Fitness milestones after undergoing chemotherapy

I sometimes get messages from women who have recently undergone treatment for breast cancer and want to know how long it will take to regain fitness after treatment.  The reason these women are asking me is because oncologists tend to respond to this question quite vaguely.  I think they're vague because there is no clear cut answer.  There is a huge variation in types of breast cancer treatment which alone can impact recovery.  Additionally, even women who receive the same treatment often recover quite differently.   Since oncologists don't like to answer this question, many women, me included, find it incredibly reassuring to see someone's timeline who has been there, done that.

So, ladies, this post is for you!

Before I get into the nitty gritty details of treatment dates and major milestones in fitness I would like to say that full recovery is very difficult to gauge.  If you asked me back in March 2012 how I felt I would have responded "Great".  Now that nine additional months have passed, I would say that in March my recovery from hard and/or long training sessions was slow.  I also woke up every day with a little bit of heaviness in my legs.  However I did feel great compared to how I felt while undergoing chemo.  It's all relative I suppose!  Today, nine months later, I recover from racing and hard workouts much more quickly and I no longer have that heavy feeling in my legs.  Admittedly, I'm not sure if the nine months has allowed my body to recover more from chemo or if my fitness has improved; likely it is a combination of both.  Regardless, I can't wait to see what "great" feels like nine months from now!

Without any further rambling, here is my timeline:

Treatment dates:

1/25/2011	Diagnosed with Invasive Ductal Carcinoma (2cm, ER/PR+,Her2-,Grade3, Oncotype Dx: 20)
2/18/2011	Lumpectomy #1 with sentinel node biopsy (margins were not clear)
2/25/2011	Lumpectomy #2 (margins were not clear)
3/25/2011	Mastectomy (clear margins, YEAH!!!)
4/15/2011	Chemotherapy #1 (Taxotere, Cytoxin)
4/16/2011	Neulasta
5/6/2011	Chemotherapy #2 (Taxotere, Cytoxin)
5/7/2011	Neulasta
5/27/2011	Chemotherapy #3 (Taxotere, Cytoxin)
5/28/2011	Neulasta
6/17/2011	Chemotherapy #4 (Taxotere, Cytoxin) Final treatment!!!
6/18/2011	Neulasta
7/11/2011	Start 5-year regimen of daily Tamoxifen
8/15/2011	Final reconstructive surgery

Two months after finishing chemo I wrote a blog post on my tips to stay fit and healthy while undergoing chemotherapy.  I also did a post on a typical week of exercise for me while undergoing chemo.  I coined it my chemo training plan.  While training and activity level need to be modified while undergoing chemo, I feel that maintaining good health and preserving as much fitness as possible accelerates regaining fitness after treatment.  There's pretty solid research to back that up too, although it also seems like common sense to me:)

Recovering from surgery, sometimes multiple surgeries, is another confounding factor when dealing with breast cancer.  Since I have had both a lumpectomy and mastectomy, I can say with certainty that a lumpectomy is a thousand times easier to recover from.  I had more pain from the sentinel lymph node biopsy, a procedure done at the same time as the lumpectomy to check for cancer cells in the axillary lymph nodes, than from the lumpectomy.  The pain was very manageable and I was back on the bike within a couple of days.    My second lumpectomy, which was a stand alone surgery, was even easier to recover from.  A mastectomy is a much more invasive surgery.  I was cleared to walk immediately and made a point to walk as far as I could every single day.  Once the drains were removed, at about 1.5 weeks post-op, I started a stretching program to work on regaining range of motion.  It was a solid 3-4 weeks before I was legitimately riding my bike outside.

Additional suggestions for exercising while undergoing chemo:

• Unless your oncologist recommends otherwise, ditch the heart rate monitor.  Chemotherapy caused significant tachycardia (increased heart rate) for me and staring at the monitor would freak me out.  I started using a heart rate monitor in January 2012, six months after finishing chemo, and have noticed over the past year that my heart rate has stabilized to be similar to pre-chemo rates.
• While undergoing chemo I was actually able to ride quite a bit but I never pushed myself.  To ensure that I didn't ride too hard, I maintained a pace where I could hold a conversation.  My body was already taxed dealing with the toxic chemicals from chemo.  I wanted exercise to help my body stay strong and healthy, not increase the stress being put on my body.   

Fitness milestones:

6/2011-10/2011	I spent the first 3 months after finishing chemotherapy working to regain some strength and fitness through cycling, hiking, and light weight training.  Upper extremity strength was emphasized as significant strength had been lost after the mastectomy.  I exercised approximately 6 days a week for 1-2 hours.  Occasionally I would exercise for up to 3 hours.  Exercise was based on how I felt and I did not follow a structured training plan.
8/2011	Somewhere toward the beginning of August I decided to test my fitness.  With very low expectations, I jumped into a local mid week mountain bike race.  How my body responded is difficult to describe.  When I put down my first hard effort trying to keep up with some of the girls I formerly raced with, my body started to go and then it shut down.  For a moment I was scared, but then I realized that my body was able to recover and I pushed on surprising myself by keeping up.  This short race effort gave me hope for a successful return to competition in 2012.
8/15/2011	My final reconstructive surgery was a set back to the upper extremity strength I had regained over the summer.  I did not resume weight training until I was fully healed in mid-October.  After surgery, I took one full week off the bike and three weeks off the mountain bike slowly easing into rides as pain levels allowed.
10/1/2011	Raced on a duo team at 6 Hours of Frog Hollow.  This was strictly for fun however I was happily surprised with my lap times being only a few minutes slower than pre-cancer.  Honestly I wasn't completely sure my body would be healed enough from surgery to race until less than two weeks before the race!
10/2011-11/2011	Dabbled in two Utah Cyclocross races.  I raced in the Singlespeed category as I did not want to compare myself in a race situation to the super fast Women A competitors that had been training and racing all season.  I knew that setting myself up to feel bad about my fitness at this point would not help my confidence going into 2012.   My goal wasn't to see how quickly I could return to racing, but to return to racing able to compete with the Pro ladies.
10/2011	Hired a coach to help me return to competition in 2012.  Started a loosely structured training program incorporating strength training, some structured rides, and some unstructured workouts.  At this point I was still recovering mentally from the diagnosis and treatment.  I had spent the previous 10 months living my life around doctor’s appointments and dealing with the inflexibility of the medical system.  Almost 70 appointments in 2011!  I needed some flexibility in my life and I did not feel that a structured training program would allow this.  Basically I just needed a mental break!
1/1/2012	Structured training began!  Once again started using the heart rate monitor for training.
2/2012	Came up with my mantra for 2012:            No excuses            Be kind and forgiving to myself*            Have fun!  *It is so important to be kind to yourself when recovering from something like chemo, however there is a point where you need to start pushing your body to gain fitness.  If it weren't for having a coach give me permission to train hard, I probably would have been too 'kind' to my body during training and fitness would have only improved marginally.  Basically my coach kicked my ass into shape!
3/3/2012	First Pro cross-country mountain bike race since undergoing treatment for breast cancer.  I was so nervous before the race that I could barely sleep the night before.  I was excited to race but also scared that I would not be able to compete with the Pro girls.  I will never forget the feeling of starting this race.  As soon as we took off I knew everything would be okay.  I no longer felt like a cancer patient.  I felt like a legitimate mountain bike racer.  Cancer and treatment had consumed my life for the entirety of 2011, but as soon as I started racing my brain shut off and I went to work racing. I did not think about my cancer treatment a single time during the race.
3/2012-present	Fitness has continued to improve throughout the year as well as my ability to recover from hard workouts and races.  Raced 35 races between March-December!  Proud to have finished top-5 at all of those races.
12/2012	Planning bigger and better for 2013!