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Working Out After A Mastectomy Can Help Patients Heal. So Why Aren’t Doctors Suggesting It?

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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.

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Courtesey

Kara Hennelly’s breast cancer was discovered during a routine mammogram in 2024.

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.

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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.

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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.”

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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.”

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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.

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courtsey photo
Sam Ciacci, a New York-based certified strength and conditioning specialist and founder of Bell Mechanics, underwent a double mastectomy in February 2023, following a stage one breast cancer diagnosis.

“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.”

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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.

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“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.”

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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

How the 3-3-3 Rule Helped Me Stick to an Exercise Routine

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How the 3-3-3 Rule Helped Me Stick to an Exercise Routine

If you’ve ever started a new workout routine with the best intentions only to find yourself skipping sessions by week two, you’re not alone. I’m the type to get trapped in the same cycle of burnout, where I go hard for a couple of weeks, feel exhausted, feel guilty, and repeat. For me, what finally broke that cycle wasn’t a new gym membership or a fancy fitness app, but a simple scheduling hack: the “3-3-3 rule.” I’d seen this rule applied it to general productivity, and all the same principles can apply to your fitness habits, too. Here’s how you can use the 3-3-3 rules to structure your workouts and create a habit that sticks.

What is the 3-3-3 rule?

The 3-3-3 “rule” (or “method,” or “gentle suggestion”) is essentially a weekly workout framework built around three types of movement, each done three times per week:

  • Three strength training sessions. This includes lifting weights, bodyweight circuits, resistance bands, whatever builds muscle and challenges your body.

  • Three cardio sessions. This includes running, cycling, swimming, jump rope, a dance class—what counts as “cardio” is up for debate, but here, I think of it as anything that gets your heart pumping.

  • Three active recovery days. This includes light walking, yoga, stretching, foam rolling, and so on.

And yes, I realize this math adds up to nine intentional days of movement across a seven-day week. Here’s the thing: You do double duty some days, or skip workouts here and there, or adjust to a nine-day cycle, because the point isn’t rigid scheduling. The point is rhythm over a strict structure. For me, the 3-3-3 rule provides a sense of momentum that’s flexible enough to fit into real life, but consistent enough to actually stick to.

Why the 3-3-3 rule works for me

Before I get into how the 3-3-3 rule helped me specifically, let’s talk about why so many workout plans fall apart in the first place. I believe most of them make two classic mistakes. The first is doing too much, too soon. You go from zero to six days a week at the gym, you get burnt out, and the whole thing unravels. The second mistake is having no real structure at all—just vague intentions, like “I’ll work out when I can,” which never materializes into anything real for a lot of people.

For me, the 3-3-3 rule solves both of those problems. It gives me enough structure to build habit and momentum, but not so much intensity that my body and brain feel overwhelmed. I personally adore running, but I struggle to motivate myself to lift weights; the 3-3-3 rhythm here helped me find a middle ground between those two workouts. When I know I have three strength sessions to hit in a week (or nine-ish day cycle), I can look at my calendar and find three slots without too much drama or dread.

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There’s also plenty of breathing room built into the plan, which was the biggest game changer for me. I used to have the (toxic) thought that my rest days were wasted days, which is a mentality that led to either overtraining or complete inactivity with pretty much no middle ground.

Plus, there’s something psychologically satisfying about the number three. I know and love the rule of threes in photography, comedy, survival tips, and all over the place.

How to make a 3-3-3 workout schedule work for you

The 3-3-3 rule has a ton of wiggle room for customization. Here are some ideas for how you can approach it:


What do you think so far?

For strength days, pick a format you actually enjoy. That might be a full-body circuit, a push/pull/legs split, or a class at your gym. (Boxing, anyone?) Your focus on these days should be a progressive challenge—push yourself, yes, but don’t obliterate yourself.

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For cardio days, variety helps. Mix a longer, easier effort with a shorter, more intense session (like a 20-minute interval run). I know I’m biased, but cardio really shouldn’t feel like punishment.

For recovery days, resist the urge to “make them count” by sneaking in extra work. The whole point is to let your body consolidate the gains from your harder days. Walk, stretch, breathe, and trust the process.

Another practical tip: Pick a night to map out your 3-3-3 week ahead of time. You’ll probably find that the week arranges itself pretty naturally once you’re looking for those nine windows.

The bottom line

As always, consistency should always be your priority in fitness. If you’ve been struggling to find a rhythm, if your past workout plans have always fizzled out around week three, give the 3-3-3 rule an honest four-week try. Maybe start with a 1-1-1 month! After all, the 3-3-3 rule isn’t a hack to totally transform your physique, but I do think it can provide something way more valuable. Finding a routine that works for you—like the 3-3-3 rule works for me—is the first step to make exercise a reliable, sustainable part of your life.

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I’m a running coach — I’ve just tested shoes actually designed for women’s feet, and they’re a total game changer

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I’m a running coach — I’ve just tested shoes actually designed for women’s feet, and they’re a total game changer

Why you can trust TechRadar


We spend hours testing every product or service we review, so you can be sure you’re buying the best. Find out more about how we test.

QLVR ENDVR: Two minute review

Most running shoes feel familiar for a reason: the formula has barely changed in millennia. We have archaeological evidence of shoes being fastened with “shoelaces” as far back as around 3,500 BC, yet the basic lace-up running trainer remains the default.

QLVR (pronounced “clever”) set out to challenge that. Its debut shoe, the ENDVR, is a laceless “running slipper” built around a women-specific mechanical structure, with a slip-on Wing Fit system inspired by the way a bird’s wing opens and closes around movement.

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Mere minutes of daily vigorous exercise can cut your risk of 8 diseases | CNN

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Mere minutes of daily vigorous exercise can cut your risk of 8 diseases | CNN

Move more. Sit less. For many years, that’s been accepted guidance for people wanting to get healthier.

Now that message is getting refined, with a growing body of research suggesting that certain types of movements may be more beneficial than others when it comes to health benefits.

The intensity of your exercise may matter as well. A new study published in the European Heart Journal found that a small amount of vigorous activity may be linked to lower risk of eight different chronic diseases.

The findings raise questions about why intensity matters and how people can incorporate more intense exercise routines into everyday life. To better understand the study’s implications, I spoke with CNN wellness expert Dr. Leana Wen, an emergency physician and clinical associate professor at George Washington University. She previously served as Baltimore’s health commissioner.

Before beginning any new exercise program, consult your doctor. Stop immediately if you experience pain.

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CNN: What did this study examine about exercise and its relationship to chronic disease?

Dr. Leana Wen: This investigation looked at how the intensity of physical activity is related to the risk of developing a range of chronic diseases. Researchers analyzed data from two very large groups in the UK Biobank, which is a long-term health study in the United Kingdom that tracks medical and lifestyle information from hundreds of thousands of participants. One group included about 96,000 people who wore wrist activity trackers that objectively measured their movement, and the other included more than 375,000 people who self-reported their activity.

The researchers followed participants over an average of about nine years and examined the development of eight conditions: major cardiovascular events, atrial fibrillation, type 2 diabetes, immune-related inflammatory diseases, fatty liver disease, chronic respiratory disease, chronic kidney disease and dementia, as well as overall mortality.

The key finding was that the proportion of activity done at vigorous intensity mattered. People who had more than about 4% of their total activity classified as vigorous had substantially lower risks of developing these conditions compared with people who had no vigorous activity at all. The numbers were stunning, with the participants having the following results:


  • 63% lower risk of dementia,

  • 60% lower risk of type 2 diabetes,

  • 48% lower risk of fatty liver disease,

  • 44% lower risk of chronic respiratory disease,

  • 41% lower risk of chronic kidney disease,

  • 39% lower risk of immune-mediated inflammatory diseases,

  • 31% lower risk of major cardiovascular events,

  • 29% lower risk of atrial fibrillation, and

  • 46% lower risk of death from any cause.

These results are amazing. Imagine if someone invented a medication that could reduce the risks of all these diseases at once — it would be very popular! Crucially, even people who exercised a lot still benefited if the proportion of time they spent doing vigorous physical activity was increased. Conversely, people who were relatively inactive also benefited from adding just a little bit of higher-intensity exercise to their daily routines.

CNN: What counts as “vigorous” physical activity?

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Wen: Vigorous activity is generally defined as exercise that substantially raises your heart rate and breathing. A simple way to gauge it is the “talk test.” If you can speak comfortably in full sentences while exercising, you are likely in the low to moderate range. If you are so out of breath that you can only say a few words at a time, that is vigorous.

Running, cycling, lap swimming or climbing stairs quickly could count. But this also depends on people’s baseline fitness. For some individuals, taking longer strides with walking can be vigorous exercise. Others who are already fairly fit would need to do more. It’s also important to remember that vigorous activity doesn’t have to be in the context of a structured exercise plan. Short bursts of effort in daily life, such as rushing to catch a bus or carrying heavy groceries upstairs, can also qualify if they raise your heart rate and make you breathless.

CNN: Why might higher intensity exercise provide additional health benefits?

Wen: Higher intensity activity places greater demands on the body in a shorter period. This type of movement can improve cardiovascular fitness, increase insulin sensitivity and support metabolic health more efficiently than lower-intensity activity alone. Some studies have also linked vigorous activity with cognitive benefits.

Greater intensity may have distinct benefits across different organ systems. The researchers found that some conditions, such as immune-mediated inflammatory diseases, appeared to be more strongly linked to the intensity of activity than to the total amount. On the other hand, type 2 diabetes and kidney disease were influenced by both how much activity people did and how intense it was. Why this is the case is not yet known, but intensity appears to have a significant impact across diseases affecting multiple organs.

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CNN: How much vigorous activity do people need?

Wen: The threshold for people seeing a benefit appears to be relatively low. The researchers found that once people reached more than about 4% of their total activity as vigorous, their risk of developing chronic diseases dropped substantially.

To put that into practical terms, we are not talking about professional athletes dedicating their lives to hours of high-intensity training. Everyday people may see benefits from just doing a few minutes of vigorous effort daily.

CNN: How can people realistically incorporate vigorous activity into their daily routines?

Wen: One helpful way to think practically is that vigorous activity does not have to happen all at once. It can be accumulated in short bursts throughout the day.

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People can take the stairs instead of the elevator and do so at a faster pace than usual. When they are heading to work, they can add some speed walking. They can park farther away when grocery shopping and walk briskly while carrying groceries.

Structured exercise also can incorporate intervals where people alternate between moderate and more intense effort. If you’re swimming laps, you can warm up at a more leisurely pace, then do a few laps at a faster pace, then again at a leisurely pace and repeat. This suggestion applies to any other aerobic exercise: Aim for multiple intervals of at least 30 seconds to a minute each where your body is working hard enough that you feel noticeably out of breath.

CNN: What about someone who is older or has mobility issues?

Wen: Not everyone can or should engage in high-intensity activity in the same way. Vigorous activity is relative to that person’s baseline. For someone who is not used to exercise, even a short period of slightly faster walking or standing up repeatedly from a chair could be considered high intensity. And not everyone may be able to walk. In that case, some exercises from the chair can have aerobic benefits.

Individuals who have specific medical conditions should consult with their primary care clinicians before embarking on a new exercise routine. People with mobility issues also may benefit from working with a physical therapist who can help to tailor exercises appropriate to their specific situation.

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CNN: What is the key takeaway for people trying to improve their health?

Wen: To me, the main takeaway from this study is that it’s not only how much total exercise you get but also how hard you push yourself that matters. And you don’t have to have a lot of high-intensity exercise: Adding just a little has substantial health benefits across a wide range of chronic health conditions.

At the same time, exercise needs be practical. People should look for opportunities to safely increase intensity in ways that fit their daily lives. The most effective approach to physical activity is a balanced one: Exercise regularly, incorporate more challenging activities when you can and build habits that are sustainable over time.

Get inspired by a weekly roundup on living well, made simple. Sign up for CNN’s Life, But Better newsletter for information and tools designed to improve your well-being.

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