PALS-Trained Professionals in Northern Virginia

Oncology Rehab and Wellness Resources is the only clinic in the region with PALS-trained professionals. Read on to learn about this groundbreaking breast cancer exercise training program and the clinical trial that started it all. 


Onc Rehab’s Arch Cox, Cheryl Guarna and Terry Drew with PALS for Life trainer Cathy Bryan

Breast-cancer survivors are at risk of developing a condition called lymphedema, which causes swelling of the arm or other areas of the upper body, after surgery/ treatment for breast cancer. Lymphedema can bring pain, numbness, discomfort, and sometimes infection. Women with lymphedema often refer to themselves as ‘swell sisters,’ but none of them thinks the condition is well…swell.

Every woman who has had breast surgery is at risk, and up to 40% of breast-cancer survivors eventually develop lymphedema (pronounced LIMF-eh-DEE-ma). The disease can develop immediately after surgery or weeks, months or many years later. Breast-cancer survivors have a lifelong risk of the condition, and when it develops, it lasts a lifetime.

Breast cancer survivors traditionally have been advised to avoid lifting anything heavy, which some doctors consider to mean as little as five- ten pounds. That advice generally rules out strength training, not to mention placing limits on functional strength such as lifting groceries or babies. Strength training (weight training, resistance training) can reduce the risk of osteoporosis, aid in weight control, reduce stress, and help women develop improved well-being and self-esteem. It also builds functional fitness.

Fortunately, recent research, called the PAL (Physical Activity and Lymphedema)Trial, showed that if a breast-cancer survivor follows specific training guidelines for slow progressive weight training, strength training may not worsen her lymphedema, nor does it trigger the condition if she does not yet have it. The PAL Trial report emphasized, however, that women wishing to incorporate safe weight lifting in their exercise programs must do so under close supervision of trainers or therapists schooled in the PAL Protocol. PAL stands for Physical Activity and Lymphedema.

Finding a PAL-trained professional can be frustrating for women who want to regain strength lost to the physical challenges of breast cancer treatment. Breast-cancer survivor Jen Starr-Reivitt is a runner who wanted to add weight lifting to her fitness program. According to Jen, ‘I asked at my local gym if I could meet with someone for training who knew about lymphedema… but they didn’t have anyone and I was too scared they wouldn’t understand my situation.’ Jen does not have lymphedema, but her breast cancer treatment was aggressive and puts her at high risk for the condition. Without professional help to guide her through safe strength training procedures, Jen is not willing to try a weight-lifting program. The PALS for Life Workshop will provide fitness and lymphedema professionals with thetraining they need to help women like Jen start—or restart—a strength-training program.

The PALS for Life Workshop brings the PAL Trial’s guidelines—called the PAL Protocol—to area personal trainers and lymphedema therapists, so they can coach and supervise their clients and patients who wish to add strength training to their exercise regimens. The workshop is a one-day session led by Cathy Bryan, owner of PALS for Life, Inc. PALS for Life is an exercise protocol that is based on the PAL research findings and on Cathy’s experience as lead personal trainer on the PAL Trial and over 20 years of working with breast cancer survivors.

About the PAL Trial and PALS for Life

The PAL Trial was a one- year weight-liftng intervention among survivors with and at risk for lymphedema. The research was conducted at the University of Pennsylvania. This randomized trial included 295 survivors who participated in a one-year randomly controlled exerciseintervention. This trial was designed to test the safety of weight-lifting for this population.

Researchers found that weight lifting is safe for women with and at risk for lymphedema and that they are perhaps at greater risk for many other conditions if they avoid activity. Weight lifting is  in no way a cure for lymphedema, but with benefits as mentioned above, it is a pretty sure path to a healthier life.

PALS for Life, Inc. is a Delaware-based provider of individual and group personal training for breast-cancer survivors, following the University of Pennsylvania PAL Protocol. The mission of PALS for Life is to provide safe, effective, research based exercise programs for breast cancer survivors- “Avoid Inactivity Before, During and After Breast Cancer.

This article was originally published on the PALS for Life web site.

Registration for individual or “buddy” training is ongoing. Group program schedules will be announced when registration opens. If you are interested in registering for an individual or group PALS for Life training workshop at Oncology Rehab and Wellness Resources, please contact Cheryl Guarna at


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