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.
Fitness
Surprising exercise secrets I learned from speaking to the fittest woman in history
Most people wouldn’t mind being a little bit fitter. But the fittest? That seems unreachable. However, many argue that all-conquering CrossFit athlete Tia-Clair Toomey is, by objective measures, the fittest woman in history.
Toomey, who is an ambassador for the fitness app Pliability, has won the CrossFit Games – an annual competition to find the fittest man and woman on earth – an unrivalled six times on the trot. In 2023, she paused to have her first child, then returned in 2024 and won the competition two more times.
In the midst of her winning streak, the 32-year-old also represented Australia in weightlifting at the 2016 Rio Olympics, won gold in the same event at the 2018 Commonwealth Games, qualified for the 2022 Winter Olympics in the two-woman bobsled and completed a Hyrox doubles race in a lightning-fast 54 minutes 24 seconds.
In short: Toomey is incredibly fit. The average person might not be able to emulate her superior fitness levels, and most don’t want to – they simply want to be fit and healthy enough to thrive in everyday life. You can, however, benefit from her insights about how to approach exercise.
Read more: Do these three things each week to be fitter than most Brits
1. Don’t let perfect be the enemy of good
“You can’t be perfect at everything all the time,” says Toomey. “Trying to juggle too many things at once is where many people come unstuck, because you’re stretching yourself too thin. So it’s important to find balance.”
The aim is not to do everything immaculately, but to identify the things that are truly valuable to you – these might be your workouts, work or supporting your family – and take pride in throwing the (cluttered) kitchen sink at them.
“Even if it’s just a simple workout, you can feel really fulfilled at the end of the day knowing you gave it your best,” Toomey says. “I think a workout is a perfect place to demonstrate this.”
Read more: Walking experts reveal the number of daily steps you need to boost health – and it’s not 10,000

2. Small changes make a big difference
Most people set themselves lofty fitness (and life) goals, then fall short of them. Just look at how many New Year’s resolutions have been discarded by the time February rolls around. Toomey suggests a more manageable approach.
“If you can get 1 per cent better every day, you can’t ask for any more than that,” she says. “It’s when you create excuses, stop challenging yourself and give up on pursuing your chosen goal that you stop progressing and plateau.”
She recommends making small tweaks to improve how you feel each day, rather than obsessing over a daunting target.
For example, you could head to bed 15 minutes earlier and keep your phone out of the bedroom, drink an extra glass of water, go for a walk after dinner or eat an extra portion of fruits and vegetables. Small changes soon accumulate to make a big difference over time.
“It takes a lot of pressure off people when they break their goals down like that,” Toomey says.
Read more: Study reveals the small changes to your diet, sleep and exercise that can add years to your life

3. Be open-minded
A lot of people use the phrase “exercise isn’t for me”. This is likely linked to a less-than-pleasant experience at some point in their past.
But exercise is a very broad umbrella, and Toomey urges people to remain open-minded when approaching it. This is something she learned firsthand.
“I enjoyed my first CrossFit session, but I didn’t really enjoy the coach, so I opted not to go back for two months,” she says. “Who knows where I would be now if I never went back because of that one interaction.”
Toomey ended up trying a different gym and finding a coach who was more passionate and encouraging. “Then I was hooked and fully committed,” she says.
For the everyday exerciser, this could mean changing the variables to make your workouts more fun. For example, if you don’t like how running feels, you could swap to a lower-impact activity like swimming or cycling. Or if you find solo strength training sessions boring, you might join an exercise class.
There is no need to suffer through a certain type of exercise just because someone told you it’s the best. Take a playful approach to your workouts and continue to experiment until you find something you enjoy. Because if your exercise plans are fun, you are far more likely to stick to them.
Read more: The easiest way to strengthen your entire body, according to this expert coach

4. Put your ego aside
If you have ever watched Toomey compete, it’s hard to imagine her struggling with anything exercise-related. But, she says, when she first started CrossFit training she found it difficult to hold a barbell overhead in a stable position.
This was exposed in a CrossFit workout named “Nancy” – five rounds of a 400-metre run and 15 overhead squats (squatting while holding a 30kg barbell overhead).
“I was a runner prior to CrossFit, so I would race ahead during the 400m runs, but then the overhead squats were very challenging for me,” Toomey says.
To learn the correct technique, she started by scaling back the overhead squats, using an empty barbell rather than one loaded up with weight. Then, as she improved, she gradually increased the load on the bar.
“It’s all about building confidence,” Toomey says. “Everyone wants to go from zero to 100, but you need to put your ego aside, take your time and put the work in to actually learn a movement. That is how people evolve.”
If Toomey is willing to scale back exercises to learn them properly, the rest of us should be too. That might mean starting with goblet squats rather than barbell squats, wall press-ups rather than full press-ups, or walking rather than running.
There are exercise options to suit all fitness levels – you just have to find the appropriate ones for you and gradually progress them over time.
Read more: Sitting all day wreaks havoc on your hips and spine – here’s how to stop that from happening

5. Variety is the spice of life
What is the one exercise Toomey wishes more people would do? She struggles to pick just one before prescribing variety.
“I just love seeing people active,” she says. “But constantly doing one thing will have a lot of impact on the body. I think it’s really important to have a variety of exercises. That way you’re constantly working different muscles, building broad fitness and stimulating the mind in different ways.”
This is good advice for any exerciser. The body works on a rough use-it-or-lose-it basis, so if you don’t use a joint or muscle to its full potential, it can weaken and tighten over time. Greasing the groove on a wide range of movement patterns is the best way to prevent this and stay mobile for decades to come.
Read more: After 50 you need to train smarter – the eight rules for strength training in midlife, according to experts

6. Commit to a plan
A one-off workout cannot transform your fitness, but a progressive exercise plan can. This is why Toomey recommends finding a structured programme to follow over a longer time period than just a single session.
“That is going to help you stay motivated, particularly if it’s linked to some sort of sports or fitness goal like your first 10K, triathlon or pull-up,” she says.
“It gives you something to aim for. Otherwise people think, ‘Oh, I’m just going to keep doing this forever,’ and it can feel quite overwhelming. Following a programme helps you build healthy habits that you integrate into your daily routine and actually stick to.”
Read more: I specialise in coaching people aged 40-plus – do these six things for immediate results

7. Look after yourself
Muscle isn’t built in the gym. What you do during your workouts triggers myriad positive physiological changes, but the actual adaptations happen while you are recovering.
For this reason, Toomey places a great emphasis on sleep and nutrition, prioritising quality fuel and recovery between her training sessions.
As part of this, she regularly uses a sauna, breathwork and completes a stretching and mobility protocol via the Pliability stretching app shortly after waking each day.
“I tend to wake up feeling a bit stiff and sore from the previous day,” she says. “But I want to walk into the gym feeling strong and confident. That stretching session acts as a form of meditation as well, helping with both mobility and mental clarity.”
Read more: Swap the gym for this trainer’s six-move kettlebell workout to build full-body strength at home
Fitness
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Fitness
How busy women can realistically hit 10 hours of exercise a week – and unlock the biggest health benefits
A huge new study published in the British Journal of Sports Medicine – which analysed the activity levels of more than 17,000 participants – suggests that to achieve a substantial (defined as greater than 30%) reduction in heart attack and stroke risk, adults should aim for 560–610 minutes of moderate-to-vigorous physical activity per week. That’s considerably more than the current 150-minute minimum guidelines for health benefits, so it’s perhaps unsurprising that only 12% of people in the study achieved it.
It’s not to say there wasn’t any reduction in risk for lower totals – just not what scientists class as ‘substantial’. And it’s also important to note that the study was observational, meaning it cannot prove any kind of direct link; just association. It could be the case, for instance, that participants were already healthier and fitter than the general population. Plus, neither sedentary time nor less vigorous exercise were measured.
When WH put the findings to personal trainers, they were very keen to stress that something is always better than nothing – and they also had some useful tips for giving it your best shot at getting those golden 10 hours in.
4 tips for adding more movement into your week
Olivia Horncastle is a personal trainer helping busy women and mums fit exercise into their schedules.
Habit stack
‘I get my busiest clients to habit stack movement – so every time they fill up a kettle, they might do some squats, when they brush their teeth, they might do a wall sit,’ says Horncastle. ‘Other small things like trying to take calls while walking, or stretching in front of the TV at night work well. It doesn’t need to always be adding a full workout – all small additions help.’
5-minute workouts matter
‘Even starting with a 5-minute bodyweight circuit and building that up over time starts a habit – something is always better than nothing.’
Set yourself daily or weekly challenges
That might be trying to do 50 squats throughout the day, increasing your steps by parking further away at the shops, or taking the stairs instead of the lift, says Horncastle.
Tie exercise into your social plans
‘Instead of drinks with friends, I might suggest we go for a walk and grab a drink at the end, or try a new Pilates class instead of brunch etc.’
What type of exercise should you prioritise?
Michael Baah is a strength coach and oncology exercise specialist working with busy professionals, athletes and people recovering from cancer. ‘All that protection for your heart works best if you maintain your muscle mass, too,’ he cautions. ‘If you walk a lot but never do any strength work, you actually lose muscle faster, and after age 30, women naturally lose about 1% of their muscle every year unless they use it.’
Baah recommends doing three 45-minute strength sessions a week, using simple, compound moves (think: squats and deadlifts) that work your whole body. ‘You should finish each exercise feeling like you could maybe do just one or two more reps – this is the safe and effective method we use in clinics.’
‘The rest of your target comes from walking,’ adds Baah. ‘Just 40-50 minutes of brisk walking every day gets you there easily. Add a swim, yoga or dance class once a week if you like, and you’re all set.’
But don’t forget to adequately fuel, notes Baah. ‘Once you’re moving regularly, food matters, too. You need enough protein every day to help your body get stronger – aim for 1.4-1.8g for every kg of bodyweight. Without this, you do the work but miss out on the best results.’
If you’re more deterred than motivated by the recent study results, Horncastle wants to leave you with a few words. ‘Start small and slow, whether that’s one workout a week and building up, or starting with a few small walks – that’s how you achieve long-term, consistent change.’
‘And don’t compare yourself – who cares if Susan does hot yoga five times a week? She isn’t living your life. You need to find what works for and benefits you, but is realistic, too.’
One of our most frequently asked questions here at Women’s Health? How to build muscle and burn fat at the same time. So, we asked superstar trainer Oyinda Okunowo exactly how to do it. In this 4-week plan – created exclusively for Women’s Health COLLECTIVE members – you’ll get the workouts and nutrition guidance needed to help you on your way to better body composition. Tap the link below to unlock 14 days of free access to Oyinda’s plan and start training today.
Get the plan
Hannah Bradfield is a Senior Health and Fitness Writer for Women’s Health UK. An NCTJ-accredited journalist, Hannah graduated from Loughborough University with a BA in English and Sport Science and an MA in Media and Cultural Analysis. She has been covering sports, health and fitness for the last five years and has created content for outlets including BBC Sport, BBC Sounds, Runner’s World and Stylist. She especially enjoys interviewing those working within the community to improve access to sport, exercise and wellness. Hannah is a 2024 John Schofield Trust Fellow and was also named a 2022 Rising Star in Journalism by The Printing Charity. A keen runner, Hannah was firmly a sprinter growing up (also dabbling in long jump) but has since transitioned to longer-distance running. While 10K is her favoured race distance, she loves running or volunteering at parkrun every Saturday, followed, of course, by pastries. She’s always looking for fun new runs and races to do and brunch spots to try.
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