Part of the fight against breast cancer includes a regular regimen of exercise and when a person is diagnosed with the illness it is important for them to keep moving even after surgery, according to exercise therapist Anne Mello.

I know I don't enjoy exercise even when I'm well, so the prospect of exercising after breast surgery, I imagine, would only add to my burden.

But Ms Mello would say that what might help my situation would be a change in attitude to exercise.

At a mini-symposium on breast cancer held by pharmaceutical company AstraZeneca in partnership with Live Well Bermuda and PALS (Patients' Assistance League), Ms Mello suggested that people celebrate their ability to move.

"I would like to have exercise approached as a gift of our human existence. We can move, not we have to move. We can move and we get to move," she said.

And she pointed out that movement was in everything that keeps humans alive.

"Of course our arms, legs and muscles move, but oxygen moves, carbon dioxide gets dispersed, our hormones are moving within our body, sweat happens. Movement is life, without movement we wouldn't be living," she added.

Ms Mello said we all need to focus on what she called "the gift of movement" and said that exercise expands movement. "If you exercise you have so much more potential. It gives the whole life you are able to live so much more value and spice," she said.

And it's particularly important in breast cancer patients who have had surgery. Ms Mello noted that often these survivors, apart from the physical pain of the surgery, begin to experience what she called "a negative spiral", where they feel bad about themselves.

It is natural to be very tired after surgery and this adds to the difficulty patients have in trying to exercise. It's typical for there to be no will to exercise at all. Many patients want to lie in bed and do nothing but rest. According to Ms Mello this will make them feel worse.

"It's really hard for me to say to someone who is not feeling well 'exercise'. So in a lot of this I think you have to find your own strength to get through it because at a time when you have so many negative things happening, it starts to spiral downward you feel bad about yourself, you don't have the energy.

"Exercise starts a positive spiral," she added. "So instead of going downward it helps you to start reversing direction. And whether it's slow movement or fast movement, exercise starts to be good. It releases endorphins and you start to feel better. Your feeling of self-worth starts to increase and you begin to feel good about yourself."

Ms Mello also noted that where patients have tight muscles as a result of surgery, exercise can help.

"Exercise, you would think would increase muscle tension but actually you get a positive benefit from it. It serves to release muscle tension. When you go through any sort of crisis your whole body gets involved.

"Your entire body decides it's going to come on board and tense up for you. That's the joy of movement it helps reduce some of that tension," she said.

While she stressed that simple movement was good, she said the body gets the most benefit from aerobic exercise movements that make the body use more oxygen.

She noted there are many exercises designed specifically for patients who have had breast surgery, whether it was a lumpectomy (removal of a tumour or lump in the breast), mastectomy (removal of the breast tissue), or even a biopsy. But she said patients should discuss what's best for them with their doctors.

"It cannot be general, everyone has a specific need; it depends on the type of surgery you had. The condition before and after depends on your rate of healing," she said.

But she added that in all cases patients should get back to moving as soon as they can. She recommended that people should be at least walking around their houses as a means of getting oxygen moving around their bodies.

"It's oxygen that makes you feel better," she said. "The delivery system happens when these big fat muscles demand oxygen. So two or three times a day, walk around your house or that environment where you feel comfortable."

She also suggested gentle warm ups like shoulder shrugs and slow shoulder rolls in both directions are helpful for most people.

And she said deep breathing where the stomach expands with the inhalation and contracts with the exhalation, should be done. "Everybody must incorporate this in their life," she added.

She advised that patients should start slowly with an exercise programme that involves activity spread throughout the day.

"Do each exercise to a point, wait about five seconds then release," she said. "Do the exercises throughout the day not in one fell swoop. It's important that the tissues are moved throughout the day. In much the same way as you can have a few drinks a day, not 21 drinks in one night.

"Quality movement is much more important than quantity but do it the best way," said Ms Mello. "Do it intuitively. Do what feels right for you. Who knows your body better than you? You have to know the difference between pain and discomfort and the only way you do that is to go inward with exercise movement."

Ms Mello said patients should take an active role in their health and in exercising should learn to read their bodies.

"Think about how it feels. Did it feel better yesterday? Am I making improvements? What kind of process am I going through today? Learn about your body," she added. "If you are the expert you will find it easier to understand and learn from the changes and how to interpret how far you can be challenged.

"Exercise movement is what our bodies are supposed to do. The idea of exercise is to get you back in the game of life again. To have you get that fighting spirit."

l For detailed guidance on appropriate exercises for breast cancer patients visit www.stayingabreast.com