How exercising changed after a metastatic breast cancer diagnosis

March 4, 2021

I have always tried to be a healthier me, using diet and exercise as a way to achieve my goal. Although not a lifelong exerciser, it has been a part of the daily fabric of my life for more than 30 years. I found that exercise helped me to be not only stronger but more focused and it helped me deal with stress from work and life in general. I biked and played golf but my greatest love was running. At the age of 54 I trained and completed my first two half marathons. I consistently placed first in my age group in many 5K, 10K, and 15K events — my husband fondly referred to me as the fastest old lady in town.

Of course, diet played a key role in performance, so nutrition became kind of a hobby for me. With a family history that included heart disease, diabetes, and osteoporosis I had lots of motivation and I worked very hard to stay off preventative medicines. I have never been a smoker or drinker so had an overall healthy lifestyle.

I thought my life choices, coupled with no family history of cancer, meant that cancer was something I would never have to worry about. It turns out that belief was horribly naive! In the fall of 2016 I had severe breast pain, a small lump, and massive fatigue. My mammogram and ultrasound were “normal” so it took 4 months to finally get my first biopsy and diagnosis. Like anyone who hears those words “you have cancer” I was in shock and really could not even comprehend what the surgeon was saying as he rattled on about potential surgery, chemo, radiation. He was the most insensitive man I have ever met and he finally threw up his hands in disgust and said that I would have to see an oncologist to see if they could get through to me.

My husband and I consulted locally with an oncologist and then went out for a second opinion to one of the top cancer centers in the country. When we met with the oncologist and surgeon in Boston they made a strong argument for me to remain as active as possible and to try to gain some weight before starting treatment. Those directives were the only things I felt I was able to control during that time and I tried to focus my energy on these efforts, but the weeks after that first diagnosis were filled with more biopsies, scans, and fear. I had to make trips between my home in Florida and my doctor in Boston for medical tests, and it was soon found that things were worse than we had initially believed — I had de novo stage IV breast cancer with mets to my liver.

We tried to prepare for the worst and finally started treatment in March of 2017. We bought cookbooks written for cancer patients and a blender to make smoothies and read a lot of information online. We learned that using metal silverware can cause a bitter metallic aftertaste so I switched to plastics. Nothing could fully prepare me for the side effects of treatment. Knowing what to eat is not the same as having the energy to prepare it or even being able to tolerate it. I soon lost my appetite for even household standards like pork, sweet potatoes, and my favorite pretzels. I found myself dealing with mouth sores, fatigue, endless nose bleeds, hair loss, and more.

Exercise took on a new look as well. My daily walk sometimes amounted to a shuffle to the end of my street followed by a rest period before shuffling back to the house. I rarely missed a day, as it was my link to sanity, but I no longer felt able to go alone. In an effort to keep something normal, I made grocery lists and went shopping, but the fatigue and weakness were always in play. At the store, I would have to select maybe six items that were essential and go for only those, always using a cart so I would have something to lean on and hoping I had the energy to get back home.

I had a complete response to my first line of treatment and was put on maintenance treatment using targeted therapies. A daily oral aromatase inhibitor causes arthritic joint pain and bone loss so I have to be sure to walk and stretch every day. I also have muscle cramping in feet and legs, which I manage by eating almonds and taking a magnesium supplement. Back issues have ended my running days, and I miss that every day, but I try to walk twice a day and use my stationary recumbent bike. For strength building I have shifted from weights to exercise bands so as not to damage my back further.

Life with metastatic breast cancer is never simple, but I am so grateful that I had healthy eating and daily exercise habits prior to diagnosis. Several of the infusion nurses have told me that I have tolerated medicines better when I have been able to stay active. It has helped with sleep, with sanity, and has given me some semblance of normalcy. Getting outside for a walk puts me in touch with nature and my God who created it. The joy of seeing a bluebird or cardinal can change my perspective. Those walks coupled with daily stretching and gentle yoga sequences help to lessen the joint pain.

For anyone who has never been a fan of a healthy diet and exercise, I would say not to beat yourself up. Do the best you can do and remember that ANY movement is a good thing and can affect your treatment tolerance. I try to make healthy food choices but life is precious and far too short and I still love my chocolate, so I make room for things I enjoy.


Cathy Knowles was diagnosed with hormone receptor-positive, HER2-positive, de novo metastatic breast cancer in January 2017. She is 66 years old and lives in Pensacola, Florida with her husband of 45 years Mike, and their two dogs Cody and Riley. She walks 4 miles every day, and loves to read, bake, listen to all types of music, and watch an occasional sappy Hallmark movie.  

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