October 20, 2023 10 min read

Breast cancer is the most commonly diagnosed cancer among women in Australia, with 57 Australians diagnosed every day, approximately  20,000 women every year. Globally, millions of women grapple with this daunting diagnosis. Thankfully, the survival rate is on the upswing, and practices like exercise aid the healing journey and act as preventive measures. 

Since more people are surviving this disease, more are having to cope with the mental and physical side effects cancer treatment leaves behind. For this reason, attention has shifted toward alternative and holistic breast cancer management and preventing reoccurrence, by incorporating activities like aquatic fitness for physical activity and wellness.

Water therapy has been around for a long time but new equipment and techniques are being introduced that improve it's effectiveness. Aquatic fitness can be used as a preventative and a rehabilitative measure for breast cancer. Aquatic activities like water cycling on a Hydrorider is starting to become an important part of breast cancer recovery plans and lifestyle management.


Being aware of the associated risk factors and the emphasis on early detection is crucial in preventing and treating breast cancer.  For breast cancer survivors, staying physically fit will serve them well to both heal and limit the likelihood of recurrence.

Physical activity emerges as a cornerstone in cancer prevention and management. Studies are showing that women engaged in regular physical activity before and after treatment are  less likely to have their cancer come back (recur) or die than those who are inactive and reaffirms how exercise enhances the survival rate. Furthermore, diet and exercise interventions diminish the chances of recurrence.

The American College of Sports Medicine (ACSM) provides exercise guidelines tailored for cancer survivors and suggests focusing on interventions and therapy that will improve physical functioning, quality of life, and cancer-related fatigue. Numerous studies highlight the substantial reduction in physical fitness and negative alterations in body composition as frequent side effects of cancer treatments. The most important thing is to avoid inactivity.

Breast cancer is often accompanied by:

  • noticeable reductions in physical fitness (ie, cardiopulmonary fitness and muscular strength)
  • negative changes in body composition (ie, increase in body mass, decrease in lean body mass, and increase in fat mass)
  • increased fatigue
  • Depression and anxiety

These common side effects of cancer treatments negatively impact the overall quality of life and increase the risk for the development of comorbidities, a secondary condition.

This article will explore the benefits of aquatic exercise for breast cancer patients considering aquatic exercise can be easier on cancer patients, more accessible, and thus more effective. Aquatic therapy or aquatic fitness also improves muscular strength, cardiovascular fitness, flexibility, balance, symptoms of lymphoedema, chemotherapy-induced neuropathy and several mental health factors like anxiety and self-image.


The two dominant treatments for breast cancer are:

  • Mastectomy: This surgical procedure, which involves removing breast tissue, is a common resort. A study highlights its long-term implications felt by a staggering 90% of survivors. While it often cures the existing cancer, this surgery can damage or remove lymph nodes which leads to lymphoedema. The loss of breasts may also impact self-esteem and balance.

  • Chemotherapy: Chemotherapy is the use of medicines used to treat breast cancer by targeting and destroying cancer cells. This method, while effective, exerts a significant toll on the body, with peripheral neuropathy being a frequent side effect, among other things.


Certain exercises are risky for people who’ve been treated for breast cancer, including; swimming, body weight exercises such as pull-ups and push-ups and some yoga poses such as inversions and downward dog as it can put too much weight on the arms.

There are many benefits of aquatic exercise for breast cancer patients. Due to its gentle nature, aquatic exercise and particularly aqua cycling is often more feasible and beneficial for patients. Engaging in water-based cycling or a specialised water therapy session can  bolsters muscular strength, cardiovascular health, flexibility, and balance, and addresses symptoms of lymphoedema, chemotherapy-induced neuropathy, and mental health challenges.

This study aimed to compare the effects of aquatic therapeutic exercise to land-based exercises on various clinical outcomes in breast cancer patients. The results showed that aquatic therapeutic exercise was feasible, safe, and had high adherence rates. It also significantly improved pain, shoulder mobility, lung function, quality of life, cardio fitness, and muscle strength compared to land-based exercises or usual care.

Aquatic exercises, being easy on the body, boost confidence and motivation. Especially crucial is the role these exercises play in enhancing balance, a facet that is often affected post-mastectomy or large mass removal.

The unique properties of water make it an excellent medium for physical activity in those struggling with any illness, including breast cancer.


Buoyancy is important because it allows exercisers to feel weightless and move without the occasionally painful effects of gravity.

Hydrostatic Pressure

The resistance exerted by the water is a very important facet for those who have lymphoedema associated with breast cancer. The pressure increases with depth. The pressure combined with the body’s movements through water acts as a lymphatic drainage massage, keeping everything flowing and combating fluid pooling in the limbs.


The refreshing nature of water energises and can be particularly refreshing for post chemotherapy patients.

Some classes or pools may have heated waters to further soothe aches and pains and encourage flexibility.  


Low-impact nature of aquatic exercise

The buoyancy of water alleviates pain and discomfort. Unlike high-impact exercises which might exacerbate pain, aquatic exercises offer intensity without the associated strain.

Despite how effective it is for breast cancer management, often the last thing someone with pain and fatigue wants to do is exercise. Even walking may be painful. With aquatic fitness, patients can still get a high-intensity workout without putting pressure on their bones, muscles, and joints

Improved cardiovascular health

Cardiovascular health is improved through cardio exercises that increase the heart rate; this is usually a rare occurrence for someone recovering from cancer who is very fatigued. The hydrostatic pressure of water also promotes blood flow, improving cardiovascular functioning.

Activities like water cycling and utilising an underwater treadmill enhance cardiovascular health without relying on weight-bearing. Aqua cycling and running also build lower body strength at the same time as this cardio workout.

Muscle strength and flexibility

Water's resistance aids in building strength and improving flexibility, which often deteriorates due to cancer treatments. The water’s constant resistance pushes back with every movement. So, the simplest movements are still considered light strength training.

This supportive nature of water also helps reduce fall risk in a population that may have lost muscle mass and have less coordination and balance than they did before. Balance may feel different than before a mastectomy surgery.

The water is especially beneficial for strengthening the core. Even standing in the water requires some level of core stability to keep upright. Every movement engages the core and stabiliser muscles to improve balance over time. The core can be more specifically targeted using equipment like aqua resistance bands and an inflatable fitness mat. However, even cycling and underwater walking, which are more cardio-focused, will engage the core for the entire workout.

Since water workouts tend to inflict less pain than land-based, participants are often able to reach a greater range of motion and improve flexibility more easily with water fitness. This is important for adequate recovery and achieving the most efficient workouts.

Weight Control

Between the potential pain, fatigue, and psycho-social issues faced by breast cancer patients and survivors, weight gain may become an additional issue eventually. Physical activity in general is crucial for maintaining a healthy body. Aquatic fitness may be low-impact, but that doesn’t mean that it is always low-intensity. A typical aqua cycling class may burn up to 800 calories in an hour-long class.

Maintaining a healthy weight is crucial to prevent comorbidities associated with cancer and also aids in preventing the cancer from coming back. Carrying excess weight can also heighten the symptoms of lymphoedema.


Lymphoedema is a prevalent issue, especially when lymph nodes are damaged or removed during breast cancer treatment, leading to lymph accumulation and causing painful swelling. Because of the painful swelling and inactivity associated with lymphoedema, survivors often avoid physical activity. However, movement is proven to help manage the symptoms.

Aquatic therapy and fitness classes are highly effective in managing lymphoedema for a few reasons. Water cycling in particular has produced some great results. Since the water offers a low-impact and supportive environment that helps with pain management, the hydrostatic pressure serves as a light lymphatic drainage massage, and the exercise itself improves cardiovascular health and range of motion.

Don’t just take our word for it. A good amount of research backs this notion. Aquatic exercises have shown improved outcomes compared to land-based routines for lymphoedema.

Post-mastectomy lymphoedema is a concern that arises for many. In a controlled trial with 50 breast cancer survivors with lymphoedema, the study group partook in eight weeks of aquatic exercise while the control group did eight weeks of similar land-based exercise. At the end of the trial, the aquatic group had significantly better results for arm range of motion and pain level.

Another small study agrees with the above, stating that aquatic exercise effectively improved arm edema in breast cancer survivors. Much of the research in this space traces back to a pivotal study in 2010 that highlighted the need for better management of side effects of breast cancer treatment for survivors, including using aquatic therapy as a tool to manage lymphoedema.

Peripheral Neuropathy

Peripheral neuropathy, a common side effect of chemotherapy, can be reduced and managed through water-based exercises. It can be associated with breast cancer from chemotherapy, surgery, or the cancer pressing on a nerve.

Peripheral neuropathy of the feet and hands is a common side effect of chemotherapy. It’s associated with pain, burning, tingling, and loss of sensation. This condition can create balance problems as well.

A randomized controlled trial compared the effects of daily water-based therapy to land-based on gait and balance in those with peripheral neuropathy. Results were comparable, but the aquatic group tested slightly better on the dynamic gait test. Our experiences have found water cycling on an AquaBike particularly beneficial to reduce the tingling and build stabilisers to counter the balance problems associated with Peripheral neuropathy.


Stress reduction and improved mental health

Aquatic exercises induce stress reduction and uplift mental well-being. Even though pools are manmade, they are still technically blue spaces, and these water bodies have an innate connection with mental health.

This study investigated the effects of 6 months of aquatic and land-based exercise on women post-breast cancer surgery. 90 women, aged 50 and above, were divided into gym-based exercise, aquatic exercise, and a control group of healthy non-exercising women. Both aquatic and land exercises enhanced mental well-being in post-surgery women. However, these women showed higher anxiety levels than the control group. Notably, the aquatic exercise group engaged in more vigorous activity. Both types of exercise improved mental well-being after breast cancer surgery, emphasising the significance of regular activity post-mastectomy.

Enhanced quality of life

Participating in these exercises can significantly enhance one's quality of life and self-image. It’s unfortunate but understandable that many women struggle with body image post-mastectomy. Physical fitness helps individuals make peace with their bodies and regain a sense of confidence.

This study aimed to assess the benefits of aquatic physical therapy for breast cancer patients. Databases were systematically searched, resulting in five randomized controlled trials involving 356 participants. The analysis found that aquatic therapy significantly reduced fatigue and improved quality of life compared to usual care and land-based exercises.

Another study found similar results which examined the impact of an 8-week aquatic exercise program on cancer-related fatigue and physical and psychological well-being in breast cancer survivors. Conducted as a randomized controlled trial with 68 participants, half attended aquatic exercise sessions in a heated deep pool 3 times per week, while the other half followed traditional oncologist recommendations. Post-program, the aquatic exercise group exhibited significant improvements in fatigue and abdominal and leg strength. Six months later, the benefits of fatigue and strength persisted, but the mood remained largely unchanged. Aquatic exercises effectively reduced cancer-related fatigue and enhanced strength in breast cancer survivors.

Even when compared to other interventions to improve the quality of life in breast cancer patients, aquatic exercise was more effective at improving emotional well-being and decreasing negative side effects of breast cancer treatment than yoga and pilates interventions. 


Supportive group environments through aquatic fitness classes foster a sense of community. These settings have proven beneficial for older adult cancer survivors. Aquatic fitness classes like cycling and water aerobics are in a group setting that may facilitate camaraderie amongst cancer patients and survivors. 

In this study, researchers explored the impact of group-based exercise therapy on the quality of life (QOL) of thirty breast cancer patients. Delivered from an outpatient clinic, participants engaged in 30-90 minutes of team-based exercises. Feedback indicated a positive reception of the program design. The intervention effectively improved fatigue and QOL, with notable enhancements in certain dimensions of both inventories. However, no significant change was observed in depression levels. A few participants continued with the exercise classes even 2.5 years after the intervention, highlighting the program's potential for long-term maintenance. Overall, group-based exercise therapy in an outpatient setting can enhance cancer patients' QOL.

Cancer is not an easy thing to go through. One is often faced with the possibility of death and not everyone has a family or support system to return to after this traumatic life experience. Having a regular schedule for group fitness classes is good for the mind and body. Some may be able to find solace in knowing others have gone through the same thing - especially if there are specific classes for cancer survivors.


For optimal results, a 45-minute session, at least three times a week, is recommended. Most experts recommend maintaining a water exercise routine for at least six months, as shorter interventions may not see significant results. However, it's essential to consult with your doctor or oncologist before initiating any regimen. Listening to one's body and modulating the exercise duration based on comfort is paramount.


This decision should always be reviewed by a physician, but getting into aquatic therapy after cancer treatment as soon as possible can be helpful in the long run. 

For those who have surgery as part of their cancer treatment, the incision must be fully closed before entering the water. This may be as soon as three to four weeks, but again, this should always be approved by your doctor first.

Starting a water fitness or water cycling program can also be a wise choice if you have a family history of breast cancer as a preventative measure.

Breast cancer, affecting millions globally, presents both physical and mental challenges for survivors. However, aquatic exercise emerges as a powerful tool in both the prevention and management of breast cancer-related side effects. The unique properties of water, such as buoyancy and hydrostatic pressure, offer survivors a low-impact yet effective medium to enhance muscular strength, flexibility, and cardiovascular health.

Additionally, water-based exercises significantly alleviate chemotherapy-induced neuropathy and symptoms of lymphoedema. Beyond the evident physical benefits, participating in aquatic fitness fosters psychological well-being, aids in managing post-mastectomy body image issues, and promotes a sense of community among survivors. Studies consistently highlight the superiority of aquatic exercises in improving overall quality of life, fatigue management, and emotional well-being when compared to other interventions. In sum, aquatic exercise stands as a promising holistic approach, offering multifaceted benefits for breast cancer patients and survivors.

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