Health and Fitness

A Pilates Instructor’s Guide to Breast Cancer

Breast cancer is one of the most common forms of cancer among women. While early diagnosis and treatment has a strong success rate, breast cancer treatments and side effects can have a significant impact on breast cancer survivors’ quality of life.


Breast cancer is caused by an abnormal growth of cells in the breast. While females are most commonly diagnosed with breast cancer, all genders can experience this form of cancer. Breast cancer can also come in a number of different types such as –

  • Inflammatory Breast Cancer
  • Ductal Carcinoma In Situ (DCIS)
  • Invasive Ductal Carcinoma (IDC)
  • Lobular Carcinoma In Situ (LCIS)
  • Mucinous Carcinoma
  • Metaplastic Breast Cancer
  • Angiosarcoma
  • Phyllodes Tumor


  • Lump(s) in the breast(s)
  • Sore nipples
  • Change in shape, colour, or size of the breast and nipple
  • Swelling in armpit or breast regions
  • Rashes, skin dimpling, or peeling skin on the breast
  • Discharge from the nipple (excluding breast milk)
  • Pain in the breasts


Breast cancer is caused by cells growing abnormally in the breast, which ultimately form a tumour. If not caught early, these cancerous cells can spread out, or metastasise to other parts of the body. While there is not a singular cause for these abnormal cells to grow into cancer, there are a number of environmental, hormonal, or lifestyle risk factors that might contribute, such as –

  • Smoking
  • Obesity
  • Drinking alcohol
  • Age
  • Family history
  • Reproductive history
  • Dense breast tissue
  • Exposure to radiation or specific chemicals
  • Carrying gene mutations, such as BRCA1 or BRCA2
  • Specific medications

While these factors may increase an individual’s risk of developing breast cancer, there are many people who have been diagnosed without any of these risk factors.


While it is not possible to prevent breast cancer altogether, there are lifestyle changes and preventative measures that could help reduce the risk or find an early diagnosis, such as –

  • Mammograms and breast cancer screening
  • Self-examinations 
  • Exercise
  • Limiting alcohol consumption 
  • Balanced diet 
  • Preventative surgery or medications 

Early diagnosis is key and doing regular breast checks can help identify breast cancer symptoms. It is advised that adults perform a breast check once a month and for those menstruating this should occur a few days after their period has ended.


Breast cancer can be diagnosed via a combination of physical examinations, mammograms, biopsies, ultrasounds, or through other types of scans. Depending on how large the tumour is and how far it has spread, it will be given a stage. The higher the stage, the more severe the cancer.

After diagnosis, a number of treatments are available and will depend on the stage of cancer –

  • Surgery eg. either to remove the tumour through a lumpectomy or a mastectomy to remove the whole breast  
  • Chemotherapy
  • Radiation
  • Hormone therapy
  • Targeted therapy via medications

While undergoing treatment for breast cancer, there can be a number of side effects, such as (Stan et al., 2012) –

  • Cording (vessels hardening under the arm)
  • Lymphoedema (swelling where lymph nodes have been damaged or removed)
  • Nerve pain
  • Hair loss
  • Menopause
  • Fatigue
  • Insomnia
  • Depression
  • Anxiety
  • Nausea
  • Cognitive difficulties eg. brain fog
  • Lowered immune system
  • Weight gain/loss


Exercise can be really important both during and after treatment for breast cancer. It can help ease some of the side-effects from treatment and also help with maintaining functionality. 

While exercise is safe to participate in while undergoing breast cancer treatments, it will be important to start slow and keep the intensity low.  Participating in regular exercise can help improve functionality, strength, and quality of life, while also reducing pain, depression, anxiety, and fatigue (Fretta et al., 2021). The general guidelines recommend participating in 150 minutes of moderate intensity exercise per week (Boing et al., 2020).


Pilates and breast cancer have a long history. One of the “Pilates elders” (a first generation Pilates instructor trained by Joseph Pilates), Eve Gentry, had a mastectomy to treat breast cancer in 1955, which was considered a pretty extreme surgery at the time. The surgery didn’t just remove Eve’s breast tissue, it removed her lymph nodes and almost her entire Pectoralis Major. Gentry initially couldn’t lift her arms above her head, but after working with Joseph Pilates for a year, she was able to regain movement and functionality. Gentry went on to rejoin her dancing career, while also helping many others who were undergoing cancer treatments and advocating for cancer treatments to be covered by insurance.

While exercise in general has been shown to benefit clients with breast cancer, Pilates can also help to improve mood, self-esteem, range of motion, fitness level, functionality, and lessen pain  (Fretta et al., 2021; Pinto-Carral et al., 2018). Pilates can also be a great way for clients to ease back into exercising as instructors can modify the equipment, resistance, build strength, increase range of motion and isolate specific body parts.


Class Types

  • Private classes will allow you to modify the whole program for your client 
  • Group classes may provide a good opportunity for clients undergoing treatment to build community and provide support to one another
  • Classes may initially include a significant amount of stretching before adding in higher intensity exercises 

Change the Focus of Your Classes

  • The aim is not to get clients back to their original fitness level, it’s to help them regain enough mobility, strength, and flexibility to achieve every day tasks, such as getting something down from a higher shelf, ultimately giving them back more independence throughout their treatment
  • Jumping back into exercise may be intimidating for some clients and they may feel anxious about participating after undergoing breast cancer treatments. As an instructor, it will be important to create an uplifting, empathetic, and motivating environment 
  • Cancer treatments can be physically challenging, so building up strength and mobility again can be important 
  • Participating in Pilates, or any form of exercise, can also help clients feel like they are taking an active part in their treatment and recovery. It can be incredibly empowering to build back strength, but also engage in an activity that makes them feel good

Create the Right Environment 

  • Keeping the room cool can help with avoiding Lymphedema (swelling due to build-up of lymph fluid in the body) and temperature regulation
  • Infection and catching a cold/illness are significant concerns for clients undergoing treatment – ensure that you have thorough cleaning/hygiene practices in place and be mindful to cancel classes if you are feeling unwell. It is also a good idea for immunocompromised clients to have a fresh/clean set of hand straps, non-slip mat and cushion
  • Providing a supportive environment is essential and it is important to check-in with your client. However, ensure not to ask how they are multiple times during a class, as this can be quite frustrating for the client who is likely keen to focus on their workout and switch-off from the outside world

Session Frequency

  • Depending their stage of treatment, the client may need to cancel classes at times (sometimes at the last minute) due to feeling unwell – consider a flexible cancellation policy for these clients

Adjusting Workout Duration and Timing

  • Start slow, increase range of motion in shoulders, strengthen the back, allow rest time between workouts and gradually increase intensity, keep reps low 


  • Specific positions may not be comfortable for clients depending on which treatments they have had, if they have scar tissue, or cording. You may need to modify or avoid certain exercises based on which positions your client feels comfortable in.




Boing, L., Do Bem Fretta, T., De Carvalho Souza Vieira, M., Pereira, G. S., Moratelli, J., Sperandio, F. F., Bergmann, A., Baptista, F., Dias, M., & De Azevedo Guimarães, A. C. (2020). Pilates and dance to patients with breast cancer undergoing treatment: Study protocol for a randomized clinical trial – MoveMama study. Current Controlled Trials in Cardiovascular Medicine, 21(1), 35–35.

Martin, S. (2017). Filling the Breast Cancer Survivor Gap of Care Through Pilates-Based Exercise. Topics in Geriatric Rehabilitation, 33(1), 14–19.

Pinto-Carral, A., Molina, A. J., de Pedro, Á., & Ayán, C. (2018). Pilates for women with breast cancer: A systematic review and meta-analysis. Complementary Therapies in Medicine, 41, 130–140.

Stan, D. L., Rausch, S. M., Sundt, K., Cheville, A. L., Youdas, J. W., Krause, D. A., Boughey, J. C., Walsh, M. F., Cha, S. S., & Pruthi, S. (2012). Pilates for Breast Cancer Survivors: Impact on Physical Parameters and Quality of Life After Mastectomy. Clinical Journal of Oncology Nursing, 16(2), 131–141.

Fretta, T. D. B., Boing, L., Stein, F., Santos, L. D., & Guimarães, A. C. D. A. (2021). Improved self-esteem after mat Pilates method intervention in breast cancer women undergoing hormone therapy: randomized clinical trial pilot study. Revista Brasileira de Cineantropometria & Desempenho Humano, 23.