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Pilates

Shoulder-kind Pilates after breast cancer: a 25-minute class for shoulder movement, posture and strength

A 25-minute Pilates class for after breast cancer surgery or treatment, once your wounds have healed and your team's early arm exercises feel easy: often from about 4 to 6 weeks after surgery without a reconstruction, and later after one. That timing is our synthesis of the UK leaflets and the PROSPER trial, so start when your team says so. The class builds shoulder movement, posture and strength, keeps your head down for trunk work to look after your bones, and uses moving exercises rather than long holds for your arm. It also suits the months and years after treatment. Its structure is our own and untested.

25 minBeginner21 movesBench or box, other / check instructions, band, anchor point, wallAbs · Shoulders · Chest · Back · Hip flexors · Glutes
Follow along: a timer, a cue and the next move, one step at a time.

Sitting: breathe and warm up the shoulders (about 4 minutes)

  1. Lateral breathing (Pilates breathing)5 to 8 breaths
    Beginner · Abs · 3D demoHands on your lower ribsHarder: Roll-up (Pilates)
  2. Shoulder rolls10 slow circles each way
    Beginner · Shoulders, Back, Neck · 3D demoSmall at first, bigger as your shoulder allowsHarder: Shoulder CARs (controlled articular rotations)
  3. Breath reach5 breaths, exhale longer than inhale
    Beginner · 3D demoArms rise only as high as is comfortableHarder: Slow breathing (6 breaths a minute)
  4. Table slide (seated forward reach)10 slow
    Beginner · Shoulders, Back · 3D demoSlide your hands forward to a gentle stretchEasier: Pendulum exercise (Codman's pendulum)Harder: Overhead lat stretch at a bench (elbows on the bench)

Lying: shoulder movement (about 5 minutes)

  1. Arm lift lying down, with a stick5 times, holding for a count of 10
    Beginner · Shoulders, Chest · 3D demoKnees bent; lift the stick over your head only to a stretch, never to painHarder: Crab reach
  2. Elbow opening with hands behind the head5, holding for a count of 10
    Beginner · Chest, Shoulders · 3D demoPillows under your elbows if lying flat is hardHarder: Fish pose (Matsyasana)
  3. Stick-assisted external rotation (lying)8 slow each side
    Beginner · Shoulders, Chest · 3D demoElbow tucked to your side; turn the forearm out to a stretchHarder: Standing band external rotation
  4. Side-lying open book6 slow openings each side
    Beginner · Back, Chest, Shoulders · 3D demoDon't lie on a sore scar, port or flap; skip it with cancer in the spine or ribsHarder: Thoracic rotation

Lying: trunk and hips, head down (about 5 minutes)

  1. Knee fold5 each side
    Beginner · Abs, Hip flexors · 3D demoHead down, spine still; after a tummy flap, only when your team agreesEasier: Supine heel slideHarder: Dead bug heel taps
  2. Supine heel slide8 each side
    Beginner · Hip flexors, Hamstrings, Quads · 3D demoSlowHarder: Hip windshield wipers
  3. Pelvic tilt into bridge8 slow
    Beginner · Glutes, Abs, Hamstrings · 3D demoWith thinner bones, peel up only part of the wayHarder: Glute bridge
  4. Side kick (Pilates side kick series)8 each side
    Beginner · Hip flexors, Glutes, Hip abductors · 3D demoHead on your lower arm; lie only on a comfortable sideHarder: Side-lying leg circles (Pilates side kick series)

Face down, if it's comfortable (about 2 minutes)

  1. Swan (Pilates swan dive)3 to 5 small lifts, each held 3 to 5 s
    Intermediate · Back, Glutes, Triceps · 3D demoForehead on your hands; lift only your chest a little, and only if lying face down is comfortable over your scar or reconstructionEasier: Mermaid (Pilates seated side bend)Harder: Double-leg kick (Pilates double kick)

Standing: strength (about 6 minutes; from about 4 weeks after surgery, if your team agrees)

  1. Band row1 set of 8 to 12, light band
    Beginner · Back, Biceps, Shoulders · 3D demoElbows close to your sides; squeeze for 3 seconds at the backHarder: Supported single-arm dumbbell row
  2. Band pull-apart1 set of 8 to 12, light band
    Intermediate · Shoulders, Back · 3D demoArms at chest height, or lowerEasier: Prone Y-T-W raisesHarder: Tuck back lever
  3. Standing band external rotation1 set of 8 to 12 each side
    Beginner · Shoulders, Back · 3D demoA rolled towel under the elbowEasier: Stick-assisted external rotation (lying)Harder: Side-lying external rotation
  4. Wall push-up1 set of 8
    Beginner · Chest, Triceps, Shoulders · 3D demoHands at chest height; after a back (latissimus dorsi) flap, wait for your teamHarder: Push-up
  5. Sit to stand from a chair8
    Beginner · Quads, Glutes, Hamstrings · 3D demoA firm chair; arms crossed if you canEasier: Sit to stand, pushing on the thighsHarder: Bodyweight squat
  6. Single-leg stand2 holds of 20 s each side
    Beginner · Hip abductors, Calves, Glutes · 3D demoFingertips on the counter, especially if your feet are numbEasier: Tandem stance and heel-to-toe walkHarder: Single-leg reach matrix

Finish (about 3 minutes)

  1. Wall climb (finger walk up the wall)5 facing the wall, 5 side-on; hold each for a count of 10
    Beginner · Shoulders, Back · 3D demoWalk your fingers up to a stretch, a little higher over the weeksHarder: Sleeper stretch
  2. Slow breathing (6 breaths a minute)2 min
    Beginner · 3D demoIn for about 4, out for about 6Easier: Breath reachHarder: Crocodile breathing (prone diaphragmatic breathing)

Tips

  • Two or three times a week, with walking building to about 30 minutes 3 times a week, which helps tiredness (our suggestion, from the American College of Sports Medicine roundtable's dose).
  • A stretching or pulling feeling is normal; pain isn't.
  • Build up the band work slowly: add a set, then a slightly stronger band, only after a week or two with no change in your arm (our suggestion, from the PAL trial's protocol).
  • Wear your compression garment if you've been given one, unless your lymphoedema team says otherwise.
  • On an aromatase inhibitor or with thinner bones, leave out curl-ups and roll-downs unless your team says otherwise; this class keeps your head down.
  • Swelling, tightness, heaviness, aching, tingling or stiffness in the arm, hand, fingers, breast, chest wall or shoulder on the side you had treatment for breast cancer: get advice from your breast care nurse, treatment team or GP as soon as you notice it. Discomfort can be an early sign of lymphoedema.
  • Don't exercise if you feel unwell or have a temperature. During treatment, a temperature over 37.5°C or below 36°C means calling your 24-hour number.

The doses are suggested starting points, not a prescription. Choose a range you can control and stop for sharp or increasing pain, numbness or tingling. Get individual advice after an injury or surgery, or if you are pregnant or managing a health condition.

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Questions people ask

How long does the shoulder-kind pilates after breast cancer: a 25-minute class for shoulder movement, posture and strength take?

About 25 minutes, including any warm-up and cool-down listed. Shorten it by doing fewer rounds; lengthen it by adding one.

What equipment do I need?

You need: A bench or box, Other / check instructions, A band, An anchor point, A wall. Each move links to its guide, where you can find an alternative if you are missing something.

Is it suitable for beginners?

It is written for beginners. 8 of its 21 moves have an easier option listed beside them if you need one.

How do I make it easier or harder?

Use the easier or harder option listed under each move, change the number of rounds, or adjust the rest. Progress one change at a time.