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© NOVA JUNE 2013
ONE Of THE most feared and
misunderstood side effects of breast c anc er
treatment is lymphoedema . Experienc ed by
nea rly one in three women who undergo
treatment, this build-up of fluid causes
swelling, usua lly in the arm or upper chest.
While many clinical guidelines recommend
that women avoid use of the affected side of
the body to prevent lymphoedema, this can
c reate confusion about the safety of e xercis e.
Speaking during Lymphoedema Awarene ss
Month in March, spokesperson for Exercise i s
Medicine Austra lia , Prof. Robert New ton of
Perth’s Edith Cowan university, said there was
no better time to set the record straight.
“ T he last thing women undergoing
breast cancer treatments need to worry about
is misinformation about side effects. So, let’s
be clear: exercise does not cause or worsen
lymphoedema – a nd in fact, recent evidenc e
su gge st s that exerci se may help prevent the
c ondition,” Profe ssor Newton said.
demonstrate that super vised, gradu al aerobic
and resistance exercise can be both safe and
beneficial. Women who exercise regularly
a re less likely to experience treatment-related
lymphoedema symptoms – and, if they occur,
the symptoms are typically less severe.
“ We recommend super vised e xercise
for women undergoing active treatment
of breast cancer, when the frequency and
type of side effects are likely to fluctuate.
The super vision required depends on the
patient’s exercise history, the timing with
respect to diagnosis, and the presence and
intensity of treatment-related side effects .”
He also debunked the need for
compression garments which are also a
reg ular subject of debate.
“Current evidence does not support the
need for women undergoing breast c anc er
treatment to wear c ompression garments
during exercise. Such ga rments may interfere
with heat transfer and physical function.
Prelimina ry studies have shown that e xercise
wa s sa fe, whether or not garments were
worn**,” he s aid.
Exercis e is Medicine recommends the
MANy OLDER ADuLTS believe that
sleep problems are just part of getting older
but this is a myth, according to the Sleep
Research ha s shown that approximately
50 percent of older adults report difficulty
sleeping, ac cording to the foundation’s
president Profess or David Hillman.
“This is of great concern because we know
that poor sleep in the elderly has been shown
to contribute to decrea sed quality of life,
more symptoms of depression and anxiety,
slower reaction times, memory problem s,
issues with balance and vision, increasing risk
of falls, and even death,” he said.
“Older people believe that sleep
problems are inevitable but this simply isn’t
true, healthy older people sleep just a s well a s
healthy younger people.
Professor Shantha Rajaratnam, President,
Austra la si an Sleep A s sociation said, “Poor sleep
in older people is most likely related to condition s
that accompany getting older such as significant
medical and psychiatric conditions, specific
sleep disorders, increa sed use of medication and
changes in circadian sleep-wake cycles.
“A s we age, our circadian body clock is
shifted to an early time, which can cause
difficulties in getting a good night’s sleep.
“Older people can achieve a good night’s
sleep but they might need to talk to their doctor
about their medication s, adjust the time they
go to bed and wake up earlier because their
PRIMARy AND SECONDARy school
students are five times a s likely to be high
consumers of sug ar-s weetened drinks, such
as soft drinks, if these drinks are available
in their home s, a cc ording to a university
of Sydney study published in the journa l
Preventive Medicine in March.
The study, which used data from the 2010
New South Wales Schools Physical Activity
a nd Nutrition Sur vey (SPANS), found
a larming levels of soft drink con sumption in
school aged children, especially those with
easy access to these drinks.
Half (52 per cent) of the 8058 students
surveyed were boys and 59 per cent were high
school students. R ese archers found students
were more likely to be high con sumers of
soft drinks if they were from a lower socio-
economic ba ckground or were boys.
Lead author dietitia n, L a na Hebden
sa id the study indicated a strong association
bet ween school students’ ac c es s to soft
drinks at school or in the home and increa sed
“We al so found students who dra nk soft
drink with mea ls at home were almost 10
times as likely to be high consumers of these
drinks,” she said.
“Pa rents need to consider what is stored
in their cupboa rds or fridge and what their
body clock ’s sleep-wake cycle s have shifted,
or get treatment for other conditions that are
interfering with their sle ep.”
Some sleep disorders, such a s insomnia
a nd obstructive sleep apnoea , a re more
c ommon in the elderly, but with diagnosis
and specialty care, these issues can be treated
a nd even prevented.
To sleep well follow The Ten
Commandments of Sleep:
1. Reser ve the bed for sle ep and sex. Don’t
use the bedroom as an office, workroom
or recre ation room.
2. fix a bedtime and a n awakening time.
3. If you are in the habit of taking siestas
(naps), do not exceed 45 minutes of
4. Avoid excessive alc ohol ingestion four
hours before bedtime and do not smoke.
5. Avoid caffeine six hours before b edtime.
This includes coffee, tea and many sodas,
as well as chocolate.
6. Avoid heavy, spicy, or sugary foods four
hours before bedtime. A light snack before
bed is acceptable.
7. Exercise reg ul arly, but not right before
8. use c omfortable bedding.
9. find a comfortable temperature s etting
for sleeping and keep the room well
10. Block out all distracting nois e a nd
eliminate a s much light as possible.
following exercise guidelines for breast-
cancer sur vivors :
• Aerobic and super vised resistanc e (weights)
training is safe and beneficial. Most sports
a nd specific activities, other than wa lking
a nd gym-ba sed exercise, have not been well
evaluated for safety or efficacy. However,
participation is enc ouraged unless clearly
contraindicated (e.g. if a risk of fracture s
or infection exists).
• Low to moderate intensity exercise is
recommended. until the upper and lower
limits of beneficial exercise intensity are known,
it is best to start a program at low to moderate
intensit y and progress gradually. If a routine
lap ses, the exerci se intensit y should be lowered
again when restarting. under the supervision
of an Accredited Exercise Physiologist , higher
intensity aerobic and resistance training can be
performed safely and will likely have greater
benefit in the long term.
• Accumulating at least 30 minutes of daily
exercise on at least three days e ach week
ca n lead to b enefits. Depending on one’s
fitness le vel, many short session s may be
needed to accumulate at lea st 30 minute s
of daily exercise. Build up to, a nd then
mainta in, at least 30 minutes of e xercis e
on five days e ach week. Equally importa nt,
at least two sessions of resistance training
should be completed ea ch week.
Download a fact sheet on the role
of e xercise in managing or preventing
side effects of breast cancer at http://
usef ul websites :
w w w.lymphoedema.org.au
w w w.exerciseismedicine.org.au .
w w w.e ssa .org.au
*: Schmitz KH. Balancing lymphedema risk: Exercise
versus deconditioning for breast cancer survivors. Exerc
Sport Sci Rev 2010 ; 38(1): 17-24.
**: Cormie, P., K. Pumpa, D.A . Galvão, E. Turner, N.
Spry, C. Saunders, y. Zissiadis and R.u. Newton. Neither
heavy or light load resistance exercise acutely exacerbates
lymphoedema in breast cancer survivors. Integrative
Cancer Therapies. Published online 25 february 2013.
children have access to.”
The study also found students who
usually purchased soft drinks from their
school canteen were three times as likely to be
high consumers. Despite a m andate being in
place since 2007 that schools should not sell
sugar-sweetened drinks, such as soft drinks,
the policy is not monitored or policed .
“Primary and secondary schools should
be supported and enc ourag ed to follow
polic y guidelines in their state reg arding
bans on the sale of sugar-sweetened drinks
from the school c anteen and vending
machines, sa id Ms Hebden.
A second study commissioned by The
Pa rents Jury advoc a cy group which e xamined
263 school menus acros s Australia found a
wide variation in complianc e with nutrition
guidelines. Thirty per c ent of surveyed
primary schools and less than 19% of
surveyed sec onda ry schools were compliant
with nutrition guidelines for a he althy food
and drink policy in school canteens. Western
Austra lia , where compliance is compul sory,
led the way with 62% of school menus
meeting the grade, while the ACT lagged
a long way behind with only 5% of school s
meeting the standa rds. Over 38% of menus
across all sur veyed se condary school s fe ature
ESCALATING R ATES Of joint
replacements could b e sla shed by tackling
obesity and preventing sports injuries,
ac cording to A rthritis Australia a nd leading
“We know that half of all knee
replacements for osteoarthritis could be
prevented by eliminating obesity and one
in five by preventing knee injuries,” sa id
Ainslie Cahill, CEO of Arthritis Australia,
in respons e to ne w data on osteoarthritis.
“Addressing these t wo risk factors c ould
cut the cost of knee replacements alone by
nearly $500 million a year,” Ms Cahill said.
“ The jump in knee replacement rate s,
which are up 56% in the last decade, is just
the start of exponential growth in these
procedures as the impact of our escalating
obesity levels begins to hit home.”
Maintaining a healthy weight ca n also
help to prevent osteoarthritis getting worse,
ac cording to osteoarthritis expert, Profess or
“Every kilogram of exc ess weight you
carry puts an extra load of four kilograms
on your knee joint. Losing weight can rea lly
reduce the severity and pain of osteoarthritis
and help to avoid the need for costly and
traumatic joint replacement surgery,” sa id
Profes sor Hunter.
To help people living with oste oarthritis,
Arthritis Austra lia has established an ea sy-
to-use , evidence ba sed website, MyJointPain.
org.au . “T his website gives pe ople living with
osteoarthritis access to a credible re sourc e
that will help them mana ge their condition
a nd improve their mobility and quality of
life,” Profes sor Hunter s aid.
Broader mea sures to tackle obesity were
also needed to reduce the prevalence and
severity of osteoarthritis.
“We need a range of programs to help
people eat more healthily and be more
active, and we also need to take a hard line
on issues such as improving food labelling
a nd restricting advertising of unhealthy food
to children,” s a id Profe ssor Hunter.
“In addition, we need to address
incre a sing numbers of sports injuries .
“We know that 7 in 10 people who have
a knee injury will develop osteoarthritis in
the damaged joint 10-15 years later.
“yet international experienc e shows that
sports injury prevention programs, ba sed
on simple neuromusc ular tra ining exercise s,
can reduce these injuries by 60%.
program to ta rget all frequent
sports participants would cost just $ 28
million to set up and less than $2 million a
year to maintain, but would save around
$200 million a ye ar in knee replacement
cost s alone.
“It’s simple and it makes sen se,” Profe ssor
Hunter s aid.
Go Easy on Your Knees
Soft Drink Overload
Sleep Well At Any Age
Exercise and lymphoedema
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