A Paving Stone a Day

It doesn’t matter how fit you are today, the aim of any exercise programme should be to progress. In other words try and do a little bit more tomorrow than you did today.  If you do this you will reach levels you wouldn’t think possible today.

This was never better demonstrated than when Henry (name changed), an 84 year old man arrived at my gym in.  He was driven up to the gym by his son and was dropped off at the disabled parking spot.  It then took him nearly 20 minutes to walk 20 metres with his walker to the front door.  He had to stop for twice on route to rest and catch his breath.

When he arrived in the gym he told us that the only things he did all day was get out of bed, get dressed, eat and collect his post from the post box at the end of his drive.  He was fed up and wanted to do more.

On day one of his plan he managed two minutes on our arm crank at the lowest setting.  On day two he started the homework we gave him which was to walk one paving stone further every day.

He also saw us at the gym three times per week.  When at the gym we gradually increased his cardiovascular exercise from progressing him from  the arm crank to a seated bike. He also started a progressive strength and balance programme.  We started easy and gradually increased the load and difficulty.

Six months later Henry arrived at the gym one morning and said ‘Look what I can do,’ before proceeding to jog, albeit slowly, along the deck.

We were amazed and thrilled that he had progressed from using a walker to being able to jog.  Not only that he was now doing two, one mile, walks a day.

So six months of progressive exercise got Henry fitter.

Big deal!!

What really counted was that he had driven to the gym himself that day, he wasn’t using his walker, he was off to play bowls after the gym and was then heading to his social club.

The time he invested in exercise really gave him quality of life back.   

Exercises Post Axillary Dissection

This leaflet has been designed in conjunction with the CanMove – exercise for all cancer patients programme.

CanMove - exercise for all cancer patients are group exercise session run every week and are free to people with a cancer diagnosis or ongoing effects from cancer and its treatments.

What is axillary dissection?

Axillary dissection is a surgical procedure that opens the armpit to identify, examine or remove lymph nodes. Lymph nodes are small glands that are part of the lymphatic system, and filter fluids. These nodes are normally removed in order to determine the necessity of further treatment based on cancer cell spread.

Why do the exercises?

The aim of these exercises is to regain normal arm and shoulder movement after axillary node surgery or radiotherapy in the armpit area. It is important to move the arm so the tissues in your shoulder don’t get tight and cause pain.
The exercises should always be done slowly. You may feel some discomfort but they should not be painful. If you develop lasting pain for 30 minutes or more you might need to change the exercises by doing less of them or doing them more gently.
If pain continues consult your Exercise Physiologist or Nurse.

When do you start?
 
It is best to start these exercises as soon as possible after surgery, so if possible aim to start the day after your surgery. Always check with your Surgeon that they are happy for you to start.

Week 1       Start with the Level 1 exercises and if tolerated add in Level 2.
Week 2       Move on to doing Level 1 and then Level 2 exercises
Week 3       Move on to the Level 1 and then Level 3 exercises
Week 4+     If you have full range of motion start with gentle strength exercises
                   (Seek further advice about which exercises are suitable)

When do you need to seek further advice?
 
Before starting these exercises check with your Nurse or Surgeon that they are happy for you to start.

If you notice any excessive oozing, redness or severe pain please stop the exercises and consult your doctor or nurse as soon as possible.

If you are in doubt about the exercises and how to do them, or if you feel you are ready to progress, you can contact the CanMove programme for further advice or assistance.

How often should I do the exercises?
 
Start by running through them twice a day and if you can aim for 3 times a day. Pick times of the day when it will be easy for you to remember to do the exercises. When you first wake, after lunch and before bed can be good times to get in the habit of doing the exercises.
Always focus on having good technique during the exercises so if you notice you are tiring during the exercises and can’t do them properly it is better to have a break and try again later. Little and often is better than doing one long session.

Over time the exercises should start to become easier. If you notice you can regularly do an exercise fully you need to move on to one of the more advanced exercises in this book or consult with a healthcare professional to find the next step.

It is important to continually progress exercises so you get stronger. Continue to exercise even if symptoms or side effects have reduced.

If you have not regained full range of motion within 3 weeks or would like further assistance please contact your Nurse or Exercise Physiologist.

LEVEL 1

Shoulder Shrugs
Aim for 3 sets of 15 repetitions per day
Keeping your arms relaxed by your side
Shrug by lifting the shoulders up towards your ears.
Return to start.

Shoulder circles
Aim for 3 sets of 15 repetitions per day
Keeping your arms relaxed by your side
Shrug by lifting the shoulders up towards your ears then roll them backwards and down.
Return to start.

LEVEL 2
 
Back scratch
Aim for 3 sets of 15 repetitions per day
Slowly reach round behind your back to just under your shoulder blades.

 

Bent arm raises
Aim for 3 sets of 15 repetitions per day
Start with arms by your side, then lift fore arm so palms are touching the shoulder and elbows are pointing forwards.
Lift the elbows up to shoulder level and then return to the start.
 

Bent arm side raises
Aim for 3 sets of 15 repetitions per day
Start with arms by your side, then lift fore arm so palms are touching the shoulder and the elbows are out to your side.
Lift the elbows up to shoulder level and then return to the start.

LEVEL 3 – These can be done seated

Arm Lifts
Aim for 3 sets of 15 repetitions per day
Lie on your back and relax the shoulders.
Hold your hands together and then lift both arms up above your head.
Aim to get the arms as near to the ground as you can without arching your back.
Hold them in this position for 5 seconds then return them to the start position.

 


















Elbow pushes
Aim for 3 sets of 15 repetitions per day
Lie on your back, relax the shoulders and place your hands behind your head.
Gently push the elbows towards the floor. Hold for 5 seconds and return to the start position.
 

Snow angels
Aim for 3 sets of 15 repetitions per day
Lie on your back, relax the shoulders and place your arms by your side with the palms up.
Keeping the backs of the hands as close as possible to the floor. Slowly bring the arms up above your head.
Return the arms to the side by keeping them as close as possible to the ground.

Side wall climbs
Aim for 3 sets of 15 repetitions per day
Stand side on to a wall with your affected arm next to the wall.
Put the hand on the wall below shoulder level and gradually crawl the finger up the wall.
Aim to get higher with each attempt.
Hold for 5 seconds and return to the start position.

 



 
Wall Climbs
Aim for 3 sets of 15 repetitions per day
Stand a wall.
Put both hands on the wall, below shoulder level, and gradually crawl the finger up the wall
Aim to get higher with each attempt.
Hold for 5 seconds and return to the start position.

  















Once you have regained full range of motion in your shoulder area and your wound has healed it is beneficial to start some gentle strength exrcises. Strength exercises will help further improve and maintain function in the area.

Exercises following Lower Limb Node Dissection

What is lower limb node dissection?

Lower limb node dissection is a surgical procedure that opens the pelvic area to identify, examine or remove lymph nodes.  Lymph nodes are small glands that are part of the lymphatic system, and filter fluids.  These nodes are normally removed in order to determine the necessity of further treatment based on cancer cell spread.

Why do the exercises?

The aim of these exercises is to regain normal leg movement after node surgery or radiotherapy in the pelvic area.  It is important to move the leg, so the tissues around your hips don’t get tight and cause pain. 

The exercises should always be done slowly.  You may feel some discomfort but it should not be painful.    If you develop lasting pain for 30 minutes or more you might need to change the exercises by doing less of them or doing them more gently.

If pain continues consult your Exercise Physiologist or Nurse.

When do you start?

It is best to start these exercises as soon as possible after surgery, so if possible aim to start the day after your surgery.  Always check with your Surgeon that they are happy for you to start. 

Week 1        Start with the Level 1 exercises

Week 2-4     Move on to doing Level 1 and then Level 2 exercises

Week 4+     If you have full range of motion start with gentle
                   strength exercises
                   (Seek further advice about which exercises are 
                   suitable)

Perform the exercises in the order shown below.

When do you need to seek further advice?

Before starting these exercises check with your nurse or surgeon that they are happy for you to start.

If you notice any excessive oozing, redness or severe pain please stop the exercises and consult your doctor or nurse as soon as possible.

If you are in doubt about the exercises and how to do them, or if you feel you are ready to progress, you can contact the CanMove programme for further advice or assistance.

How often should I do the exercises?

Start by running through them twice a day and if you can aim for 3 times a day.   Pick times of the day when it will be easy for you to remember to do the exercises.  When you first wake, after lunch and before bed can be good times to get in the habit of doing the exercises.

Always focus on having good technique during the exercises so if you notice you are tiring during the exercises and can’t do them properly it is better to have a break and try again later.  Little and often is better than doing one long session.

Over time the exercises should start to become easier.  If you notice you can regularly do an exercise fully you need to move on to one of the more advanced exercises in this book or consult with a healthcare professional to find the next step.   

It is important to continually progress exercises so you get stronger.  Continue to exercise even if symptoms or side effects have reduced.

If you have not regained full range of motion within 3 weeks or would like further assistance please contact your Nurse or Exercise Physiologist.

LEVEL 1

Legs elevated

Before starting the exercises lie on your back with your feet elevated.

Toe curls and extension

Aim for 3 sets of 15 repetitions per day

Keeping your legs and ankles relaxed and elevated curl the toes towards the sole of your foot then extend them back as far as you can. Each foot can be done either together or one at a time.

Pointing Foot

Aim for 3 sets of 15 repetitions per day

Keeping your legs relaxed and elevated point your feet keeping the toes extended then flex them back as far as you can. Repeat.

Ankle Circles

Aim for 3 sets of 15 repetitions per day

Keeping your legs relaxed and elevated move the feet in clockwise circles trying to get the ankle working at its full range in every direction. 

Repeat anticlockwise.

Knee to chest

Aim for 3 sets of 15 repetitions per day. Hold for 5 seconds.

Keeping one leg elevated pull the other leg by the shin towards your chest and hold.

 LEVEL 2

Knee roll

Aim for 3 sets of 15 repetitions per day

Lie with both knees at 90 degrees and roll both knees to the left and right slowly. 

Keep the upper body still.

If you are comfortable you may lift the feet off the ground with the knees at 90 degrees and roll them to either side.

Leg Raise Aim for 3 sets of 15 repetitions per day. Keeping one leg elevated brace your stomach muscles and lift the other leg off, pause for a couple of seconds then lower it gradually.

Leg extension Aim for 3 sets of 15 repetitions per day Raise alternate legs, with knee bent at 90 degrees, one at a time while maintaining the contraction.

Side leg raise Aim for 3 sets of 15 repetitions per day Clench buttocks and raise top leg and return to start without touching the top leg on the ground.

WEEK 4+

Once you have regained full range of motion in your pelvic area and your wound has healed it is beneficial to start some gentle strength exercises.  Strength exercises will help further improve and maintain function in the area.