous outside, and you’ll just want to go. But first of all, I want to express our gratitude to all of our speakers. Thank you all so very much. It’s not easy.

It’s not easy getting up in front of an audience. So thank you all so very much. Joanne, our patient speaker had to go on, but I just would like to put on the record to thank her so very much. I think you can all agree that she spoke brilliantly and she was very, very inspiring. So thank you so much, Joanne, for your time today.

In Cancer Services, we are committed to providing the best treatment and care for our patients and families and so at the back of the key messages booklet, which is in your pack that you got at the start, there are ways for you to get involved in helping to shape our future services. And these include task and finish groups and readers panels.

So if if that is of interest to you, have a look in the booklet and please get in touch with us as we would love you to get involved. Thank you to all of you, our wonderful audience. We really do appreciate your participation and engagement today. And so we would really value your feedback on today. Because these events are for you and we want to ensure that we get it right for those who are coming after you as well.

Ok. So there are two ways for you to provide us with your feedback. So for those of you who have a smartphone and are phone savvy, there’s a QR code on the screen. If you take out your smartphone and open your camera, you’ll be able to open a link, which will take you to an online form to provide your evaluation and comments if you don’t want to do it that way there is a paper copy in the pack that you were given at the start. So whatever way that you decide to give us your feedback, we’d be very, very grateful if you could do that before you leave today. And please be honest, we won’t cry. Ok, thank you. Thank you so very much to the organisations that attended that were around the room.

We really do value their time for coming to promote their services, and I hope that you engaged with them today. Finally, I want to thank our team. Ok, so Michael and Connor our sound and camera guys, thank you so much. I think it’s great that we’re able to provide this event online to those who weren’t able to be here, but also for you to tap into afterwards if there’s anything that you would like to to listen to again.

Thank you to Amy, Kathy and Colette for their hard work in organising today. Thank you all so much. To Liz and Hilary, our fabulous volunteers who gave so generously of their time. Thank you so much. We couldn’t do this without you. Thanks to Shauna, who we roped in earlier today to help us out. Thank you. I do apologise if I have forgotten to thank anyone.

So apologies if I have forgotten, but thank you all so much. I hope that you found today useful and informative. Some of us will be hanging around at the end, so if you want to come and speak with any of us, please do come ahead. I think that’s everything. So please fill in your evaluation and yeah, get out and enjoy this wonderful weather and a safe journey home. Thank you.