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1. ¡Welcome! We will begin shortlyhttp://streaming.biocom.arizona.edu/Please complete the surveys For Technical assistance: For internet viewing: (520) 626-0167 Videoconferencing:(520) 626-6978

2. Easing into Exercisefor a Healthy, Happy Recovery Joy Kiviat, PhD, MSN, RN Oncology Certified Nurse ACSM certified Cancer Exercise Trainer and Group Exercise Instructor

3. Exercise helps PREVENT breast cancer Growing evidence that, along with healthy weight and good nutrition, exercise throughout your life can reduce the risk of breast cancer later in life Even among overweight women, active women had 25% reduction in risk compared to those who were inactive.

4. Exercise Promotes Recovery! • So much evidence now that the American Cancer Society, the American College of Sports Medicine, and the American Institute for Cancer Research have all published guidelines for exercise after a cancer diagnosis • But most breast cancer survivors are LESS active than before diagnosis…. How about you???

5. Feel like you just can’t? During and after cancer therapy, it’s normal to feel… • Fatigue • Pain • Weakness • Low spirits

6. Exercise helps with this! Extensive research by exercise specialists, oncologists, nurses, and psychologists all point to these benefits: Exercise is safe during and after treatment Exercise reduces fatigue and pain Exercise improves balance & bone density Exercise improvesstrength & flexibility Exercise elevates moodand improves quality of life

7. Exercise promotes Recovery, AND…. Evidence is mounting that maintaining a healthy weight and moderate activity can help prevent cancer recurrence* Strongest evidence in breast and colon cancer; recent studies suggest exercise reduces risk for prostate and brain cancer recurrence too. *Source: Physical activity and survival after breast cancer diagnosis” Journal of the American Medical Association 2005.

8. How do we know? 2009 Study: Patients treated for breast cancer enrolled in 12 weeks aerobic and strength training exercise – compared to “usual care” they had significant gains in fitness, strength, lean body mass, and overall quality of life. Source: “A randomized trial to increase physical activity in breast cancer survivors.” Medical Science Sports Exercise 2012 Review: Compiled all recent data; concluded that moderate physical activity reduces burden of disease and mortality rates after cancer diagnosis Source: “Physical activity, biomarkers, and disease outcomes in cancer survivors: A systematic review.” Journal of the National Cancer Institute 2012 Provider Guidelines: Exercise recommendations Source:“Nutrition and physical activity guidelines for cancer survivors”.CA: A Cancer Journal for Clinicians.

9. What about Lymphedema? Recent study showed upper body resistance exercise does not increase swelling and may reduce risk of progression (Schmitz et al., 2009) NLN 2011 guidelines: Start with low weights, gradual increase with regular measurements; advise compression garment if lymphedema already present No studies on value of compression garments during exercise for prevention of lymphedema

10. But am I ready to start? • Ask your healthcare provider (severe anemia, blood clots, asthma, heart or respiratory failure should be treated first) • Ask yourself Do you want to …. feel better, look better, regain strength, energy, balance, and confidence?

11. Doctor says OK, but…. I’m so tired… I’m worried I might get injured… I’ve never exercised, or haven’t in years… I don’t know what to do or where… Stop talking yourself OUT of it – think how much BETTER you will feel

12. Preparing to Exercise Select exercise clothes and shoes Find comfortable sports bra! Find a friend to work out with Think about activities you’ve enjoyed before Get any equipment you’ll need

13. Testing the water…. Try a group class – most fitness centers offer one free Set up a session with a personal trainer Find a friend or colleague who likes to walk and try that for a week Tune in to Fit TV and sample several styles of exercise

14. Join a group class

15. Find a workout buddy

16. Or go it alone

17. Found something fun? Now make a plan: start small – 20 minutes 3 times/week, add 5 minutes each week Post your exercise schedule where you’ll see it every morning Put a reminder in your phone or appointment book Tell your family & friends about your plan

18. Get Started Set a reminder (smartphone, cell phone?) The first minute is the hardest! Energetic music motivates & pushes you! Sore muscles? Take pride! Reward yourself with bath, movie, relaxation time….

19. How Much is Enough? ACS & ACSM roundtable concluded cancer survivors should strive for: • 150 minutes/week aerobic exercise (aim for 30 minutes, 5 days a week; try brisk walk, run, swim, dance) • 2-3 sessions/week resistance exercise (weights, bands, water bottles… 1-2 days off between sessions) • Daily stretching/toning

20. Safety First! • Use sunscreen if you exercise outdoors • Wear stable, supportive shoes • Let someone know where you’re going on walk or run; bring cell phone • Stop exercising and call for help if you have: • chest pain • new onset numbness or tingling anywhere • sudden weakness or severe headache

21. Barriers to success:Don’t give up… Traveling? Find a fitness center, walking path, or bring resistance bands along Too tired? Find your best time of day, exercise in several short sessions Got sick? Take a break, call MD if you have fever or shortness of breath, but push through for minor aches & colds. Constipation and nausea may improve with exercise.

22. Reach your goals, then raise them

23. Exercise Resources Pima County Health Department Nutritional & Fitness Resources http://www.pimahealth.org/news/NNM.asp Mall Walking Tucson Mall Walkers Club6:30 am daily. Information: (520) 293-7330. Park Place Mall Walking: Mon-Sat. 6:30am, Sun: 8am. Information: (520) 747-7575. Better Than Ever (BTE)- a fitness training program that raises money for cancer research and prevention. Starts in early September.For information contact Marisa Allen at (520) 626-7177 Website: www.arizonabte.org Urban Fitness – Mondays at Maynard’s Multiple fitness options from walking to jiujitsu, all free or discounted. Check in at Maynard’s in Hotel Congress, 3rd & Congress downtown. http://www.meetmeatmaynards.com Beat Cancer Boot Camp. Boot Camp, Basic Training Class or Walking Groups. Classes at Brandi Fenton Park, Udall Park and NW Community Park. http://www.beatcancerbootcamp.com, or call 520-546-1601. THRIVE! Personal training/group exercise classes provided by certified trainer specializing in cancer exercise, supervised by oncology certified RN/Cancer Exercise Trainer 425-2589 or 780-8412.