PROGRESS: Day 14.2 – Fitness Update

Progress since the end of chemo

Yesterday marks 2 weeks since my last chemo and I feel like there’s been a very rapid improvement in just the last couple of days. I’m think my Herceptin infusion last week caused a bit of an inflammatory response especially since I’m still a bit off from the chemo. Qualitatively, I have a lot more energy and I feel like I’m back to myself for the most part. My skin is improving too! I was getting so many little pimples on my face and neck. I wasn’t sure if it was the Zoladex or the chemo and/or steroid, but I think it must have been the latter. My hair is still hanging around, as are my eyelashes and eyebrows. I’m really hoping I don’t lose my eyelashes and brows, but if it’s going to happen, I think it’ll happen this week.

It’s kind of funny because I thought about October being my “month off” between treatments. Even though I don’t have treatments, I have loads of doctors appointments! I have:

• 2 Herceptin-Only infusions
• 2 Radiation prep meetings
• 1 Radiation Proton Therapy “2nd opinion”
• 1 primary care physician
• 1 breast surgeon follow-up
• 1 echocardiogram
• ?? some actual radiation treatments (TBD depending on start date)

I actually joked at work today that I was going to my “second home” – the hospital! November will definitely feel like that when I’m going to the hospital every day for radiation treatments. Oh well, not much longer. I’m starting to understand how people say they feel somewhat lonely or sad after active treatment is done. You went from multiple appointments every week to almost nothing. Technically, I won’t be done with active treatment until July 2023. I suppose I will still have plenty of medical appointments to keep me company!

Chemo fitness goals vs actual

My goals were to:

1. Focus mostly on Zone 2 training
2. Ride 4-5 times per week
3. Spice up my weeks with some “harder” rides
4. Weight train 3 times per week

How did I actually do against those? Well, Zone 2 training was particularly challenging to achieve mostly because I have no idea what Zone 2 was for me during chemo. My perceived effort and heart rate was all over the place and it wasn’t completely dependable. For example, I could ride one day and it would feel really easy, but that same ride at the same power level could be much harder just a few days later. Since I was no longer dialed-into my normal metrics, I basically just did whatever I felt like.

I was successful at riding 4-5 times a week though! It was more often four times, but I think that ended up being a good rhythm for me. I rode every Thursday since I would routinely get a good night’s sleep and I would usually ride every Monday and Tuesday. I’m really proud of myself for doing this. I’ll admit that sometimes I didn’t quite feel up to it, but I just told myself to get on the bike and ride really easy. Usually, after a few minutes, my body would warm up and I’d start feeling really good. I would almost always be happy I made myself do it, because it left me feeling really good and in such a great mood! My understanding is that exercise might also help to prevent the cardiotoxicity that can be a side effect of Herceptin. I have my first echo tomorrow to check on my heart function – yikes!

For my third goal, spicing up my rides was not something I needed to do intentionally. Similarly to what I already said about trying to do Zone 2 training, I couldn’t easily predict when efforts would actually end up being hard or easy. When I did ride outside, those rides usually ended up being harder efforts where my heart rate would be closer to 150-160 beats per minute. When I rode indoors, I tried to go a little easier in anticipation of riding outside. I did a couple of sessions with some sprints, but those were pretty pitiful.

A fifth cycling goal I added was to complete Zwift Road Academy 2022. I have done Zwift Academy for the last few years and I really wanted to be able to complete it this year as well. They have made it a bit easier to complete by not requiring so many live rides where you have to sign-up and start at a specific time. The first year I did it was in 2018. You had to complete 10 workouts, a few live group rides and then there were a few live races as well. It was a lot to complete and, since you had to complete the live events, you had to plan ahead and schedule a ride at a specific time. The structure this year was much more flexible. It had you complete a live baseline ride to get an initial reading on three different segments. Then, you could complete the 6 workouts at your own time and pace. Finally, you had to complete your finish line ride, which was just the baseline ride again after you supposedly finished your workouts. Hopefully you would see improvement on your segments. Ha! Not me!

First, I accidentally rode the finish line ride first thinking that I had signed up for the baseline ride. But even still, the second time I did the ride (where I actually did the baseline ride), my times on the segments were not always better. But I did complete the first ride the day after my last chemo and the second one two days later. It’s not exactly like I set myself up for success, but I was aware of that. The crazier thing is comparing some of those segments with times before I did treatment in March. For example, there was one segment called the Volcano KOM. In March I completed that segment with an average power of 206 Watts in 8 minutes, 40 seconds (that’s not really that impressive as it is!). This time it took me 12 minutes, 23 seconds at an average 153 Watts! Ouch!

As for my final goal, I was only able to stick to weight training for about 5 weeks. I didn’t really decide to do that until I was in my second week of chemo, but still 5 out of 11 is a little disappointing. I’ve suffered from my usual problem – of all the things I want to spend time on, weight training is the hardest to find time and motivation to do. I have resumed walking Ginny almost everyday, which takes up some of my time in the day making it even harder to find time to lift. I really should be lifting, but I don’t want to sacrifice my time on the bike. Also, I need to start getting back to more normal work hours which will make it even more challenging. I’m not exactly sure how I will overcome this, but I really need to find 45 minutes three times a week to achieve this.

Fitness metrics

Resting heart rate

I haven’t really seen much change in my resting heart rate (RHR), which was somewhat surprising to me. Prior to treatment, my average 7-day resting heart rate would be around 53-55. During treatment, that was also pretty true as well and it’s the same now. This all surprised me because I didn’t pay too much attention to it, but I thought for sure my RHR was going up. After looking at my data, I can clearly see that’s not true, so I can’t really say that my resting heart rate was all that affected by the treatment.

Stress

This is definitely an area where I’ve seen changes. Prior to knowing anything about breast cancer, my average daily stress score would be around 26 (on a scale of 0 – 100). After my surgeries in May and June and then during treatment, my average daily stress would be up around 31-32. This past week it was back down to 26! The other really big thing I’ve noticed related to my sleep score is that during treatment, especially as I entered the 2nd half, my stress scores over night would be much higher. I would wake up and my stress was already at 20. Prior to surgeries and treatment, my stress score would only be under 10. Clearly my sleep was less restful during treatment. I know I’ve mentioned this metric before, but it’s a measurement my Garmin watch makes that takes into account your pulse and heart rate variability and puts that through some proprietary algorithm.

Sleep score

Sleep disturbance was another big thing I know I complained about during my chemotherapy. Prior to all of this happening, I would routinely have sleep scores that ranged from 88 – 92, on average. After my surgeries and then into chemo, my average sleep scores plummeted to the 70s. Unfortunately, those have not completely recovered yet. I’m still in the high 70s and low 80s right now, but I hope to see that improve as well. I’ve included a graph below where you can see my sleep scores plummet around my first surgery and where they have yet to recover completely. Actually that second drop in the beginning of the year was around April 8th when I learned of my diagnosis.

Weight

My weight seemed to remain steady during my surgeries in May and June, but with the start of chemo in July it creeped up a little. Then in August it creeped up a little more. And then in September it creeped up a little more. I don’t think I’m brave enough to post a graph of this metric! That was a bit demoralizing to be honest. I wasn’t trying to lose weight and I was trying not to think too much about eating too much. I was afraid to eat too little. I instead tried to make sure that I ate a lot of healthy fruits and vegetables. The only problem was that I ate a lot of desserts, too. Oh, and a lot of burgers… you know, for the hemoglobin and hematocrit. But since I’ve stopped treatment, I’ve been able to lose about 4 pounds. And I’ve tried to maintain the healthy foods but backed off on the desserts. Losing weight for me now is more about doing everything I can to avoid diabetes (which I’m already had higher risk for) and trying to create as much of an anti-cancer environment in my body as possible.

Strava fitness

My fitness score on Strava was what I used to monitor my overall progress. It is a measure of your training and recovery added up over time. Before I started chemotherapy, I had spent most of June and early July healing from my surgeries where they told me I wasn’t allowed to ride for at least 4 weeks. Since I had three surgeries, that really slowed me down and my fitness plummeted to 20. But over the last 3 months, I’ve been able to increase my fitness score to 41! My peak over the last few years has been 70, so I have a ways to go, but this feels like a pretty big achievement.

In summary

Overall, I think I have to be pretty proud of myself. First, I made it through! It physically sucked and it was mentally very challenging. I didn’t achieve all of my goals, but I tried my best and I think my results were admirable. I’m not sure I could have done any better. I tried to practice some self-compassion when I fell short of my goals. Despite having all of these fitness-related goals, my true number 1 goal was to get through chemo and I did that! I still have the hurdle of radiation to get through before I can truly hope to build back my fitness and general health. I’m sure radiation will be uncomfortable both physically and mentally, so I’m going to have to think about what my goals are to get through that!