Fitness
Working Out After A Mastectomy Can Help Patients Heal. So Why Aren’t Doctors Suggesting It?
Kara Hennelly always took pride in staying active. In her 20s and 30s, she trained for and ran two half-marathons. In her 40s, as a busy pediatric emergency medicine physician in St. Louis and mom of three, she continued to prioritize working out, carving out time to exercise five days a week, mixing strength-training and spin sessions on her Peloton.
“After turning 40, I wasn’t so much focused on being a certain weight but feeling good about myself and feeling strong—that I could handle what life throws at you,” she says of her regimen.
That mental strength would become just as vital as her physical strength. In January, the then-44-year-old received a diagnosis that would change her life: She had hormone-positive, HER2 negative stage 3 breast cancer, which was discovered during a routine mammogram.
“When I saw the word ‘metastatic’ on my pathology report, I thought I was dying—that it had spread everywhere,” Kara recalls. “In truth, it is metastatic locally, meaning in my lymph nodes, but breast cancer is a whole other medical world to me.”
Kara opted for a double mastectomy, preceded by 16 weeks of chemotherapy. In the days and weeks leading up to her surgery, Kara tried to stay active. But with the physical ups and downs of chemotherapy, her routine certainly wasn’t as rigorous as it had once been. She did three days a week of “scaled down” strength-training, trying to be gentle with her body and taking as much rest as she needed.
So, by the time she was two weeks post-op from her mastectomy, Kara was itching to tie up her sneakers and hit the street. The only problem: She’d been given very little guidance about how to safely start reincorporating exercise.
“I was discharged the same day as my surgery, and my surgeons had me meet with a physical therapist before I left. They gave me a piece of paper with exercises you would tell your grandma to do!” Kara says with a laugh. “‘Put your arms to the side and do tiny arm circles!’”
At home, Kara tried doing her own research. “I was Googling the timeframes for certain activities: When can I run? When can I lift three-pound weights? I would’ve loved to have just a little more guidance on what to do to start building my strength back up.”
Meet the Experts: Marcella Fornari, DO, is a breast oncology surgeon at Atlantic Breast Associates in New Jersey. Sam Ciacci, PA-C, CSCS, a New York-based fitness specialist and founder of Bell Mechanics.
If a literal doctor isn’t sure how to get back into fitness after a mastectomy, what’s the average woman to do?
The Big Exercise Question Mark
The road to recovery after a mastectomy is different for every woman—and is heavily influenced by the type of reconstructive surgery she’s undergone, according to Marcella Fornari, DO, a breast oncology surgeon at Atlantic Breast Associates in New Jersey.
If a woman chooses to go flat (a.k.a. not have implants), that’s typically the “easiest” surgical option in terms of recovery, Dr. Fornari says.
The next level up would be a mastectomy with implants, which is typically a four- to six-hour surgery, and often entails inserting temporary implants (called expanders). Over time, this creates space for the actual implants, which will be swapped in after about three months. Most patients will be sent home the day of their surgery.
The third option, which has the longest recovery time, is a DIEP flap reconstruction, which uses the patient’s own tissue (typically from the abdomen) to form the implants. That surgery typically takes eight to 10 hours and has a hospital stay of one to three nights.
Once discharged, a patient is usually able to move around and care for themselves—within reason, says Dr. Fornari. “What I tell my patients is, you’re fully functional in that you’re going to dress yourself. You can go to the bathroom by yourself. You can eat. But you’re not doing anything strenuous. You’re not reaching up high for anything. You’re not scrubbing floors. You’re taking it easy.”
During recovery, some women may work with a physical therapist to begin gently gaining mobility and flexibility in their upper body, as many report feeling tight after surgery.
“What people with the expanders will tell me is it feels like they did a thousand pushups, or it feels like they have two bricks on their chest,” Dr. Fornari says. “It feels tight and makes you want to hunch over to keep those muscles on top of the implant from being stretched out.”
Typically, about four weeks post-op, women will be cleared to resume exercising their upper body. But what that should look like remains under-studied.
“I don’t know anything in the literature that even looks at that,” Dr. Fornari says of how to return to exercise post-mastectomy. “Even in our training, it’s not like there’s anything in our textbooks or in fellowship that we focused on.”
This lack of knowledge leaves women vulnerable—and at potential risk of injury. If she goes too hard too fast at the gym, she could, for instance, pop a stitch, resulting in a hematoma (a.k.a. a pooling of blood) that could necessitate returning to the operating room. (Though this is rare, says Dr. Fornari, it is something to be mindful about.) Less dramatically, she could be left with general swelling or soreness.
Dr. Fornari’s blanket advice: “You just have to listen to your body. You’re not going to go back in and go straight back to where you were. Ease yourself in, and if it doesn’t feel good, then step back and work yourself up again.”
Trial and Error Leads to Epiphany
Intuitively, Kara began following a similar approach as she got back into running.
“I started walking three days after surgery—just up the street and back, very slow,” she says. She waited until her four-week post-op check-in to pick up her pace to something resembling a run.
“I was finally like, I’m just going for the run,” she says. “I think it was a 16-minute mile. I could have walked it faster, but it just felt good to move.”
Kara kept building up her stamina and distance. One day she was able to run 5k without stopping. Then she quickened her pace, notching 15-minute miles instead of 16.
“I’ve just been slowly adding, going up to four miles or trying to work on going a little faster,” she says.
In the strength-training department, she’s taken a similar trial-and-error approach. Right now, a tricep dip—which had been part of her typical routine prior to surgery—seems intimidating, so she’s swapped in tricep kickbacks instead. Bicep curls with 15 lb. dumbbells feel good, so she’s doing those too. “I just want to feel like I have my strength back,” Kara says.
That need to reclaim her strength and feel at home again in her body is a familiar one to Sam Ciacci, PA-C, CSCS, a New York-based fitness specialist and founder of Bell Mechanics. Sam underwent her own double mastectomy in February 2023, following a stage one breast cancer diagnosis.
And just like with Kara, Sam was sent home with scant information about how to get back into fitness following her surgery.
“I was told for the first two weeks, don’t lift anything heavier than five to 10 pounds and don’t go overhead,” she says. “Then, once I got the clearance at about four to six weeks, I could return back to activity. That was it.”
Sam heard similar stories on her breast cancer message board, which planted the germ of an idea. As a personal trainer with a background as a clinician, maybe she should be the one to create a program for women just like her.
“There’s no guidance,” Sam says. “I’m not accepting the [recommended] wall walks or little range-of-motion exercises. I don’t think that’s enough.” After all, she reasons, the shoulders and arms are connected to the rib cage, so it doesn’t make sense to work them in isolation. Instead, Sam incorporates moves that mobilize the entire torso.
As she began working weights back into her regimen, Sam took copious notes of what worked and what didn’t. After a year of tinkering, tweaking, and tracking, a structured fitness program emerged, which she called HER Journey. The 12-week program, which incorporates both strength and cardio, takes women through three progressive four-week phases, each building towards the next.
The healing phase focuses on mobility and range of motion. “You’re not having to lift heavy weights,” Sam says. “You’re just doing reps and getting the volume in. You’re getting back into your squats, into your presses.”
Next comes rebuild, which begins focusing more on strength-training. “That is more loading—or decreasing the reps and increasing the weight,” she says.
Finally, comes empowerment, which adds explosiveness to the movements. “The new exercises that they learned, we’re going to do it with heavy weight and we’re going to work on doing it fast,” she says.
The program is designed to be done with a handful of equipment like bands, dumbbells, kettlebells, and medicine balls. And while it’s meant to take three months, Sam stresses that there’s a lot of flexibility built into the plan. If a woman feels like she needs an extra week or two in the healing phase, for instance, she can take it. The program is about building both strength and confidence.
“I really want to educate through this program, so women feel empowered and confident to know, I can lift this weight, if I do it safely and do it correctly based on how Sam’s teaching it—and I can go heavier,” Sam says. “That is when the transition from a fragile to an anti-fragile mindset begins to happen.”
And a woman can feel like her body is, finally, once again her own. One user who tested Sam’s program said that the plan made her feel more confident.
“The program was easy to follow and progressed at a speed that didn’t feel overwhelming but was still challenging,” she says. “I was so happy to see the difference it has made in just one week and I’m excited to continue this journey.”
Amy Wilkinson is an entertainment editor who also specializes in health and wellness. When not editing or writing, she can be found teaching Pilates as a comprehensively certified instructor.
There’s no bad time to take a more active interest in your health, but the new year, for lots of us, feels like a fresh start. Maybe you’re planning to sign up for a 10k or finally have a go at bouldering, eat a bit better or learn to swing a kettlebell. Maybe you want to keep up with your grandkids — or just be a little bit more physically prepared for whatever life throws at you.
To help things along, Guardian Live invites you to a special event with public health expert Devi Sridhar, journalist and author Mariella Frostrup, and health and fitness columnist Joel Snape. They’ll be joining the Guardian’s Today in Focus presenter Annie Kelly to discuss simple, actionable ways to stay fit and healthy as you move through the second half of life: whether that means staying strong and mobile or stressing less and sleeping better.
To make the whole event as helpful as possible, we’d love to hear from you about what you find most challenging — or confusing — when it comes to health and exercise. What should you actually be eating, and how are you going to find the time to make it? What sort of exercise is best, and how often should you be doing it? Is Pilates worth the effort — and should we really all be drinking mugfuls of piping hot creatine?
Whether your question is about exercise, eating, or general wellness, post it below and we’ll put a selection to our panel on the night.
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Jan 6 (Reuters) – The U.S. Food and Drug Administration said on Tuesday that it will limit regulation of wearable devices and software designed to support healthy lifestyles, issuing new guidance to clarify its regulatory approach.
The guidance, along with comments from FDA Commissioner Marty Makary, adds to existing policy that classifies low-risk wellness tools, such as fitness apps and activity trackers that encourage exercise, as non-medical devices exempt from stringent regulation, provided they do not make claims related to disease diagnosis or treatment.
Sign up here.
“We have to promote these products and at the same time, just guard against major safety concerns,” Makary said in an interview with Fox Business about artificial intelligence software such as ChatGPT, adding that “if people are looking up a symptom on an AI-based tool, let’s have that conversation when they come in to see their doctor or do a virtual visit.”
“We want to let companies know, with very clear guidance, that if their device or software is simply providing information, they can do that without FDA regulation,” Makary told Fox Business.
“The only stipulation is if they make claims of something being medical grade … like blood pressure measurement. We don’t want people changing their medicines based on something that’s just a screening tool or an estimate of a physiologic parameter.”
The agency also sent out a broader warning to consumers about the risks posed by unauthorized devices.
Reporting by Puyaan Singh in Bengaluru; Editing by Peter Henderson and Sherry Jacob-Phillips
Our Standards: The Thomson Reuters Trust Principles.
January is peak season for fitness sales, with major discounts on gym memberships, fitness trackers, activewear and beginner-friendly exercise equipment. No wonder — it is a perfect opportunity for retailers to clear inventory and capitalize on all those “New Year, New You” resolutions.
For an exercise novice, however, this endless sea of workout gear and gadgets can be downright overwhelming. But if that is you, do not worry! You do not need a gym’s worth of exercise equipment, a high-end Garmin watch or a professional athlete’s wardrobe to begin. Starting simple is often the most effective strategy for a long-term lifestyle change — not to mention that it is much easier on the wallet.
Here’s what to buy (and what to skip) to launch your fitness journey in strategic fashion — and save yourself some money in the process.
Anna Gora is a health writer and reviewer at Live Science, as well as a highly experienced personal trainer, nutritionist and fitness coach. Over the years, she has helped numerous exercise beginners kickstart their fitness journey, and is always on the lookout for versatile, easy-to-use fitness gear to recommend to her clients. At Live Science, Anna has written a guide to the best exercise equipment for beginners and is a significant contributor to our round-ups of the best fitness trackers, cardio machines and running shoes.
The essentials: Gear that gets you out the door
Before investing in a premium running watch or one of the best rowing machines, focus on the basics. Buying the right footwear and workout clothing is an essential first step on your fitness journey. This is not about fashion; it is about comfort and safety.
Footwear: Your most important investment
This is your non-negotiable purchase. Appropriate footwear helps you maintain good foot health, reduces the risk of injuries and boosts your overall well-being, according to a 2024 review published in the journal Applied Sciences. Choose shoes that are stable, comfortable to wear and suitable for your intended activities.
That said, do not get bogged down in premium brands and ultra-specialized shoes. Start with a quality pair of all-purpose trainers or cross-trainers. The best beginner-friendly options have a good balance of cushioning and stability for a mix of gym workouts, walking, jogging and low- to moderate-intensity aerobics. Good looks are just the cherry on top.
Workout clothing: It is all about comfort
Workout clothing should help you withstand the demands of intense exercise, not actively impede your attempts to get fit. Look for synthetic, moisture-wicking fabrics like polyester or spandex — they help regulate body temperature and prevent sweat from lingering on your skin, while cotton, for example, holds sweat and can cause chafing.
Then, focus on freedom of movement. A well-designed piece of activewear will allow for freedom of movement and not slip off or irritate your skin during intense workouts. Start with a few core pieces to build a rotation: a few tops and bottoms, several pairs of sports socks and, for women, a couple of good-quality sports bras.
Again, there is no need to invest in premium brands and highly specialized activewear; affordable lines from major retailers work perfectly fine. Comfort here is key — if you feel good, you are more likely to get moving.
The best retailers for finding deals on beginner-friendly workout clothing:
- Puma: Now up to 60% off on Puma Essentials and Puma Elevated Essentials
- Adidas: End of Year Sale with up to 60% off on shoes and activewear
- Reebok: End-of-Season Sale with up to 50% off selected styles
- CRZ Yoga: A budget alternative to Lululemon, now with up to 81% off on yoga pants, leggings, tops and jumpsuits
- Target’s All in Motion: A highly-rated line of affordable workout clothing, running shoes and exercise equipment
- Amazon’s Aurola: Soft and versatile workout tops and bottoms for under $35
The home-gym starter pack: Simple, space-savvy exercise equipment
While you may be tempted to splash out on a premium treadmill or super-smart exercise bike, hold off on the big purchases for now. You can build remarkable strength, endurance and mobility with basic, space-savvy equipment too, and at a much lower cost. A yoga mat, adjustable dumbbells and resistance bands, for example, are very beginner-friendly, offering maximum versatility with a minimal footprint.
If you are not entirely sure how to use them, look up beginner-friendly home exercise video tutorials or join an online fitness class. January fitness sales are not just about physical gear — many fitness apps and services are discounted, too, or offer free taster sessions. There is also plenty of good-quality content that is entirely free of charge.
Fitness trackers: A source of useful data and exercise advice
A well-chosen fitness tracker can provide a lot of valuable feedback and positive reinforcement in the early stages of your fitness journey. Counting your daily steps, tracking an active workout and reviewing your past activities can help you make more sense of your workouts and general progress.
Training by “feel” is hard for beginners, and continuous heart rate measurements provide objective data on your efforts. It helps you understand zones: are you in a moderate, fat-burning zone or pushing into high intensity? This ensures your easy days are genuinely promoting recovery and your hard days are truly effective.
Moreover, the goal-setting and “closing your rings” features (a visual representation of your progress towards your daily exercise goals) leverage gamification, and this in itself can be a powerful motivator. Not to mention, many fitness trackers come in handy outside of the gym or running track, too.
However, do not get swayed by the trends here. A basic Fitbit, Garmin or Apple Watch SE will track steps, heart rate, sleep, and active minutes just as well as the more advanced and expensive models. They also tend to be more beginner-friendly in terms of their user interfaces and the language they use to describe your fitness stats.
What NOT to buy (right away)
The allure of a shiny new machine is strong, but impulsive buys often become expensive clothes racks. Here are some tips on how to avoid costly mistakes as an exercise beginner.
Hold off on major equipment. Do not start by buying an expensive treadmill, elliptical, or full home-gym system. Use your foundational gear or a gym trial for one month at least. If you have consistently stuck with your routine, then research what machine would best suit the activities you have genuinely enjoyed.
Avoid over-specialization. You do not need cycling shoes until you are sure indoor cycling is your go-to sport. Similarly, you do not need Olympic weightlifting shoes for general strength training. Let your sustained interest guide niche purchases, not the other way around.
Beware of fads and “quick fix” gadgets. If a product promises insane results with minimal effort, it is likely selling a fantasy. Sustainable fitness is built on consistent effort, not electrical muscle stimulators, ab belts or dodgy supplements. Stick to the good-old healthy diet and regular workouts, and you will be primed for success in 2026.
The bottom line
The goal of your initial purchases is not to equip a pro athlete from the get-go, but to minimize barriers to exercise and help you establish healthy habits. Every item should make it easier to say “yes” to your workout and harder to make an excuse.
This New Year, invest first in the basics that support consistency. Let your proven dedication over weeks and months, not your initial January enthusiasm, guide your future investments. Your journey starts not with the fanciest gear, but with the first step taken in the right shoes.
We hope that our list will help you do just that.
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