A cancer diagnosis turns life upside down, but for many, it is the side effects of the treatment that pose the biggest challenge in recovery.
After the shock of her breast cancer diagnosis, Sarah (name changed for privacy) underwent a double mastectomy and chemotherapy. When Sarah met our EP Shara two months later, her life was on hold due to persistent, severe fatigue. Previously a busy and active woman, the energy she once had for work and exercise was replaced by exhaustion, headaches, and an overwhelming fear of pushing her body too far.
Her goal? To return to her highly cognitive role, working 20 hours per week, while also reclaiming her love for movement. But at the time of referral, she wasn’t working at all, and exercise felt daunting.
Where We Started
At the time of meeting Shara, the daily fatigue was overwhelming. Boom and bust patterns were evident, and prohibiting her from moving forwards in her recovery. Sarah experienced whole body weakness, struggled with everyday tasks, and needed up to four hours of napping to get through the day. Cognitive fatigue made it hard to recall information, finish tasks, or concentrate for long periods.
She was anxious about using her core, shoulder and chest muscles due to their proximity to the mastectomy surgery, and as a result, had developed muscular tension through her upper body and neck. Tension headaches were common, at times leading to migraines. She wasn’t exercising, fearing it would make her symptoms worse.
The Plan
Shara took a measured approach, focusing on:
✔ Upper body mobility – Gently stretching the chest, upper back, and trapezius muscles.
✔ Gradual Strength Building – Starting with bodyweight, resistance bands, and heldhand weights, Shara selected exercises which targeted the upper body and core muscles.
✔ Cardio – As Sarah started to gain more confidence in her ability to exercise, she started building up her walking endurance.
Fatigue management education was also a key piece to the puzzle, and Shara introduced her to the benefits of Heart Rate Variability (HRV) tracking. Sarah became more comfortable with using the ‘morning readiness scores’ to guide her activity levels, helping her understand her fatigue patterns, and adjust accordingly. Strategies for pacing, building routine, and spreading out key activities across the week were kept top of mind.
Shara also worked closely alongside an occupational therapist, who supported Sarah with a workstation assessment and structured RTW (return to work) plan. Together, Shara and the OT reinforced the importance of pacing herself with cognitive tasks as well as physical – a necessity to manage the cognitive load in the work place.
The Progress
Fast forward a few months, and the changes have been incredible. She’s now walking 30 minutes daily, completing strength training 3-4 times per week, and even getting back into the pool. Her energy levels have improved significantly—no more extreme highs and lows. Strength gains have doubled (and even tripled!) in some movements. Her fatigue scores speak for themselves – marked improvement across all three domains, even in the context of her increased physical and cognitive activity (MFIS scores improving from 57/84 to 36/84).
Returning to Work
At closure, Sarah was certified fit to work for 3 hours a day, 4 days per week, and progressing through her Return to Work (RTW) plan to reach her desired 20 hours. Cognitive fatigue remains a challenge, but with structured breaks and pacing strategies, she’s on track for success.
This journey highlights the power of structured rehabilitation—helping clients not just return to work, but also to the life they love!
Author: Tessa Nielsen