The Power of Movement: Cancer Rehabilitation, Pilates & Lymphedema with Hope Spencer

Season 3 Episode 19· August 2026 · 75 min

Listen to the full Spotify episode here

Most people are still told to rest when they're diagnosed with cancer — but the research says the opposite is true. Oncology physiotherapist Hope Spencer reveals that your muscles actually produce their own chemicals during exercise that can help create a cancer-suppressive environment in the body, and that resting for the six months of a chemotherapy journey can do more harm than the treatment itself. From lymphedema myths to why Pilates reformers are the perfect entry point back into movement after surgery, this episode reframes everything we think we know about cancer and exercise. In this episode, I sit down with Hope Spencer to talk about cancer rehabilitation, lymphedema, and the role Pilates plays in helping people reclaim their strength, confidence, and quality of life during and after cancer treatment.

ABOUT Hope Spencer 

Hope Spencer is the founder of the Positive Health Project and an oncology and lymphedema physiotherapist who has spent 14 years helping people optimize their health before, during, and after cancer treatment. She holds a Bachelor of Science in Exercise Science, a Master of Physiotherapy, and a Graduate Diploma of Rehabilitation Sciences, and is a qualified cancer rehabilitation practitioner through PINC & STEEL International, an accredited lymphedema therapist, and a Restore Oncology Scar Specialist. Learn more at Positive Health Project website 

WHAT YOU'LL LEARN IN THIS EPISODE

• Understand what lymphedema actually is: a dysfunction of the lymphatic system that causes fluid buildup, most often triggered by lymph node removal, surgery, or radiation.
• Learn why exercise is now considered "medicine" in cancer care, and how muscles release chemicals (myokines) that help create a cancer-suppressive environment in the body.
• Discover why resting during cancer treatment can backfire — leading to lost strength, stamina, and mobility on top of the toll treatment already takes.
• Find out which types of cancer carry the highest lymphedema risk (breast, melanoma, gynecological, and head and neck cancers) and what actually triggers a flare-up (trauma and infection — not blood pressure cuffs or flying).
• Learn the two real red flags that mean a client should be referred back to their medical team: new, persistent, worsening symptoms unrelated to movement.
• Understand why Pilates reformers are an especially safe, beginner-friendly way to reintroduce movement after surgery, chemotherapy, or radiation.
• See why heavier resistance training (not just reformer work) is essential for protecting bone density, especially for women pushed into early menopause by endocrine therapy.
• Get practical language and communication tips for supporting a client or loved one through a cancer diagnosis without over-protecting or instilling fear.

FROM THE EPISODE

"If we could bottle exercise up into a pill, we would be giving it to everyone for pretty much every single chronic health condition, but especially cancer. That's how strong the evidence is."

"We can't let it take everything from you. You need to have something that is either just a normal sense of routine or something that makes you, you."

FREQUENTLY ASKED QUESTIONS

What is lymphedema? Lymphedema is a dysfunction of the lymphatic system that causes fluid to build up somewhere in the body. It commonly happens after cancer treatment when lymph nodes are removed, tissue is cut during surgery, or lymph nodes and tissue are radiated, all of which can disrupt normal lymphatic flow.

Is it safe to exercise during chemotherapy or radiation? Yes — exercise done the right way is considered safe and is now recommended as part of standard cancer care. It can help combat fatigue, support the immune system, and even help create a cancer-suppressive environment in the body through chemicals released by working muscles.

Can exercise cause lymphedema? No, exercise done in the right way does not cause lymphedema, even in people at high risk. The two main triggers for lymphedema are significant trauma to the area (like further surgery or a serious injury) or an infection such as cellulitis — not general exercise, blood pressure checks, or flying.

Should someone with lymphedema avoid lifting weights? No — that's a myth. People with lymphedema can lift weights, including heavy weights, as long as it's introduced gradually and in the right way, without going too hard too soon.

What are the warning signs that someone should go back to their doctor or oncologist? Red flags include anything new, persistent, and worsening — such as pain that isn't related to movement and doesn't ease with rest or pain relief, unexplained swelling progression, new lumps, or heat and redness in an area. A single day of normal exercise soreness is not a red flag.

Why is Pilates recommended for people going through cancer treatment? Pilates, particularly reformer Pilates, is beginner-friendly and can be done lying down, seated, or standing, which makes it easy to adapt to wherever someone is in their treatment. It builds strength, flexibility, and confidence gradually and can serve as a gateway into other forms of exercise later on.

Does cancer treatment affect bone density? Yes. Treatments like endocrine therapy for breast cancer block estrogen (which protects bone), often pushing women into early menopause and increasing the risk of osteopenia or osteoporosis. Heavier resistance training, beyond what a reformer alone can provide, is important for stimulating bone growth.

What should Pilates instructors know before working with a client who has or has had cancer? Instructors should understand roughly what the client has been through and where they are in treatment, since side effects like fatigue, peripheral neuropathy, and lymphedema can affect positioning and balance. The goal is to adapt exercises thoughtfully rather than avoiding them altogether, while checking in with the client regularly.

FULL EPISODE TRANSCRIPT

Lightly edited for readability

Louise: Welcome to the Art of Pilates. Today I'm delighted to welcome Hope Spencer, founder of the Positive Health Project. Hope is an oncology and lymphedema physiotherapist whose passion is helping people diagnosed with cancer optimize their health and wellbeing through every stage of the journey. She works with people before, during, and after cancer treatment, helping prevent, manage, and treat the physical side effects of cancer through evidence-based rehabilitation, hands-on therapy, and exercise. Hope holds a Bachelor of Science in Exercise Science, a Master of Physiotherapy, a Graduate Diploma of Rehabilitation Sciences, and is a qualified cancer rehabilitation practitioner through PINC & STEEL International. She's also an accredited lymphedema therapist and a Restore Oncology Scar Specialist — I know it's a mouthful, it's like you do ten things, it's absolutely crazy. Hope, welcome to the Art of Pilates, it's so wonderful to have you here. Before we start, can you explain to our listeners what exactly is lymphedema? It's a very big word we've all heard before, but tell us what it is.

Hope: Okay, so lymphedema — it's probably best to start with what the lymphatic system is first, because you have to understand the lymphatic system to understand what lymphedema is, which is a dysfunction of the lymphatic system. The lymphatic system is very similar in a way to the network of our blood vessels, except there are a few differences. It carries lymphatic fluid rather than blood, and it's a one-way system rather than a two-way system. Our blood travels from our heart out to our body and comes back around. The lymphatic system just goes from your body back into the central system. It has two main functions: transport and balance of fluid — it's a waste removal system — and it has an immune function. Most people have heard of lymph nodes, but not so much the lymphatic system or lymphedema. The lymph nodes check the fluid coming through the lymphatic system for anything that shouldn't be there — bacteria, or anything that rings alarm bells — and then the lymph nodes mount an immune response. That's why we normally get a bit swollen or sore around the neck when we're sick, and that happens throughout the entire body, because the lymphatic system and lymph nodes are throughout the entire body. It's a complex and very fragile system, so when we go messing with it, we can end up with problems. With lymphedema, there's been some issue with the lymphatic system, meaning we get an accumulation of fluid, and this can happen anywhere in the body. With cancer, we either remove lymph nodes, cut tissue during surgery, or radiate lymph nodes and tissue. This can disrupt the lymphatic system, meaning fluid builds up — that's what lymphedema is.

Louise: I hope that makes sense — so "lymph" is the lymph, and then—

Hope: Yes.

Louise: —"edema" — is that Latin for swelling or fluid?

Hope: Fluid, yeah.

Louise: Got it — edema, fluid. That does make sense. You see people who've had lymph nodes removed because of breast cancer get that swollen arm.

Hope: Yes.

Louise: My mum actually had some lymph nodes removed when she had cancer cells on her cervix, so she had a hysterectomy and they removed some lymph nodes. This was a long time ago, and now she has lymphedema — that leg will swell up at different times, not all the time.

Hope: So interesting.

Louise: So tell us about yourself — what inspired you to become an oncology physiotherapist?

Hope: I've been a physiotherapist for 14 years, and about six years ago, during one of my many degrees, I went down a rabbit hole of cancer rehabilitation. I was doing an assignment about rehabilitation and came across the Clinical Oncology Society of Australia — they had just put out a position statement that exercise should be part of standard cancer care. For a big national organization to put out such a strong statement, I thought there must be a lot of evidence behind it. Why hadn't I heard about exercise and cancer, especially as a physiotherapist — it wasn't part of any of my studies when it came to exercise. So I went down the rabbit hole for that assignment, and my mind was blown by how much evidence there was and how much the skills I had as a physiotherapist could help people with cancer. It really resonated with me. Then I thought, okay, how do I specialize in this? That's where the PINC & STEEL training came in, then the lymphedema training. Then I thought, I need to get a job doing this — and that's when I realized there's a big gap between what the research says we need to do and actually implementing that, having services available to do it. That was my pathway into becoming an oncology physiotherapist and eventually starting my own practice focused solely on that.

Louise: Wow. Was there a defining moment that led you to establish the Positive Health Project?

Hope: Yes — I'd decided this was what I really wanted to do, and when I went looking for a job to do it, I couldn't find one. So it was something I was so passionate about, and luckily I had the support of my husband and my family — they were like, okay, let's support you to do that. So it was, okay, let's do it.

Louise: Wow. What exactly is an oncology physiotherapist? Many people may never have heard of this specialty.

Hope: No, that's exactly right. When you think about physiotherapy, you might think about your normal sports physio, or seeing one when you injure yourself, or maybe within the hospital system. When I tell people I'm an oncology physiotherapist, they don't realize that's a thing. Oncology physiotherapy is using the skills a physiotherapist has and pairing that with knowledge of what cancer is, what it does to the human body, the treatments used to treat it, and the side effects of those treatments — then using our skills to help manage those side effects and help the person achieve their goals and get their quality of life back. That's still the ultimate goal of a physiotherapist — quality of life and function — but it's about being very specific in helping someone diagnosed with cancer.

Louise: And there are so many levels to that diagnosis. What does an oncology physiotherapist actually do?

Hope: Good question. As you alluded to in your introduction, it ranges from manual therapy techniques — massage, myofascial stretching — all the way through to fully hands-off exercise prescription, helping someone get their body moving again, addressing any pain they might have. It's about identifying the person's goal and figuring out how to best achieve that. It really depends on where they're at in their cancer pathway. Early on — say, after surgery — hands-on techniques are usually more helpful, since they've got restricted movement, pain, swelling, scars. We're giving them some stretches and exercises too, but we're mainly trying to calm the system down and help with healing. As they move into chemotherapy, radiation, and then recovery, we get less hands-on and focus more on movement and exercise.

Louise: And who can benefit — who comes to see you?

Hope: Anyone with any cancer diagnosis absolutely benefits. I personally see a lot of breast cancer, but I've also seen melanoma, brain cancer, colorectal cancer, and gynecological cancers. There's no real limit on the type of cancer an oncology physiotherapist can see, though prostate and breast cancer are among the highest diagnoses, so those are what I see most commonly. You can see anyone at any stage — my preference is to see someone as soon as they're diagnosed, so I can be part of their care team, help fill in gaps, and educate and support them from the start. But really, at every stage — diagnosis, treatment, recovery — an oncology physiotherapist can help.

Louise: How has cancer rehabilitation evolved over the last decade? Didn't exercise used to be discouraged when you had cancer? People said don't exercise.

Hope: It wasn't so much "don't exercise" specifically — it was very much, you're sick, you're unwell, you should be resting and recovering, you shouldn't exert yourself and risk becoming more unwell. Cancer rehabilitation as a field really only started to become a thing in the last 10 to 15 years. Before that, we had the complete opposite view of how to approach someone with cancer. It's taken a lot of research to prove that keeping someone active, making sure they can do the things they want to do during and after treatment, is beneficial. Cancer rehab is now a thing — we're still working on translating the research into services, but hopefully in the next decade it becomes part of standard cancer care. As much as you get chemotherapy treatment, you get exercise treatment — that's the ultimate goal.

Louise: Because if you're doing nothing for such a long period of time, you'd lose so much muscle mass and bone density, and the treatment itself is really harrowing — on top of losing what you already have.

Hope: Exactly — you're opening yourself up to more injuries and aches and pains. If anyone thinks about it — chemotherapy can take six months. So imagine if someone stops working, stops their normal dog walk or gym routine — you're going to lose strength, lose stamina, stiffen up, and be more susceptible to other health conditions or injuries. Then you throw quite intense treatment on top of that, and by the time those six months are up and treatment's done, someone's weak, tired, and unable to do the things they want to do, because they've done nothing for six months.

Louise: Whoa. What's the difference between chemotherapy and radiotherapy? Do they come hand in hand, or is there one before the other?

Hope: It depends on the type of cancer, which determines the pattern of treatments. The main treatments are surgery, chemotherapy, and radiation. Surgery physically removes the cancer cells — that can be small or quite extensive, and sometimes it removes lymph nodes too, which is how we get lymphedema. So surgery isn't just damaging local tissue, it can impact the lymphatic system. Surgery isn't always first — sometimes chemotherapy comes first to kill cancer cells and shrink a tumor, so less tissue needs to be removed during surgery. Chemotherapy is usually intravenous, put into the blood, and there are different types for different cancers. It's a systemic treatment — we can't control where it goes, it travels through your blood and hits cancer cells but also healthy cells. Radiation is different — it's much more targeted to the area where the cancer was, killing cancer cells in a specific area. So sometimes you need chemotherapy, sometimes you don't; sometimes you need radiation, sometimes you don't. It depends on the diagnosis, how big the tumor was, how aggressive the cancer was. They act very differently and serve different purposes.

Louise: And chemo — that's like chemicals, is that where the name comes from?

Hope: Yeah, they're usually derived from plants, but unfortunately they're quite poisonous and toxic — not just to cancer cells, but to healthy cells too. The idea is that it targets rapidly duplicating cells, which is what cancer does — it duplicates and replicates in an uncontrolled, quick way. That's what chemotherapy targets: the processes cancer uses to grow. Some of our normal healthy cells — hair, nails, the lining of our digestive system — replicate quickly too, so unfortunately those get damaged during chemotherapy. That's why we lose our hair, why nails can fall off or die. That's why we get so many side effects — it's not just targeting cancer cells, it impacts rapidly changing healthy cells too, like the digestive system.

Louise: I didn't know about that — what can happen with the digestive system?

Hope: The lining can be damaged, so we can get constipation or diarrhea. It can impact the mouth too — mouth ulcers and dryness. The effects are widespread throughout the entire body, top to bottom, inside and out.

Louise: Oh my god, I've got so many questions. Why is rehabilitation so important before treatment?

Hope: We've just gone through some of the scary things the body goes through during treatment, so you can imagine the toll it takes. What we try to do the moment someone is diagnosed is strengthen their body — their muscles, bones, immune system — and get everything prepped and ready for what's about to happen. That's important, because if we can get them up a little bit before treatment, things will inevitably start to come back down.

Louise: And how can you rehabilitate people while they're having chemotherapy?

Hope: That's where a lot of research is focusing now — how we can prescribe exercise like medicine. Not just generically telling people to walk or exercise, but saying, just as you're having this specific drug at this specific dose at this specific time, this is what we're going to do with your exercise. There's a lot of research now showing your muscles produce their own chemicals that, once in your system, can help create a cancer-suppressive environment. Your body has its own defenses against inflammation and the processes cancer cells use, and by keeping someone active, we're enhancing their treatment while also combating some of the damage and side effects that happen during treatment. It's not just about keeping them moving because it's good for the body — it's also good for their treatment.

Louise: And that's both radiation and chemotherapy?

Hope: Yes, they're both causing damage. Radiation does it in a more targeted way, but it still takes a toll on the body. Fatigue is very common with radiation, so if we can keep someone moving, keep their energy levels, stamina, and strength up, we combat some of that fatigue.

Louise: And I can imagine the whole process is so exhausting — mentally and emotionally too.

Hope: Absolutely. We're talking a lot about the physical side, but you can't separate the emotional side.

Louise: Moving always makes me feel better too. How is rehabilitation important following surgery?

Hope: With surgery we're more focused on pain, restriction, and swelling. The impact of surgery isn't usually just on that one part of the body — it affects connected areas too. For breast cancer, because the breast is so close to the shoulder and shoulder girdle, surgery can cause a lot of pain, restriction, and loss of arm movement, and tightness and pain through the scar. It's really important to make sure we don't fall into protective patterns. It can be normal to want to protect the area, but our rehab focus is on settling the pain down, reassuring the person that movement is good, and working within their discomfort to help them regain full movement — not just of the surgical area, but the whole complex of the body it can impact.

Louise: Because frozen shoulder is really associated with breast cancer surgery recovery — a lot of people end up with that. Is that just because people don't want to move the arm?

Hope: There's a level of that protective mechanism — not wanting to do something wrong, fear of injuring yourself. But with breast cancer, women often go onto endocrine therapy, which blocks estrogen, a natural lubricant and anti-inflammatory in the body. So it all comes together in a perfect storm that makes a woman much more susceptible to developing frozen shoulder after breast cancer.

Louise: Frozen shoulder is very common with menopause too, with that dramatic drop in estrogen — as soon as the estrogen's gone, frozen shoulder, gluteal tendinopathy—

Hope: Yes, plantar fasciitis, cough problems, arthritis — all the fun things females get to experience with menopause.

Louise: Yes! And why is rehabilitation so important for long-term survivorship?

Hope: The way we treat cancer is pretty full-on for the body, and it's not something where the moment you stop treatment, everything magically gets better. There are a lot of long-term or even permanent side effects. Once a scar is there, it's there forever — we can't undo surgery. Chemotherapy goes throughout the entire body, so we can end up with nerve damage — chemotherapy-induced peripheral neuropathy, which can affect the hands and feet and can take a year or two to go away, or may never fully resolve. Pain and tightness can linger too.

Louise: Is that like pins and needles in the fingers?

Hope: It can be numb, or it can be unpleasant to even painful — in the hands and the feet, both.

Louise: Does it cause problems with balance?

Hope: It does. Imagine if you can't really feel your feet on the floor — sometimes it gets described to me as spongy, like walking on sponges. You can imagine tripping, or even shoes not being comfortable. It can really impact your mobility and your risk of having a fall.

Louise: One of the biggest fears people have is whether exercise is safe. What type of exercise can people do when they're undergoing treatment?

Hope: Whatever exercise they want, really. To me it's never about "you should be doing X, Y, and Z" — it's about finding something they hopefully enjoy, or at least don't hate. I try to frame it more as movement rather than exercise, because exercise can carry a slightly negative connotation for some people. We've got two types of exercise, aerobic and resistance, and to me they're both important — I really love the resistance side because of the benefit of muscle tone, strength, and stamina. It's about working with the person to figure out what movement looks like to them, what they like, what's available, what's realistic as they go through their cancer pathway, and then optimizing that and letting them know any adjustments to get the best out of it.

Louise: And what does the research actually say — that it is safe?

Hope: Oh my god, it's one of the best things. If we see exercise as medicine, everyone would be prescribed it. If we could bottle it up into a pill, we'd give it to everyone for pretty much every chronic health condition, but especially cancer. That's how strong the evidence is — it's not just safe, it's really, really important.

Louise: And what benefits do you actually see with the people you see — how do you see yourself helping them? That must feel so good.

Hope: It does. It can take a bit of convincing, especially with men — they tend to be quite logical, thinking "I'm not feeling well, I should rest," or "I'm so tired, how's exercising going to help my tiredness, it'll just make me more tired." It's about educating them that it's safe first, because there's a lot of fear around that. Once you break that barrier down and share the evidence, it's a whole change in mindset and approach — the confidence they get from it, the things they couldn't do that they now can. It's quite a shift in perspective, from "cancer patient" to something they can control that's actually good for them and beneficial for their life. It's really rewarding to see the benefits once someone throws themselves into it.

Louise: That's fantastic. I remember one of your clients at the Pilates Expo said she found hope through you, and I thought — it's so bizarre your name is Hope, you actually give people hope.

Hope: I love hearing things like that. We can get very technical about exercise, but really it comes down to giving someone confidence and hope that things can get better, and that there are things they can do for themselves within a very uncontrollable environment. Hearing "you have cancer" is devastating. For them to find something positive that they can control, I think everyone deserves the right to feel like that.

Louise: And the whole treatment process is exhausting. Does exercise actually help give them more energy — do you see that change?

Hope: Absolutely, yes. It's called cancer-related fatigue — it's not the same as tiredness, and it's not something a good night's sleep can erase. It's a deeper, visceral tiredness — patients describe it like their battery just dies and there's nothing you can do but stop. Fatigue is much more multifaceted — it comes down to sleep and diet, but also to a cellular level, where cancer treatment impacts a cell's ability to produce energy. When we're happy and healthy, we've got 100% battery capacity and recharge overnight. But going through cancer treatment shrinks that capacity — you might have 50% of your normal battery, and things that would normally cost 2% of your battery, like having a shower, now cost 15%. Exercise aims to give that capacity back — building stamina and strength, reducing inflammation, and getting the good chemicals happening again, so we can hopefully get back to full capacity. It takes time, but exercise helps with mood, sleep, and a lot of the things that make fatigue overwhelming — getting someone back to driving to work and going to work, rather than driving to work and needing to sleep in the car because that's their energy for the day.

Louise: And what about strength — do you see people actually getting stronger?

Hope: Absolutely, especially on the reformers — it's such a great way to get the body moving and build strength safely. I constantly get asked, even by older patients, whether it's possible to get muscle back and get stronger again. The answer is always: no matter what, we can always build strength — we just need to do it the right way. Sometimes things fall apart if we go too slowly or too soon, but we can always build strength, and it's really important that's seen as something important.

Louise: And where does Pilates fit into cancer rehabilitation? You just mentioned reformers.

Hope: It's been a really important part of my practice, being able to offer reformer Pilates as a way to reintroduce patients to exercise at whatever point in their pathway I see them. There's a lot of fear and uncertainty around exercise after something like cancer, so being able to tell a patient they can lay down to exercise, sit to exercise — it's a real beginner-friendly, safe way to get to know your body again and get moving. The number of patients who've never exercised before but fall in love with their reformer is amazing.

Louise: Why is Pilates such a valuable form of exercise rather than, say, CrossFit?

Hope: It's very beginner-friendly, and the way we can progress things on a reformer is unique — from starting laying down to eventually fully standing and doing everything. The reformer allows for that full progression and focuses on the whole body — flexibility, mobility, and strength — rather than just pure strength and grit like CrossFit, which is great for some people, but after cancer that can sometimes be too much, at least to start. I see Pilates as a gateway to other forms of exercise. It targets all the right muscles the right ways, and for me as the instructor it lets me individualize easily — I've got clients who've been coming for four years and know things inside out, and a brand new person coming in, and I can adjust and progress with each of them while they still feel part of the class. That sense of community is something the classes provide too. It's beginner-friendly, or four-or-five-year veteran-friendly — very flexible.

Louise: And what should Pilates teachers understand before working with someone who has cancer?

Hope: That's quite complex, because there's a lot to consider around safety. It's important to have some understanding of what they've been through or where they're at in their pathway. It doesn't mean they can't participate in your classes — but the more knowledge an instructor has from a client, the better equipped they are to help. Not every cancer diagnosis leads to the same treatment, so having some understanding of common side effects — peripheral neuropathy, fatigue, lymphedema — helps take away uncertainty and fear, for both the instructor and the client. Meeting the person where they are on that day is important too, because it can really fluctuate — they might feel great one day and not so much the next. I think it's just having that little bit of extra knowledge, because it gives the instructor confidence, and the client confidence that they're in the right space, because we want them there, we want them with instructors, we want them moving. Open communication and checking in to make sure nothing's changed is important too, so you can make adjustments as needed.

Louise: And even how we communicate with people going through that — how do we need to change our language? One of my clients told me she'd just been diagnosed with cancer, and I started crying — which was not the appropriate response, especially since she'd already moved past that phase.

Hope: I get that, and it's a natural response — it's a shock, and you can't help it if you're an empathetic person, so I think that response is very normal. But after that, communication and the words we use are really important. It can be tempting to want to protect them, wrap them in cotton wool, keep asking "are you okay, are you okay" — they're probably getting that a lot. It's more about building their confidence and the relationship, letting them know you're here to work with them, and moving away from that need to over-protect or instill fear by constantly checking in with worried questions. A quick check-in is enough, but we definitely want to provide positive feedback and create an environment that builds their confidence, so they want to come back and keep doing more.

Louise: Going back to lymphedema — who's at risk of getting it? Just people who've had breast cancer, or a hysterectomy with lymph nodes removed — are there others?

Hope: Absolutely, others too. The lymphatic system is throughout the entire body, and lymph nodes can be removed from anywhere depending on the cancer's location. Melanoma can happen anywhere on the body, and because it travels through the lymphatic system and blood, it's quite common for lymph nodes to be removed — so lymphedema occurrence with melanoma is quite high. Any gynecological or pelvic cancer can travel to the lymph nodes in the groin, so we can get lymphedema in the leg and genitalia. Breast cancer is the most common one we know of, because lymph nodes are often removed from the armpit, impacting the arm and breast. But it's not just the removal of the lymph node — cutting and removing tissue impacts the lymphatic vessels in that area too, and the scar tissue formed can block lymphatic flow. Radiation can create fibrosis — scarring in the tissue — which can also block lymphatic flow. So any type of cancer treatment can mean we end up with lymphedema; the more damage done to the lymphatic system, the more likely lymphedema is to develop. If a woman has all the lymph nodes removed from her armpit after breast cancer, her risk is much higher than if only one or two were removed. Same with any other cancer — head and neck cancer is quite common, since a lot of lymph nodes get removed from around the neck, so we can see lymphedema in the face and neck too. The bigger the trauma, the more likely we are to see lymphedema develop — it's not a guarantee, some people have had all their lymph nodes removed and don't develop it, the body finds another way. But we do need to know who's more at risk, so we can monitor them closely for early warning signs and catch things early.

Louise: So can exercise cause lymphedema if someone's vulnerable to it?

Hope: The simple answer is no, but there's nuance. Exercise done the right way is not going to cause lymphedema, even in someone at high risk. Exercise done the wrong way can put extra stress on the lymphatic system and create an environment where lymphedema might occur. So we do want to know—

Louise: I was going to say — putting a booty band around someone's thighs and having them do traveling squats — would that be bad for lymphedema if they had it in their legs? It's a theory, just asking.

Hope: If someone was vulnerable to lymphedema in the legs and you put a booty band around the legs — if the band is very strong and cutting into the leg, creating trauma or bruising, which we wouldn't want to be doing anyway, that's bad. But the right resistance — one that isn't digging in, not done for too long — really shouldn't cause a problem. A lot of research has gone into risk factors for triggering lymphedema, and the two main ones are significant trauma to the area — further surgery, a broken wrist, a bad fall — or an infection or cellulitis. Those are the two things that will more than likely trigger something if you're at risk. Other things we used to warn people at risk to avoid — blood pressure checks, blood draws, flying — we now know are unlikely to trigger anything. So a booty band, we should be good.

Louise: That's very reassuring, because it's great for the glutes. I had my guys doing booty bands quite a bit yesterday, so they've probably got sore butts today.

Hope: Exercise done the right way, in the right conditions, is not going to set off lymphedema. If we're lifting too heavy too soon, that muscle soreness we get is trauma to the muscle, which means we need healing — we're sending blood there and getting extra fluid in the area that the lymphatic system has to process. Too much trauma means potentially more fluid in the area. But done the right way, without too much soreness, we should be fine. Exercise is actually recommended and part of how we treat and manage lymphedema — it's not something to be scared of, if done the right way it's perfectly safe.

Louise: So if you have lymphedema in your arms, would things like "star hands" and arm exercises help get the fluid moving, as well as neck and shoulder work?

Hope: Yes, absolutely. Our muscles are the heart of our lymphatic system — if we're not moving, the lymphatic system isn't pumping like we want it to. It can be as simple as pumping arms up and down, all the way to a full workout — it doesn't need to be anything crazy, simple movements can be enough to get the lymphatic system moving.

Louise: And what are the guidelines for someone who already has lymphedema — a swollen arm or leg? Should we just do feet and straps, or are there guidelines like no jumping, no running while that limb is swollen?

Hope: No definitive "no's." It's about making sure we're doing things as the body is ready for. If someone comes to your Pilates class for the first time, hasn't exercised in the last 12 months, and has lymphedema, I'd encourage them to wear their compression sleeve if they have one, which they should. If they feel comfortable, wear it — but otherwise treat them like anyone starting out, not going too hard too soon. Check in after their first class — did you feel a difference in your swelling? If their hand felt a bit sore or extra swollen but it went down within a day, that's fine — you're seeing how their body responded. There's no hard "do not do this," just don't go too hard too soon — all the general safe exercise principles apply.

Louise: And you're also a Restore Oncology Scar Specialist. How important is scar rehabilitation?

Hope: So important. A dysfunctional scar can really impact how a person's body moves, their posture, everything. We often think of scars as something external, that we want to look good and fully healed. But a scar is never just superficial — it can be quite deep and impact structures further down. Making sure a scar is healthy means it heals with the flexibility and movement that part of the body needs, especially if it's close to a joint. With women who've had lymph nodes removed, they get an incision high up under the armpit, and mastectomy scars can come quite far across too — so one or two scars close to the axilla, armpit, and shoulder can impact the entire shoulder and arm movement, posture, everything. Yes, we want the scar to look nice, but we also want it to not stick to the rib cage, to move as the person moves, and not pull them forward and affect their posture. It's about the function and health of the tissue, not just how the scar looks.

Louise: And how do you get that function back — if something's limiting arm range of movement, how do you release that scar tissue?

Hope: A lot of manual techniques — myofascial stretches, scar massage — making sure that as collagen fibers are laid down in a scar, we're getting them in the right direction with enough flexibility and movement so they don't restrict that area of the body. It's a lot of manual movement, stretches, and moving through whatever range the person can manage, breaking down anything too fibrotic or hard. I also use a device with negative pressure, lifting and stretching the tissue in different directions, not just one plane — so the tissue moves in all directions rather than laying down and only able to move one way, and making sure we're not getting adhesions where the scar sticks to surrounding tissues.

Louise: Many cancer treatments affect bone density — you mentioned you also teach ONERO. Does that fit in? Do you have a Pilates studio and also a weights studio?

Hope: Yes, I've got weight racks and stuff here too. I love the whole concept of bone building — I did a conversation with Belinda Beck and was blown away, she's incredible. It's a great program, developed very much with the aging elderly population in mind, but as we mentioned with menopause, women with hormone-receptive breast cancer will go onto endocrine therapy, which sends them quickly into menopause if they're not already, blocking estrogen and progesterone receptors throughout the body. Our bone is protected by estrogen, so when women start that medication, that protection disappears — potentially prematurely. If a woman's diagnosed with breast cancer at 40 but wouldn't have gone through menopause naturally until 55, that's 15 years earlier without that bone protection, so she's likely to end up with osteopenia or osteoporosis much sooner. Men can go on androgen deprivation therapy, which impacts their bones and muscles too, and chemotherapy can be damaging to bone as well. So a lot of it is hormonal, but other treatments impact bone quality too. A lot of my clients are concerned about their risk of osteoporosis, so ONERO was a great fit — Pilates is great for starting to build strength, but for bone health specifically, we need the intensity of heavier weights and some impact loading too.

Louise: So for bone health, is it more the load-bearing exercises, lifting heavy weights in an upright position type of thing?

Hope: It doesn't necessarily need to be upright — it's more about lifting as heavy as we can. A reformer's only got a certain amount of springs, so there's a maximum resistance it can provide. That's where free weights come in, so we can go as heavy as a person's body is ready to tolerate. Our bodies get used to certain things, so if we're not lifting heavier than what we do in normal everyday life, we're not stimulating the bone to a point where it feels like it needs to respond. It needs to be heavy — and that's heavy for the individual person, not a blanket number; five kilos is heavy for one person, twenty kilos is heavy for another. It's about that appropriate stimulation for the bone. That's where the ONERO program specifically tackles what the research shows really helps stimulate bone growth.

Louise: And it's very hard with some reformer exercises to go heavier — like external rotators, rotator cuff pulls, they're such small muscles, hard to load up all the springs for that.

Hope: Exactly — there's safety, positioning, all those things. So there does become a bit of a limit for bone health specifically. The reformer's very good at laying the foundations, and then we take it from there to get a bit heavier through the main bone areas we look at for osteoporosis — wrists, hips, and spine.

Louise: With your ONERO program, do you take people who haven't had cancer, or only your cancer clients?

Hope: We've got a few other providers around my area who offer it, more for the elderly population generally, which is fine — but that's not what I do. I specifically wanted to target my oncology population, so I just take people who've had cancer.

Louise: Wow. What are some common mistakes Pilates instructors make working with people going through or who've been through cancer treatment?

Hope: "Mistakes" is a hard word — I think it's more about being either too cautious or not cautious enough, sometimes a confidence thing for instructors. There can be that initial response of "oh my gosh, okay, we'll take it easy, we won't do this or that" — feet in straps, everyone loves feet in straps, and that might be okay for the first class, but we're not encouraging that person to start using their body and building strength and confidence. It's a bit different from working with a healthy population — there are more considerations when formulating your class. A woman who's had breast surgery isn't going to want to lie flat on a box. A woman on endocrine therapy has probably got arthritis in her knees and can't kneel. Someone who's been through chemotherapy and can't feel her feet isn't going to want to stand up on the reformer, and even simple scooter exercises won't feel comfortable without holding on. It's about having that pre-thought — knowing her feet or balance aren't the best right now, and adjusting to make it safe rather than avoiding it altogether. There's usually a way to still do it safely, so that in a few weeks her confidence and balance might be better and she's willing to try a scooter without holding on, or take some tentative steps onto the reformer. It can be tempting to just avoid things, but I think that does everyone a disservice. We don't want to be too cautious, but we also don't want to be ignorant to what that client might be experiencing.

Louise: So true. What are some red flags that mean a client should be referred back to their medical team?

Hope: This can be tricky — after a cancer diagnosis, every little new pain or niggle can trigger someone to think their cancer's come back. It's about balancing that caution rather than sending them back to the doctor every time something feels sore. The main things to watch for are anything really new, persistent, or progressing — a worsening of symptoms, not just a one-off. If lymphedema seems to have progressed and they haven't changed anything, or they've got shoulder pain that nothing touches — no painkillers, nothing — hurting all day and night, unrelated to movement. Heat, redness, a new lump — those are red flags where we'd say, probably best to head back to your GP or make an appointment with your oncologist. But if it's within the normal soreness we'd expect from exercise, we don't want to jump straight to that conclusion, because their mind's probably already gone there. You can also refer them to their lymphedema therapist, oncology physiotherapist, or breast cancer nurse if either of you aren't sure whether it's something to worry about.

Louise: Cancer affects so much more than just the body. How do you help people rebuild that confidence?

Hope: That's really what it's all about. Their body's been through so much, they've been through so much — their body's not what it used to be, and they're not the person they used to be. It's about reassuring them that what they're experiencing is normal for where they're at in their recovery — "normal" is the best word you can say to someone who's been through this, they love hearing it. Reassuring them there's something they can do about it — if they're still in pain, there's no need to be, there are things we can do to help — giving them support to feel what they're feeling, helping them take those first baby steps into whatever they're wanting to do, knowing they've got someone on their team to help guide them, that they don't have to do it alone. There's a lot of fear around things — body image, and a lot people deal with after cancer, it's very complex. It's about giving small achievements, small realistic goals, and helping guide them to find their new normal — getting used to their new body and new self, because unfortunately they're never going to be the person they were before cancer. But that's not necessarily a bad thing — there are ways to find their way to their new self, and it comes down to confidence.

Louise: And how important is moving in a supportive environment?

Hope: The most important thing. Having a relationship with an instructor — reformer Pilates or another form of exercise, a personal trainer, a physiotherapist — a good therapeutic relationship is really important in creating that supportive environment. A lot of people, not just after cancer, fall off the bandwagon because they don't have that accountability and safe environment. In my classes, I can create an environment where a new woman coming in knows the other women in the class have been through something similar, which creates that support and familiarity — someone next to you who understands to some level what you've been through. That supportive environment, however it's created, is really important in getting someone exercising and building that consistency, which is key — we want them to feel safe, feel the benefits, and keep coming back.

Louise: And showing up for their classmates too — if you don't turn up to a class, in a way you're letting others down.

Hope: Absolutely — you turn up for them just as much as they turn up for you. The friendships that form, going out for lunch or coffee after class — it really can be quite a community that people form together after going through something like this.

Louise: That's fantastic. Let's do some myth-busting — true or false: people with cancer should rest.

Hope: Totally false — as false as it can get.

Louise: Lifting weights is dangerous when done wrong.

Hope: True, but encouraged — strongly encouraged — when done right.

Louise: People with lymphedema shouldn't lift anything heavy.

Hope: Completely false. We've got to do it the right way, but if someone with lymphedema wants to become a bodybuilder and lift a hundred kilos, let's do it — the right way.

Louise: Fatigue means you should stop exercising.

Hope: Absolutely not. It's important to listen to your body, but exercise is one of the best things you can do when you have fatigue.

Louise: Pilates is only stretching.

Hope: Oh god, no — that's just as false as the rest. Some people are so surprised when they come to their first Pilates class and experience what it actually is. There's a stretching component, and flexibility and mobility are important, but it's definitely not just stretching — it's strengthening every part of the body, building confidence, learning how your body moves, helping with posture. It is definitely not just stretching.

Louise: Where do you see oncology rehabilitation heading over the next ten years?

Hope: I really hope oncology physiotherapy and cancer rehabilitation become part of standard cancer care — that we see exercise as medicine and see the benefit rehabilitation can have in someone's cancer journey. I hope that as soon as someone's diagnosed, it becomes an automatic referral, just like being referred to an oncologist or for a scan, straight to the rehab team — so we can be there through every part of their treatment and recovery, making sure their treatment is as effective as it can be, that they can achieve their goals, be the grandma who babysits her grandkids, keep working through treatment if they want to, and form a good relationship with exercise, not just during treatment but for the rest of their lives. It might take longer than ten years, but I hope it becomes much more automatic than it is now.

Louise: What excites you most about where you're going, about the future?

Hope: The more we understand about how exercise positively influences the body — not just the chemical side, strength, and everything else we know it's good for, but how important it is in creating that cancer-suppressive environment. It's exciting to know that just one bout of exercise, lifting some weights, moving your body, releases a whole bout of chemicals into your body — whether you have cancer or you're healthy and want to prevent it — your body has the power to make such a difference in making your treatment as effective as possible, or to give itself the best chance of clearing cancer cells if they're there. It's much better if our bodies can fight cancer than having to rely solely on the treatments we have at the moment.

Louise: So the chemicals from exercise could be a cancer preventative, is that the idea? Like endorphins?

Hope: It's not endorphins — those are more in the brain. These are chemicals our muscles produce, called myokines. They create a chain of events that can help reduce inflammation and create an environment cancer cells don't like. So it's your muscles creating these chemicals — not just the good, happy hormones your brain produces, but your muscles making their own magical drugs.

Louise: Oh my god, that's why it's so important — I'm getting it a bit more now. What's one exercise everyone recovering from cancer should do?

Hope: Some form of a squat — that could be simply standing up and sitting down from a chair, an actual squat, weighted, a deadlift, a leg press — some form of a squat, because it targets those bigger muscle groups. We want them good and chunky and muscular, because the stronger you are, the more muscle you've got, the more things you can do in life, and the better you can tolerate your treatment.

Louise: What's one health habit you never skip?

Hope: Good sleep. I try not to, but sleep is so important — even if you've had a bad day with water or eating, that's fine, but it's amazing what good quality sleep can do for the body.

Louise: What's one thing you wish every health professional knew about cancer rehabilitation?

Hope: That everyone diagnosed with cancer should be doing it. Maybe understanding of the myokines we spoke about, the amazing medicine our own body produces, and that exercise should be seen as medicine — something that needs to be incorporated a lot more, not just for cancer, but for all chronic health conditions.

Louise: And Hope, what's the best piece of advice you've ever received?

Hope: To follow your dreams — that's always stuck with me. My husband told me that when I took the leap into oncology physiotherapy and opened my own practice. If you have a passion about something — and you can probably tell I'm quite passionate about this — being able to follow that and have a job you love and enjoy, I think I'm very lucky. If you've got a passion and a dream, it's really important to try to follow it if you can.

Louise: Do you have coffee or tea?

Hope: Neither.

Louise: Neither, no?

Hope: My patients are always like, "come for coffee," and I say I don't drink coffee. "What about tea?" No, not tea either. I'll have a hot chocolate, but no caffeine for me — I just don't like the taste, it's nothing to do with whether it's healthy or not, I just never got hooked. I'll have an espresso martini if that counts as coffee — that's about it.

Louise: What's your favorite way to unwind?

Hope: At the moment, my husband and I like playing board games — with the kids too, just getting something out and having some fun. Or reading a book — those are the two things I like to do to unwind.

Louise: And if someone has just been diagnosed with cancer and is listening today, what would you want them to know?

Hope: We've discussed a lot of it — people are going to want to wrap you in cotton wool, tell you to rest, do everything for you, tell you that you can't do this or that. As much as their intentions are good, and they're doing it because they love you, we don't want that. If you want to keep cooking, doing the things you love, going to work, I want people to know that a cancer diagnosis, as scary and as big as it is, can't be allowed to take everything from you. You need something that's a normal sense of routine, or something that makes you, you. It's important to try to modify rather than automatically say "don't do this, you can't do that." Find the things you can control, because there'll be plenty you can't. Listen to your body, get the basics right — eat well, sleep well, stay hydrated. And exercise, of course.

Louise: Absolutely. And where can people find you and learn more about the Positive Health Project? You should be everywhere — in every doctor's waiting room.

Hope: Just on social media — the Positive Health Project on Instagram and Facebook, and I'm on LinkedIn as Hope Spencer, and I've got my website as well — all the usual places. There are hopefully more people like me out there — physiotherapists, exercise physiologists, lymphedema therapists — trying to get this message out through social media and workshops. Try to get your information from reputable sources, and following people like myself on social media can help.

Louise: Well, this has just been so amazing. Thank you so much for sharing your expertise with us today. There have been so many valuable takeaways, from understanding the importance of oncology physiotherapy and cancer rehabilitation to dispelling myths about exercise and lymphedema. Your passion for helping people regain confidence, function, and quality of life really shines through, and I'm sure our listeners will come away feeling empowered and better informed. If you'd like to connect with Hope and learn more about the Positive Health Project, we'll include all the links in the show notes. If you've enjoyed today's episode, please subscribe, leave a review, and share this conversation with someone who could benefit from it. Until next time, keep moving, keep learning, and remember — movement has the power to change lives. Thanks so much for listening to The Art of Pilates.

Links & Resources

• Positive Health Project — website [find link]
• Positive Health Project — Instagram [find link]
• Positive Health Project — Facebook [find link]
• Hope Spencer — LinkedIn [find link]
• Clinical Oncology Society of Australia (COSA) [find link]
• PINC & STEEL International (cancer rehabilitation training/certification) [find link]
• Restore (oncology scar rehabilitation program/certification) [find link]
• ONERO program (osteoporosis/bone-loading exercise program) [find link]
• Belinda Beck — researcher referenced re: bone health/ONERO program [find link]
• Taube Pilates — Louise Taube's business [find link]