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The Pink Ribbon Post-Operative Rehabilitation Program at Enliven Health MK

Here at Enliven Health MK, we are passionate about improving the standards of Physiotherapy in the area, and want to increase the availability of services to clients who have had surgery as part of their treatment for Breast Cancer. This blog post provides information about the Pink Ribbon Post-Operative Program, aimed at women and men who have had surgical procedures including reconstructions, which we are now running at Enliven Health.


As a Physiotherapist working with Musculoskeletal and Women’s Health conditions, I come into contact with clients who have had Breast Cancer on a regular basis. Many of these people have had surgical procedures as part of their treatment, including reconstructions and have asked me questions about their recovery, some of which I felt I initially couldn’t answer in much depth. Questions such as;

What exercise can I do?

How long will it take to recover?

When will I get back to normal function?

I felt that I couldn’t serve these clients to the extent that I wanted to and so thought there was a need to develop my knowledge in this area. This lead to my qualification as a Pink Ribbon Post-Operative Exercise Instructor, where I have gained the skills required to rehabilitate this client population after their surgery.

The clients I see have had a variety of surgical procedures as part of their Breast Cancer treatment, ranging from lumpectomies, to mastectomies to a variety of reconstructive procedures, which often involve other parts of the body being removed or transferred as part of the reconstructive process. Due to the advancement of medicine and surgery over the years, it is remarkable what can be done in terms of surgery these days, however the rehabilitation and Physiotherapy afterwards is generally lacking. Clients are not routinely referred for Physiotherapy after their operations, however this is something that most of them need due to strength issues, postural problems, stiffness and pain. Clients may suffer from problems such cording, peripheral neuropathy, cancer-related fatigue and from long-term effects of radiotherapy, including fibrosis and scar tissue formation. They want to return to exercise and normality and this can be difficult without proper rehabilitation and guidance.

I strongly feel that all clients who have had surgery for Breast Cancer should have Post-Operative rehabilitation, and this should be a standard referral process, similar to that received by clients who have had knee surgery. Clients are normally provided with a basic exercise leaflet however I feel they need more than this to enable them to progress and return to complete function. This has lead to a new service which I am now offering to this client population at Enliven Health.

The Benefits of Exercise after Breast Cancer

We know that 1 in 9 women will be diagnosed with Breast Cancer at some point in their lifetime and there are over 600,000 people who have been treated for Breast Cancer currently living in the UK. It is also estimated that by 2030, Breast Cancer cases are set to rise to 60,000 per year, however survival rates are improving as treatment advances.

But what does the research say about exercise after Breast Cancer? Well, we know that more and more evidence is emerging to support exercise in the treatment and recovery process after the disease. It has been shown to increase life expectancy, to reduce the recurrence of cancer and that it improves the quality of life of survivors during the recovery process. It may help with Cancer-related fatigue, and regular walking has been shown to improve sleep and reduce depression.

There is also evidence to support lower intensity exercise and its beneficial effects in the recovery process after Breast Cancer, as it does not stress the body as much as higher intensity exercise. This is important when people are going through treatment processes such as chemotherapy, or who may be experiencing some side effects of this treatment.

Some cancer drugs, although extremely important for the treatment and prevention of the cancer, may also cause side effects which may be helped with exercise. These drugs can affect levels of hormones in the blood including oestrogen, which has a protective role on the bones and the heart. Exercise can be very useful in helping these systems by boosting cardiovascular function, and resisted and weight bearing exercise has been well documented to prevent and manage osteoporosis and osteopenia, which may be risk factors affecting bone, caused by changes in hormones. The pelvic floor is another area which responds to circulating oestrogen in the blood, and women may find that certain medications and chemotherapy can alter their pelvic floor function, leading to symptoms of urinary dysfunction, incontinence and sometimes, pelvic organ prolapse.

Thus it is important to consider each individual holistically, rather than just focusing on the operation site. The whole body needs to be considered during the rehabilitation process after Breast Cancer and the Pink Ribbon takes all of these systems into consideration.

About the Program

The Pink Ribbon Post-Operative Program is a rehabilitation pathway whereby clients who have had surgery after their Breast Cancer can enter, as soon as they have been given the ‘okay to do so’ by their consultant.

The program may be completed as a group set up, which is a 6 week course of exercise sessions, which are progressive in nature. Clients have an assessment session before they start the course and again once they have completed the course, to determine their level of progress. The group session is useful as it puts clients in touch with other survivors of Breast Cancer, however clients can also opt for a one to one approach, where they can receive individual rehabilitation sessions with a Physiotherapist.

The aim of this program is to gradually restore movement, strength, postural awareness and function over time, under the skilled eye of an experienced Physiotherapist. Clients are put back in control of their health and recovery whilst the Physiotherapist supports them every step of the way, ensuring they are exercising appropriately, taking into account their symptoms and individual needs.

The Pink Ribbon Program at Enliven Health is run by an experienced Musculoskeletal Physiotherapist, who also specialises in Women’s Health conditions, such as urinary incontinence and pelvic organ prolapse and has undertaken further training in the exercise for osteoporosis and menopausal symptoms. These skills tie together to provide a unique, comprehensive service, using a multisystem approach and addressing the important needs highlighted above, in relation to exercise after Breast Cancer surgery.

We will undertake a full assessment of your physical status before you start the program and then again after the 6 weeks to gauge your level of progress. You will also be provided with a progressive home exercise program to complete in between your exercise sessions, as you feel able to.

We have developed links with Breast Cancer support services including Bosompals MK, Willen Hospice Lymphedema team and the Macmillan team in Milton Keynes and will be able to fully support you and refer you to other practitioners or liaise with them as required.

What Our clients have said about the program

“Although I was diligent in performing the exercises given to me by my Breast Cancer Nurse after surgery for breast cancer, both in 2014 and 2015, these exercises only took me so far in recovering my range of movement. I was aware of the Pink Ribbon Programme but sadly there was no one in this area offering the service at that time, so finding a Physio-led service had come to Bedfordshire/Buckinghamshire is fantastic news. 

Alex from Enliven Health did a thorough assessment of my limitations due to surgery and developed a programme that has enabled me to improve my range of movement and regain some of the lost functionality. This programme is delivered through her Pink Ribbon specific classes at her lovely studio in Aspley Guise, and with exercises to perform at home with accompanying video instructions. Alex understands that issues from cancer treatment such as fatigue and joint pain play a large part in how effectively I can participate in the programme and she paces the classes accordingly, while ensuring a gentle progression each week. I very much look forward to my weekly session with Alex and the benefit of sharing the experience with other breast cancer survivors. This is a much needed service in our area and I hope clinicians at our local breast units will refer patients to Alex as soon as their important cancer treatment is complete; allowing cancer patients to take their own positive steps towards recovery is of immense benefit to general well-being and improves long-term outcomes”

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