Functional Movement and Exercise: A Guide for Living With and Beyond Cancer

During and after breast cancer treatment, it is common to experience physical side effects and challenges such as pain, reduced range of movement, postural changes, tight scar tissue and much more. This blog post explores how functional movement and exercise can help optimise physical strength, movement and function.

What is functional exercise?

Functional exercise is a form of activity that focuses on movements, rather than specific muscles. The goal is to mimic real-life movements using multiple joints and muscle groups. These exercises help prepare and train your body for daily life, for example:

• Reaching overhead to put dishes away in a cupboard

• Carrying heavy shopping bags

• Getting on and off public transport

• Picking up a child or grandchild

What is the difference between isolated exercise and functional exercise?

Isolated exercises focus on a single muscle, working it to fatigue to increase microtrauma and hypertrophy and are often prescribed by physiotherapists for a specific issue. In contrast, functional exercises concentrate on multiple muscle groups in compound movements that mimic real-life activities, as described above. They are less likely to be performed to the point of fatigue due to the variable stamina and limitations associated with multiple muscle groups, but they aim to improve a person's self-efficacy and confidence day-to-day. Calisthenics is another form of activity that may also involve multiple muscle groups through more natural, combined movements, but they use the body's own weight for resistance and are designed to improve the ability to adapt to various real-life scenarios - for example, pull ups, handstands, shoulder dips.

Why is functional exercise important after cancer treatment?

Functional training can help in endless ways, after:

• Restoring Daily Function: It helps with preparing for everyday tasks like dressing or carrying groceries.

• Managing Treatment Side Effects: It can improve shoulder mobility and strength, manage lymphedema risk, reduce fatigue, and correct muscle imbalances and posture.

• Optimising Quality of Life: By regaining independence and confidence, you can better enjoy your hobbies.

• Injury Prevention: By promoting proper movement patterns, this type of exercise can help prevent injuries.

• Increased Strength: It can lead to enhanced strength, stability, and balance.

• Time Efficient: Functional exercises are compound movements that target multiple areas within one exercise session.

Examples of Functional Exercises

Functional exercises are based on the seven "primal" movements: gait, lunging, squatting, bending, torque (rotation), pushing and pulling. Here are some examples of functional exercises and the real-life movements they mimic:

• Squat: Mimics sitting on a chair or toilet, or bending down to pick something up.

• Lunge: Mimics stepping over obstacles or reaching for an item.

• Push-up: Mimics pushing open a door or pushing up from the floor.

• Deadlift: Mimics lifting heavy objects from the floor.

• Row: Mimics opening a drawer, closing a door or pulling a trolley or pram.

• Step-up: Mimics climbing stairs or stepping onto a platform, bus or train.

• Farmer's walk: Mimics carrying shopping bags.

squat after breast cancer

Lunge after breast cancer

Box step up

Deadlift after breast cancer

Seated row

Isolated movements and functional movements can be practised alone to begin with, before adding increasing resistance to improve your body’s stamina and strength. For example, start with shoulder and hip range of movement exercises, introduce resistance exercises such as biceps curls and shoulder flexion with small weights, before progressing onto functional movements such as squatting with shoulder press.

Important Considerations

Before starting any new exercise program, it's essential to be mindful of your own body and any specific risks you may personally have as a result of your cancer treatment:

1)     Consider whether you are at risk of lymphoedema, fractures or falls. If you are, consider supervised exercise to help guide your progress. If you are unsure, please be certain to ask your own medical team.

2)     With all exercise programmes, start small with low repetitions and resistance, gradually building up your intensity over time and monitoring closely for adverse effects.

3)     As functional exercises focus on multiple joints and muscles, it can be easier to ‘over-do’ it during a session. Be mindful of your body and check how you are feeling between each exercise and set.

4)     Don't hesitate to seek professional help and supervision as needed, to ensure you are exercising safely and effectively.

Hannah is a specialist oncology physiotherapist - for further advice and support, you can contact her by email (hannah@strongerthan.co.uk), on Instagram (@strongerthanphysio) or on her website (www.strongerthan.co.uk).