Breast Cancer Prehabilitation: How to Prepare Your Body Before Treatment Begins

For many people newly diagnosed with breast cancer, the weeks before treatment can feel like a waiting period. Ashley Perry, P.T, D.P.T., cancer rehab navigator at Brooks Rehabilitation, sees that window as an opportunity. For Breast Cancer Awareness Month, Perry spoke with The Educated Patient about prehabilitation, an approach to preparing the body before surgery, chemotherapy, radiation or other treatment begins.

Perry explained that each part of a breast cancer treatment plan carries some risk to physical function, from fatigue to shoulder problems to lymphedema, so the goal is to raise function before it starts to decline. “The stronger you are going into something, the stronger you are coming out of it,” she said.

Your Desk and Pillow May Matter More Than You Think

Many of Perry’s patients with breast cancer are in their 30s, 40s and 50s and plan to keep working through treatment, which makes the workspace a practical place to start. Desk work and phone use pull the shoulders forward. That posture may not bother a healthy person, but it can cause significant pain after surgery. “Anything forward causes impingement of the shoulders,” Perry said.

Her team gives patients ergonomics handouts and sometimes asks them to photograph their workspace to find adjustments. They also address sleeping posture and sleep hygiene and strengthen the back muscles that stabilize the shoulder. When patients aren’t ready to exercise, Perry said, changing their environment can still make it safer.

Baseline Measurements Help Catch Lymphedema Early

Lymphedema risk depends largely on the treatment plan, with more extensive surgery, additional treatments and radiation each adding a layer of risk. Perry stressed that patients shouldn’t avoid needed treatment, but should understand the risks so problems can be caught early.

Her clinic sorts patients by risk based on treatment, lifestyle, age and body type. Before surgery, therapists record baseline strength, range of motion and arm and chest measurements, then repeat them three to four weeks after surgery and at later points in care. If a problem begins to develop, they treat it before it becomes severe.

One factor that patients can influence is body mass index. Perry said she now sees patients gain weight during treatment more often than lose it, due to steroids given with chemotherapy, hormonal changes and treatment-induced menopause. Healthy eating and staying active are the best ways to limit that risk.

Moving Through Fatigue

Fatigue makes many patients want to stop moving, but Perry said the research is clear that “the best medicine for cancer-related fatigue is exercise activity,” with medications having minimal effect by comparison. She suggests finding an enjoyable activity, such as walking, gardening or swimming, and gradually raising its intensity.

How to Ask Your Doctor for a Rehab Referral

Perry said oncologists are focused on treating the cancer, so rehab may not come up unless patients raise it. Telling the doctor that you want to maintain your strength and mobility during treatment, and asking for a referral to an oncology rehab provider, is often enough.

If a doctor says therapy isn’t needed, Perry suggests tying the request to a specific activity, such as reaching into a cabinet, styling your hair or getting back to pickleball. As a last step, patients can politely ask whether there’s a medical reason it wouldn’t be safe. For most patients, she said, there isn’t.

Doctors don’t always know which therapists specialize in patients with breast cancer, so Perry encourages patients to vet providers. They can ask whether a therapist treats patients with breast cancer and what training they have, since most physical therapy programs teach little about cancer. If rehab helps, she asks patients to tell their oncologist, which she said often carries more weight than hearing it from a therapist.

Shared Waiting Rooms Become Support Networks

Long medical journeys tend to focus patients on what they can no longer do. Perry said connecting with others in similar situations shifts attention toward what’s still possible and can offer practical workarounds. “Humans are not meant to do the world alone,” she said. At her clinic, patients with breast cancer are often scheduled around the same time, and many become friends after meeting in the lobby.

Community also helps patients focus on what they can control, like choosing a healthy lunch or going to a yoga class, when so much of treatment is out of their hands.

Practical Ways Loved Ones Can Help

Family and friends can take over tasks like cooking or laundry so a patient’s limited energy can go toward a walk, a workout, or a support group, helping them not feel guilty about prioritizing themselves. Rides to classes or events help, too. Perry also recommended going along to appointments, since high-stress visits make it hard to retain information, and a second set of ears can make a real difference.